Publications by authors named "Manel Njima"

36 Publications

Parapharyngeal Lymph Node Metastasis From Papillary Thyroid Carcinoma.

Ear Nose Throat J 2021 Sep 24:1455613211045566. Epub 2021 Sep 24.

Department of Otolaryngology-Head and Neck Surgery, Tahar Sfar Hospital, Mahdia, Tunisia.

Metastatic parapharyngeal lymph nodes (LNs) from papillary thyroid carcinomas (PTC) are uncommon and can easily remain undetected. We describe a case that involves a 62-year-old woman treated for a PTC, who presented a rise in serum thyroglobulin (TG) levels. A computed tomography scan was performed, and revealed metastatic nodes in the left parapharyngeal space (PPS). A surgical resection of the nodes was performed with external cervical approach. A histological exam confirmed the diagnosis of a metastatic LN of a PTC. The aim of this report is to emphasize on the possibility of parapharyngeal metastatic nodes in PTC and to describe the diagnosis methods, treatment options, and impact on the prognosis.
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http://dx.doi.org/10.1177/01455613211045566DOI Listing
September 2021

Two Lip Carcinomas following Allogeneic Hematopoietic Stem Cell Transplantation: A Case Report and Literature Review.

Int J Dent 2021 27;2021:6662381. Epub 2021 Aug 27.

Dental Medicine Department, Fattouma Bourguiba Teaching Hospital, Monastir, Tunisia.

Background: Secondary solid cancers are severe complications in patients who have undergone allogeneic hematopoietic stem cell transplantation (AHSCT) for malignant and nonmalignant lymphohematopoietic diseases.

Objective: The aim of this work was to report a case of two lip carcinomas following AHSCT and to warn doctors about the importance of regular check-ups of patients who have received HSCT. . A 57-year-old man was referred by the dermatology department for the management of exophytic budding lesions on the lower lip evolving since 5 months. The patient was in complete remission following allogeneic bone marrow transplantation for acute myeloid leukemia since five years. Clinical and histological findings confirmed the diagnosis of a squamous cell carcinoma of the two lesions.

Conclusion: It is of paramount importance to seek an oral squamous cell carcinoma in the presence of persistent lesions in HSCT recipients.
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http://dx.doi.org/10.1155/2021/6662381DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8419498PMC
August 2021

A case of interstitial granulomatous dermatitis associated with human immunodeficiency virus infection.

Australas J Dermatol 2021 Aug 23. Epub 2021 Aug 23.

Dermatology Department, Research Laboratory LR20SP03A, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia.

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http://dx.doi.org/10.1111/ajd.13696DOI Listing
August 2021

Small bowel and lung histiocytic sarcoma revealed by acute peritonitis: A case report with review of literature.

Ann Med Surg (Lond) 2021 Aug 27;68:102638. Epub 2021 Jul 27.

Department of Pathology, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia.

Introduction And Importance: Histiocytic sarcoma (HS) is a rare malignant neoplasm showing morphologic and immunohistochemical features of histiocytes. It is characterized typically by extranodal presentation and a poor clinical course, particularly in cases with disseminated disease.

Case Presentation: This report documents a case of bifocal and aggressive HS in small bowel and lung revealed by acute peritonitis in a 63-year-old man.

Clinical Discussion: Despite its rarity, we believe that the correct diagnosis of HS is crucial for clinical treatment and prognostic prediction.

Conclusion: The collection of additional cases of HS are important to obtain further progress in prognosis and guide treatment decisions.
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http://dx.doi.org/10.1016/j.amsu.2021.102638DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8339142PMC
August 2021

Acute localized exanthematous pustulosis: Clinical features, pathophysiology, and therapy.

Dermatol Ther 2021 Aug 5:e15087. Epub 2021 Aug 5.

Department of Dermatology, Fattouma Bourguiba University Hospital, Monastir, Tunisia.

