[Benign granular cell anal tumor]

INTRODUCTION

Granular cell tumors (GCT) are rarely located in the perianal area.

OBSERVATION

Over the past 3 years, a 56 year-old man presented a papule of the right margin of the anus that had progressively increased in size (1.5 cm). Cell proliferation was located in the dermis and strongly expressed the S100 protein. It was covered by a pseudo-epitheliomatous hyperplasia of the overlying epidermis. Forty months after local surgical excision, there was no sign of recurrence.

COMMENTS

Granular cell tumors are rare and usually benign. When cutaneous or mucosal, the pseudo-epitheliomatous hyperplasia of the overlying epithelium may, on superficial samples, be mistakenly diagnosed as squamous cell carcinomas. Malignant GCT may, histologically, appear identical to a benign GCT and only the appearance of metastases (generally after local recurrence) permits the subsequent diagnosis of malignancy.

[Dedifferentiated chordoma of the skull base. A case report]

Sarcomatous transformation in chordoma is a very rare condition and has been emphasized as a distinct entity because of its more aggressive clinical course. Here we describe a case of dedifferentiated chordoma arising from the skull base region of an 11-year-old boy, with tumor recurrence within one year. This tumor showed features of pleomorphic cell sarcoma with areas more typical of chordoma. Most of tumor cells expressed cytokeratin, epithelial membrane antigen, vimentin and S-100 protein, thus confirming the diagnosis of dedifferentiated chordoma.

[Imaging findings in 122 cases of Pott's disease]

Spinal tuberculosis is a frequent skeletal involvement in tuberculosis. We report 122 cases between 1983 and 1998 of Pott's disease explored by plain radiographies in all cases, CT-scan in 22 cases and MRI in 6 cases. The lesion involved one localization in 98 cases, two localizations in 9 cases and multiple localizations in 15 cases. The usual form associating the discal and vertebral involvement was noted in 70%. Unusual forms were seen in 30% of the cases The localizations were: posterior arch (20 cases), centrosomatic (10 cases), suboccipital (4 cases) and subligamentar (2 cases). In addition, the CT scan noted vertebral lesion with soft tissue abscess in all cases and epidural lesion in 9 cases. MRI performed in 6 cases showed epidural lesions in 4 cases: epiduritis (2 cases) and abscess (2 cases). The disco-vertebral puncture-biopsy, performed in 12 cases, confirmed the diagnosis in 7 cases. The diagnosis of Pott's disease was confirmed biologically in 30 cases. Radiographic exploration of Pott's disease is improved by the contributions of CT and MRI which can identify sequestra, perilesional sclerosis and epidural or soft tissue abscesses. Discovertebral aspiration biopsy provides the key to diagnosis.

Occlusion of an aberrant artery to a pulmonary sequestration using a duct occluder

This report describes a female infant with a rare chromosome defect, del. 12 (q22-24.1), who has severe pulmonary valve stenosis, an atrial septal defect, and a small muscular ventricular septal defect. At 4 months of age a balloon pulmonary valvuloplasty was performed in the cardiac catheterization laboratory. During the procedure, a large aberrant artery from the aorta to a sequestration of the right lower lobe of lung was found. The flow-off from the sequestration was into a dilated left atrium. The single artery supplying the sequestration was successfully occluded using an Amplatzer Duct Occluder device. There were no complications and the infant remains well at 1-year follow-up.

[Late discovery of Lafora disease: a family study]

Lafora disease is a progressive myoclonic epilepsy, Clinically defined by the association of myoclonic, epileptic fits and dementia. We report a case with an atypical Lafora disease, marked by delayed onset at 25 years of age, prolonged course, associated with secondary cognitive impairment and myoclonic features.

Central nervous system tumors in Morocco. Retrospective analysis of 2374 cases

BACKGROUND

No epidemiological data about central nervous system tumors in Morroco have been published. The objective of the present study is to assess topographic and demographic patterns of a large series of histologically confirmed tumors of central nervous system (CNS), skull and vertebral column, examined in the main neuropathology laboratory of the country.

