Laila Chbani

Phyllodes tumors of the breast: clinicopathological analysis of 106 cases from a single institution

BACKGROUNDnPhyllodes tumors (PT) are uncommon biphasic tumors, accounting for less than 1% of all breast primary neoplasms. They form a wide variety of tumors ranging from benign to malignant. Several histological features are used to grade PT into 3 categories: benign (gradexa0I), borderline (gradexa0II) and malignant (gradexa0III) tumors. The aim of our study was to analyse histolopathological, radiological and clinical features of PT from an experience of a single center.nnnMETHODSnIt was a retrospective study including 106 patients diagnosed with phyllodes tumors on surgical specimens at the department of pathology, of Hassan II university hospital (Fez, Morocco), from 2009 to 2016.nnnRESULTSnThe mean age was 33.81 years (range of 13-66xa0years), and the mean age increases with the tumor grade (mean ages of 32.32, 32.87 and 33.65 years respectively for grade I, II and III PT) (p = 0.023); 78 patients (73.58%) had benign PT, 20 (18.86%) had borderline PT and 8 (7.54%) patients were diagnosed with malignant PT. Mostly, the tumor size was <5xa0cm (63.2%), with BI-RADS 3 (51 patients, 48.11%). The tumor size and the radiological suspicion (ACR/BI-RADS) increased with the tumor grade (p < 0.001). Mitosis count, cellular atypia and stromal cellularity increased with the tumor grade (p < 0.001). Also, the presence of necrosis is associated with malignant PT (p < 0.001). Before surgery, patients had undergone core needle biopsies (CNB) for diagnostic purpose, and the overral sensitivity of this diagnostic procedure was 71.83%. The sentivity of the CNB decreased from gradexa0I PT to gradexa0III PT (from 56.81% to 37.5%), however its specificity increased from grade I to gradexa0III PT (from 59.25% to 100%).nnnCONCLUSIONnPhyllodes tumors of the breast are rare neoplasms with a wide range of clinicopathologic presentations. The core needle biopsy has a good diagnostic sensitivity compared to definitive diagnosis on surgical specimens. There was a statistically significant association between the histological grade of PT and tumor size, radiological suspicion, mitotic count, cellular atypia, stromal cellularity, and tumor necrosis.

Bone pathologic fracture revealing an unusual association: coexistence of Langerhans cell histiocytosis with Rosai-Dorfman disease

BackgroundThe coexistence of Rosai-Dorfman disease (RDD) with Langerhans cell histiocytosis (LCH) is very rare, as to date only 17 cases have been reported in the english literature. The pathophysiology of this uncommon co-occurrence still remains enigmatic and a subject of various speculations.Case presentationWe report a case of a 30-year-old female patient who presented with a pathologic fracture of the left proximal femur. Her medical history was unremarkable, there were no fever, skin lesions, lymphadenopathy or other organomegaly at physical examination. X-ray radiograph of the fractured femur showed an isolated and ill-defined osteolytic lesion. The histopathological analysis of biopsies from this lesion were consistent with a combined RDD-LCH of the bone.ConclusionCombined RDD-LCH is a very rare phenomenon, whose pathophysiology still remains unclear and a subject of various speculations.