Acute localized exanthematous pustulosis (ALEP) is a rare disease characterized by the acute onset of multiple localized non-follicular, pinhead-sized pustules. ALEP is considered a localized form of acute generalized exanthematous pustulosis but its pathogeny is not well identified. We performed a systematic review of the literature of all publications regarding ALEP cases using the term "acute localized exanthematous pustulosis," to provide an update on this disease and its management. Results and conclusion ALEP is an uncommon skin condition attributed primarily to a hypersensitivity reaction to a systemic drug (classical or herbal); though a contact mechanism has been reported. It may be misdiagnosed as infectious or inflammatory disease but the clinico-pathological correlation in addition to the rapid response to withdrawal of the culprit agent supports this diagnosis. The pathogenesis of ALEP is still unclear, and there are no standardized treatment guidelines to manage this disease. Both AGEP and ALEP have a good prognosis if an early diagnosis is made.
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http://dx.doi.org/10.1111/dth.15087DOI Listing
August 2021

Disseminated intravascular coagulation type of amniotic fluid embolism: a challenging case report with favorable outcome.

Pan Afr Med J 2021 1;38:325. Epub 2021 Apr 1.

Anesthesia-Intensive Care Department B, Maternity and Neonatology Teaching Center of Monastir, Monastir, Tunisia.

Amniotic fluid embolism (AFE) is an unforeseeable, life-threatening complication of pregnancy and child birth. Although rare in an absolute sense, most contemporary series of maternal deaths from developed countries report AFE as a leading cause of mortality in the pregnant population. It has a heterogeneous presentation. This clinical heterogeneity makes the diagnosis of AFE difficult based on a beam of clinical and para-clinical arguments. Rapid diagnosis and immediate interdisciplinary treatment are essential for a good outcome. The present is a case of AFE with a disseminated intravascular coagulation (DIC) and a cardiorespiratory collapse following a vaginal delivery.
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http://dx.doi.org/10.11604/pamj.2021.38.325.23434DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8265244PMC
August 2021

Ossifying fibromyxoid tumor of soft tissue: A case report with review of literature.

Ann Med Surg (Lond) 2021 Jul 9;67:102479. Epub 2021 Jun 9.

Pathology Department of Fattouma Bourguiba University Hospital, Monastir, Tunisia.

Introduction And Importance: The ossifying fibromyxoid tumor of soft tissue is a rare tumor of intermediate differentiation and uncertain lineage that occurs in adults mostly in the extremities and the trunk.

Presentation Of Case: we present a case of 57 year-old man presenting with a right scapular mass. It was a subcutaneous and painless mass that was largely excised. The diagnosis of ossifying fibromyxoid tumor of the right shoulder was made. The follow up of 1 year was without recurrence and metastasis.

Clinical Discussion: The ossifying fibromyxoid tumor of soft tissue is exceptional, microscopic diagnosis and management is challenging, considering the scarcity of the tumor.

Conclusion: More cases and retrospective studies are needed to understand the pathogenesis and to determine optimal treatment regimens.
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http://dx.doi.org/10.1016/j.amsu.2021.102479DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8209675PMC
July 2021

[Breast cancer and pregnancy: about 15 cases collected at the maternity center Monastir, Tunisia].

Pan Afr Med J 2021 17;38:180. Epub 2021 Feb 17.

Service de Gynécologie Obstétrique, Centre de Maternité et de Néonatologie de Monastir, Centre Hospitalier Universitaire Fattouma Bourguiba Monastir, Université de Monastir, Monastir, Tunisie.

The purpose of this study was to describe the clinical, radiological, histological and therapeutic features of breast cancer diagnosed during pregnancy. We performed a review of all medical records of patients with breast cancer diagnosed during pregnancy in the Maternity and Neonatal Center, Monastir-Tunisia, over the period 2004-2019. We collected data on 15 cases. The average age of patients was 34 years; most pregnancy-associated breast cancers (PABCs) had been diagnosed during the postpartum period. Invasive ductal carcinoma was the major histological type (93% of cases), a rare case of secretory breast carcinoma had been observed. The main clinical stages were T2 and T4 breast cancer. Hormone receptor (HR)-negative breast cancers had been reported in 40% of cases, HER2-positive breast cancers in 26.6% of cases. Treatment included surgery, radiotherapy, chemotherapy and palliative chemotherapy. The median overall survival was 32.2 months. Pregnancy-associated breast cancer is a rare entity. Patients' prognosis is generally poor due to the young age at onset and a usually delayed diagnosis. Patients should participate in therapeutic decision making, which is difficult and multidisciplinary. Targeted therapy is the great hope for new therapies.
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http://dx.doi.org/10.11604/pamj.2021.38.180.23108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077675PMC
May 2021

Cystic form of Actinomycotic mycetoma: A new case with a diagnostic challenge.

