Biomedical subjects
Karima Mrad
Publications and source records attributed to Karima Mrad.
Papillary lesions of the breast: a molecular progression?
INTRODUCTION: Breast papillary lesions represent a heterogeneous group of tumors ranging from benign to malignant, including several intermediate forms. Malignant papillary tumors are rare and their molecular characterization is still limited. A few studies pointed to the presence of specific genetic alterations that could be relevant both for diagnostic purposes and to elucidate tumour development and progression. In order to look into the issue, we compared LOH relative frequencies of four microsatellite markers located on chromosome 16 in a set of morphologically different papillary breast lesions. LOH at TP53 locus was also analyzed throughout lesions. MATERIALS AND METHODS: Fifteen cases were analyzed. Sections including a malignant papillary lesion, a benign lesion (when available), and normal breast tissue were selected. Fifteen malignant and twelve benign areas were microdissected using the Leica laser microdissection system (AS LMD). After DNA extraction samples were tested for the following markers: TP53, D16S423, D16S310, DS163210 and D16S476, and analyzed on ABI PRISM 3100 (Applied Biosystems, Foster city CA). RESULTS: Fourteen malignant lesions and twelve paired benign areas appeared to be informative for at least one of the four markers on chromosome 16. In particular, LOH at loci 16p13 and 16q21 was detected in both benign and malignant lesions, whereas LOH at locus 16q23 was limited to malignant lesions. Nine malignant and seven benign lesions were informative for LOH at TP53 locus, that was found to be significantly associated (p=0.01) with the malignant phenotype. CONCLUSIONS: Our data suggest an involvement of chromosome 16 mutations in the early steps of breast papillary tumorigenesis. TP53 deletion and possibly LOH at 16q23 appear to play a role as progression factors, being they significantly associated with malignant transformation of breast papilloma.
[A mesenchymal tumor of the breast].
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[An unusual site for a bone tumor].
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[An unusual cutaneous metastasis].
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Primary broad ligament cystadenocarcinoma with mucinous component: a case report with immunohistochemical study.
Primary cystadenocarcinoma that arises in the broad ligament is extremely rare, especially when it is mucinous. We report the case of a 59-year-old woman with a cystic mass of the right broad ligament who underwent a complete excision of the mass (7 x 7 x 3 cm) with hysterectomy, right salpingo-oophorectomy, omentectomy, appendicectomy, and peritoneal biopsies. Pathologic examination showed a low-grade cystadenocarcinoma with a mucinous component limited to the broad ligament. Despite the chemotherapy (cisplatinum and cyclophosphamide) performed, early tumor recurrence occurred after approximately 6 months. Our observation revealed an abundant mucin production with pools of mucin similar to those of pseudomyxoma peritonei and an inflammatory infiltrate with prominent lipid phagocytosis. Immunohistochemical analysis demonstrated a strong and diffuse positivity for both cytokeratin 7 and epithelial membrane antigen. A less extensive staining with carcinoembryonic antigen and a focal unequivocal positivity with cytokeratin 20, particularly in mucin-secreting cells, were also observed. This finding could indicate a metaplastic process toward colonic phenotype similar to primary ovarian tumors.
Lymphoepithelioma-like carcinoma of the submandibular salivary gland associated with Epstein-Barr virus in a North African woman.
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Cervical cancer in Tunisia: an epidemiological, clinical and pathological study.
BACKGROUND: This study was undertaken to determine epidemiological and pathological profile of cervical cancer in Tunisia. DESIGN STUDY: Registration and analysis of all cervical cancer newly diagnosed during the year 1994 (year of general census) based on review of all pathology laboratory files in the country with exclusion of previously diagnosed cases according to clinical data. RESULTS: During the year 1994, 216 new cases were registered among which 195 cases (89.81%) were invasive carcinoma. The standardized incidence (invasive cancer) is 5.91 per 100000 women per year. The average age was 53.7 year. Sixty-three percent cases are diagnosed at an advanced stage (IIB, III, IV FIGO stages). Invasive carcinoma has distributed as follows: 177 cases (91.23%) were squamous invasive carcinoma, 17 cases (8.77%) were invasive adenocarcinoma. In the same year, 21 cases of in situ squamous carcinoma were registered with an average age equal to 44.21 year. Only one case of cervical cancer was a sarcoma (0.52%). CONCLUSION: The incidence of cervical cancer in Tunisia is relatively low in spite of the absence of a screening program. This may be related to monogamy and observance of legal age of marriage. Squamous invasive carcinoma is the most frequent pathological type. CONDENSATION: The incidence of cervical cancer in Tunisia is relatively low in spite of the absence of a screening program.
