Coexistence of xanthogranulomatous cholecystitis and gallbladder adenocarcinoma: a fortuitous association?

Xanthogranulomatous cholecystitis is a relatively uncommon variant of chronic cholecystitis, characterized by marked thickening of the gallbladder wall and dense local adhesions. Not only does xanthogranulomatous cholecystitis mimic malignancy, it can also be infrequently associated with gallbladder carcinoma in 0.2% to 35.4% of cases. Herein, the authors report a new case of xanthogranulomatous cholecystitis concomitant with gallbladder adenocarcinoma in a 65-year-old female patient. Because of its overlapping clinical, radiological and macroscopic findings with gallbladder cancer, definitive diagnosis of xanthogranulomatous cholecystitis relies on extensive sampling and thorough microscopic examination of the surgical specimen to exclude the possibility of coexisting tumour. It is still a matter of debate whether xanthogranulomatous cholecystitis is truly a precursor of gallbladder carcinoma or if it is just an incidental finding. This aspect needs to be explored in the future with further studies.

Undifferentiated pleomorphic sarcoma of the broad ligament

AIMS

Sarcomas of the broad ligament are exceptionally rare. To our knowledge, the present case is the first description of undifferentiated pleomorphic sarcoma (UPS) occurring in the broad ligament. Herein, we report this unusual case, and discuss differential diagnoses and treatment.

RESULTS

A 55-year-old postmenopausal woman was admitted for lower abdominal pain and vaginal spotting. Radiological examination revealed a latero-uterine mass that was independent of the surrounding organs. Treatment consisted in a total resection of the mass in addition to total abdominal hysterectomy and bilateral salpingo-oophorectomy. Based on histological examination, immunohistochemical study and quantitative PCR, a diagnosis of undifferentiated pleomorphic sarcoma (UPS) was made. The patient was lost to follow-up for 6 months, and then presented with a local recurrence of the tumour in addition to secondary pulmonary and vertebral localizations. The patient died less than one year after the first diagnosis.

CONCLUSIONS

Diagnosis of UPS of the broad ligament is based on exclusion using a large panel of antibodies. There is no consensus for treatment. The prognosis of this disease cannot be assessed due to its rarity, but it can be hypothesized that early recurrence is indicative of poor prognosis.

[Peutz-Jeghers' syndrome with malignant development in a hamartomatous polyp: report of one case and review of the literature]

The malignant potential of hamartomatous polyps in Peutz-Jeghers' (PPJ) syndrome has been debated. Although it is a very rare event, these polyps can become malignant, as demonstrated by this report. One case of colonic adenocarcinoma associated with Peutz-Jeghers' syndrome is described in a 62-year-old woman. The patient had colonic carcinoma which developed in a hamartomatous polyp. The malignant development of this colonic hamartomatous polyp arising in Peutz-Jeghers' syndrome was pathologically confirmed at surgery. This case also shows a sequence of hamartoma-dysplasia-carcinoma in a hamartomatous polyp without adenomatous changes. This suggests that hamartomatous polyps in Peutz-Jeghers' syndrome may develop into adenocarcinoma and may be a precursor of gastrointestinal carcinomas. STK 11 is a tumor suppressor gene regulating the development of hamartomas, and this somatic mutation promotes gastrointestinal cancer at later stages in Peutz-Jeghers' syndrome.

[Polymorphous low-grade adenocarcinoma of the accessory salivary glands--a case report]

A case of polymorphous low-grade adenocarcinoma of minor salivary gland is reported. This tumor was first described in two clinical case series in 1983. Before that time most of these neoplasms were diagnosed as benign salivary gland neoplasms (pleomorphic adenomas) or salivary malignant conditions (malignant pleomorphic adenomas, adenoid cystic carcinomas, papillary adenocarcinomas and adenocarcinoma not otherwise stated). This neoplasm, with few exceptions, originates in minor salivary gland tissues of the palates or buccal mucosa. It is characteristically slow to enlarge. Clinical reports show the neoplasm present for many years before diagnosis. The tumor have a variety of morphological patterns, a cytological uniformity and an infiltration into adjacent structures. The treatment is a wide local excision. Recurrences and lymph node metastases are rare.

