Parapharyngeal Lymph Node Metastasis From Papillary Thyroid Carcinoma

Metastatic parapharyngeal lymph nodes (LNs) from papillary thyroid carcinomas (PTC) are uncommon and can easily remain undetected. We describe a case that involves a 62-year-old woman treated for a PTC, who presented a rise in serum thyroglobulin (TG) levels. A computed tomography scan was performed, and revealed metastatic nodes in the left parapharyngeal space (PPS). A surgical resection of the nodes was performed with external cervical approach. A histological exam confirmed the diagnosis of a metastatic LN of a PTC. The aim of this report is to emphasize on the possibility of parapharyngeal metastatic nodes in PTC and to describe the diagnosis methods, treatment options, and impact on the prognosis.

Small Intestine Gastrointestinal Clear Cell Sarcoma: A Case Report and Review of the Literature

Gastrointestinal clear cell sarcoma (GICCS)/malignant gastrointestinal neuroectodermal tumor (GNET) is an extremely rare form of cancer with aggressive clinical behavior. It has distinct pathological, immunohistochemical, ultrastructural, and molecular features. Herein, we present the case of a 20-year-old woman with no notable medical history who presented to the outpatient department with complaints of abdominal pain and vomiting. Symptoms had been evolving for 3 months. The physical examination revealed slight abdominal tenderness and melena. Biological investigations revealed iron-deficiency anemia. The upper and lower endoscopies showed no abnormalities. Magnetic resonance enterography revealed small bowel wall thickening of 15 mm × 2 mm. Exploratory laparotomy revealed an ileal mass with mesenteric lymphadenopathy. A wide resection of the mass was then performed. The final pathological report confirmed the diagnosis of small bowel GICCS/GNET. After 11 months of follow-up, the patient presented with mesenteric lymph node metastases.

A rare association of a high grade glioblastoma, cerebral abscess and acute lymphoblastic leukemia in a child with Noonan syndrome

Noonan syndrome is a genetic disorder frequently caused by PTPN11 mutations. Patients with Noonan syndrome are characterized by facial dysmorphism, short stature and congenital heart defects and they have a reported predisposition to malignancies such as leukemia, and solid and central nervous system tumors. Here, we report a case of a 14-year-old boy with Noonan syndrome treated for T-cell acute lymphoblastic leukemia who presented with 2 concomitant abnormalities: cerebral abscess and high grade glioblastoma. This exceptional association exhibits to a poorer prognosis and may sometimes delay the diagnosis and therefore the therapeutic intervention.

Treatment of Helicobacter pylori infection 14-day concomitant quadruple therapy versus triple therapy: A parallel double-blind randomized controlled trial

Background and Aims

Successful Helicobacter pylori (Hp) eradication with the traditional 7-day course of proton pump inhibitor triple therapy is declining. Prolonging therapy to 14 days is associated with better eradication rates. Most learned societies recommend concomitant quadruple therapy (QC) as a first-line alternative therapy for this bacterial infection. The aim of this study is to compare the efficacy and safety of triple therapy (TT) and QC for the eradication of Hp infection.

Methods

A parallel double-blind randomized controlled trial was conducted. The diagnosis of Hp infection was made by pathological examination of gastric biopsies. Patients were randomly assigned to two treatment groups: either QC (esomeprazole 80 mg, amoxicillin 2000 mg, clarithromycin 1000 mg, and metronidazole 1000 mg daily) or triple therapy (esomeprazole 80 mg, amoxicillin 2000 mg, and clarithromycin 1000 mg daily in divided doses) for 14 days. The efficacy of the treatment is defined by Hp eradication attested by a negative breath test performed 6 weeks after the completion of treatment. Treatment outcomes were compared using the chi-square test, while binary logistic regression identified predictors of treatment failure.

Results

Ninety-two patients were included. Forty-two patients belonged to the QC group and 50 to the TT group. No significant difference was noted between the two groups concerning the rate of Hp eradication either by intention to treat (81% vs. 72% respectively, p = 0.31) or per protocol (81.6% vs. 76.1% respectively, p = 0.54). Likewise, there was no difference between the two groups in terms of tolerance to treatment (59.5% for QC vs. 58% for TT, p = 0.88). No factor has been associated with treatment failure.