Schistosomiasis mimicking ovarian neoplasm

Comparison of Salmonella Typhi and Paratyphi A occurrence in a tertiary care hospital. J Clin Diagnos Res 2013; 7: 2724–2726. 4. Krishna S, Thunga R, Bairy I, et al. Carrier status or uropathogenic Salmonella Paratyphi A: urinary isolation of variant Salmonella Paratyphi-A in a case of catastrophic systemic lupus erythematosus. J Case Rep 2015; 5: 75–78. 5. Mathai E, John TJ, Rani M, et al. Significance of Salmonella Typhi bacteriuria. J Clin Microbiol 1995; 33: 1791–1792. 6. Wielding S and Scott G. Sexually acquired Salmonella Typhi urinary tract infection. Int J STD AIDS 2016; 27: 494–496. 7. Perilla M, Ajello G, Bopp C, et al. Manual for the laboratory identification and antimicrobial susceptibility testing of bacterial pathogens of public health importance in the developing world. Haemophilus influenza, Neisseria meningitides, Streptococcus pneumoniae, Neisseria gonorrhoeae, Salmonella serotype Typhi, Shigella and Vibrio cholerae. Atlanta, GA: Centers for Disease Control and Prevention, 2003. 8. Pitzer VE, Bowles CC, Baker S, et al. Predicting the impact of vaccination on the transmission dynamics of typhoid in South Asia: a mathematical modelling study. PLoS Negl Trop Dis 2014; 8: 1–12. 9. Senthilkumar B and Prabakaran G. Multidrug resistant Salmonella Typhi in asymptomatic typhoid carriers among food handlers in Namakkal District, Tamil Nadu. Ind J Med Microbiol 2005; 23: 92–94. 10. Saphra I and Winter JW. Clinical manifestations of salmonellosis in man: an evaluation of 7,779 human infections identified at the New York Salmonella Center. N EngI J Med 1957; 256: 1128–1134. 11. Eng SK, Pusparajah P, Ab Mutalib NS, et al. Salmonella: a review on pathogenesis, epidemiology and antibiotic resistance. Front Life Sci 2015; 8: 284–293. 12. Dougan G, John V, Palmer S, et al. Immunity to Salmonellosis. Immunol Rev 2011; 240: 196–210. 13. Ruby T, Mc Laughlin L, Gopinath S, et al. Salmonella’s long termrelationship with its host. FEMS Microbiol Rev 2012; 36: 600–615. 14. Saene HKFV, Taylor N and Damjanovic V. Carrier state is a major risk for emergence of antimicrobial resistance to typhoidal salmonellae. Br Med J 2009; 338: b1159. 15. Klosterman SA. Salmonella-related urinary tract infection in an elderly patient. Br Med J Case Rep 2014. doi: 10.1136/bcr-2014-204552. 16. Hasham AL and Uehling DT. Salmonella lithiasis. J Urol 1976; 115: 110–111.

Isolated splenic lymphangioma presenting as a huge mass causing anemia and abdominal distension in an adult patient: a case report

BackgroundLymphangiomas are uncommon benign lesions of lymphatic vessels very rarely affecting the spleen. Isolated involvement of the spleen in adult patients is rarely reported.Case presentationWe report a case of a 40-year-old Arabic woman who presented with a 25-cm abdominal mass, fatigue, and anemia evolving for 6xa0months. Her physical examination revealed anemic syndrome and an enormous splenomegaly extending beyond the umbilical area. An abdominal computed tomographic scan showed a 25-cm splenic mass with multiple hypodense nodules without enhancement after contrast injection. A surgical total splenectomy was performed. Histopathological analysis led to the diagnosis of cystic splenic lymphangioma. The patient’s postoperative course was uneventful, and she was discharged from the hospital.ConclusionsIsolated splenic lymphangioma in adult patients is very rare. The preoperative diagnosis is challenging because imaging techniques are not specific. Pathological analysis of the resected specimen is the only effective way to render the definitive diagnosis. Splenic lymphangiomas have a benign course after complete surgical resection.

Astroblastoma – a rare and challenging tumor: a case report and review of the literature

BackgroundAstroblastoma is a controversial and an extremely rare central nervous system neoplasm. Although its histogenesis has been clarified recently, controversies exist regarding its cellular origin and validity as a distinct entity. Because of its extreme rarity and because its common features are shared with other glial neoplasms, this tumor is prone to misdiagnosis and remains challenging not only in terms of diagnosis and classification but also in the subsequent management. This case report describes a new case of astroblastoma. It discusses clinical, radiologic, pathological, and therapeutic features and differential diagnosis of this rare neoplasm, with a review of the recent literature.Case presentationWe report the case of an 8-year-old Moroccan girl who presented with a 1-year history of epileptic seizure, headache, and decreased visual acuity. Cranial magnetic resonance imaging revealed a right occipito-temporal mass. A tumor resection was performed and histological examination combined with immunohistochemical study confirmed the diagnosis of low-grade astroblastoma.ConclusionsAstroblastoma is a very rare primary brain tumor. Its diagnosis is often challenging because of the astroblastic aspects that can be found in astrocytic tumors, in ependymomas, and in non-neuroepithelial tumors. Considerable confusion surrounds its histogenesis and classification. The low incidence rate makes it difficult to conduct studies to examine tumor characteristics.

