Schistosomiasis of the female genital tract: a two-center study.

Schistosomiasis (also known as bilharziosis) is a parasitic infection still endemic in Madagascar. Its transmission is perpetuated by population lifestyles in tropical countries. A genital location is relatively rare; diagnosis is histological. This is a retrospective, descriptive study of genital schistosomiasis observed in the anatomic pathology laboratory of Sampan'asa luteriana ho an'ny fahasalamana and the Joseph Ravoahangy Andrianavalona University Hospital Center over the 6-year period from January 2010 through December 2015. We collected 13 cases. The mean age of the patients was 31.6 years and ranged from 4 to 48 years. Localization was cervical (n = 10), tubo-ovarian (n = 2), and vulvar (n = 1). Clinical signs were isolated bleeding or associated with other signs for cervical localization, suspicion of cyst for the vulva, and suspicion of mass for the ovary. The diagnosis was based on the presence of schistosome eggs in all cases, associated with tuberculoid granulomas (n = 9), eosinophilic polynuclear cells (n = 1), and giant cells (n = 2). We observed one case of squamous cell carcinoma that developed on cervical schistosomiasis. Schistosomiasis is a neglected tropical diseases. Malignant transformation is possible. A cervical hemorrhage is not synonymous with cancer but may reveal a specific inflammatory lesion. Histological examination is necessary for diagnosis.

[Kikuchi-Fujimoto disease: a rare cause of adenopathy mimicking lymphoma or tuberculosis]. / La maladie de Kikuchi-Fujimoto : une cause rare d'adénopathies mimant un lymphome ou une tuberculose.

Kikuchi-Fujimoto disease or histiocytic necrotizing lymphadenitis is a rare and unfamiliar clinicopathological entity characterized by cervical lymphadenopathy, often associated with systemic signs such fever and night sweats. We report the first three Malagasy cases of Kikuchi-Fujimoto disease, diagnosed at the Pathology Lab of Joseph Ravoahangy Andrianavalona Hospital, occurring in three female patients of 11, 19 and 35 years old. The clinical course mimicked lymphoma in one case and tuberculosis in two cases. In all cases, lymph node biopsy allowed the diagnosis and showed necrotizing lymphadenitis with acidophil necrosis, histiocyte infiltrate, presence of plasmacytoid monocytes and multiple apoptotic cells. The three patients received a low-dose corticosteroid treatment. Clinical remission was achieved within a few weeks. This disorder must be included in the differential diagnosis of "lymph node enlargement" because its course and treatment differ dramatically from those of lymphoma and tuberculosis.

[Osteosarcoma of the radius after intramedullary osteosynthesis]. / Ostéosarcome du radius après une ostéosynthèse par embrochage centromédullaire.

Osteosarcoma is a malignant neoplasm characterized by local lytic or plastic processes. We observed a case of radius osteosarcoma in a 10-year-old boy 3 months after intramedullary osteosynthesis in the ipsilateral distal radius. Treatment consisted of amputation of the distal humerus and adjuvant chemotherapy; no complications were observed.

[Thyroid cancers in Madagascar]. / Les cancers de la thyroïde à Madagascar.

This is a retrospective study, conducted on thyroid cancer observed for 13 months (from June 1(st) 2004 to June 30(th) 2005). Data were collected from four main surgical pathology laboratories in Antananarivo, Madagascar. Among 6,036 surgical samples, 179 were of thyroid gland, a rate that is near 3% of the total. Among them were found 40 cases of thyroid cancer, which is 0.66% of all screened samples, and 22.32% of all examined thyroid samples. In the studied population was observed a female preponderance (82%) with a mean age of 43.9 years when diagnosis was confirmed. It was evidenced a 50 % of papillary carcinoma and 45% of follicular carcinoma, with a rate of 2.5% respectively for the medullar and anaplastic carcinoma. Metastases were seen in 20%, originated from papillary type for the lymph node involvement and from the follicular type for the bone involvement. In Antananarivo, thyroid cancer is seen mainly in people from the surrounding Highlands, supposed to be sites of endemic goiter related to iodine deficiency. Despite its limits, this study may be used as reference about thyroid cancer in Madagascar. Further studies are required to find out other factors involved in the development of this disease.