Conclusion

There was no significant difference in the rate of HP eradication between the QC and the 14-day triple therapy. Neither regimen should be used topically because of their low eradication rates.

Noncalcifying type of calcifying epithelial odontogenic tumor: A rare case report and literature review

Key Clinical Message

There has been a recent spike in reporting of noncalcifying variants of CEOT with the WHO 2022 classification of head and neck tumors. The present case describes a rare histopathological variant of CEOT of which a handful of cases have been reported.

Abstract

This work aimed to report a rare case of noncalcifying type of Pindborg Tumor involving the right mandible. The absence of calcifications in the calcifying epithelial odontogenic tumor presents a diagnostic challenge and prognostic implications. A literature review of the 16 reported clinical cases of this scarce variant was performed.

Chronic recurrent annular neutrophilic dermatosis: A rare entity

We report a new case of chronic recurrent annular neutrophilic dermatosis in a woman. Through our observation, we aim to make the clinician aware of this rare entity, in order to consider it among the diagnostic hypotheses of annular dermatosis, with centrifugal, recurrent, and chronic evolution.

Spinal clear cell meningioma without dural attachment: a case report and literature review

Clear cell meningiomas (CCM) are a very rare histologic subtype of meningioma usually affecting younger patients. The reported data on spinal CCM are extremely rare. Until today, only 89 cases have been reported. Furthermore, CCM without dural attachment is even rarer since only 19 cases have been reported in English literature. In this article, we present the twentieth case of a spinal CCM without dural attachment. Our patient was a 58-year-old female who was presented with pain in her lower back and bilateral sciatica for 6 months. Magnetic resonance imaging showed an intra-dural well-demarcated lesion at L3. Via a posterior approach, total resection was possible due to the lack of dural adhesion of the tumor. Histologic diagnosis was clear cell meningioma.

Subcutaneous Fat Necrosis of the Newborn

A boy weighing 4500 g was born at 41 weeks' gestation by Cesarean section due to fetal distress. The pregnancy was complicated by gestational diabetes. He had an Apgar score of 5 and 6 after 5 and 10 minutes, respectively. At birth, the newborn manifested respiratory distress, which needed assisted ventilation for 48 hours. He developed a convulsive attack, diagnosed as a grade 2 hypoxic-ischemic encephalopathy, which was controlled by phenobarbital. Four days later, dermatologic examination revealed subcutaneous and firm nodules, ranging from 1 to 4 cm in diameter, on the cheeks, neck, arms, legs, and back (Figure 1). Some nodules became fluctuant as abscesses. Fine-needle aspiration cytology performed on a nodule revealed a dirty background with necrotic fat-containing characteristic, radially- oriented, refractile, needle-shaped crystals (Figure 2), which was diagnosed as subcutaneous fat necrosis. The diagnosis of subcutaneous fat necrosis of the newborn was made. Laboratory studies revealed hypocalcemia at 1.65 mmol/L, hypomagnesemia at 0.48 mmol/L, and hypokalemia at 3 mmol/L. The infant received calcium, magnesium, vitamin D, and potassium supplementation. On day 18, the serum calcium increased to 3.3 mmol/L. It was associated with hypertriglyceridemia at 2.6 mmol/L. Bilateral nephrocalcinosis was detected on renal ultrasound. So, hyperhydration, diuretics, and withdrawal of vitamin D were indicated. The patient was given betamethasone 0.125 mg/kg/day for 3 weeks. After a two months course, there had been complete healing of the fat necrosis (Figure 3), normalization of the calcium and triglyceride levels, and a normal growth pattern.

Small bowel and lung histiocytic sarcoma revealed by acute peritonitis: A case report with review of literature

INTRODUCTION AND IMPORTANCE

Histiocytic sarcoma (HS) is a rare malignant neoplasm showing morphologic and immunohistochemical features of histiocytes. It is characterized typically by extranodal presentation and a poor clinical course, particularly in cases with disseminated disease.

CASE PRESENTATION

This report documents a case of bifocal and aggressive HS in small bowel and lung revealed by acute peritonitis in a 63-year-old man.

CLINICAL DISCUSSION

Despite its rarity, we believe that the correct diagnosis of HS is crucial for clinical treatment and prognostic prediction.

