Sabeh Mzabi

Loss of galectin-3 expression in mucinous colorectal carcinomas is associated with 5'CpG island methylation in Tunisian patients.

The &bgr;-galactoside-binding protein galectin-3 (gal-3) has pleitropic biological functions and has been implicated in cell growth, differentiation, adhesion, RNA processing, apoptosis, and malignant transformation. To investigate the pattern of inactivation of the gal-3 gene (LGALS3) in colorectal cancers (CRC), we studied a series of Tunisian patients with CRC to identify abnormal methylation in LGALS3 promoter using a methylation-specific PCR. We also examined the gal-3 gene expression by reverse transcription-PCR and the expression of gal-3 protein by immunohistochemistry. Analysis of DNA methylation in nonmucinous colorectal carcinomas expressing gal-3 protein showed an unmethylated profile of LGALS3 promoter, whereas gal-3 was aberrantly methylated in mucinous colorectal carcinomas. Complete loss of the gal-3 expression both at mRNA and the protein level was associated with the gal-3 methylation in the mucinous colorectal carcinomas. Our results show that methylation of the gal-3 promoter could be an important mechanism in the regulation of the expression of this gene in mucinous CRCs.

The prognostic value of p73 overexpression in colorectal carcinoma: a clinicopathologic, immunohistochemical, and statistical study of 204 patients.

IntroductionThe protein p73 is the first identified homolog of the tumor suppressor gene p53, but its function in tumor development has not been established. Indeed, the results regarding the p73 implication in colorectal cancers is still controversial. AimWe investigated whether the p73 is implicated in colorectal cancer, whether the p73 expression is related to prognosis and whether the p73 expression is correlated with p21-ras or p53. Materials and MethodsWe performed a comparative immunohistochemical analysis of p73, p53, and p21ras proteins in primary colorectal tumor with matched normal mucosa and metastasis from 204 patients with colorectal cancer. We correlated these expressions with clinicopathologic variables and we compared the different profiles between nonmucinous carcinoma and mucinous carcinoma. ResultsIn this study, we did not find any correlation between p73 expression, sex, age, site, differentiation and stage. Overexpression of p73 was significantly correlated with infiltrating growth pattern (P<0.0001) and nonmucinous carcinoma (P<0.0001). Furthermore, frequency and intensity of p73 expression were marquedly increased from normal mucosa (26%), to primary tumors (75%) and to metastasis (97%). Furthermore, expression of p73 was also correlated with shorter survival period. The prognostic significance of p73 expression remained, even after adjustment for the clinical and pathologic variables. The p73 expression was positively correlated only with p21ras expression (P<0.0001). ConclusionsAll these findings prove that p73 expression should be considered as a valuable poor prognostic marker. Our data also suggest that TP73 gene may play a role in colorectal carcinoma development.

Relationship Between SDF-1G801A Polymorphism and its Expression in Tunisian Patients with Colorectal Cancer

The aim was to evaluate the relationship between SDF-1G801A polymorphism and its immunohistochemical expression in colorectal cancer tissues in the Tunisian cohort. The molecular and immunohistochemical analysis showed that SDF-1G801A polymorphic variant was higher in CRC patients with TNM stage II and III, the SDF-1 expression was significantly increased from normal mucosa to primary tumor (p < 0.05). CRC patients have higher frequency of A allele (52.01%) than controls (26.8%) (P = 0.0001). Thus, SDF-1 polymorphism is a risk factor of colorectal cancer susceptibility in our population, the polymorph genotype of SDF-1 maybe associated with clinical manifestations in CRC patients in Tunisia.

