Sana Ben Slama

Le fibrome desmoplastique de la côte : À propos de deux observations

Resume Le fibrome desmoplastique est une tumeur primitive tres rare de l’os, equivalente a la tumeur desmoide des parties molles. Bien qu’elle soit consideree comme une lesion benigne, elle peut etre tres agressive localement avec un haut risque de recidives locales apres exerese chirurgicale. En l’absence de specificite radiologique, elle peut simuler un osteosarcome, une dysplasie fibreuse ou un fibrosarcome. L’atteinte costale par un fibrome desmoplastique est extremement rare. Nous rapportons deux cas illustrant cette localisation exceptionnelle avec lyse costale et extension endothoracique. L’examen anatomo-pathologique apres exerese chirurgicale montrait une proliferation tumorale peu dense de petites cellules fusiformes s’entremelant a des faisceaux collagenes et resorbant les travees osseuses. Il n’a pas ete observe d’atypies ni de mitoses ni de necrose. Nous discuterons les aspects radiologiques, cliniques et morphologiques ainsi que les diagnostics differentiels de cette tumeur dont la reconnaissance est importante afin d’assurer un traitement chirurgical adapte.Desmoplastic fibroma is a very rare primary tumor of bone, closely related to aggressive fibromatosis of soft tissue. Although considered a benign lesion, it can be very aggressive locally and has a high rate of local recurrence after incomplete surgical excision. Radiologically, the lesion shows no distinctive features, often simulating osteosarcoma, fibrous dysplasia, or fibrosarcoma. Rib involvement by desmoplastic fibroma is extremely rare. We present two cases of desmoplastic fibroma involving this unusual location with lytic costal lesion and chest wall extension. Histological examination after surgical resection revealed that the tumor consisted of spindle cells with small, elongated nuclei in a background of numerous collagen fibers and infiltrating lamellar bone. There was no evidence of nuclear atypia, mitotic activity, or necrosis. We also discuss histological differential diagnosis as well as clinical features and the radiological and pathologic findings of this rare disease. Recognition of this entity is important to ensure proper surgical treatment.

Gastrites chroniques à hélicobacter pylori: évaluation des systèmes OLGA et OLGIM

Helicobacter pylori (H pylori) gastritis presents a risk of cancer related to atrophy and intestinal metaplasia. Two recent classifications OLGA (Operative Link on Gastritis Assessment) and OLGIM (Operative Link on Gastritic Intestinal Metaplasia assessment) have been proposed to identify high-risk forms (stages III and IV). The aim of this study is to evaluate the OLGA and OLGIM staging systems in H pylori gastritis. A descriptive study of 100 cases of chronic H pylori gastritis was performed. The revaluation of Sydney System parameters of atrophy and intestinal metaplasia, of gastric antrum and corpus, allowed identifying respectively the stages of OLGA and OLGIM systems. The progressive risk of our H pylori gastritis was 6% according to OLGA staging and 7% according to OLGIM staging. Significant correlation was revealed between age and OLGA staging. High-risk gastritis according to OLGIM staging was significantly associated with moderate to severe atrophy. High-risk forms according to OLGA staging were associated in 80% of the cases to intestinal metaplasia. OLGA and OLGIM systems showed a highly significant positive correlation between them with a mismatch at 5% for H pylori gastritis. The OLGA and OLGIM staging systems in addition to Sydney System, allow selection of high risk forms of chronic gastritis requiring accurate observation.

Gastrites chroniques à hélicobacter Pylori : Évaluation des systèmes OLGA et OLGIM Helicobacter pylori gastritis: Assessment of OLGA and OLGIM staging systems

Helicobacter pylori (H pylori) gastritis presents a risk of cancer related to atrophy and intestinal metaplasia. Two recent classifications OLGA (Operative Link on Gastritis Assessment) and OLGIM (Operative Link on Gastritic Intestinal Metaplasia assessment) have been proposed to identify high-risk forms (stages III and IV). The aim of this study is to evaluate the OLGA and OLGIM staging systems in H pylori gastritis. A descriptive study of 100 cases of chronic H pylori gastritis was performed. The revaluation of Sydney System parameters of atrophy and intestinal metaplasia, of gastric antrum and corpus, allowed identifying respectively the stages of OLGA and OLGIM systems. The progressive risk of our H pylori gastritis was 6% according to OLGA staging and 7% according to OLGIM staging. Significant correlation was revealed between age and OLGA staging. High-risk gastritis according to OLGIM staging was significantly associated with moderate to severe atrophy. High-risk forms according to OLGA staging were associated in 80% of the cases to intestinal metaplasia. OLGA and OLGIM systems showed a highly significant positive correlation between them with a mismatch at 5% for H pylori gastritis. The OLGA and OLGIM staging systems in addition to Sydney System, allow selection of high risk forms of chronic gastritis requiring accurate observation.

Gastric schwannoma: a case report

Schwannomas are generally benign, slow growing tumors. They are rarely observed in the gastrointestinal tract with the most common site being the stomach. These tumors are usually asymptomatic. The preoperative diagnosis via endoscopy is a challenging issue due to the difficulty of differentiation from other submucosal tumors. A 54-year-old woman presented with epigastric pain persisting for the last 10 months. Upper endoscopy revealed an elevated submucosal mass of the gastric antrum. The overlying mucosa was normal. Biopsy specimens yielded only unspecific signs of mild inactive chronic inflammation. Endoscopic ultrasound examination noted a hypoechoic homogeneous mass lesion located in the gastric antrum. The mass appeared to arise from the muscularis propria, and there was no perigastric lymphadenopathy. A contrast-enhanced computed tomography scan identified a homogeneous round mass and arising from the antrum of the stomach. Submucosal tumor was suspected and surgical intervention was recommended. The patient underwent an elective laparoscopic partial gastrectomy. The histopathologic features and immunohistochemical-staining pattern were consistent with a benign gastric schwannoma. Our patient shows no recurrence with a follow-up of one year. The definitive diagnosis of gastric schwannomas requires immunohistochemical studies. Complete margin negative surgical resection, as in this case, is the curative treatment of choice. The clinical course is generally benign.

Multiples ileal adenomas in Crohn's disease: Sporadic or ileitis associated dysplasia?

La Presse Medicale - In Press.Proof corrected by the author Available online since jeudi 29 decembre 2016

Primary renal carcinoid metastasizing to distant sites 12 years after the initial diagnosis

Primary renal cancinoids are rare, with one hundred cases reported in the literature. Histologically, it is a well-differentiated tumor which shares a morphological pattern similar to that seen in carcinoids identified at other anatomic locations. We report a case of a 45-year-old man with primitive renal carcinoid, with diagnosis made after the detection of liver metastases. The tumour was peculiar given its tubulopapillary architecture, wrongly suggesting a diagnosis of papillary renal carcinoma. This diagnosis was revised 12 years after, following the appearance of other liver, bone and lung metastases.

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.