CONCLUSION

The collection of additional cases of HS are important to obtain further progress in prognosis and guide treatment decisions.

Ossifying fibromyxoid tumor of soft tissue: A case report with review of literature

Introduction and importance

The ossifying fibromyxoid tumor of soft tissue is a rare tumor of intermediate differentiation and uncertain lineage that occurs in adults mostly in the extremities and the trunk.

Presentation of case

we present a case of 57 year-old man presenting with a right scapular mass. It was a subcutaneous and painless mass that was largely excised. The diagnosis of ossifying fibromyxoid tumor of the right shoulder was made. The follow up of 1 year was without recurrence and metastasis.

Clinical discussion

The ossifying fibromyxoid tumor of soft tissue is exceptional, microscopic diagnosis and management is challenging, considering the scarcity of the tumor.

Conclusion

More cases and retrospective studies are needed to understand the pathogenesis and to determine optimal treatment regimens.

Disseminated intravascular coagulation type of amniotic fluid embolism: a challenging case report with favorable outcome

Amniotic fluid embolism (AFE) is an unforeseeable, life-threatening complication of pregnancy and child birth. Although rare in an absolute sense, most contemporary series of maternal deaths from developed countries report AFE as a leading cause of mortality in the pregnant population. It has a heterogeneous presentation. This clinical heterogeneity makes the diagnosis of AFE difficult based on a beam of clinical and para-clinical arguments. Rapid diagnosis and immediate interdisciplinary treatment are essential for a good outcome. The present is a case of AFE with a disseminated intravascular coagulation (DIC) and a cardiorespiratory collapse following a vaginal delivery.

Cystic form of Actinomycotic mycetoma: A new case with a diagnostic challenge

Mycetoma, commonly known as Madura foot, is a chronic granulomatous infection caused either by fungi (eumycetoma) known as actinomycete. This disease occurs preferentially in young adults, and it affects the foot in particular. We report a Tunisian case of mycetoma occurring in an old patient, particular by its cystic presentation.

[Breast cancer and pregnancy: about 15 cases collected at the maternity center Monastir, Tunisia]

Le but de cette étude était de décrire les caractéristiques cliniques, radiologiques, histologiques et thérapeutiques du cancer du sein diagnostiqué au cours de la grossesse. Nous avons effectué la revue de tous les cancers du sein diagnostiqués au cours de la grossesse dans le centre Maternité et de Néonatologie de Monastir -Tunisie, sur une période allant de 2004 à 2019. Nous avons ainsi colligé 15 cas. L'âge moyen des patientes était de 34 ans. La plupart des cancers du sein associés à la grossesse (CSAG) était diagnostiquée en post-partum. Le carcinome canalaire infiltrant était le type histologique majeur (93% de cas), un cas rare de carcinome sécrétoire a été observé. Le stade clinique était dominé par les formes T2 et T4. Les récepteurs hormonaux étaient négatifs dans 40% des cas, le récepteur HER2 était positif dans 26,6% des cas. Le traitement incluait la chirurgie, radiothérapie, chimiothérapie et palliative. La moyenne de survie est de 32,2 mois. Le cancer du sein associé à la grossesse est une entité rare. Son pronostic est globalement mauvais en raison de l'âge jeune de survenue et d´un diagnostic souvent tardif. La décision thérapeutique constitue une contrainte difficile, par nécessité, multidisciplinaire à laquelle participera la patiente. La thérapie ciblée reste le grand espoir des nouvelles thérapies.

Giant recurrent liposarcoma of the retroperitoneum - A surgical challenge: A case report

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Giant retroperitoneal dedifferentiated liposarcoma can extend to the scrotum.

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Dedifferentiated histologic subtypes of liposarcomas are associated with poor prognosis.

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Performing an en bloc resection through a right iliac incision extended to the scrotum.

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Obtaining negative margins after surgical resection is the curative treatment.

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Careful follow-up to detect early recurrence is essential for optimal care.

Introduction

Sarcomas are a rare entity with heterogeneous clinical behavior. We herein present the case of a giant retroperitoneal dedifferentiated liposarcoma and aim to remind the clinical, histological, and therapeutic features of this rare tumor.