METHODS

No. 2363 tumors have been collected in the department of Neuropathology in Hôpital des spécialités oto-neuro-ophtalmiques, Rabat, between 1988 and 1997. Data concerning age, sex, tumor location and histological type were retrieved from the laboratory files. Histological typing was based on the World Health Organization (WHO) classification of central nervous system tumors and grading on the Kernohan and Mayo Clinic-St. Anne systems.

RESULTS

No. 1454 intraparenchymatous and 904 extraparenchymatous tumors were studied. The topographic repartition of these tumors presented no differences when compared to the literature data. The main differences were noted for malignant astrocytomas and glioblastomas which were less frequent than in Western countries and occurred in younger people. The young age of Morrocan population probably explains these findings. Childhood tumors repartition was similar to Western series.

CONCLUSIONS

These results emphazise the need for a population based registry in order to verify our findings and adapt efficient health intervention.

[Epithelial cyst in the superior internal angle: a case report]

Most orbital cysts in childhood are epidermoids or dermoids. We report one uncommon case of an 8-years old girl with a lacrimal orbital cyst revealed by discrete proptosis and pseudo-ptosis in which the cystic histopathological study revealed a lacrimal structure.

[Pulmonary metastasis from a glioblastoma. A case report]

Glioblastoma is a primary malignant astrocyte tumor of the central nervous system. Extraneural metastasis is uncommon. We report a case of spontaneous lung metastasis from a glioblastoma without prior surgery. Positive diagnosis was achieved from histology and immunohistochemistry

[Massive lytic osteodystrophy or Gorham-Stout disease of the craniomaxillofacial area]

Gorham's disease also called idiopathic massive osteolysis represents a rare affection with unknown aetiology. This disease was described in different bones of the body but its location on maxillo-facial skeleton is particular by the number of cases in the world (only 32), by morphological, functional consequences and the prognosis. The authors describe a new case of male teenager (17 years old) who had a massive osteolysis of mandibular ramus, upper maxillary, malaire, sphenoid, temporal and occipital left bone. The authors give precision about epidemiological data, methods of diagnosis and therapeutic procedures.

[Bilateral hydatid cyst of the fallopian tubes: a case report]

We report an exceptional case of bilateral hydatid cysts that developed solely in the fallopian tubes of a young girl. The diagnosis was suggested by the clinical history, the patient's residence in an endemic area, and the ultrasound findings and was confirmed peroperatively. Due to the extensive damage bilateral salpingectomy was required compromising future reproduction potential. We discuss the pathogenesis of pelvic localizations and the ultrasound aspects of pelvic hydatid cysts.

Desmoplastic non-infantile ganglioglioma. Case report

Desmoplastic gangliogliomas are rare mixed glial and neuronal cerebral tumors, especially described in infants below 4 years of age but exceptional cases have been reported in young adults. These tumors are generally localised in parietal or temporal lobes, present as a large cystic lesion with peripheral contrast enhancement. They also have characteristic histological features: extensive desmoplasia and tumoral cells of variable size exhibiting immunohistochemical and ultrastructural features of glial and neuronal differentiation. Total surgical removal is sufficient for the treatment of these tumors and no radiotherapy or chemotherapy are indicated if complete resection is achieved. We report a case of desmoplastic ganglioglioma in a 19-year-old male. This tumor presented as a large parieto- temporal cystic lesion with rimmed contrast enhancement. At histological examination, this tumor exhibited extensive desmoplasia and comprised 2 types of tumoral cells: small cells with round nuclei, positive for NSE, neurofilaments and synaptophysin and sometimes presenting typical morphological features of neuronal differentiation, and large cells with abundant eosinophilic strongly staining for GFAP. This observation emphazises on the fact that desmoplastic ganglioglioma can no more be considered as a specific entity of infancy and must be well recognised even in young adults because it may be misdiagnosed as malignant glioma.