[Isolated prostate tuberculosis. Report of a case in Madagascar]. / Tuberculose prostatique isolée. A propos d'un cas à Madagascar.

Isolated prostate tuberculosis is uncommon. Authors report herein the case of 64-year-old man who presented obstructive syndrome of low urinary tract. After clinical and biological examination, and imagery, prostate cancer was highly suspected. Transrectal biopsy was performed and histological examination showed tuberculosis lesions. We suggest that prostate tuberculosis should be evoked in old patient presenting similar signs and living in tuberculosis endemic zone.

Profil bacteriologique des infections urinaires nosocomiales en reanimation chirurgicale de deux CHU a Antananarivo

Objectif : Apporter des donnees bacteriologiques sur l'infection urinaire nosocomiale en reanimation dans deux centres hospitaliers universitaires d'Antananarivo. Methodes : Les auteurs ont mene une etude retrospective descriptive a partir des resultats bacteriologiques des patients ayant contracte une infection urinaire nosocomiale entre le 1er janvier 2006 et le 31 decembre 2007. Resultats : Quatre-vingt cinq resultats ont montre Staphylococcus aureus comme germe le plus frequent (23 cas; 27); Enterococcus chez 19 cas (22) et Escherichia coli chez 17 cas (18). Les cocci Gram positifs sont sensibles a la penicilline A associee a l'acide clavulanique. Les bacteries Gram negatifs necessitent au moins une cephalosporine de 3eme generation; de la colistine; ou de l'Amikacine. Des levures ont ete aussi identifiees. Conclusion : On note une grande disparite des germes

[Thoracic myopericytoma in a child. A case report]. / Myopericytome à localisation thoracique chez l'enfant. A propos d'un cas.

Myopericytoma is a ubiquitous, benign tumor that is likely to be found in the muscular-cutaneous system. Symptoms are related to its location and to the mass effect it may cause on surrounding organs. Diagnosis is usually made by the pathologist and treatment is surgical. We report herein a rare thoracic location in a 4-year-old girl.

[An uncommon rib tumor in a child: aneurysmal bone cyst]. / Tumeur costale rare de l'enfant : le kyste anévrismal.

The authors report a case of rib aneurysmal-bone cyst in a rachitic 7-year-old boy. He had a 6-month history of right-back pain and dyspnea. Pulmonary X-ray and computed-tomography scan showed a huge mass located in the 4th right rib posterior arch. Right thoracotomy was carried out and complete surgical excision of the rib mass was successfully performed. Histological examination confirmed the diagnosis. Diagnosis and management of aneurysmal-bone cyst of the rib were discussed with a review of the literature.

Pseudotumeurs fibreuses inflammatoires du cordon spermatique chez l'enfant

Les pseudotumeurs fibreuses inflammatoires du cordon spermatique observe chez l'enfant sont rares. Les auteurs rapportent un cas observe chez un garcon de 9 ans presentant une tumefaction paratesticulaire gauche. L'examen echographique du scrotum revele un nodule hypoechogene du cordon spermatique gauche. A partir de cette observation et d'une revue de la litterature; nous discutons les aspects diagnostiques et therapeutiques de ces tumeurs

Hemorragie digestive du sujet jeune. Possibilite d'une tumeur stromale

Nous rapportons un cas de tumeur stromale gastrique chez un jeune homme de 20 ans; se manifestant par une hemorragie digestive haute persistante. Le traitement etait uniquement chirurgical; la tumeur; bien que volumineuse; etant localisee. L'evolution etait defavorable avec dissemination neoplasique amenant le deces du patient apres cinq mois. A travers une revue de litterature; les aspects diagnostiques et therapeutiques des tumeurs stromales sont discutes

Deux cas de lipome geant au niveau de la cuisse

Les tumeurs des tissus mous des membres sont souvent vues au stade avance de l'evolution dans notre pays. Devant la negligence et l'ignorance des patients; la malignite ne peut etre ecartee d'emblee dans l'arbre decisionnel therapeutique et la surveillance au long cours s'avere indispensable. De ce fait; l'examen anatomopathologique a une place importante dans la prise en charge de ces tumeurs. Nos deux observations de lipomes geants de la cuisse illustrent l'apport de cet examen