Clin Case Rep 2021 Apr 16;9(4):e04064. Epub 2021 Mar 16.

Department of Pathology Fattouma Bourguiba University Hospital Monastir Tunisia.

Mycetoma, commonly known as Madura foot, is a chronic granulomatous infection caused either by fungi (eumycetoma) known as actinomycete. This disease occurs preferentially in young adults, and it affects the foot in particular. We report a Tunisian case of mycetoma occurring in an old patient, particular by its cystic presentation.
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http://dx.doi.org/10.1002/ccr3.4064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077338PMC
April 2021

"Generalized exanthematous pustular dermatophytid" in a 4-year-old child: A misdiagnosed entity.

Indian J Dermatol Venereol Leprol 2021 Mar-Apr;87(2):249-252

Department of Dermatology Fattouma Bourguiba Hospital, Monastir, Tunisia.

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http://dx.doi.org/10.25259/IJDVL_1036_18DOI Listing
December 2018

Giant recurrent liposarcoma of the retroperitoneum - A surgical challenge: A case report.

Int J Surg Case Rep 2020 12;77:486-489. Epub 2020 Nov 12.

Department of Urology, Hospital Taher Sfar, 5100, Mahdia, Tunisia.

Introduction: Sarcomas are a rare entity with heterogeneous clinical behavior. We herein present the case of a giant retroperitoneal dedifferentiated liposarcoma and aim to remind the clinical, histological, and therapeutic features of this rare tumor.

Presentation Of Case: An 80-year-old patient was complaining of significant abdominoscrotal swelling. On physical examination, a 25-cm swelling extending from the right iliac fossa to scrotums, was observed. CT scan revealed a retroperitoneal fatty mass with necrotic areas. Ultrasonography-guided biopsy was carried. Pathological report demonstrated a dedifferentiated sarcoma. An en bloc resection of the tumor was performed through a right iliac incision extended to the scrotum. After one year of follow up, the patient had a 30-cm local recurrence. After complete resection, the patient died two days after the procedure due to neurological distress.

Discussion: 'Giant' liposarcomas over 20kg are extremely rare. CT-Scan and MRI are very useful for defining their size and limits. The resection of a retroperitoneal sarcoma of remarkable size is a challenge for the surgeon owing to the anatomical site that makes it hard to obtain safe margin and to the adherences with the contiguous organs. Dedifferentiated histologic subtypes and negative surgical margins are associated with poor prognosis. This explains the high rate of local recurrence after surgical excision.

Conclusion: In rare cases, retroperitoneal dedifferentiated liposarcomas can extend through the inguinal canal to the scrotum. Surgical resection obtaining negative margins, remains the curative treatment that reduces the risk of recurrence. Careful follow-up to detect early recurrence is essential for optimal care.
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http://dx.doi.org/10.1016/j.ijscr.2020.11.051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7700956PMC
November 2020

High grade transformation of adenoid cystic carcinoma in the palate: Case report with review of literature.

Int J Surg Case Rep 2021 Jan 13;78:162-166. Epub 2020 Dec 13.

Department of Pathology, Fattouma Bourguiba University Hospital of Monastir, 5000, Tunisia; Faculty of Medecine, University of Monastir, 5000, Tunisia. Electronic address:

Introduction: Adenoid cystic carcinoma (ACC) is a rare tumor developed in minor salivary glands, the palate being the most common site.