New model of atherosclerosis in insulin resistant sand rats: hypercholesterolemia combined with D2 vitamin

To overcome the sand rats' resistance to cholesterol induced atherosclerosis, animals were given D2 vitamin at 2000 IU/rat per day associated with cholesterol-enriched diet for 45 days, following 45 days of high cholesterol diet alone. At days 0, 45 and 90, plasma parameters, aortic and heart morphology were examined. Other animals receiving a high cholesterol diet alone were used as a control group. Results showed at day 45 severe hypercholesterolemia, elevated plasma LDL and VLDL-cholesterol, oxidized LDL and calcium levels, a rise of lecithin cholesterol acyl transferase activity and moderate hyperinsulinemia. Lesions were characterized by widening of the first interlamellar spaces in the aorta, fibrosis of coronary arterial wall and recent foci of myocardial fibrosis. At day 90, plasma calcium level decreased and oxidized LDL were more enhanced. Insulin resistance development was associated with glucose intolerance and hyperinsulinemia. The D2 vitamin administration induced advanced atherosclerotic lesions in arterial wall, represented by the rupture of elastic lamellae, smooth muscle cell proliferation and lipid-calcic core. The complicated plaque frequently evolved into ulcerations. The ischaemic effects were represented by acute myocardial infarction. D2 vitamin is an atherogenic agent which, when associated with hypercholesterolemia, allows the development of advanced atherosclerotic lesions in sand rat which resembles human plaque.

[The oculomotor effects of the fractures of the floor of the orbit]

PURPOSE

Fractures of the orbit floor have very disabling oculomotor after effects. The objective of this study was to report that close collaboration between the maxillo-facial specialist and ophthalmologist is necessary to avoid oculomotor after effects.

METHODS AND PATIENTS

Our study included 10 cases of the fracture of the orbit floor. These cases were recorded between 1992 and 1996.

RESULTS

This pathology affected young subjects aged between 20 and 40 years in 70 % of the cases. 80 % of the subjects were males. 90 % of the patients presented a vertical diplopia as a result of a transitory oculomotor deficit. 20 % of the subjects presented a permanent oculomotor deficit at the stage of after effects. All these deficits were of a mechanical origin and, contrary to other authors, we found no deficit with nervous sensory origin.

CONCLUSION

Therapeutic success is based on early diagnosis and treatment that requires close collaboration between the maxillo-facial and ophthalmology teams.

New model of atherosclerosis in sand rats subjected to a high cholesterol diet and vitamin D2

In order to defeat the atheroresistance in sand rats, 25 animals were given a high cholesterol diet for 45 days, which was then associated with oral treatment with vitamin D2 2000 IU/day for a further 45 days. At days 0, 45 and 90, plasma parameters, and aortic and heart morphology were examined. Results showed at D45 hypercholesterolaemia, increased plasma LDL and VLDL cholesterol, oxidized LDL, triglycerides, free fatty acids (FFA) and calcium levels and moderate hyperinsulinaemia. At D90, plasma-oxidized LDL and FFA were more enhanced, whereas calcium level was reduced. Development of hyperglycaemia was associated with hyperinsulinaemia and insulin resistance. The vitamin D2 administration induced advanced lesions, represented by the degenerescence of elastic lamina, smooth muscle cell proliferation and lipid calcic plaque at an ulcerated stage in most cases. The ischaemic effects were represented by acute myocardial infarction. The potential of the sand rat to develop atherosclerotic lesions at different stages opens the field to therapeutic tests of new anti-atherogenic agents.

[Intracranial malignant melanoma. Report of 4 cases]

We report 4 cases of intracranial melanoma without any clinically diagnosed extracerebral location. These tumors presented at different sites and had different histological aspects. Intracytoplasmic melanin was present in all cases, immunohistochemistry confirmed the diagnosis and eliminated a possible glioblastoma or metastatic carcinoma. Clinical and pathologic characteristics of primary pigmented lesions of the CNS are discussed with particular interest in diagnostic difficulties and histogenesis of these lesions.

Genetic mapping of Russian wheat aphid resistance genes Dn2 and Dn4 in wheat

To obtain markers for marker-assisted breeding of Russian wheat aphid resistance in wheat (Triticum aestivum L.), resistance genes Dn2 and Dn4 were mapped with restriction fragment length polymorphism (RFLP) markers, using populations derived from PI 62660 x 'Carson' and PI 372129 x 'Yuma'. PI 262660 and PI 372129 are the donor parents of Dn2 and Dn4, respectively. A locus detected by marker KsuA1 was linked to Dn2 at a distance of 9.8 cM on the long arm of chromosome 7D, and a locus detected by marker ABC156 was 11.6 cM away from Dn4 on the short arm of chromosome 1D.Key words: Russian wheat aphid, RFLP markers, Triticum aestivum.