Pseudotumeurs fibreuses inflammatoires du cordon spermatique chez l'enfant

Les pseudotumeurs fibreuses inflammatoires du cordon spermatique observe chez l'enfant sont rares. Les auteurs rapportent un cas observe chez un garcon de 9 ans presentant une tumefaction paratesticulaire gauche. L'examen echographique du scrotum revele un nodule hypoechogene du cordon spermatique gauche. A partir de cette observation et d'une revue de la litterature; nous discutons les aspects diagnostiques et therapeutiques de ces tumeurs

[Post-abortum peritonitis pelviperitonitis at the Androva Mahajanga University Hospital: 23 cases]. / Les péritonites et pelvi-péritonites post-abortum au CHU d'Androva Mahajanga: à propos de 28 cas.

In many underdeveloped countries, illegal abortion can lead to death or sequelae. Pregnancy termination is illegal in Madagascar except for medical reasons. We report 23 observed between April 1990 and December 1994 at the Androva Mahajanga University Hospital. Post-abortum infectious complications ranked 19th for hospital admissions. Peritonitis was the most frequent (70%) and most serious complication. The women were young (mean age 24 years, 44% under the age of 20 years). Thirty percent were primigravidae and had poor living conditions (74% were homemakers and 13% were students; 44% were single). Clinical signs were malodorous loss and abdominal pain. A surgical procedure was performed in 74% of the cases: 3 salpingo-oophoectomies, 2 hysterectomies and 10 uterine sutures. Mortality was high, 13%. Illegal abortion must be prevented with better information on contraception and better health education programs. The question of the usefulness of current legislation is discussed.

[Etiologic approach in infertile couples in Mahajanga]. / Approche étiologique des stérilités du couple à Mahajanga.

In Madagascar, as in other places in the world, infertility is associated with social stigmatism and an underlaying long-term risk for separation of the couple. A 12 months prospective study was carried out in 1999 in the Department of Gynecology, Obstetrics and Reproductive Health at the University Hospital in Mahajanga in order to collect data related to possible causes of infertility. For the women, serologic tests for Treponema pallidum (syphilis) and Chlamydia trachomatis were performed. And, in addition to sonography and hysterosalpingography, cervico-vaginal smears were obtained as part of the pelvic examination. A semen sample was obtained from each male partner. Of the 37 couples enrolled in the study 35 were classified as primary infertile (n = 9) or secondary infertile (n = 28). The mean age of the women and the men was 30.7 years (ranged 20 to 41 years) and 34.3 years (ranged 24 to 46 years), respectively. Various potential causes of infertility among the women were observed, such as hormonal disturbance (76%), tubal occlusion (76%), genital infection (70%). The figures indicate that there seems to coexist the possibility of multiply causes of infertility. Of 37 semen samples 24 (65%) were found with abnormalities, predominantly of oligospermia type. In 21 couples a possibly cause of infertility was observed in both partners.

[Value and limits of cytology in the diagnosis of cervico-vaginal lesions at the Mahajanga University Hospital Center: 465 cases]. / Apports et limites de la cytologie dans le diagnostic des lésions cervico-vaginales au Centre Hospitalier Universitaire de Mahajanga: à propos de 465 cas.

Cervix neoplasms are the most frequent of female neoplasms in Madagascar. The authors reported a prospective study carried out at the Hospital Center of the University of Mahajanga for ten months (January-October 1993). 500 patients were investigated. 465 results of cervix and vaginal smears were considered. The Bethesda group classification was used to interpret lesions. 333 specific pathological lesions were listed. Bacterial infections and trichomoniasis were their principal causes. 4 cases were presumed as human papillomavirus condylomata. 39 SIL low-grade and 24 SIL high-grade were detected. 5 cervix neoplasms were diagnosed. Only few patients had consultation to perform cervix and vaginal smears because these exams are expensive. It may be an explication to the chronicity of lesions, a favourising factor of cancer. The role of viruses, especially human papillomavirus, in the development of cervix neoplasms is mentioned. The authors conclude that the low number of cervix neoplasms they founded is misleading. Cervix neoplasms are the first female cancers in Madagascar. A systematic surveillance of all female genitalia diseases must be programed. While its settling, cervix neoplasms control must be centred on Information--Education--Communication.