Presentation of case

An 80-year-old patient was complaining of significant abdominoscrotal swelling. On physical examination, a 25-cm swelling extending from the right iliac fossa to scrotums, was observed. CT scan revealed a retroperitoneal fatty mass with necrotic areas. Ultrasonography-guided biopsy was carried. Pathological report demonstrated a dedifferentiated sarcoma. An en bloc resection of the tumor was performed through a right iliac incision extended to the scrotum. After one year of follow up, the patient had a 30-cm local recurrence. After complete resection, the patient died two days after the procedure due to neurological distress.

Discussion

‘Giant’ liposarcomas over 20kg are extremely rare. CT-Scan and MRI are very useful for defining their size and limits. The resection of a retroperitoneal sarcoma of remarkable size is a challenge for the surgeon owing to the anatomical site that makes it hard to obtain safe margin and to the adherences with the contiguous organs. Dedifferentiated histologic subtypes and negative surgical margins are associated with poor prognosis. This explains the high rate of local recurrence after surgical excision.

Conclusion

In rare cases, retroperitoneal dedifferentiated liposarcomas can extend through the inguinal canal to the scrotum. Surgical resection obtaining negative margins, remains the curative treatment that reduces the risk of recurrence. Careful follow-up to detect early recurrence is essential for optimal care.

Inflammatory myofibroblastic tumor of the lung: A rare entity

Inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal tumor usually seen within the first and second decade. They are extremely rare in adults, constituting less than 1% of adult lung tumors. It's usually benign, but it had a tendency for local recurrence. We report a case of asymptomatic inflammatory myofibroblastic tumor of lung in a 46-year-old non-smoker woman.

Simultaneous bilateral spontaneous pneumothorax as the first manifestation of primary pulmonary MALT lymphoma

Primary pulmonary lymphoma is a rare entity. Furthermore, simultaneous bilateral spontaneous pneumothorax (SBSP) is a very rare condition which is often related to therapeutic complications. We present, to the best of our knowledge, the first case of primary pulmonary mucosa associated lymphoid tissue (MALT) lymphoma revealed by SBSP. A 50-year-old female was diagnosed with organizing pneumonia. One month later, she presented with sudden chest pain and shortness of breath due to SBSP. Bilateral chest tubes were inserted. A scan- guided right lung biopsy led to the diagnosis of primary pulmonary MALT lymphoma. The patient was treated with R-CHOP chemotherapy. The association between lymphoma and pneumothorax is extremely rare, often related to therapeutic toxicity. We report the case of SBSP as the first manifestation of primary pulmonary MALT lymphoma.

An unusual presentation revealing Peutz-Jeghers syndrome in adult

Introduction

Peutz-Jeghers syndrome (PJS) is a rare hereditary disease characterized by hyperpigmentation on the lips and oral cavity and gastrointestinal hamartomatous polyps. The most common complications in PJS patients are bleeding, bowel obstruction and intussusception.

Presentation of case

We hereby report a case of a 33-year-old female, without a family history of the disease, who presented to the emergency room with acute abdominal pain, bloating and not passing gas. On abdominal examination, upper abdominal and periumbilical tenderness was found. Computed tomography (CT) of the abdomen demonstrated suspected ascending colon intussusception. The patient underwent a mid-line laparotomy that showed an ileocolic intussusception. Reduction of this intussusception was successfully done with resection of the affected segment that showed presence of two pedunculated polyps. The specimen was sent thereafter to our department for histopathological evaluation, which confirmed the diagnosis of hamartomatous Peutz-Jeghers polyps with no malignancy. Afterwards, the patient was carefully reexamined and the physical examination revealed multiple pigmented spots on the face and lips. Thus, the diagnosis of Peutz-Jeghers syndrome was made.

Discussion

PJS is a rare autosomal dominant disorder that often remain undiagnosed for many years. Acute complications such as intestinal obstruction secondary to intussusception is one of infrequent revealing symptoms.

Conclusion

Early identification, in patients with PJS and family members, as well as close cancer surveillance can improve certainly prognosis in these individuals.

Primary pancreatic tuberculosis mimicking pancreatic body cancer. A case report and review of the literature

Isolated pancreatic tuberculosis (PT) is an extremely rare disease, with non-specific clinical characteristics, making the diagnosis often challenging with pancreatic cancers.

