Assessment of EGFR mutation status in Tunisian patients with pulmonary adenocarcinoma.

BACKGROUND: Despite recent advances, non-small cell lung cancer carries a grim prognosis. For appropriate treatment selection, the updated guidelines recommend broad molecular profiling for all patients with pulmonary adenocarcinoma. Precise histological subtyping and targeted epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) testing are mandatory. METHODS: Herein, we assessed the EGFR mutation status of 26 formalin fixed-paraffin embedded (FFPE) samples of lung adenocarcinoma. Mutational analysis concerned exons 18-21 of EGFR by real-time polymerase chain reaction (Real time-PCR) using the Therascreen EGFR RGQ PCR mutation kit. ALK status was established on 22 among 26 patients using D5F3 antibody with a fully automated Ventana CDx technique. RESULTS: Activating EGFR mutations were found in 3 men among 26 patients (11.5%). Positive ALK expression was found in 2 cases among 22 patients (9.09%). CONCLUSION: Frequency of EGFR mutations in pulmonary adenocarcinomas of our series is similar to that found in the European ones with some particularities. The mutations detected are uncommon. Whereas, we found a high frequency of positive ALK expression in our series compared to frequency reported in literature. Further studies with larger Tunisian series are required to obtain more conclusive results.

[Myoepithelial carcinoma ex-pleomorphic adenoma of the parotid gland]. / Carcinome myoépithélial ex-adénome pléomorphe de la parotide.

INTRODUCTION: Myoepithelial carcinoma accounts for less than 1% of salivary gland malignant tumors. It may develop de novo or, in approximately 50% of the cases, from a pleomorphic adenoma. OBSERVATION: A 57-year-old man with a history of a pleomorphic adenoma of the parotid treated surgically 6 years earlier, presented with a 2 cm tumor mass, palpable in the scar region. The histological examination and immunohistochemical study revealed a low-grade myoepithelial carcinoma. The patient had no complementary treatment. He presented 5 years later with a 2 cm parapharyngeal recurrence which was resected. There was no evidence of recurrent tumor or of distant metastasis at 4 year follow-up. DISCUSSION: Although myoepithelial cells are often predominant in pleomorphic adenomas, carcinomas developing in pleomorphic adenomas show in most cases a glandular differentiation and myoepithelial carcinomas are rare. Currently the diagnostic criteria, the prognosis, and the management of myoepithelial carcinomas are not well documented. Invasive carcinomas developing in pleomorphic adenoma are known to be highly aggressive neoplasms and myoepithelial carcinomas ex-pleomorphic adenoma seem to have a better prognosis. Our reported case was characterized by the weak aggressiveness of the lesion.

[Study of the ploidy and cellular cycle of hidradenomas and hidradenocarcinomas: a series of 13 cases]. / Etude de la ploïdie et du cycle cellulaire des hidradenomes et des hidradenocarcinomes: a propos d'une série de 13 cas.

AIMS: To study by flow cytometry (FCM) the ploidy and the cellular cycle of nodular hidradenoma (NH) and hidradenocarcinoma (HC) and to assess the prognostic utility of this technique in such tumors. METHODS: We studied retrospectively 2 HC and 11 NH one of which was considered as an atypical NH. Monoparametric study by FCM was realized on paraffin-embedded material. The extracted cells were marked by Propidium's lodure and cellular cycle was analyzed by the software Mod-Fit LT. RESULTS: Our study showed eleven 100% diploid profiles, 10 of which had low S-phase varying between 2 and 12%. All of these 11 tumors were NH. S-phase was high (23.79%) in a single case that corresponded to the atypical NH. Two tumors showed aneuploid profiles; these corresponded to the 2 HC. CONCLUSION: The results of the cytometric study suit perfectly to those of the histopathologic examination. FCM could so help to establish the prognosis of these tumors. But further studies are necessary to determine the value of this technique.

[Contribution of cell cycle and DNA content study by flow cytometry in the prognosis of superficial bladder cancer: Tunisian experience]. / Apport de l'étude du cycle cellulaire et du contenu en ADN par cytométrie en flux dans le pronostic des tumeurs superficielles de la vessie : expérience tunisienne.

Clinico-pathological study of superficial bladder cancer (pTa/pT1) informs about prognostic factors such as the size of the tumor, its uni or multifocal character, its grade and stage. Presently, these factors constitute the basis of therapeutic decision but do not allow to foresee the prognosis with certainty. Many technics have contributed to a better knowledge of such tumors; however, they have not allowed to fully master prognostic uncertainties. During the last decades, cell cycle and DNA content study by flow cytometry has been developping, bringing an additional prognostic element to various types of tumors. We have decided to study the impact of this technique to the assessment of the prognosis of superficial bladder tumors. The study concerned 65 patients presenting superficial bladder tumors (pTa/ pT1), with a follow-up of at least two years in case of not recurrence and in case of recurrence, having had a second resection with analysis of sections. Flow cytometry was applied to formol-fixed and paraffin-embedded endoscopic resection material of initial tumors by simple-labelling of DNA with propidium iodide. Following cytometric study, 35 (54%) of tumors were aneuploid and 30 (46 %) were diploid. For the diploid ones, S-phase mean value was 14.94% (from 2.72% to 33.43%); and G2M mean value was 8.3 (from 1% to 18%). The presence of an DNA- aneuploid peak had a predictive value of recurrence and progression in stage, with relative risks of 12 and 6.85 respectively. It was also correlated with the histological grade and stage. On the other hand, S-phase and G2M values had no prognostic significance.

