H. Rais

Tumeurs cérébrales de l’enfant: à propos de 136 cas

Les tumeurs cérébrales sont les tumeurs solides les plus diagnostiquées chez les enfants de moins de 15 ans dans le monde. Toutefois, peu de publications ont rapporté le profil épidémiologique et anatomopathologique de ces tumeurs en Afrique et particulièrement au Maroc. Les auteurs rapportent les particularités épidémiologiques et anatomopathologiques des tumeurs cérébrales primitives de lenfant dans la région de Marrakech (Sud du Maroc). Cest une étude rétrospective réalisée au service danatomie pathologique du CHU Mohammed VI de Marrakech de 2004 à 2016. Cent trente-six cas de tumeurs cérébrales primitives étaient diagnostiqués avec une moyenne de 11,33 cas par an. Lâge moyen était de 8,28 ans. Le sex-ratio (H/F) était de 1,6 avec une légère prédominance masculine. Ces tumeurs étaient infra-tentorielles dans 61,53% des cas et siégeaient en supra-tentoriel dans 38,47% des cas. A létage infra-tentoriel, les tumeurs des hémisphères cérebelleux occupaient le premier rang (61,4%). Parmi les dix-huit types histologiques diagnostiqués, lastrocytome et le médulloblastome représentaient ensemble 46,32% (29,41% et 16,91% respectivement). Dans notre contexte, la majorité des tumeurs cérébrales de lenfant prédominait dans les 2 groupes dâge: 5-9 ans et 10-15 ans. Les résultats épidémiologiques de ces tumeurs au sud du Maroc concordent majoritairement avec ceux déjà publiés du Nord du pays et des autres pays non Africains.

Antidiabetic potential of Caralluma europaea against alloxan-induced diabetes in mice

Medicinal plants play an important role in the management of diabetes mellitus especially in developing countries where resources are lacking. Herbal of natural origin, unlike the synthetic compounds, are more effective, safer and have less side effects. For continuing research on biological properties of Moroccan medicinal plants, the present work was undertaken to evaluate the potential and mechanism of the antidiabetic activity of the Caralluma europaea methanolic extract in alloxan-induced diabetic mice. A high-performance liquid chromatography technique (HPLC) was used to identify and quantify the major phenolic compounds in the methanolic extract. The in vitro antioxidant property was evaluated using 2,2-diphenyl-1-picrylhydrazyl radical (DPPH) scavenging method, reducing power and ß-carotene-linoleic acid assays. The acute toxicity of the extract was evaluated by giving it orally to mice at single doses of 200, 500, 1000, 2000u202fmg/kg body weight. The antidiabetic effect was conducted on Swiss albino mice. Diabetes was induced with single intraperitonial injection of alloxan monohydrate (200u202fmg/kg body weight) and animals were treated with methanol extract at a dose of 250u202fmg/kg and 500u202fmg/kg body weight. The blood glucose levels were measured and histopathological analysis of pancreas was performed to evaluate alloxan-induced tissue injuries. The main phenols identified and quantified in the extract were ferulic acid, quercetine, 3,4 dihydroxybenzoic acid, rutin, epigallocatechin, and catechin. Ferulic acid was found to be the main phenolic compound ant its proportion was up to 52% of total phenolic compounds, followed by quercetin (36%). The result showed that methanol extract exhibited an antioxidant effect. Acute toxicity studies revealed that C. europaea extract was safe up 2000u202fmg/kg body weight and approximate LD50 is more than 2000u202fmg/kg. Moreover, the methanol extract prevented the diabetogenic effect of alloxan and decreased significantly the blood glucose level (Pu202f<u202f0.001) in treated mice. Morphometric study of pancreas revealed that C. europaea extract protected significantly the islets of Langerhans against alloxan-induced tissue alterations.

Lateral cervical thymic cyst in a child: a case report

BackgroundCervical thymic cysts are uncommon lesions, rarely considered in the differential diagnosis of neck cysts in children.Case presentationWe report a rare case of multiloculated thymic cyst in an 8-year-old boy on the right side of the neck. Perioperative diagnosis was a cystic hygroma. Macroscopic examination showed a cystic mass measuring 6.5xa0cm in total length. Histopathology of the excised specimen revealed thymic tissue with prominent Hassall’s corpuscles associated with multiloculated cyst. The cyst wall is bordered by a flattened or multilayered epithelium, often abraded.ConclusionThis case is presented here for its rarity and should be included in the differential diagnosis of neck masses in children. So, it’s a lesion to be well aware of, particularly by pathologists.