[Buschke-Loewenstein giant condyloma in the perianal region with inguinal invasion: a case report]

The giant condyloma acuminatum of the perianal region is a tumor characterised by its large size with the propensity to infiltrate into deeper tissues, contrasting with a microscopically benign pattern. The evolution after malignant transformation of condyloma and lymph node invasion is rare. However it is exceptionally observed a lymph node invasion of microscopically benign condyloma acuminatum. The authors report a case of microscopically benign giant condyloma acuminatum of the perianal region associated with inguinal invasion, discovered in a 47 year-old man. Treatment consists in extensive surgery of the tumor and inguinal nodes, followed by a radiation therapy.

[Anatamo-pathological aspects of malignant ovarian tumors in children. Apropos of 16 cases]

The authors present 16 cases of malignant ovarian tumors in childhood, censed in Pasteur Institute - Tunis. These tumors are scarce, and present in the literature only 3% of the malignant tumors in childhood. In this series, germ cell tumors are the most frequent and present 81.25% of these cases, of which 43.75% of dysgerminoma. Gonadal stromal tumors are more scarce (6.25%). The prognosis of these tumors was transformed by the radiation therapy in dysgerminoma, and the chemotherapy in the other germ cell tumors. These tumors must be diagnosed and treated early.

[Bronchial cytology in the diagnosis of broncho-pulmonary cancer in Tunisia]

The authors present a retrospective study of 287 pulmonary cytologic exams censed in Pasteur Institute - Tunis between 1970 and 1986. These 287 exams consist of 145 bronchic aspiration liquids and 142 spittles. A systematic exam was practiced in patients presenting a pulmonary symptomatology suggesting little or not at all broncho pulmonary cancer. 40 of these exams present cancerous cells (15 cases) or suspected cancerous cells (25 cases). The biopsy confirms a malignant tumor in 25 patients (5%). These results should urge us toward a cytologic exam not only in adults presenting any respiratory symptomatology, but also in subjects at high risk, especially smokers. Localising the tumor is necessary for the biopsy. This biopsy will lead us to determine the histologic type and consequently the adequate therapy.

[Fibro-inflammatory polyposis of the stomach: apropos of a case]

The stomach fibro-inflammatory-polyp is distinguished from the eosinophilic granuloma by some authors because of their geographic assessments. It is an inflammatory affection represented by a pseudo tumoral lesion. We present a case concerning a woman, 62 years old, who presented since 10 years a Biermer anaemia; a neoplastic affection was suspected, and then denied by histopathologic exam. We shall discuss the pathogenic and therapeutic data proposed by the literature. Recently, the treatment of this benign lesion consists in endoscopic resection. There no recurrence or malignant degeneration.

[Endosalpingosis: apropos of a case of colonic localization]

The endosalpingosis is a benign affection which is in the most often asymptomatic. It means the presence of tubal mucosa in ectopic location; often in the tubal wall; the pelvic peritoneal and adjacent lymph node. We present here a colic endosalpingosis case with intestinal occlusion. We review in this purpose the literature, and discuss the etiopathogenicity. It shows that a previously tubal affection can have a great part in the birth of this pathology.

[Anatomo-clinical study of 102 cases of primary lung cancer]

The authors do a clinical anatomic study showing 102 cases of lung primitives cancers to be diagnose in 60% cases on biopsy and 40% on operation'piece. The matter in boundless majority of cases is carcinoma 92%, themselves overlooked by squamous cells carcinoma 55%, forwarded by adenocarcinoma 20%, small cells carcinoma represent 11% of cases and large cells carcinoma 7%. The mean age of occur is 55 years and any cases of carcinoma is observed at persons under 30 years of age. 94% of person are masculine. The majority of tumors 58% cases present themselves as bulky masses exceeding 6 cm of diameter. The authors insist in this study on necessity of early diagnosis when the therapeutic will be curative.

[2 cases of mycotic infection caused by Cryptococcus neoformans]

The authors present two cases of Cryptococcus neoformans disease in two young persons. Its appears, in the first case, a diffuse ganglionnary and cutaneous lesion with an evolutive meningo-encephalic localization, and in the second case it appears only a meningitic lesion. These two observations are characterized by the apparition of the infection in a immunodepression patient and by an unfavorable evolution in spite of the treatment.