Case Presentation: Here, we report a case of a 58-year-old man with a 3-year-growing swelling in the right palate diagnosed with high grade transformation adenoid cystic carcinoma. The exam revealed a 4 cm large mass. A tumor resection with a radical neck dissection was performed.

Discussion: High grade transformation in adenoid cystic carcinoma is recently described by Cheuk et al. in 1999. This transformation has more aggressive behavior than conventional solid ACC and has usually been associated with recurrences, early distant metastasis, and greater mortality.

Conclusion: The aim here is to highlight clinical, histopathological, therapeutic and prognostic aspects of high-grade transformation in ACC with literature review.
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http://dx.doi.org/10.1016/j.ijscr.2020.12.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7753240PMC
January 2021

Inflammatory myofibroblastic tumor of the lung: A rare entity.

Respir Med Case Rep 2020 11;31:101287. Epub 2020 Nov 11.

Pulmonology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia.

Inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal tumor usually seen within the first and second decade. They are extremely rare in adults, constituting less than 1% of adult lung tumors. It's usually benign, but it had a tendency for local recurrence. We report a case of asymptomatic inflammatory myofibroblastic tumor of lung in a 46-year-old non-smoker woman.
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http://dx.doi.org/10.1016/j.rmcr.2020.101287DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7683262PMC
November 2020

Clinical and Dermoscopic Features of an Extradigital Glomus Tumor of the Back.

Dermatol Pract Concept 2020 Oct 26;10(4):e2020077. Epub 2020 Oct 26.

Department of Dermatology, CHU Fattouma Bourguiba, Monastir, Tunisia.

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http://dx.doi.org/10.5826/dpc.1004a77DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588152PMC
October 2020

Incidentally diagnosed hydatid cyst of uterus.

Eur J Obstet Gynecol Reprod Biol 2020 Dec 16;255:267-268. Epub 2020 Oct 16.

Department of Pathology, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia; Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia.

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http://dx.doi.org/10.1016/j.ejogrb.2020.10.029DOI Listing
December 2020

Simultaneous bilateral spontaneous pneumothorax as the first manifestation of primary pulmonary MALT lymphoma.

Pan Afr Med J 2020 3;37:11. Epub 2020 Sep 3.

Pneumology Department, Fattouma Bourguiba Hospital of Monastir, Avenue Farhat Hached, Monastir 5000, Tunisia.

Primary pulmonary lymphoma is a rare entity. Furthermore, simultaneous bilateral spontaneous pneumothorax (SBSP) is a very rare condition which is often related to therapeutic complications. We present, to the best of our knowledge, the first case of primary pulmonary mucosa associated lymphoid tissue (MALT) lymphoma revealed by SBSP. A 50-year-old female was diagnosed with organizing pneumonia. One month later, she presented with sudden chest pain and shortness of breath due to SBSP. Bilateral chest tubes were inserted. A scan- guided right lung biopsy led to the diagnosis of primary pulmonary MALT lymphoma. The patient was treated with R-CHOP chemotherapy. The association between lymphoma and pneumothorax is extremely rare, often related to therapeutic toxicity. We report the case of SBSP as the first manifestation of primary pulmonary MALT lymphoma.
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http://dx.doi.org/10.11604/pamj.2020.37.11.24494DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532852PMC
January 2021

An unusual presentation revealing Peutz-Jeghers syndrome in adult.

Ann Med Surg (Lond) 2020 Oct 1;58:87-90. Epub 2020 Sep 1.

Department of Pathology, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia.

Introduction: Peutz-Jeghers syndrome (PJS) is a rare hereditary disease characterized by hyperpigmentation on the lips and oral cavity and gastrointestinal hamartomatous polyps. The most common complications in PJS patients are bleeding, bowel obstruction and intussusception.