Neurocytomes centraux: corrélations cliniques et radiopathologiques à propos de 12 observations

Les neurocytomes centraux sont définis comme étant des néoplasmes composés de cellules rondes, uniformes, ayant un profil immunophénotypique neuronal et un index de prolifération bas. Elles représentent 0,5% des tumeurs intracrâniennes. Elles sont habituellement situées à proximité du foramen de Monro et peuvent être à l’origine d’une hydrocéphalie obstructive. Nous rapportons 12 observations de neurocytomes centraux colligés au laboratoire d’anatomie pathologique du CHU Mohammed VI de Marrakech entre janvier 2006 et juin 2015. Le but de ce travail est de rapporter et décrire les aspects radio-pathologiques de ce type histologique rare. Le sex-ratio homme/femme était de 1,4. L’âge moyen au diagnostic était de 22,3 ans. La symptomatologie révélatrice était dominée par l’hypertension intracrânienne chez tous nos patients, associée à une baisse de l’acuité visuelle et une diplopie. Notre matériel d’étude a concerné une biopsie simple dans un cas, une exérèse subtotale dans sept cas et une exérèse totale dans quatre cas. L’étude histopathologique a montré une prolifération tumorale d’architecture endocrine. Les cellules tumorales sont uniformes de petite taille le plus souvent. L’index mitotique était bas. Cette prolifération tumorale s’accompagnait d’un fond fibrillaire et d’un réseau vasculaire développé de type arborescent. L’étude immunohistochimique était identique chez tout les patients. Elle a montré une positivité des cellules tumorales à l’anticorps anti synaptophysine, à chromogranine et NSE. Chez tous nos patients la corrélation radiopathologique était en faveur d’un neurocytome central (Grade II – OMS 2016). A travers cette série, nous rapportons les particularités anatomo-cliniques, radiologiques et évolutives de ces tumeurs rares.Central neurocytomas are defined as neoplasms composed of round, uniform cells, with neural immunophenotypic profile and low proliferation index. They account for 0.5% of intracranial tumors. They usually occur near the foramen of Monro and can cause obstructive hydrocephaly. We conducted a retrospective data collection from records of 12 patients with central neurocytomas in the Anatomopathological Laboratory at the Mohammed VI University Hospital, Marrakech, between January 2006 and June 2015. This study aimed to report and describe the radiopathological features of this rare histologic type. The male/female sex-ratio was 1.4. The average age at diagnosis was 22.3 years. The revealing symptomatology was dominated by intracranial hypertension associated with decreased visual acuity and diplopia in all patients. Our study concerned about simple biopsy in one case, subtotal resection in seven cases and total resection in four cases. Histopathological examination showed tumor proliferation with endocrine architecture. Tumor cells are more often small and uniform. Mitotic index was low. Tumor proliferation was associated with fibrillary fundus and vascular network with three types of trees. Immunohistochemical examination was identical in all patients. It showed tumor cells positive for anti-synaptophysin antibodies, chromogranine and NSE. In all patients the radio-pathologic correlation suggested central neurocytoma (grade II - WHO 2016). This study highlights the anatomo-clinical, radiological and evolutionary features of these rare tumors.

Molecular Profile of Breast Cancer in Young Women in the Marrakech Region, Morocco: Experience of the Oncology Department CHU Mohamed VI Marrakech, Morocco

Breast cancer in young women is increasing. The objective of this work was to analyze the epidemiological, clinical, therapeutic and prognostic characteristics of breast cancer in young women under 40 years. Through a retrospective study spread over five years from 1 January 2008 to 31 December 2012 and held at the Radiation Oncology Service of the University Hospital Mohammed VI Marrakech, we identified 272 cases of breast cancer in patients aged 40 years and under. The frequency of breast cancer in young women under 40 years was 24.42%. The average age was 35.6 years. The pauciparity and nulliparity were predominant (60.6%). 8 % had a family history of breast cancer. The self-examination of a nodule was predominant (93%). Tumors classified T2 were the most frequent (45%), followed by T4 tumors (29%).17% were metastatic immediately with predominant hepatic localizations (37.6%). It was Invasive breast carcinoma no special type (NST) in 82.3% of cases, with the predominance of SBR grades II and III (96%). Hormone receptors were positive in 68% of cases and HER2 overexpressed in 29 % of cases. 218 patients underwent surgery, which was radical in 68% and conservative in 21%. 149 had a locoregional irradiation. 71% received adjuvant chemotherapy with the predominance of FAC60 protocol (35%). Hormonotherapy was prescribed in 78% of cases with positive hormone receptors and trastuzumab in 73.8 % of patients over expressing HER2. After a median follow-up of 8.1 months, 41.4 % had relapses. Overall survival at three years was 70%, and the relapse free survival was 62%. Our study joins the data in the literature advocating more advanced forms and worse prognosis of breast cancer in young patients.

