SYNCHRONOUS OCCURRENCE OF THREE DIFFERENT THYROID TUMORS.

BACKGROUND: Thyroid nodules are common; however, the association of two or more different tumors in the thyroid gland is unusual. We present a first case with the association of three histological types of thryroid tumors. To the best of our knowledge, this association has not been reported in the literature before. We aim here to highlight the possible coexistence of many lesions in the thyroid gland and to discuss treatment options. CASE PRESENTATION: We report the case of a female patient who presented with a multinodular goiter. The final pathology after total thyroidectomy found the association of a multifocal papillary thyroid microcarcinoma arising within a Hurthle cells adenoma in a lobe and a noninvasive follicular thyroid neoplasm with papillary nuclear features in the other lobe. Due to the very low risk of recurrence, the patient was not treated with radioactive iodine. CONCLUSIONS: Many controversies remain about the management of Hurthle cells tumors and many variants of papillary thyroid carcinoma. Although the management of our case did not change, more studies are necessary to analyze the evolution of patients with multiple thyroid neoplasms. When discussing therapeutic options, the advantages and disadvantages should be considered case by case based on disease staging.

[Coinfection with hydatid cyst and pulmonary tuberculosis]. / Coinfection pulmonaire par un kyste hydatique et une tuberculose pulmonaire.

Morocco is an endemic area for both hydatid cyst and tuberculosis (TB). The co-occurrence of these two diseases in lung is unusual, especially when localized in the same area. We describe the case of a patient with pulmonary hydatid cyst associated with tuberculosis infection where the diagnosis was unknown prior to surgery because TB tests were negative. The surgical resection was very difficult because of inflammation in the surrounding tissue and its fragility. However, the postoperative course was uneventful. The goal of this case report is to keep in mind that such co-infection is possible especially in endemic countries.

Myxofibrosarcoma of the thyroid gland.

INTRODUCTION: Myxofibrosarcoma of the thyroid is exceptional: a Medline search found a single case report. We report a new case which raised diagnostic and therapeutic problems. OBSERVATION: We report the case of a 74-year-old woman who presented with swelling of the left thyroid lobe and ipsilateral cervical lymphadenopathy. Total thyroidectomy with cervical lymph-node dissection was performed. Histological analysis diagnosed myxofibrosarcoma. Evolution was marked by rapid local recurrence, and chemotherapy based on doxorubicin and ifosfamide was introduced. DISCUSSION/CONCLUSION: Head and neck myxofibrosarcoma is rare. MRI is essential and should always precede treatment. Diagnosis is histological. There is elevated risk of local recurrence after resection, accompanied by worsening tumor grade, whence the need for accurate diagnosis, appropriate treatment and regular MRI follow-up.

[Heterotopic ossification on a midline laparotomy scar after digestive surgery: etiopathogenic discussion about two cases]. / Ossification heterotopique sur cicatrice mediane abdominale apres chirurgie digestive: discussion etiopathogenique a propos de deux cas.

Heterotopic ossification (HO) is rarely seen after abdominal surgery and usually occurs after orthopedic surgery. It is a benign affection with an unknown mechanism and an unpredictable occurrence rate; but some etiopathogenic hypotheses have been put forward. Therapeutic attitudes were not assessed in this study. We report two observations of heterotopic ossification on mid-line laparotomy scar which could support the etiopathogenic hypothesis of osteoblastic cells migration in granulation tissue from the neighbouring bone tissue, particularly from the sternum or pubian structures. The etiopathogenic mechanism and treatment of this affection are discussed with regards to previously published literature.

L'ossification hétérotopique (OH) est rare au cours de la chirurgie abdominale et intéresse surtout la pathologie orthopédique. C'est une affection bénigne, de survenue imprévisible, de mécanisme encore discuté et des hypothèses étiopathogéniques sont proposées. L'attitude thérapeutique n'est pas codifiée. Nous rapportons deux observations d'ossification hétérotopique sur cicatrice médiane sus ombilicale qui pourraient supporter l'hypothèse étiopathogénique d'une greffe de cellules ostéoblastiques au sein du tissu de granulation à la faveur d'un tissu osseux de voisinage notamment les structures osseuses xiphoïdiennes ou pubiennes. L'étiopathogénie et le traitement de cette affection sont discutés à la lumière des données de la littérature.

Colorectal juvenile polyposis in an adult with ulcerative colitis.

Juvenile polyposis is a rare disorder. We report an unusual case of juvenile polyposis in a 22-yr-old woman with ulcerative colitis, apparently one of the first cases reported in the literature.

[Rosai-Dorfman disease mimicking meningiomatosis: a case report]. / Maladie de Rosai-Dorfman mimant une méningiomatose: à propos d'un cas.

Rosai-Dorfman disease (RDD), also known as sinus histocytosis with massive lymphadenopathy, is a rare idiopathic histioproliferative disease affecting the lymph nodes. Although extranodal involvement has been reported in diverse sites, central nervous system manifestations, particularly in the absence of nodal disease with clinical and radiological findings suggestive of meningioma, are extremely rare. Histopathology and immunohistochemistry are essential for a positive diagnosis. We report a case of RDD in a patient presenting multiple meningeal nodules with a review of the literature and discussion of differential diagnosis.

[Desmoplastic ameloblastoma in a 7 year old child]. / Améoblastome desmoplastique chez un enfant de 7 ans.

Desmoplastic ameloblastoma is a benign, locally aggressive neoplasm of proliferating odontogenic epithelial origin. It is seen among old patients from 17 to 72 years with an average age 42 years and without predilection of sex. We report the case of a 7 year old child, having presented since the 5 years age, a gingival tumefaction on the left higher incisivo-canin group which increased volume gradually. The stomatologic examination showed a gingival tumefaction covered with a healthy mucous membrane, ovoid form and measuring 3 cm on its horizontal axis. The tomodensitometry of the jawbone showed in front of the 21st and the 22nd tooth, the presence of an osseous lesion associating of the hearths of osteolysis and osteocondensation with rupture of cortical and invasion of the soft tissue. A curetting of the lesion was carried out and the anatomopathologic examination retained the diagnosis of desmoplastic ameloblastoma. The characteristic of our observation is the youth of the patient. In addition, the desmoplastic ameloblastoma is relatively rare, is characterized by an anatomical distribution, a radiological appearance and a morphological aspect differents from the traditional ameloblastoma. A radical surgical treatment is suggested for this tumour to avoid recurrency.