Presentation Of Case: We hereby report a case of a 33-year-old female, without a family history of the disease, who presented to the emergency room with acute abdominal pain, bloating and not passing gas. On abdominal examination, upper abdominal and periumbilical tenderness was found. Computed tomography (CT) of the abdomen demonstrated suspected ascending colon intussusception. The patient underwent a mid-line laparotomy that showed an ileocolic intussusception. Reduction of this intussusception was successfully done with resection of the affected segment that showed presence of two pedunculated polyps. The specimen was sent thereafter to our department for histopathological evaluation, which confirmed the diagnosis of hamartomatous Peutz-Jeghers polyps with no malignancy. Afterwards, the patient was carefully reexamined and the physical examination revealed multiple pigmented spots on the face and lips. Thus, the diagnosis of Peutz-Jeghers syndrome was made.

Discussion: PJS is a rare autosomal dominant disorder that often remain undiagnosed for many years. Acute complications such as intestinal obstruction secondary to intussusception is one of infrequent revealing symptoms.

Conclusion: Early identification, in patients with PJS and family members, as well as close cancer surveillance can improve certainly prognosis in these individuals.
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http://dx.doi.org/10.1016/j.amsu.2020.08.034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7486423PMC
October 2020

Primary pancreatic tuberculosis mimicking pancreatic body cancer. A case report and review of the literature.

Ann Med Surg (Lond) 2020 Oct 29;58:80-83. Epub 2020 Aug 29.

Department of Digestive Surgery, Fattouma Bourguiba University Hospital, Monastir, Tunisia.

Isolated pancreatic tuberculosis (PT) is an extremely rare disease, with non-specific clinical characteristics, making the diagnosis often challenging with pancreatic cancers. Here we report a case of a 36-year-old female, who was admitted to our hospital after suffering from a 3-month history of epigastric abdominal pain, night sweats and weight loss. The physical examination was normal. The radiological findings revealed the presence of a pancreatic mass and multiple abdominal lymphadenopathy, suggestive of malignancy. The initial differential diagnosis suspected was pancreatic tuberculosis. Tuberculosis skin test was performed and was highly positive (>22 mm). Computed tomography (CT)-guided biopsy of peripancreatic lymph node was carried out and the histopathological exam confirmed the diagnosis of PT. Therefore, anti-tuberculous therapy was initiated, leading to clinical and radiological improvement. The diagnosis of PT is rare and can sometimes be misleading. It should be considered when a pancreatic mass is observed, especially in endemic countries, to ovoid unnecessary interventions.
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http://dx.doi.org/10.1016/j.amsu.2020.08.040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7486414PMC
October 2020

[Breast cancer treated with primary chemotherapy: predictive factors for radical treatment (retrospective study of 72 cases)].

Pan Afr Med J 2020 10;36:174. Epub 2020 Jul 10.

Department of Gynecology and Obstetrics, Fattouma Bourguiba University Hospital, Monastir, Tunisia.

Neoadjuvant chemotherapy has become the first-line treatment for locally advanced breast cancers. On the one hand, it allows for increasing options of breast conservation without an increased risk of recurrence, on the other hand it allows for locoregional control of patients with inoperable cancer. However, some clinical, radiological and histological factors are associated with an increased risk of mastectomy, such as microcalcifications, multifocality, SBR1 and 2 grade, cT3 and cT4 stages and overexpressed HER2. The purpose of this study was to determine the predictive factors for mastectomy after neoadjuvant chemotherapy (NAC), whether mastectomy was justified or not histologically and what were the predictors for unjustified mastectomy. We conducted a retrospective study of 72 patients with breast cancer treated by neoadjuvant chemotherapy in the Departments of Gynecology and Medical Oncology at the Fattouma Bourguiba Hospital in Monastir, Tunisia. The rate of conservative treatment was 18.1%; 63.15% for stage T2 tumors. Mastectomy was not justified by definitive histologic diagnosis in 26.3% of cases. In our study, unjustified mastectomy predictors were negative RH status and CT2 stage. This study led to reflection on our practice and its modifications. Conservative surgery should be considered as standard therapy and should be routinely suggested to all patients treated with neoadjuvant chemotherapy for breast cancer, including the cases with multifocality, large clinical tumor size, extensive microcalcifications, in order to significantly reduce the number of unjustified mastectomies.
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http://dx.doi.org/10.11604/pamj.2020.36.174.24036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7467888PMC
January 2021

Sarcoma undifferentiated (unclassified) fusiform cell type of mesentery: a case report and literature review.