A method providing bidirectional control of coil delivery in occlusions of patent ductus arteriosus with shallow ampulla and Pott's shunts

A novel method using a snare and bioptome to provide bidirectional control of a Gianturco coil for occlusion of a patent ductus arteriosus with a shallow ampulla and Pott's shunts is presented. This method greatly reduces the risk of coil embolization and optimizes coil position in difficult cases.

Cerebrospinal fluid examination in a case of childhood orbital granulocytic sarcoma

The diagnosis of a case of childhood orbital granulocytic sarcoma, initially classified as a poorly-differentiated malignant tumor, was finally considered at the time of relapse following primary treatment with chemotherapy and local irradiation. At this time, systematic cerebrospinal fluid examination showed numerous blast cells with Auer rods, consistent with the diagnosis of meningeal acute myeloid leukemia of M2 type, and concomitant biopsy of the tumor indicated the diagnosis of chloroma. Reevaluation of the primary biopsy confirmed this diagnosis.

[Central giant cell reparative granuloma of the jaw]

The authors report a series of 22 cases of central giant cells Granuloma of the jaws. There were 12 located in the maxilla, and 10 in the mandible. The majority of lesions were observed in patients under the age of 30 years, and occurs more often in females than in males, particularly in mandibular lesions. This lesion, which the pathogenesis still remains obscure, appears as radiolucency, well or ill-defined, uni or multilocular with trabeculations coursing through the lesion. Histologic study shows giant cells, fibroblastic cells, and foci of hemorrhage and osteoid tissue. The authors insist on the problem of differential diagnosis which can make a radiolucency with giant cells. It must be differentiated especially from giant cells tumor, which treatment and course are different. Finally, the authors underline a good prognosis of this lesion, which simple curettage is generally sufficient, and which recurrences remain rare.

[Peutz-Jeghers syndrome with carcinomatous degeneration of a duodenal hamartomatous polyp]

The authors report a case of Peutz-Jeghers syndrome in a young patient revealed by a duodenal carcinoma developed in a hamartomatous polyp. The absence of adenomatous lesion a the level of duodenal tumour, and the presence of hamartomatous lesions, particularly smooth muscular fibres, contiguous to carcinomatous glands, are favorable to a degenerescence of hamartomatous polyp. The question of malignant change or of the association of digestive carcinomas is discussed.

[Contribution of radiology to the diagnosis and treatment of nasopharyngeal fibroma. Apropos of 6 cases]

The authors report about their experience with 6 cases of nasopharyngeal fibroma. They emphasize the interest of CT examinations in the diagnostic study, and above all in the assessment of regional extension. The angiographic study must be as complete as possible, and should include an embolization within 2 to 5 days prior to surgical excision as often as this is possible. Embolization is a simple procedure if performed strictly and carefully in order to avoid any complication.

What's new in cerebral pathology in acquired immune deficiencies?

Over the last few decades, a new pathology has appeared, directly related to the modified immune status of the hosts. It presents several distinctive points. The central nervous system is particularly affected. The opportunistic pathogenic agents do not usually injure the brain parenchyma and are not known for their aggressiveness in normal adults (papovavirus). Diagnosis of these different diseases is often difficult, some biological tests being irrelevant because of alterations of the immune system (toxoplasmosis). The lesions may be exclusively located in the brain (tuberculosis, lymphomas) which is not usually affected by these agents. Response to therapy is frequently poor, the clinical course being rapid and fatal. However, therapy may be successful in some cases, justifying the use of somewhat aggressive procedures (biopsy) in order to obtain an accurate diagnosis. It is important to be aware of these data, and an understanding of them may help in managing these already difficult patients. They also make possible some interesting pathogenic hypotheses.

Proved viraemia in Asian influenza (Hong Kong variant) during incubation period

During an outbreak of influenza specimens were obtained from 21 patients with influenza-like illnesses and from 29 healthy subjects in close contact with the patients. Throat washings from 12 of the patients were positive for influenza virus but virus was not detected from the blood specimens. One healthy contact became ill 12 hours after the specimens were obtained, and the virus was isolated from his blood and throat washings. The remaining contacts showed no clinical illness; but the virus was isolated from the throat washings of four of them, with no viral isolation from the blood specimens.