Here we report a case of a 36-year-old female, who was admitted to our hospital after suffering from a 3-month history of epigastric abdominal pain, night sweats and weight loss. The physical examination was normal. The radiological findings revealed the presence of a pancreatic mass and multiple abdominal lymphadenopathy, suggestive of malignancy. The initial differential diagnosis suspected was pancreatic tuberculosis. Tuberculosis skin test was performed and was highly positive (>22 mm). Computed tomography (CT)-guided biopsy of peripancreatic lymph node was carried out and the histopathological exam confirmed the diagnosis of PT. Therefore, anti-tuberculous therapy was initiated, leading to clinical and radiological improvement.

The diagnosis of PT is rare and can sometimes be misleading. It should be considered when a pancreatic mass is observed, especially in endemic countries, to ovoid unnecessary interventions.

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Isolated pancreatic tuberculosis is an extremely rare disease, with non-specific clinical characteristics.

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Clinical presentation and radiological findings of a pancreatic mass may be suggestive of malignancy.

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Preoperative microbiological or/and histological diagnosis should be made to avoid the patient unnecessary surgical procedures.

[Breast cancer treated with primary chemotherapy: predictive factors for radical treatment (retrospective study of 72 cases)]

La chimiothérapie néoadjuvante est devenue le traitement de première intention des cancers du sein localement avancés. Elle permet d’une part, une augmentation des chances de conservation mammaire sans pour autant une majoration du risque de récidive, et d’autre part un contrôle locorégional des formes inopérables d’emblée. Cependant, certains facteurs cliniques, radiologiques et histologiques sont associés à une augmentation du risque de mastectomie, tels que la présence de microcalcifications, la multifocalité, le grade SBR1 et 2, les stades cT3 et cT4 et la surexpression d’HER2. A partir de ce travail, nous avons cherché à déterminer les facteurs prédictifs de mastectomie après chimiothérapie néoadjuvante (CNA), si la mastectomie était justifiée ou non histologiquement et quels étaient les facteurs prédictifs de mastectomie non justifiée. Nous avons réalisé une étude rétrospective colligeant 72 patientes atteintes de cancer du sein et traité par CNA aux départements de gynécologie et d’oncologie médicale au CHU Fattouma Bourguiba de Monastir-Tunisie. Le taux du traitement conservateur était de 18,1%, il passe à 63,15% pour les tumeurs stade T2. La mastectomie n´était pas justifiée par l’histologie définitive dans 26,3% des cas. Les facteurs prédictifs de mastectomie non justifiée retrouvés dans notre étude étaient le statut RH négatif et le stade cT2. La réalisation de ce travail a conduit à une réflexion sur nos pratiques et leurs modifications. Le traitement chirurgical conservateur devra être considéré comme un standard thérapeutique et être systématiquement proposé à toutes les patientes traitées par CNA pour un cancer du sein y compris en cas de multifocalité, une taille clinique importante, des microcalcifications étendues, dans le but de diminuer de façon conséquente le nombre de mastectomies non justifiées.

Thyroid metastasis revealing a lung adenocarcinoma

Thyroid metastasis revealing a primary lung cancer is an extremely rare condition. Only few cases have been reported in the literature. A multidisciplinary approach is essential for the diagnosis. The prognosis is generally poor. We report a case of a 50-year-old man presented with cervical nodules corresponding to a thyroid nodule and lymph nodes. The ultrasonography-guided fine-needle aspiration cytology of the thyroid nodule and a cervical lymphadenopathy concluded to a poorly differentiated adenocarcinoma. Cervical lymphadenopathy biopsy with immunohistochemistry and additional imaging explorations contributed to the diagnosis of a lung adenocarcinoma stage IVB. He died few days after the diagnosis.

Sudden death due to left ventricular thrombosis: A report of two autopsy cases

PURPOSE

In this paper, we report two rare cases of sudden death due to giant left ventricular thrombus revealed at autopsy and we discuss the manner and the cause of death.