Pan Afr Med J 2020 26;35:58. Epub 2020 Feb 26.

Department of Gynecology and Obstetrics, University Hospital of Monastir, Monastir, Tunisia.

Sarcomas are a heterogeneous group of malignant tumors that come from mesenchymal tissues. Undifferentiated sarcoma represents approximately 20% of soft tissue sarcomas. This entity represents approximately 20% of soft tissue sarcomas. These tumors are subdivided according to their appearance. Morphological in 4 subtypes: pleomorphic cells, fusiform cells, round cells, epithelioids. We report the case of a 72-year-old woman operated for a complicated adnexal tumor, but it turned out that it was sarcoma undifferentiated (unclassified) fusiform cell type of mesentery. It is a rare and a latent tumor. Its diagnosis is histological. Its treatment consists on surgical wide excision if possible. This type of sarcoma has a poor prognosis considering the limited benefits of radio-chemotherapy. Undifferentiated sarcoma type fusiform cells of the mesentery is an exceptional entity. Its diagnosis is difficult. Its treatment is to discuss case by case, surgery is the best option if it is possible. The prognosis is bad. This entity remains to be studied.
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http://dx.doi.org/10.11604/pamj.2020.35.58.17749DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7250212PMC
December 2020

Thyroid metastasis revealing a lung adenocarcinoma.

Respir Med Case Rep 2020 16;30:101065. Epub 2020 May 16.

Pulmonology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia.

Thyroid metastasis revealing a primary lung cancer is an extremely rare condition. Only few cases have been reported in the literature. A multidisciplinary approach is essential for the diagnosis. The prognosis is generally poor. We report a case of a 50-year-old man presented with cervical nodules corresponding to a thyroid nodule and lymph nodes. The ultrasonography-guided fine-needle aspiration cytology of the thyroid nodule and a cervical lymphadenopathy concluded to a poorly differentiated adenocarcinoma. Cervical lymphadenopathy biopsy with immunohistochemistry and additional imaging explorations contributed to the diagnosis of a lung adenocarcinoma stage IVB. He died few days after the diagnosis.
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http://dx.doi.org/10.1016/j.rmcr.2020.101065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7256324PMC
May 2020

IGF1 polymorphisms and colon cancer risk in Tunisian population.

Tunis Med 2020 Jan;98(1):60-69

Background: Insuline-like growth factor I (IGF1) is a peptide growth factor that promotes cell proliferation and inhibits apoptosis.

Aim: To examine the association of genetic variants in IGF1 (rs12423791, rs1019731, rs5742632, rs2033178 and rs2373722) with risk of colon cancer in Tunisia.

Methods: The study included 76 formalin-fixed paraffin embedded primary colorectal carcinomas and paired normal colon. The five IGF1 polymorphisms were determined by polymerase chain-restriction fragment length polymorphism (PCR-RFLP).

Result: A significant differences in genotypes and alleles frequency of the five examined IGF1 polymorphisms was determined between tumor and healthy tissues of colon cancer patients (P<0,01). While, no significant association was found between genetic variation in IGF1 variants and clinic-pathological parameters in tumors tissues. Expect for rs2373722, a statistically significant correlation was detected between tumor localization and the presence of the (A) mutated allele (OR=0,49; 95% CI 0,25-0,99; P=0,03).

Conclusion: This analysis shows that IGF1gene polymorphisms rs12423791, rs1019731, rs5742632, rs2033178 and rs2373722 are associated with the risk of colon cancer in Tunisian population.
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January 2020

Sudden Death Due to a Cerebellopontine Angle Epidermoid Cyst: Case Report.

Am J Forensic Med Pathol 2020 Jun;41(2):128-130

From the Departments of Forensic Medicine and Laboratory of Research LR12SP14.

