[Algorithm for the treatment of ameloblastoma in Tunisia]. / Algorithme de prise en charge des améloblastomes en Tunisie.

INTRODUCTION: Ameloblastoma is a benign but locally aggressive and infiltrative odontogenic neoplasm. Numerous methods of treatment have been proposed but the latest studies showed that a radical treatment is the recommended protocol for the surgical management of ameloblastomas. The purpose of this study was to review the clinical features and surgical treatment of ameloblastomas treated in our department and to propose an algorithm for the treatment adapted to our country. PATIENTS AND METHODS: Data was collected from the records of patients treated at our Surgery Unit between 1993 and 2004. Data with respect to the patients' ages, sex, tumor locations, and surgical treatment history, as well as radiographic findings and number of recurrences, was analyzed. RESULT: 8 male and 5 female patients were included in the study. Sixty-two percent of ameloblastomas were located in the mandibular angle. Swelling was the most common symptom and was experienced by 85% of the patients. A radiographic assessment of the tumors showed that 85% were multicystic. Conservative surgery was used in 92% of the cases. The 8 patients followed-up all presented with recurrence. The other 5 patients were lost to follow-up. A radical treatment was used for 6 of the recurrent ameloblatomas with immediate iliac bone reconstruction. One patient refused radical treatment, he benefited from a conservative treatment, and the other one was lost to follow-up. DISCUSSION: This study was characterized by the preponderance of the conservative treatment, the non-specification of histological types, systematic relapse, and the significant number of lost to follow-up. We recommend significant modifications in the management of ameloblatomas in Tunisia, based on radical surgical treatment. This suggests implementing further training of operators (free flaps) and pathologists (histochemistry), as well as a better education and information of patients.

[Mandibular aneurysmal bone cyst mimicking a malignant tumor]. / Kyste osseux anévrismal mandibulaire mimant une tumeur maligne.

CASE: We report the case of a 24-year-old woman presenting with a rapidly growing mass in the right masseteric region. MRI suggested a diagnosis of a rhabdomyosarcoma but CT-scan evoked a benign lesion such as chondroblastoma or aneurismal bone cyst. The biopsy specimen proved the diagnosis of aneurismal bone cyst and the patient was treated by surgical curettage. There was no recurrence after 4 years of follow-up. DISCUSSION: The aneurismal bone cyst of the jaw is a rare pseudocystic lesion, characterized by replacement of the normal bone with fibro-osseous tissue containing blood-filled sinusoidal or cavernous spaces. The lesion generally affects young persons under 20 years of age. The molar region, the angle, and the ascending ramus of the mandible are the predominantly affected sites. The lesion does not have any clinical or radiological specificity and surgical curettage is the standard treatment. Recurrence is rare and occurs within 30 months after surgery.

[Difficulties of the management of head and neck neurofibromatosis]. / Difficultés de la prise en charge des atteintes de l'extrémité céphalique dans les neurofibromatoses.

INTRODUCTION: Neurofibromatoses represent a group of 7 diseases having the same cutaneous signs due to a common embryologic origin. The types 1 and 2 are the most frequent and the most studied. Neurofibromatosis type 1 (NF1) or Von Recklinghausen's neurofibromatosis is an autosomal dominantly inherited disease, whose prevalence is 1/4500. The cranio-orbitotemporal lesions exist in 1 to 10% of the cases. Neurofibromatosis type 2 (NF2) is also an autosomal dominantly inherited disease, but is ten times less frequent than the NF1 and is characterized by bilateral vestibular schwannomas (former acoustic neurinomas). The purpose of this work was to detail the clinical features, highlighting the diagnostic and therapeutic difficulties. MATERIAL AND METHODS: Nine patients managed between 1990 and 2005 were reviewed retrospectively. Eight patients were found carrier of NF1 and one patient carrier of NF2 according to the diagnostic criteria of the 1988's National Institute of Health consensus. RESULTS: Five women and four men were managed; patient age varied between 13 and 62 years and the mean age was 26 years. Surgical resection of the tumor was carried out among 8 patients with bone reconstruction of the orbit on 3 patients and cutaneous expansion on one other. The results are difficult to appreciate especially that the surgery was iterative. However, all our patients were satisfied with the result and we noted recurrence in a patient presenting a retro-auricular tumor, which filled the external auditory canal requiring a further surgery. The patient having NF2 was treated by neurosurgery and showed a good result. DISCUSSION: The NF1 manifestations are extremely variable. Facial neurofibromatoses are difficult to control given the presence of soft tissues infiltration and the associated osseous dysplasia. The results are modest and recurrence is frequent. Cancer risks and the disease's completely unpredictable evolution urge a regular and multidisciplinary patient follow-up.

[Sclerosing hemangioma of the lung: a rare lesion with a difficult diagnosis]. / L'hémangiome sclérosant du poumon: une lésion rare et de diagnostic difficile.

Sclerosing hemangioma of the lung is a rare lesion described for the first time in 1956 by Liebow. We report a case in a 45 year-old woman who was admitted for exploration of chronic cough. The chest x-ray revealed a round opacity, well delimited in the left pulmonary parenchyma. Surgical resection enabled the histopathological diagnosis of sclerosing hemangioma. We review progress in our knowledge of the histogenesis and diagnosis of this tumor. Immunohistochemistry has been highly contributory although numerous points remain controversial.