[Pseudo-angiomatous hyperplasia of mammary stroma: a case with gigantomastia].
Pseudo-angiomatous hyperplasia of mammary stroma (PASH) is a histopathological entity which is a microscopic fortuitous finding in mammary biopsies performed for different reasons. It may be symptomatic and appears then as a palpable lump. The term pseudo-angiomatous emphasizes the characteristic aspect of the stroma simulating a vascular tumor. We report a case of PASH in a 71 year-old woman who presented a recurring breast mass with rapid swelling of the mammary gland (70 x 60 x 20 cm) treated by mastectomy. PASH must be distinguished from a well-differentiated angiosarcoma. It is ruled out by immunohistochemistry.
[The value of cytology in the diagnosis of extragonadal germ cell tumors].
Extragonadic germinal tumors are frequently mixed tumors. When a metastatic sacrococcygeal teratoma is clinically suspected in children, a yolk-sac tumor component could be judiciously demonstrated by either an elevated serum level of alphafoetoprotein (AFP), or fine needle aspiration cytology. We report the case of a 25 month aged girl presenting a metastatic sacrococcygeal tumor (lymph node and bone metastasis) with high level of AFP (34.100 microg/ml). Fine needle aspiration cytology identified the yolk sac tumor component, characterized by papillae and glandular clusters, composed of pale isomorphic cells with vesicular and nucleolated nucleus and some intracytoplasmic hyaline globules. The yolk sac tumor component could not be identified in the sacrococcygeal surgical specimen, exclusively composed of immature teratoma.
[Extra-nodal Rosai-Dorfman disease: a case report with thyroid involvement].
Extra nodal involvement by Rosaï-Dorfman disease (RDD) is not rare but remains poorly described clinically and microscopically. We report a case of RDD involving the thyroid and revealed by a 15 mm cold nodule developed on an ancient goiter. The patient was a 53 year old North African woman. She also presented an involvement of cervical lymph nodes, respiratory tract and right kidney. Microscopic analysis of thyroid revealed a diffuse and dense infiltrate of large pale histiocytes with few features of lymphophagocytosis. To the best of our knowledge, this is the fifth case reported in the literature. In previous reported cases, thyroid RDD was associated to constant lymph node involvement (massive lymphadenopathy in 3 cases and occult in one case) and no other extra nodal localization except the respiratory tract in one case. The characteristic features of lymphophagocytosis must be searched with great care.
[Abdominal mass with calcifications].
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[Intracapsular carcinoma ex mixed tumor].
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[Langerhans cell histiocytois of the thyroid: a rare disease not to be ignored].
Thyroid involvement by Langerhans cell histiocytosis is rare. We report the case of a ten-year old boy who presented with a 5 cm goitre. He was treated for diabetes insipidus 14 months before. Thyroid isotopic scan showed hypoactivity of right lobe and revealed a cold left nodule. The patient was treated by right lobo-isthmectomy with adjuvant corticotherapy and chemotherapy (vinblastine). He is well with 12 months follow-up. Microscopic analysis demonstrated a diffuse infiltrate of thyroid parenchyma by sheets of CD1a positive Langerhans cells associated with lymphocyte foci. This case is remarkable by the abundance of Langerhans cells and scarcity of eosinophils. The diagnosis of thyroid langerhans cell histiocytosis should not be ignored in both children and adult patients.
[Fibromatosis of the breast: clinical and pathology analysis of two cases].
Fibromatosis of the breast is an uncommon benign disease that mimics carcinoma clinically as well as radiographically. Its microscopic diagnosis among spindle cell tumors is fundamental, especially on frozen sections. We report two cases of mammary fibromatosis observed in young woman (26 and 31 years old). The two were clinically and mammographically suspect. Diagnosis was made on frozen sections and confirmed on paraffin embedded specimen. The lesions are characterized by spindle cell proliferation of variable cellularity and collagenization. Few mitotic figures were present in one case. Several lesions must be considered in the differential diagnosis of mammary fibromatosis. Wide local excision is recommended for initial therapy, but local recurrence is frequent. In our cases, In spite of apparently complete excision, one patient relapsed.
Primary leiomyosarcoma of bone: report of 4 cases.
Primary leiomyosarcoma of bone is a very rare tumor. Four cases are reported: 3 tumors were located in the femur and 1 in the talus. Clinical and imaging findings including radiographs, CT, and MRI are described. The final diagnosis was made by histopathological, immunohistochemical, and/or ultrastructural study after biopsy.