Biomedical subjects
Publications and source records attributed to N Kamoun.
Thymolipoma is an uncommon benign tumor of the thymus. Asymptomatic, it is an incidental discovery. Pathogenesis remains controversial. We report a new case in a 36-year-old woman that was discovered on a chest x-ray ordered for pneumonia. The MRI findings suggested the diagnosis which was confirmed at the pathology examination of the surgical specimen.
BACKGROUND: Tumors of the rib cage are uncommon and malignant in 29% of the cases. Chondrosarcoma predominates, accounting for 40% of all cases of malignant costal tumors. CASE REPORTS: Four patients (3 women, 1 man, mean age 28.2 years) were hospitalized for costal chondrosarcoma. Pain and tumefaction dominated the clinical presentation. Calcifications suggested the diagnosis in 3 cases. Curative surgery was performed in all cases. Postoperative radiotherapy was unable to improve prognosis in 2 patients. DISCUSSION: Chondrosarcoma of the ribs is characterized by a strong potential for invasive extension. Diagnosis is suspected on the basis of imaging findings and confirmed at pathology. Surgery is required. Chemotherapy and radiotherapy do not improve prognosis significantly.
The authors report two cases of rare localization of intra muscular myxoma: one in the buttock, and the other in the lumbar area. The first case, a 58 years old woman had a four month history of a mass in the buttock. Computed tomography revealed the presence of a solid tumor. Diagnosis was based on histological examination. After surgical treatment no recurrence was observed after fourteen months. The second case was a 54 years old woman who presented a sciatica with back pain and neurological signs. The symptoms didn't response to medical treatment. Computed tomography showed an enlarged and-cystic lumbar lesion extending to the first sacral hole, with bone erosion of L3 and L4 articular apophysis and spinous process. Needle biopsy and surgical excision of the tumor were performed. Total neurological recovery was observed and no recurrence was observed after three years. The authors reminded the characteristics of this rare and benign soft tissue tumor and specified the place of magnetic resonance imaging (MRI) to establish the diagnosis which was still confirmed by histological examination of an open biopsy. Clinical follow-up revealed exceptional recurrence and no metastasis.
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Synovialosarcoma is a rare tumor, of difficult diagnosis. Authors report 8 cases diagnosed in the two pathology departments of Salah Azaïz Institute and the Universitary Hospital of Sfax, from 1985 to 1991. This tumor represents 2.96% of all soft tissues sarcomas treated in Salah Azaïz Institute. It occurs in young adults (the average age in our series: 28.8 years) with a male predominance (6 out of 8 cases), localized preferentially in the lower extremity. In the histological study, immunohistochemistry provides a great contribution in the diagnosis and classification of these tumors. The histoprognosis grading of Trojani applied to our cases shows the good correlation between the grade and the prognosis. Treatment is primarily surgical, consisting in wide excision to avoid recurrences that are unfortunately very frequent. Radiotherapy and chemotherapy give very inconstant results. Some authors recommend radiotherapy to sterilize the tumor field, and chemotherapy to prevent metastasis. The clinical course is characterized by a high frequency of local recurrences and pulmonary metastases.
The authors report the observation of a family with different dystrophies of the retinal pigment epithelium: a macroreticular dystrophy (1 case), a butterfly-shaped dystrophy (1 case), a butterfly-shaped or a macroreticular dystrophy associated with vitelliform lesion (3 cases), and hard drusen (2 cases). The association of pattern dystrophies and vitelliform lesions was described in some families or subjects in previous reports. The different fundoscopic aspects could constitute the same autosomal dominant dystrophy with variable expressivity. The presence, in this family, of two cases of probably inherited drusen could reflect the similarity of this disease with the other autosomal dominant dystrophies of the retinal pigment epithelium. Further biological studies should be performed to identify the pathogenesis of these diseases and will allow clearer classification.
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The authors report the case of a 31-year old patient who successfully completed a pregnancy despite unsuspected bladder pheochromocytoma. After delivery, the patient required care post-partum due to serious hemodynamic problems. Hypertension had been attributed to toxemia of pregnancy. The authors recall the diagnostic difficulties of tumors of this type, and the means which can be used for topographical diagnosis and the precautions to be taken before this tumor can be treated surgically.
The authors report a case of aortic insufficiency with aneurysm of the ascending aorta of syphilitic origin. The diagnosis was made only histologically in the presence of a syphilitic granuloma. This opportunity is taken to review the various aspects of cardiovascular syphilis.
Congenital glaucoma has a very serious prognosis. It represents the first cause of blindness in Tunisian children. Trabeculectomy introduced by Cairns in 1968, was initially proposed as second-line treatment in congenital glaucoma surgery. It has now become more frequently used as first-line treatment in this indication. We have already used this technique directly in 35 children suffering from congenital glaucoma with a total of 54 eyes. Forty four eyes underwent a single operation, ten eyes underwent two to four trabeculectomies. Then study of these cases with a mean follow up of 24 months shows an overall success rate of 64% after one trabeculectomy, with or without additional medical treatment. The study of tonometric diagrams shows that the successful results obtained after 3 months persisted in the long term. Trabeculectomy gives better results in congenital glaucoma with intraocular pressure greater than 40 mmHg. Repeated operations are sometimes necessary. In these cases, postoperative subconjunctival 5 fluorouracil (SFU) did not improve the surgical outcome.
The authors report a case of malignant giant cell soft tissue tumor which appeared as a skin tumor of the thigh in a Tunisian women aged 17 years. Immunohistochemical study showed that the giant cells recognized KP1 antibody, while spindle interstitial cells reacted with anti-factor XIIIa antibody. The patient is alive and well eighteen months after large surgical removal. Two similar cases have been reported in the literature. Differential diagnosis, histogenesis and prognosis of this rare tumor are discussed.
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The authors report the case of a juvenile secretory carcinoma of the breast in a 4 year old girl. The study of the first local excision leads to the thought of a "duct ectasia with a luminal benign papilloma". At the age of 6 years, there is a local relapse. A second local excision is performed and connected with simple mastectomy and an axillary node sampling. The pathological examination shows the aspect of a multifocal secretory juvenile carcinoma of the breast without lymph node axillary metastase. The authors emphasize the cystic appearance of the first tumor and the distinctive histologic pattern of this particular breast carcinoma.
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