Gastric metastasis and peritoneal carcinosis revealing primary breast cancer: an unusual presentation.

Breast cancer is the most frequent cancer among women. Gastrointestinal tract metastases are uncommon and might be misidentified as primary carcinoma.A noteworthy case-study involved 53-year-old-woman complaining from epigastric pain, ascites and overall health decline. Initial investigations were inconclusive, prompting laparoscopic peritoneal biopsies which revealed independent cell proliferation. Subsequently, a second look upper digestive endoscopy showed multiple gastric ulcerations suggestive of gastric carcinoma. Histologic examination confirmed independent cell proliferation with estrogen receptors expression, a characteristic feature of breast carcinoma. Further investigations led to bilateral invasive lobular breast carcinoma diagnosis. Epirubicin cycophosphamide was prescribed after progression under letrozole ribocilib therapy.This case aims to raise awareness among clinicians about the importance of ruling out breast cancer in patients with peritoneal carcinosis and paying attention to digestive symptoms in breast cancer patients with careful gastric endoscopic examination to avoid misdiagnosis.

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An Acute Jejunojejunal Intussusception Revealing a Metastatic Combined Lung Cancer.

Intussusception is a relatively common disease in pediatric age but it is uncommon in adults. We report a case of a 49-year-old male who presented with an acute jejunojejunal intussusception revealed by abdominal pain and vomiting. He underwent an en bloc resection, and pathological findings concluded to a metastasis of a pulmonary combined small cell carcinoma and adenocarcinoma. A subsequent CT scan revealed the primitive mass of the right lung with no evidence of secondary localization. The biopsy was difficult to perform. The patient underwent a pneumonectomy with lymph node dissection confirming the same diagnosis. He made a good recovery from the surgery, and a postoperative chemotherapy was administrated, and he is in remission until this date.

Thyroid oncocytic neoplasms.

BACKGROUND: Oncocytic tumors (OT) are rare, representing 3 to 10% of epithelial tumors of the thyroid. It is important to individualize these TO given the relatively high frequency of carcinomas in this group: 30% against 15% for micro-vesicular lesions of classical cytology and the aggressiveness of malignant OT due to their low iodine uptake. AIM: The aim of our study was to describe the anatomo-clinical aspects of oncocytic tumors of the thyroid. METHODS: Our study was retrospective, realized on 99 cases of oncocyte thyroid tumors collected at the Anatomy and Pathology Cytology laboratory of Tunis Charles Nicolle Hospital during a 10-year period (2004-2014). RESULTS: Our series included: 76 oncocyte adenomas, 13 oncocytic papillary carcinomas, 7 oncocytic carcinomas and 3 tumors of uncertain malignant potential (3%). The correlation of the anatomo-clinical data with the diagnostic categories showed a statistically significant difference concerning the macrovesicular architecture. We found no difference between benign and malignant TO, in relation to age, echogenicity, tumor size, macroscopic appearance, capsule thickness, percentage of oncocyte cells, and the presence of associated lymphocyte thyroiditis. CONCLUSIONS: In view of the literature data and the findings of our study, it seems that there are no predictive factors for the malignancy of oncocytic tumors at the pre- and peroperative stage, with the exception of papillary-type nuclear atypia for Oncocytic papillary carcinoma.

Evaluation of fine needle aspiration cytology in the diagnosis of cervical lymph node lymphomas.

PURPOSE: Surgical biopsy examination is the gold standard for the diagnosis of lymph node lymphomas. Fine-needle aspiration cytology (FNAC) is a quick and safe method in the management of cervical lymph nodes. Its value in confirming recurrent or residual lymphoma is well established. However, its role in the primary diagnosis of lymph node lymphoma remains controversial. The aim of this study was to assess, in our experience, the reliability of FNAC in the diagnosis of cervical lymph node lymphomas. MATERIALS AND METHODS: This was a retrospective study carried out over a 6-year period (January 2011 to December 2016) and conducted at the Cytology Unit in our Pathology Department (Charles Nicolle Hospital, Tunisia). The measures of diagnostic accuracy of FNAC in the diagnosis of cervical lymph node lymphomas were calculated taking histopathology as the gold standard. RESULTS: A total of 937 FNA samples were obtained from 851 patients. The diagnosis of lymphoma was obtained in 65 cases (6.9%). Cytological diagnoses of lymphoma were as follows: 28 (44%) Hodgkin lymphoma, 17 (25%) high-grade lymphoma, 15 (23%) low-grade lymphoma, and 5 (8%) "suggestive of lymphoma." FNAC of cervical lymph nodes had a sensitivity of 95.5%, specificity of 98.7%, positive predictive value (PPV) of 97.7%, and negative predictive value (NPP) of 97.5%. CONCLUSION: The present study demonstrated that cytology is capable to detect nodes suspicious for the presence of lymphoma precisely, in terms of low- or high-grade lymphoma, which is a relevant and very achievable first step in the management of patients with cervical lymph node lymphoma.

ALK protein expression in pulmonary adenocarcinoma of Tunisian patients.

BACKGROUND: It is now necessary to determine ALK status in order to use targeted therapy. AIM: herein, we assess immunohistochemical profile of ALK protein in a series of Tunisian patients with pulmonary adenocarcinoma. MATERIALS AND METHODS: ALK protein expression was studied applying the D5F3 antibody with a fully automated Ventana CDx technique on a series of 19 patients. RESULTS: Positive ALK expression was found in one case (5.2%) corresponding to a papillary adenocarcinoma which showed a strong granular and homogenous cytoplasmic staining. The patient was a 30-years-old woman. CONCLUSION: The frequency of positive ALK expression based on immunohistochemistry in our series was similar to that reported in the world literature.

Salivary duct carcinoma of the parotid gland.

Salivary duct carcinoma of the parotid gland is an uncommon tumor, highly aggressive. About 200 cases have been reported in the English literature. Pathomorphologically, these tumors showed great similarities to ductal carcinoma of the female breast, which is why they described this tumor as "salivary duct carcinoma." The authors describe a new case of salivary duct carcinoma of the parotid gland. We present the case of a 50-year-old patient with progressive facial paralysis. The MRI examination of the head showed two ill-defined formations. A malignant tumor was strongly suspected, so that a total left parotidectomy with excision of the adjacent facial nerve and left lymph node dissection was performed. Microscopic examination concluded to a salivary duct carcinoma of the left parotid gland negative with Her2/neu antibody with lymph node metastasis. There were no recurrences or metastases within 3 years of follow-up. Salivary duct carcinoma of the parotid gland is a rare tumor with an aggressive behavior. This is due to its propensity to infiltrate distant organs. The diagnosis is based on microscopic examination. Treatment modalities are non-consensual, but some authors advocate the necessity of aggressive approach, especially in tumors negative with Heur2/neu antibody. This is due to the fact that the overexpression of this antigen was reported to be associated with a poor prognosis.