[Prognosis of local recurrence of breast cancer in Tunisia]

OBJECTIVE

To evaluate locoregional recurrence rate of breast cancer, determine its anatomoclinical characteristies and discuss the available therapeutic alternatives.

PATIENTS AND METHODS

A retrospective study including 41 patients with LRR following modified radical mastectomy or conservative surgery of invasive breast carcinoma without metastasis, between January 1993 and December 2002.

RESULTS

38 cases of LRR occurred after mastectomy and 3 cases after conservative surgery. LRR rate was 4.84%, mean follow-up 44.7 months. Mean age of patients was 45 years and LRR mean occurrence time-interval 22.4 months. Recurrence was parietal in 25 cases, mammary in 2 cases, and nodal in 14 cases. 18 patients had to be operated on.

CONCLUSION

Prognosis of breast cancer depends on distant metastasis. LRR constitutes the second major risk liable to influence the overall prognosis.

[Well differentiated neuroendocrine carcinoma of the stomach: a case report]

Gastric well differentiated endocrine carcinomas were previously believed to be rare lesions, representing less than 1% of gastric neoplasms. These tumours are often associated with chronic atrophic gastritis, rarely with Zolling-Ellison syndrome. Some sporadic lesions are rarely reported. The prognosis is relatively good, but sporadic forms are more aggressive. We report a case of gastric endocrine carcinoma developed by a 52 year-old man classified as sporadic form after many investigations. Through this observation and after a review of literature, the clinicopathologic features of these tumours, their histogenesis and clinical behaviour are reviewed and discussed.

Étude du contenu en ADN nucléaire dans les nodules thyroïdiens

Thyroid nodules are frequent and sometimes they pose a diagnostic and prognostic problem. DNA ploidy study and cell cycle analysis could be of value in the distinction between benign tumors and malignant tumors. Formalin-fixed and paraffin-embedded tissues from 69 patients with different benign and neoplastic lesions were investigated. Nuclear DNA content in thyroid cells was measured after Feulgen staining using SAMBA 200 image analysis system. A diploid DNA stemline was revealed in 75% of histologically proven benign thyroid tumors (15/20) and aneuploidy was found in 57.2% of malignant tumors (28/49). There is a significant correlation between aneuploidy and extra-thyroid extension (p=0.007) and bilateral and/or mediastinal lymph node metastasis (p=0.02). In the majority of benign tumors (19/20), the proliferation index was lower than 3% (< or =3%) however, this index value was higher than 3% (>3%) in more than 83% of malignant tumors (41/49) (p<0.001). The S phase fraction analysis revealed that the threshold of 14% divide the near whole of benign and malignant tumors (p<0.001). Our findings show that in follicular lesions, proliferation index and S phase fraction study appears interesting and helpful in the distinction between benign and malignant tumors, and aneuploidy seems more interesting in prognosis evaluation of these tumors.

[Prevalence of Epstein-Barr virus in non-Hodgkin's lymphomas in central region of Tunisia]

The purpose of this study was to evaluate the prevalence of EBV in non-Hodgkin's lymphomas occuring in non-immunocopromised patients in Tunisia through a series of 126 cases. EBV was investigated by EBER oligonucleotide in situ hybridization (ISH) and LMP1-immunohistochemistry. Serological study of EBV has been performed before therapy in 28 patients. EBV was detected in tumor cells by ISH in 28/126 (22.2%) cases. Variable proportions of tumor cells were positive. LMP1 was identified in only 8 cases. EBV was more frequently observed in T-cell lymphomas (9/24 patients; 37.5%) than in B-cell lymphomas (19/102 patients; 18.6%) (p=0.04). There was a strong relationship between EBV and small intestine lymphomas (6/8 patients; 75%) and T/NK nasal type lymphomas (3/3 patients; 100%). EBV serological reactivation was noted in 7/13 patients in clinical stages III/IV and in only 1/10 patients in stages I/II (p=0.03). In conclusion, the prevalence of EBV in Tunisian non-Hodgkin's lymphomas is low but variable depending on the histological type and anatomical location with a predilection for small intestine and nasal lymphomas.

[Cord compression secondary to extramedullary hematopoiesis in a patient with beta-thalassaemia]

Extramedullary hematopoiesis (EMH) is a common manifestation in beta-thalassemia, but can also occur in several clinical hematologic disorders or neoplasms. It has been reported in almost all sites of the body. Often asymptomatic, it can be manifested by compression of the adjacent organs. Spinal cord compression as a consequence of EMH in the intraspinal epidural space is an extremely rare complication. We report a case of a 34 year old man who was hospitalised for complete paraplegia and spasticity of both lower limbs; spinal cord compression on D4-D8 by EMH was diagnosed by MRI and confirmed by histologic examination.

[Epstein-Barr virus in Hodgkin's disease: the example of central Tunisia]

The purpose of this study was to evaluate the prevalence of Epstein-Barr virus in Hodgkin disease in Tunisia through a series of 77 cases. Association with Epstein-Barr virus was demonstrated by Epstein-Barr encoded early RNA transcripts (EBER) in situ hybridization in 70% of cases and by latent membrane protein 1 (LMP1) immunohistochemistry in 58.4% of cases. EBER positive cases were more frequent in extreme age classes (<15 and>54 years) there was no correlation with sex, histologic sub-type and clinical stage. Our findings show a high prevalence for EBV infection in Tunisian Hodgkin's disease particularly among extreme ages.

[Assessment of cancer incidence in Tunisia 1993-1997]

The objective of this study is to estimate in Tunisia on a national scale the incidence of the main cancerous localizations for the period 1993-1997 while taking results of registers of the cancer of the region of the North, Sousse and Sfax as a basis. After having verified the relation of exponential type between the incidence of cancers and the life expectancy at the birth (Evo) in a certain number of country we extrapolated levels of governorates incidence included in registers of the North, Sousse and Sfax to the other governorates while taking the similarity of the Evo level as a basis. The incidence rate of in all localizations are 100.11/100.000 for male and 86.4/100.000 for female. The main cancerous localizations for male are the lung (20.8/100.000) the bladder (10.7/100.000), the cutaneous cancers (7.2/100.000) and the prostate (6.1/100.000). For female the main localization are the breast (19.7/100.000), skin (5.8/100.000) and the cervix uteri (4.8,100.000). These results illustrate the interest of tobacco control, screening of the breast cancer of and cervix uteri cancer, as components fundamental of the cancer control.

[Mucocele of the appendix. Retrospective study of 10 cases]

PURPOSE

The purpose of our work was to assess the value of abdominal sonography (US) and computed tomography (CT) in the preoperative diagnosis of appendiceal mucocele.

MATERIAL

and methods. We retrospectively reviewed 10 cases of mucocele of the appendix, 7 cases without pseudomyxoma peritonei, and 3 cases with pseudomyxoma peritonei. All cases were investigated radiologically by plain film and US, barium enema was performed in 3 cases and CT in 5 cases.

RESULTS

Mucoceles of the appendix are rare and their clinical presentation is not specific. US confirms the appendicular involvement, but often poses the differential diagnosis with acute inflammation, abscess or localized appendicular peritonitis. CT appears as a mandatory examination since it allows accurate preoperative diagnosis period. In this series, the diagnosis was made preoperatively in the 5 cases where CT had been performed.

CONCLUSION

US is useful to confirm the abnormal pattern of the appendix but does not allow accurate diagnosis of mucocele. CT is more specific and accurate for diagnosis of mucocele of the appendix.