The Assessment of HER2 Gene Status by Fluorescence In Situ Hybridization in Invasive Breast Carcinomas With Equivocal HER2 Immunostaining: Experience From a Single Institution:

Background. A subset of breast carcinomas harbors overexpression of the human epidermal growth factor receptor 2 (HER2). Fluorescence in situ hybridization (FISH) should be performed in breast carcinomas with equivocal HER2 immunostaining (immunohistochemistry [IHC] HER2 2+). The aim of our study is to investigate clinicopathologic factors associated with HER2 status in breast invasive carcinomas with IHC HER2 2+ through FISH analysis. Methods. This is a retrospective study including the FISH analysis of 111 patients with invasive breast carcinomas with equivocal HER2 immunostaining. Results. The mean age was 49.51 ± 10.48 years, and invasive breast carcinoma of no special type was the most histological type in our study (96.4%). Most patients had tumors positive for hormones receptors (88.2% positive for estrogen receptor and 81.4% for progesterone receptor). On FISH, the HER2 amplification rate was 22.5%. There was no significant association of HER2 status with any clinicopathologic factors (P > .05). Conclusions. Our study shows that there are no reliable clinicopathologic factors to predict the HER2 status in breast tumors with equivocal HER2 immunostaining, supporting the necessary usage of FISH in such circumstances.

EWSR1 Rearrangement and CD99 Expression as Diagnostic Biomarkers for Ewing/PNET Sarcomas in a Moroccan Population

Ewing sarcoma/primitive neuroectodermal tumor (Ewing/PNET sarcomas or EPS) are a group of round cell tumors. Malignant round cell tumors form a large and diverse group that includes rhabdomyosarcoma, synovial sarcoma, non-Hodgkins lymphoma, neuroblastoma, hepatoblastoma, Wilms tumor, desmoplastic small round cell tumor, and other morphologically similar entities. Differential diagnosis of Ewing sarcoma/primitive neuroectodermal tumor (Ewing/PNET sarcomas or EPS) is difficult. In addition to morphology and immunohistochemistry (IHC), differential diagnosis of these tumors is based on molecular analysis of the EWSR1 gene rearrangement using fluorescent in situ hybridization (FISH) technique. We investigated the diagnostic value of combined CD99 immunostaining and EWSR1 t(22q12) alteration using a dual-color, break-apart rearrangement probe in forty-one formalin-fixed paraffin-embedded (FFPE) tissue samples from pediatric and adult patients diagnosed with EPS. IHC was performed in all cases using the CD99 antibody and showed a positivity of 92.7% in the enrolled cases (38/41) followed by FISH analysis where 48.8% of the cases (20/41) were rearranged. Sensitivity and specificity for IHC assays were 88% and 58%, respectively. Notably, FISH had a sensitivity of 100% and a specificity of 87%. In addition, CD99 positivity was found to correlate with EWSR1 rearrangement (p < 0.05). This report shows that FISH has better sensitivity and specificity than IHC in the Moroccan population, and supports its combination with CD99 immunostaining as diagnostic biomarkers for this rare malignant entity.”