Colorectal cancer in young adults: a retrospective study of 32 tunisian patients

Young people under the age of 40 with colorectal cancer represent a distinct subgroup with a more aggressive disease behaviour compared to older patients. This study aim to provide an updated overview on clinicopathological features, treatment and outcome of colorectal cancer in young adults under the age of 40. In our retrospective study, we reviewed 32 cases of colorectal cancer in young adults aged less than 40 years that were diagnosed at the pathology department of Mongi Slim hospital over a fifteen-year period (April 2000 - November 2014). Our study group included 13 male and 19 female patients (sex-ratio M/F = 0,68) between 17 and 39 years of age (mean = 31,25 years). The presenting clinical symptoms were dominated by altered bowel habits (n=17), followed by bleeding per rectum (n=16). Histopathological examination of the surgical and biopsy specimens established the diagnosis of mucinous adenocarcinoma in nine cases, well-differentiated adenocarcinoma in 11 cases, moderately differentiated adenocarcinoma in six cases, poorly differentiated adenocarcinoma in four cases and signet ring cell carcinoma in two cases. The tumours were classified after surgery as stage I (n = 2) (6%), stage IIA (n = 7) (22%), stage IIB (n=4) (13%), stage IIC (n=1) (3%), stage IIIB (n=8) (25%), stage IIIC (n= 4) (12%), stage IVA (n=4) (13%) and stage IVB (n=2) (6%). During the follow-up period which ranged between one month and 9 years, local recurrence of the tumour occurred in six cases, seven patients had hepatic metastases and seven patients died after a mean follow-up period of seven months. Molecular genetic studies are increasing the understanding of the pathobiology of colorectal cancer and may ultimately allow at-risk patients to be identified at an earlier stage.

Solid pseudopapillary neoplasm of the pancreas in two male patients: gender does not matter

Solid pseudopapillary tumour (SPT) is an unusual pancreatic neoplasm which predominantly affects young women. Less than 10% of patients with SPT in the reported literature were male. In this paper, the authors report two new cases of SPT that occurred in two male patients aged respectively 25 and 20 years old. Abdominal computed tomography scan showed a well-defined heterogeneous mass involving respectively the tail and the body of the pancreas with peripheral calcifications in the first case. The two patients underwent distal splenopancreatectomy. Histopathological examination of the surgical specimen coupled with immunohistochemical study was compatible with solid pseudopapillary tumour. On postoperative day 8, the first patient developed abdominal wall abscess and peritoneal collection. Postoperative course was uneventful for the second patient. In summary, a large, well-encapsulated cystic mass in the pancreas of a young man should raise suspicion of solid pseudopapillary tumour.

Hepatocellular carcinoma: a clinicopathological study of 64 cases

Hepatocellular carcinoma (HCC) is the most common of all liver cancers and is a major worldwide public health problem. The aim of this study was to provide an updated overview on clinicopathological features, treatment and outcome of HCC. In our retrospective study, we reviewed 64 cases of HCC that were diagnosed at the pathology department of Mongi Slim hospital over a fifteen-year period (2000- 2014). Relevant clinical information and microscopic slides were retrospectively reviewed. Our study group included 38 men and 26 women (sex ratio M/F = 1,26) aged between 8 and 83 years (mean = 56,64 years). The presenting clinical symptoms were dominated by abdominal pain (n=34), followed by altered general health (n=25) and jaundice (n=4). Fifty-five patients underwent surgical treatment. Liver transplantation was performed in two cases and transarterial chemoembolization was achieved in seven cases. Histopathological examination of the surgical or biopsy specimen established the diagnosis of conventional HCC in 55 cases, fibrolamellar carcinoma in 6 cases and clear cell HCC in 3 cases. Seven patients with HCC died postoperatively. Local recurrence of the tumour occurred in three cases and two patients had distant metastases postoperatively. The other patients are still being followed-up. Hepatocellular carcinoma is associated with a high rate of mortality because of early invasion, widespread metastasis and lack of effective therapeutic modalities. Accurate diagnosis and staging of these tumours is critical for optimal treatment planning and for determining prognosis.