Primary hyperoxaluria detected by bone marrow biopsy: case report

BackgroundPrimary hyperoxaluria is a rare disease with an estimated prevalence of 1 to 3 cases per million. It is due to a hepatic enzyme deficiency responsible for an endogenous overproduction of oxalate. Oxalate crystals commonly deposit in the kidney and more rarely in bone marrow.The literature has reported, to the best of our knowledge, only two cases of hyperoxaluria diagnosed by bone marrow biopsy and our case is the only one that does not show radiological bone lesions.Case presentationA young 22xa0year old chronic hemodialysis patient with nephrocalcinosis. The patient had a personal and family history of recurrent kidney stones. He presented bone pain with worsening of his general state. On physical examination, no organomegaly was detected. Biological check-up showed only a normochromic and normocytic regenerative anemia resistant to treatment and a bone marrow biopsy was performed. It showed deposits of crystals of oxalate in the bone marrow surrounded by inflammatory reaction against foreign bodies. Given our context, no liver biopsy or genetic studies, which are gold standard of diagnosis testing, were done. The diagnosis of primary hyperoxaluria was made based on morphological characteristics of crystals, his medical and family history, and the absence of any secondary cause of the condition. Since curative treatment is not available in our country, the patient only receives a palliative treatment.ConclusionPrimary hyperoxaluria is rarely evoked by the histological study of a bone marrow biopsy. The lack of the possibility of the only effective treatment in our context and the diagnosis, usually late, of this pathology are at the origin of the fatal evolution of the disease in almost all the cases.

Primary breast angiosarcoma: a rare presentation of rare tumor – case report

BackgroundPrimary breast angiosarcoma is defined as malignant proliferation showing endothelial differentiation. It is a very rare tumour (0.05% of primary mammary cancers), whose diagnosis can be difficult.Case presentationWe report the observation of a patient with no previous history, aged 27xa0years. The clinical examination finds a right breast discreetly increased in volume. The trucut biopsy was in favour of a lactating tubular adenoma. However, an immunohistochemical complement was requested. An absence of pancytokeratin labelling contrasted with strong expression of CD31, CD34 (endothelial markers) are described. The proliferation index (Ki67) was estimated at 30%. This led to the conclusion that the phenotypic aspect is related to a vascular proliferation that evokes an angiosarcoma. After a multidisciplinary assessment, the patient benefited from an enlarged excision of the tumour. The histopathological examination of the surgical specimen found an infiltrating mesenchymal proliferation made of vessels of variable sizes anastomosed to vascular slits with lesional limits. The immunohistochemical examination on the surgical specimen showed to the same phenotypic profile on biopsy. The final diagnosis was a high-grade mammary angiosarcoma of incomplete excision. The patient refused any additional surgical management; external radiotherapy and close supervision were prescribed. After eight months of evolution, no local or remote recurrence was reported.ConclusionPrimary breast angiosarcoma is a mesenchymal malignant tumour of rare vascular origin. Our observation is peculiar by the absence of any prior radiotherapy, its clinical presentation, its morpho-phenotypic characteristics, its management and its evolutive aspects.

Acquired Immunodeficiency Syndrome Revealed by Oral Kaposi's Sarcoma

Introduction n nKaposi’s Sarcoma (KS), being first described in 1872 [1], is an unusual vascular neoplasm that most likely arises from endothelial cells, with some evidence of lymphatic origin. Different clinical and epidemiological variants have been identified. Lesions of KS typically manifests as bluish-purple macules and plaques on the skin, particularly of the face and lower extremities. Oral mucosa, lymph nodes and visceral organs may be affected, sometimes without cutaneous involvement.

THO22 Leiomyosarcome primitif du diaphragme, a propos d’un cas

Objectifs Moins de 10 cas de leiomyosarcomes diaphragmatiques ont ete rapportes dans la litterature. L’interet de ce travail est d’evaluer a travers une observation, les aspects cliniques, radiologiques et evolutifs de cette pathologie. Materiels et methodes Jeune de 18 ans consultant pour une masse abdominale apparue depuis 20 jours. Resultats L’examen clinique a revele une masse du flanc gauche mobile avec la respiration. L’echographie a montre une masse kystique, multicloisonnee au niveau epigastrique. La TDM thoraco-abdo-minale a objective un volumineux processus tumoral sus-mesocolique gauche refoulant l’estomac a droite, largement necrose et prenant faiblement le contraste, associe a un epaississement parietal gastrique irregulier faisant suspecter une tumeur mesenchymateuse a point de depart gastrique. L’exploration chirurgicale a objective une tumeur du dome diaphragmatique gauche. L’histologie avec etude immuno-histochimique a confirme le diagnostic de leiomyosarcome primitif du diaphragme. Le scanner de controle realise 4 mois apres l’intervention chirurgicale a objective une recidive tumorale. Le patient est decede 18 mois apres le diagnostic initial. Conclusion Les leiomyosarcomes primitifs du diaphragme sont des tumeurs exceptionnelles de diagnostic souvent tardif. Le scanner multicoupe et surtout l’IRM permettent de preciser le point de depart diaphragmatique de la tumeur bien que son aspect radiologique soit peu specifique.