Syringocystadenoma papilliferum: report of 8 cases.

Syringocystadenoma papilliferum (SCAP) is a rare cutaneous adnexal neoplasm with variable clinical appearance and characteristic histology. It arises in about one third of cases within a sebaceous hamartoma (SH) and in this case, multiple other benign adnexal neoplasms may be associated with it. We report the clinical and pathological data of 8 cases of syringocystadenoma papilliferum. The age at the time of the diagnosis varied from 3 to 48 years with an average age of 28 years. Three tumors were localized in the scalp, 2 in the trunk, and 3 others of unusual locations: 1 in the eyelid, 1 in the thigh and 1 in the popliteal fossa. Histopathological examination revealed 3 SCAP occurring within SH. The SCAP observed in the eyelid was associated with an apocrine cystadenoma without features of SH. The four others were not associated with any other lesion.

[Endometrioid adenocarcinoma of the uterine cervix associated with mucinous ovarian cystadenocarcinoma]. / Association d'un adénocarcinome du col de type endométrioïde à un cystadénocarcinome mucineux de l'ovaire.

The authors report the case of a 40-year-old woman, who was operated for an ovarian mucinous cystadenocarcinoma. The pathologic findings of the hysterectomy specimen with bilateral salpingoophorectomy showed an ovarian mucinous cystadenocarcinoma associated with an endometrioid adenocarcinoma of the uterine cervix. The mucinous cystadenocarcinoma represents the third most common type of ovarian carcinoma. In the literature, this tumor had been found in association with endocervical adenocarcinoma or with minimal deviation adenocarcinoma (adenoma malignum) of the uterine cervix. However, its association with an endometrioid adenocarcinoma, to our knowledge, has not been reported.

Perivascular epithelioid cell tumor of the uterus: a case report.

A case of a perivascular epithelioid cell tumor (PEComa) arising in the uterus of a 35-year-old woman is presented. Imaging studies revealed a 5 cm well circumscribed mass in the uterine fundus. The tumor was composed of clear to faintly eosinophilic, epithelioid and spindled cells. Immunohistochemically, most tumour cells were strongly positive for HMB-45, smooth muscle actin and desmine, but negative for epithelial markers, S-100 Protein and neuroendocrine markers. Reevaluation of the patient for signs of tuberous sclerosis complex after the diagnosis gave negative results. At the most recent follow-up 4 months later there was no evidence of recurrence.

[Uterine smooth muscle tumors: retrospective epidemiological and pathological study of 2760 cases]. / Les tumeurs musculaires lisses de l'utérus: étude épidémiologique et anatomo-pathologique rétrospective de 2760 cas.

INTRODUCTION: Smooth muscle tumors of the uterus are frequent. Most of them are benign. Some leiomyomas may have unusual morphologic features difficult to distinguish from leiomyosarcoma. These tumors are: cellular leiomyoma, atypical leiomyoma and mitotically active leiomyoma. OBJECTIVES: The purpose of our work is to study cases of leiomyosarcomas, cellular leiomyoma, atypical leiomyoma and mitotically active leiomyoma among a large series of uterine smooth muscle tumors. MATERIALS AND METHODS: We reviewed retrospectively 2760 uterine smooth muscle tumors. The slides were reviewed and the tumors reclassified according to the criteria of the WHO 2003 classification. Chi-square test or Fisher's exact were used for statistical analyses as appropriate. RESULTS: Review of the slides demonstrated: 12 mitotically active leiomyomas, 18 cellular leiomyomas, 20 atypical leiomyomas, 16 leiomysarcomas, only one case of smooth muscle tumor of uncertain malignant potential. The 2709 remaining tumors were all common leiomyomas. So mitotically active, cellular and atypical leiomyomas were as rare as the leiomyosarcomas. The average age of patients with leiomyomas was 39 years. That of patients with leiomyosarcomas was 54 years (p=0,000002). Average size of leiomyomas was 7.4cm. That of leiomyosarcomas was 10.2cm. The average age and size of the 3 studied variants of leiomyomas were identical to those of the common leiomyomas. Leiomyomas were unique in 60.9% of cases. On the other hand 87.5% of leiomyosarcomas had unique nodules (p=0,04).

[Adenomyoepithelioma of the breast: two cases]. / Les adénomyoépithéliomes du sein: à propos de deux cas.

Adenomyoepithelioma of the breast are very rare and form a heterogeneous tumoral group in terms of their morphology and biological behaviour. We report two adenomyoepitheliomas of the breast. One appeared in a 29-year-old woman and was a tubular adenomyoepithelioma. The patient was free of disease at a 22 months follow-up. The other was a lobular adenomyoepithelioma that appeared in a 76-year-old woman and was characterized by its high mitotic rate and its association with myoepitheliosis. Adenomyoepitheliomas of the breast are currently classified as low grade malignant tumors that may recur and rarely metastasize, but their histoprognostic factors are not yet defined.