RESULTS

Cases presentation: The two cases reported are about two men aged 55 and 53 years respectively. In the two cases, no past cardiac history was found. Prior to the onset of complications and subsequent death, both patients presented to the emergency department with progressing asthenia, faintness and shortness of breath, were treated symptomatically. At autopsy, atherosclerosis of coronary arteries was found. In the first case, death was attributed to thrombosis of the pseudoaneurysm. In the second case, it was due to thrombosis complicating a myocardial infarction. The mechanism of death in the first case was explained by the hemodynamic shock caused by a total left ventricular pseudoaneurysm thrombosis secondary to old myocardial infraction. In the second case, death was the consequence of a cardiogenic shock secondary to thrombosis of the cardiac pseudoaneurysm complicating a myocardial infraction.

CONCLUSION

Complications of myocardial infarction represent frequent causes of adult sudden death. Left ventricular thrombosis is a complication that is often fatal and its discovery during an autopsy remains rare. The first-line doctor must take these types of complications into consideration in order to detect them and thus ensure timely management.

IGF1 polymorphisms and colon cancer risk in Tunisian population

BACKGROUND

Insuline-like growth factor I (IGF1) is a peptide growth factor that promotes cell proliferation and inhibits apoptosis.

AIM

To examine the association of genetic variants in IGF1 (rs12423791, rs1019731, rs5742632, rs2033178 and rs2373722) with risk of colon cancer in Tunisia.

METHODS

The study included 76 formalin-fixed paraffin embedded primary colorectal carcinomas and paired normal colon. The five IGF1 polymorphisms were determined by polymerase chain-restriction fragment length polymorphism (PCR-RFLP).

RESULT

A significant differences in genotypes and alleles frequency of the five examined IGF1 polymorphisms was determined between tumor and healthy tissues of colon cancer patients (P<0,01). While, no significant association was found between genetic variation in IGF1 variants and clinic-pathological parameters in tumors tissues. Expect for rs2373722, a statistically significant correlation was detected between tumor localization and the presence of the (A) mutated allele (OR=0,49; 95% CI 0,25-0,99; P=0,03).

CONCLUSION

This analysis shows that IGF1gene polymorphisms rs12423791, rs1019731, rs5742632, rs2033178 and rs2373722 are associated with the risk of colon cancer in Tunisian population.

Rare case of cavernous hemangioma of the thymus

Cavernous hemangioma (CH) of the thymus is an extremely rare congenital venous malformation. Related symptoms are non-specific and patients are often asymptomatic. The diagnosis is difficult to make either by non-invasive or mini-invasive procedures. Surgical resection is usually required for diagnosis and treatment. We report a case of a 46-year-old men with an incidental finding of an anterior mediastinal tissue mass on chest computed tomography scan. A complete surgical resection of the mass was performed. Histopathological examination concluded to a thymic CH.

[Diagnostic and therapeutic features of invasive lobular carcinoma of the breast: a study of 30 cases]

Le cancer lobulaire infiltrant (CLI) du sein représente 5 à 15% des cancers du sein, il est classé le deuxième type histologique le plus fréquent, après le cancer infiltrant de type non spécifique (CINS) et son incidence est en nette augmentation. Son diagnostic clinique et radiologique est difficile. Il est plus fréquemment bilatéral. C'est un cancer d'évolution plus lente que le CINS avec de meilleurs facteurs pronostiques notre étude vise à détailler les caractéristiques cliniques, radiologiques, thérapeutiques et pronostiques du CLI. Il s'agit d'une étude rétrospective descriptive de 30 cas de CLI du sein colligé au Centre de Maternité et Néonatologie Monastir sur une période de 10 ans. L'incidence du CLI était de 5,2%. L'âge moyen est de 53,43 ans. Dix pourcent avaient des antécédents personnels de mastopathies bénignes, 6,66% avaient des antécédents personnels du cancer du sein et 3,33% avaient des antécédents familiaux du cancer du sein. Le CLI était diagnostiqué à un stade tardif chez 18 cas. La masse était bifocale chez 5 patientes, multifocale chez 4 patientes et bilatérale chez 3 patientes. Une seule patiente avait présenté une métastase hépatique lors du diagnostic. La chirurgie radicale type Patey était réalisée d'emblée chez 63,33% des patientes. Des lésions multifocales étaient détectées dans 44,80% des cas lors de l'examen anatomopathologique. Le curage ganglionnaire était positif chez 21 patientes. Vingt-huit patientes soit 93,33% avaient bénéficié d'une radiothérapie et d'hormonothérapie adjuvante. La survie globale à 5 ans était estimée à 77,3%.