[Spindle cell breast sarcoma]. / Sarcome mammaire à cellules fusiformes.

A voluminous tumor of the right breast, weighing 3,950 g, is described in a 42-year-old malagasy woman. On microscopic examination eight of ten slides showed a monomorphic proliferation of spindle cells; on the two slides, they were associated with scarce ducts and rare epithelial cell clusters. This case raises the question of the association of a phyllodes tumor with a spindle cell sarcoma and their prognostic significance.

Leiomyomatosis peritonealis disseminata. Report on two cases and differential diagnosis with peritoneal metastases of a low-grade stromal sarcoma of the ovary.

With the same aspect of multiple peritoneal leiomyomas, the diagnosis of typical leiomyomatosis peritonealis disseminata was established in two women aged 43 and 49, while in a third case the mature metastasis of a primary low-grade bilateral ovarian stromal sarcoma in a woman aged 63 was diagnosed.

[Ovarian carcinomas. Retrospective study of 318 cases]. / Carcinomes ovariens. Etude rétrospective de 318 cas.

OBJECTIVE: Evaluate the diagnosis of cancer of the ovary over time and histological type as a function of outcome. METHODS: Primary neoplasms of the ovary diagnosed at the Pathology Institute of Strasbourg between 1975 and 1984 were reassessed to determine the outcome as recorded in the Bas-Rhin Cancer Register. RESULTS: Among the 845 primary neoplasms diagnosed, 318 were carcinomas. More than half of the cases (n = 162) were serous carcinomas followed by mucinous carcinoma (n = 60), endometrioid carcinoma (n = 53), clear-cell carcinoma (n = 13), and poorly differentiated carcinoma (n = 30). Diagnosis was consistent with time and independent of the pathologist. The patients were divided into three groups on the basis of survival. Longest survival was observed in patients with mucinous and endometrioid carcinoma, intermediary survival in those with serous and clear-cell carcinoma, and shortest survival in those with poorly differentiated carcinoma. CONCLUSION: The histological type of ovary carcinoma, independent of the stage of invasion, is a reliable predictive factor.

[The value of anatomo-pathologic examination of the placenta in areas of endemic malaria and low socio-cultural levels]. / Intérêt de l'examen anatomo-pathologique du placenta dans les zones d'endémie palustre et de faible niveau socio-culturel.

OBJECTIVES: Determine the sensitivity of the pathology examination of the placenta as a screening examination for malaria and the consequences of this infection on prematurity and birth-weight. METHODS: Eighty placentas were examined at the Mjunga, Madagascar dispensary at the beginning of the rainy season. The aspect of the placenta was compared with a malaria index and to malaria disease state as a function of parity and anti-malarial prophylaxis used by the mother as well as with the state of the infant. RESULTS: Among the placentas examined, 41.3% were considered normal and abnormal or clearly pathological in 58.7%. Estimating the gestational age on the basis of the histological examination of the amniotic cells was in agreement with the gestational age calculated from the last cycle in 53 cases and in disagreement in 8 cases. The percentage of cases of malaria discovered by the pathology examination (20%) was greater than that after thick swab screening (10%). 75% of the mothers has Plasmodium falciparum infection at the time of delivery and 13.8% of the mothers with negative thick drops had malaria lesions of the placenta. The parity of infected mothers was similar to non infected mothers. All the premature newborns had pathological placentas included 12.5% with malarial lesions. 90% of the hypertrophic newborns had pathological placentas included 50% with malarial lesions. No case of congenital malaria was observed. CONCLUSION: Pathology examination of the placenta is as sensitive as blood drop tests for screening for malaria. The histological examination of amniotic cells can give a good estimation of gestational age in developing countries.