Tubular Adenoma of the Breast: A Clinicopathologic Study of a Series of 9 Cases

Tubular adenoma of the breast is one of the most rare benign neoplasms, accounting for only 0.13% to 1.7% of all breast benign tumors. Little is known about this rare neoplasm as the current literature offers only some case reports or a few number of small series. The aim of our study is to provide some clinicopathologic features of the breast tubular adenoma. We retrospectively analyzed at our department of pathology all cases of breast tubular adenomas confirmed by immunohistochemistry over a period of 9u2009years (2009-2017). Nine cases of breast tubular adenoma have been recorded, with an average age of 31.44u2009years. Five tumors were located at the right side (55.55%), and most cases had suspicious aspects on imaging techniques (6 cases out of 9). The diagnosis has been made on 5 resected specimens (lumpectomy) and on 4 core needle biopsies. The tumor size ranged from 0.9 to 7u2009cm (mean size of 3.08u2009cm) and had well-circumscribed margins with elastic consistency. The histopathologic analysis showed a typical pattern of proliferating round and uniform tubules lined by regular epithelial cells surrounded by myoepithelial cells, packed in a small amount of stroma, highlighted by CD34 immunostaining. Tubular adenoma is a rare breast benign neoplasm of young premenopausal women. The radiologic aspects are often worrisome and only the histopathologic analysis can achieve the correct definitive diagnosis by excluding all potential differential diagnoses.

The expression of MDM2 in gastrointestinal stromal tumors: immunohistochemical analysis of 35 cases

BackgroundGastrointestinal stromal tumors (GIST) are the most common primary mesenchymal tumors of the digestive system. The assessment of their biological behavior still remains a scientific challenge. To date, there are no well-established biological prognostic markers of GIST. Our aim is to study the expression of the MDM2 oncoprotein in GIST through an immunohistochemical analysis.MethodsIt was a retrospective study of 35 cases of GIST diagnosed from 2009 to 2012 in the department of pathology of Hassan II university hospital, Fès, Morocco. MDM2 immunohistochemical staining was performed on archival paraffin-embedded and formalin-fixed specimens (with a threshold of nuclear positivity >u200910%). Analysis of correlations between MDM2 immunoexpression and clinicopathological features of GIST has been performed.ResultsThe mean age was 55.23xa0years (range 25–84xa0years) with a male predominance (sex ratiou2009=u20091.5). The stomach was the main site of GIST, with 17 cases (48.57%) followed by the small bowel (9 cases, 25.71%). The spindle cell type GIST was the most frequent morphological variant (29 cases, 82.85%). Tumor necrosis was present in 8 cases (22.85%). Two patients (5.71%) had very low risk GIST, 5 (14.28%) had low risk GIST, 7 patients (20%) had intermediate risk tumors. The remaining 21 cases (60%) had high risk GIST. At the time of diagnosis, 9 patients (25.71%) had metastatic tumors. At immunohistochemical analysis, 40% of cases (14 patients) stained positive for MDM2. Of these MDMD2-positive tumors, 11/14 (78.57%) had high risk tumors and 8/14 cases (57.14%) presented with metastatic GIST. MDM2 positivity was significantly associated with the metastatic status (pu2009=u20090.001).ConclusionThe current study suggests that MDM2 immunohistochemical expression is a negative histoprognostic factor in GIST with a statistically significant correlation with metastasis.

Breast tuberculosis: a report of five cases

BackgroundBreast tuberculosis is a rare form of extrapulmonary tuberculosis with clinical and radiological misleading presentations. We report herein a retrospective study of clinicopathological features of five cases of breast tuberculosis collected at Hassan II University Hospital of Fès, Morocco, a country where tuberculosis is endemic.Case presentationThe mean age was 40.6xa0years (range of 21–59xa0years). Two patients presented with abscessed lesions, and three cases presented with breast lumps with a suspicion of malignancy on imaging techniques. The diagnosis has been made on histological specimens (3 biopsy specimens, 1 excisional biopsy, and 1 lumpectomy). All patients have been successfully treated after the completion of the standard antibiotherapy.ConclusionsOur current study shows that the breast is rarely affected by tuberculosis even in endemic area. The clinical presentation is often misleading, and the histopathological analysis constitutes a valuable diagnostic tool. The prognosis of breast tuberculosis is good after treatment by a standard antibiotherapy.