IGF1 polymorphisms and colon cancer risk in Tunisian population

BACKGROUND

Insuline-like growth factor I (IGF1) is a peptide growth factor that promotes cell proliferation and inhibits apoptosis.

AIM

To examine the association of genetic variants in IGF1 (rs12423791, rs1019731, rs5742632, rs2033178 and rs2373722) with risk of colon cancer in Tunisia.

METHODS

The study included 76 formalin-fixed paraffin embedded primary colorectal carcinomas and paired normal colon. The five IGF1 polymorphisms were determined by polymerase chain-restriction fragment length polymorphism (PCR-RFLP).

RESULT

A significant differences in genotypes and alleles frequency of the five examined IGF1 polymorphisms was determined between tumor and healthy tissues of colon cancer patients (P<0,01). While, no significant association was found between genetic variation in IGF1 variants and clinic-pathological parameters in tumors tissues. Expect for rs2373722, a statistically significant correlation was detected between tumor localization and the presence of the (A) mutated allele (OR=0,49; 95% CI 0,25-0,99; P=0,03).

CONCLUSION

This analysis shows that IGF1gene polymorphisms rs12423791, rs1019731, rs5742632, rs2033178 and rs2373722 are associated with the risk of colon cancer in Tunisian population.

Phytoestrogens inhibit key-enzymes linked to obesity, type 2 diabetes and liver-kidney toxicity in high fructose-fat diet in mice

Objective: To evaluate the effect of the administration of phytoestrogens on obesity, type 2 diabetes, and liver-kidney toxicity. Methods: Phytoestrogens (phyto(E2)) were administrated to high fructose-fat diet (HFFD). Results: This study showed that administration of phyto(E2) to HFFD-mice inhibited lipase activity by 34%, decreased body weight by 20% and modulated lipid profile, showed a decrease in total-cholesterol (TC) and LDL-cholesterol (LDL-C) rates in the plasma by 59% and 42%, respectively, and increased the HDL-cholesterol (HDL-C) level by 31%. In addition, the administration of phytoestrogens to HFFD-mice exerts an inhibitory effect on α-amylase activity and decreased glucose level by 28% and increase in liver glycogen level by 33%; and ameliorate oral glucose tolerance test. Conclusions: This study demonstrate that phyto(E2) has both a promising potential with regards to the inhibition of intestinal lipase and α-amylase activities, and a valuable hypoglycemic and hypolipidemic function.

Primary adenoid cystic carcinoma of the tracheobronchial tree: report of two cases

Adenoid cystic carcinoma (ACC) is a rare malignant epithelial tumor that predominantly originates in the salivary glands. Primary ACC of the tracheobronchial tree is extremely rare. We report two new cases of central airways primary ACC: a 58 year-old male with an ACC of the left main bronchus who underwent a pneumonectomy with node dissection, and a 52 year-old female with proximal tracheal ACC presenting as asthma treated by surgical resection and a postoperative radiotherapy. Primary ACC of the tracheobronchial tree is often misdiagnosed given the non-specific clinical presentation. An early diagnosis is essential to ensure good outcomes. An interdisciplinary treatment is required based especially on surgery and radiotherapy.

Fetal Rhabdomyomatous Nephroblastoma in a 31-Year-Old Woman: A Case Report

Fetal rhabdomyomatous nephroblastoma (FRN) is a rare variant of Wilms tumor with distinct morphologic features and biologic behavior compared to conventional nephroblastoma. It mainly occurs in patients under 4 years. In adults, extremely rare cases of nephroblastoma were reported. Among these cases, none has been interested a FRN. We report an exceptional case of a 31-year-old woman diagnosed with FRN discovered incidentally, to illustrate clinical and histopathological characteristics of this entity.