Crohn’s disease and schistosomiasis: a rare association

Schistosomiasis is a chronic enteropathogenic disease caused by blood flukes of the genus Schistosoma. Coexistence of schistosomiasis with Crohns disease is very rare. To the best of our knowledge, this association has been described in literature only once. A 20-year-old male patient with a past medical history of appendectomy and ileocecal Crohns disease, presented with abdominal pain and vomiting. Ileocolonoscopy showed an ulcerated and congested appearance of the upper rectum and sigmoid. Computed tomography scan revealed a circumferential thickening of the terminal ileum with luminal stenosis. Histopathological examination of the biopsy specimens revealed a focally ulcerated colonic epithelium. The lamina propria was fibrous harbouring a polymorphic inflammatory infiltrate including lymphocytes and plasma cells organized in lymphoid follicles admixed with eosinophils and neutrophils. In the submucosa, there were two well-preserved schistosoma eggs surrounded by a thick shell with a barely visible terminal spine. The final pathological diagnosis was colonic schistosomiasis associated with Crohns disease. The patient underwent an ileocecal resection for stenosis of the terminal ileum complicated with enterocutaneous fistula. The postoperative course was uneventful. A stool examination and serology tests were planned for this patient who was lost to follow-up.

Collagenous Gastritis: A Rare Entity -

Collagenous gastritis is a rare entity of unknown etiology characterized histologically by the presence of a thick subepithelial collagen band associated with an inflammatory infiltrate of gastric mucosa. A 40-year-old male presented with a history of chronic intermittent abdominal pain for about 6 months. Physical examination was unremarkable, and biological tests were within normal range. The patient underwent esophagogastroduodenoscopy and colonoscopy which showed a nodular mucosa of the stomach. Biopsies of the duodenum and colon were unremarkable. However, biopsies of the gastric fundus revealed a mild chronic gastritis characterized by lymphocytic and plasma cell infiltration of deep mucosa, without lymphoid follicle formation or active inflammation. No microorganisms were identified on routine hematoxylin and eosin or Giemsa-stained sections. Subepithelial collagen in the gastric biopsies was thickened and showed entrapped capillaries. Subepithelial collagen was highlighted by Masson’s trichrome staining and was negative for amyloid by Congo Red. In the areas containing thickened collagen, there were no intraepithelial lymphocytes. The final pathological diagnosis was collagenous gastritis. Collagenous gastritis is an extremely rare disease, but it is important to recognize its characteristic endoscopic and pathologic findings to make a correct diagnosis. Specific therapy for this rare entity has not yet been established.

Unusual Locations of Hydatidosis: Cryptorchid Testicle and Peritoneum -

Hydatid cyst is a parasitic infection due to the larval stage of the tapeworm Echinococcus. It most commonly involves the liver and lung. Location at unusual sites in the body can have atypical presentations and poses a diagnostic challenge. Herein, the authors report a new case of hydatid disease involving the peritoneum and the tunica vaginalis of a cryptorchid testicle in a 57-year-old patient. They conclude that hydatid disease should be kept in mind when a cystic lesion in encountered in the testicle or the peritoneum in endemic areas.

Une dermatose papuleuse rare

Une jeune fille âgée de 16 ans nous a été adressée pour une dermatose peu prurigineuse des membres et du tronc. L’éruption était apparue depuis un an, sans cause déclenchante, en particulier médicamenteuse. Elle était faite de papules en tête d’épingle, de 1 mm de diamètre, translucides, hypopigmentées, organisées en plaques, arrondies, bien limitées, de taille variant de 4 à 7 cm de grand axe. Cette éruption intéressait les membres supérieurs, le cou, le tronc et la racine des cuisses. Aux avant-bras, certaines papules commençaient à s’affaisser laissant place à des macules pigmentées. Le reste de l’examen cutanéomuqueux et viscéral était normal. La biopsie d’une papule montrait la présence dans le derme papillaire d’un infiltrat composé de lymphocytes, d’histiocytes et de cellules épithéloïdes associés à de rares cellules géantes (Fig. 1 et 2). Cet infiltrat s’organisait en nodules bien limités, occupant quatre à cinq papilles dermiques, encerclés latéralement par deux crêtes épidermiques allongées. L’épiderme sus-jacent, focalement parakératosique et discrètement papillomateux, était aminci du fait d’une couche granuleuse réduite et comportait une exocytose modérée essentiellement lymphocytaire. Devant l’absence de gêne fonctionnelle ou esthétique, aucun traitement n’a été proposé.