Rare case of primary extranodal marginal zone lymphoma of the thorax

Primary lymphoma presenting a solitary lesion of the chest wall is extremely rare, as the majority of chest-wall tumors arise from metastasis. We report a case of a 64-year-old man with no history of HIV infection or pyothorax who presented with dry cough, right pleuritic pain and dyspnea. A computed tomography scan revealed an irregular pleural mass invading his right chest wall with pleural effusion. CT-guided needle biopsy revealed extranodal marginal zone B-cell lymphoma. The patient was treated with chemotherapy and radiotherapy. The patient has 9 years of follow up with 2 relapse's episodes.

Adenosquamous carcinoma of the right colon: A case report and review of the literature

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Adenosquamous carcinoma is a rare colorectal tumor with both glandular and squamous histologic component.

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To the best of our knowledge only few cases have been reported in the literature till date.

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Adenosquamous carcinoma is a rare colorectal neoplasm with non-specific complaints.

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Its clinicopathologic behavior is not understood.

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Preoperative diagnosis is often difficult. Surgical resection remains the mainstay of treatment.

Introduction

Adenosquamous carcinoma is a rare colorectal tumor with both an adenocarcinoma and a squamous cell carcinoma component. To the best of our knowledge, only few cases have been reported in the literature.

Case presentation

We report a case of a 46-year-old woman, hospitalized for large bowel obstruction syndrome. Computed tomography scan showed an irregular mass of the right colic angle, responsible for an occlusive syndrome with distension of the right colon, the appendix and the terminal ileum. The patient underwent right hemicolectomy with D2 lymphadenectomy. Histopathological examination revealed mixed adenocarcinoma and squamous carcinoma. Adjuvant chemotherapy was prescribed for the patient.

Discussion

Adenosquamous carcinoma is a rare colorectal neoplasm revealed by non-specific complaints. Its clinicopathology is not yet understood. Preoperative diagnosis is often difficult. Surgical resection remains the mainstay of treatment.

Conclusion

Adenosquamous carcinoma is a malignant tumor with poorer prognosis than adenocacinomas.

Metanephric stromal tumor: An unusual presentation of a rare paediatric renal neoplasm

A 2-year-old boy with prenatal diagnosis of a malformation uropathy was referred to paediatric surgery department. On systemic examination, there were no palpable masses. An ultrasonography of abdomen with color Doppler, a renal artery angiographic and scintigraphy revealed a preostial aneurysm at the left renal artery. The patient had a left nephrectomy. Grossly, the specimen measured 75 mm × mm 50 × 20 mm with renal artery aneurysm measuring 30 mm × 35 mm. On cut section, the renal parenchyma contained a whitish tumor that measured 35 mm × 10 mm. Histopathologically, this tumor was diagnosed as metanephric stromal tumor.

Tumor budding is a prognostic factor linked to epithelial mesenchymal transition in pancreatic ductal adenocarcinoma. Study report and literature review

BACKGROUND

Pancreatic ductal adenocarcinoma (PDAC) has a devastatingly poor prognosis. Surgical resection is undertaken in only 20% of patients. Most of well-known prognostic factors reflect tumor stage more than its biology. So it is important to identify new biological indicators related to survival in order to develop new therapies.

OBJECTIVE

To determine the relation between tumor budding and Epithelial Mesenchymal Transition (EMT) and to evaluate their impact on survival for patients after resection of PDAC.

METHODS

We herein report a retrospective study of 50 patients with resected PDAC. Tumor budding, immunohistochemical expression of vimentin and other standard factors were correlated with survival using the Kaplan-Meier method and Cox multivariable survival analysis. For tumor budding assessment, an inter-observer variability study was performed using 100 images of tumor slides stained with Hematoxylin & Eosin and Pan-Cytokeratin.

RESULTS

Tumor budding was present in all tumors. A substantial agreement between six pathologists was established in distinguishing high-grade from low-grade budding (κ = 0.6 and 0.73 for H&E and PCK images respectively). High-grade budding was identified in 56% of tumors (28/50). It was an adverse prognostic factor independent of tumor size, resection margins status, nodal status and vascular invasion (p = 0.008). Tumor budding was significantly associated with vimentin expression (p = 0.002).

CONCLUSIONS

The association of tumor budding with vimentin expression supported the idea that EMT is a key process in PDAC responsible for progression and drug resistance. Consequently, the elucidation of EMT molecular biology and development of new targeted therapy may improve disease outcome.