Epidermoid cyst of the brain is a rare benign embryonal tumor. It has an excellent prognosis because of its slow-growing nature. Clinically, symptoms are variable and depend on the location of the cyst. Sudden death may occur as a result of lethal complications because of the tumor growth, but it is still rare. In this article, we present a rare case of sudden unexpected death of a 58-year-old man, with no neurologic history, due to an epidermoid cyst of the brain diagnosed at autopsy.
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http://dx.doi.org/10.1097/PAF.0000000000000548DOI Listing
June 2020

Sudden death due to left ventricular thrombosis: A report of two autopsy cases.

J Forensic Leg Med 2020 Apr 29;71:101934. Epub 2020 Feb 29.

Department of Forensic Medicine - Teaching Hospital of Monastir (Tunisia) - Faculty of Medicine, Tunisia. Electronic address:

Purpose: In this paper, we report two rare cases of sudden death due to giant left ventricular thrombus revealed at autopsy and we discuss the manner and the cause of death.

Results: Cases presentation: The two cases reported are about two men aged 55 and 53 years respectively. In the two cases, no past cardiac history was found. Prior to the onset of complications and subsequent death, both patients presented to the emergency department with progressing asthenia, faintness and shortness of breath, were treated symptomatically. At autopsy, atherosclerosis of coronary arteries was found. In the first case, death was attributed to thrombosis of the pseudoaneurysm. In the second case, it was due to thrombosis complicating a myocardial infarction. The mechanism of death in the first case was explained by the hemodynamic shock caused by a total left ventricular pseudoaneurysm thrombosis secondary to old myocardial infraction. In the second case, death was the consequence of a cardiogenic shock secondary to thrombosis of the cardiac pseudoaneurysm complicating a myocardial infraction.

Conclusion: Complications of myocardial infarction represent frequent causes of adult sudden death. Left ventricular thrombosis is a complication that is often fatal and its discovery during an autopsy remains rare. The first-line doctor must take these types of complications into consideration in order to detect them and thus ensure timely management.
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http://dx.doi.org/10.1016/j.jflm.2020.101934DOI Listing
April 2020

IGF1 polymorphisms and colon cancer risk in Tunisian population.

Tunis Med 2019 Dec;97(12):1407-1414

Background: Insuline-like growth factor I (IGF1) is a peptide growth factor that promotes cell proliferation and inhibits apoptosis.

Aim: To examine the association of genetic variants in IGF1 (rs12423791, rs1019731, rs5742632, rs2033178 and rs2373722) with risk of colon cancer in Tunisia.

Methods: The study included 76 formalin-fixed paraffin embedded primary colorectal carcinomas and paired normal colon. The five IGF1 polymorphisms were determined by polymerase chain-restriction fragment length polymorphism (PCR-RFLP).

Result: A significant differences in genotypes and alleles frequency of the five examined IGF1 polymorphisms was determined between tumor and healthy tissues of colon cancer patients (P<0,01). While, no significant association was found between genetic variation in IGF1 variants and clinic-pathological parameters in tumors tissues. Expect for rs2373722, a statistically significant correlation was detected between tumor localization and the presence of the (A) mutated allele (OR=0,49; 95% CI 0,25-0,99; P=0,03).

Conclusion: This analysis shows that IGF1gene polymorphisms rs12423791, rs1019731, rs5742632, rs2033178 and rs2373722 are associated with the risk of colon cancer in Tunisian population.
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December 2019

Clear cell gynecologic carcinomas: about 5 cases.

Pan Afr Med J 2019 14;34:87. Epub 2019 Oct 14.

Department of Gynecology and Obstetrics, El Omrane Hospital of Monastir, Monastir, Tunisia.

Clear cell carcinoma (CCC) can simulate yolk sac tumor if the location is ovarian. In this case, the morphological distinction between these tumors is often difficult, but immunohistochemistry, the determination of CA125, of alpha fetoprotein (AFP) and the response to chemotherapy are particularly useful for solving this differential diagnosis problem. Endometrial and vaginal localization is even rare and appears to be related to distilbene uptake for vaginal localization. Whatever the gynecological location, CCC seems to have a poor prognosis. We report 5 cases of gynecological CCC including 1 case of vaginal carcinoma, 1 case of endometrial carcinoma and 3 cases of ovarian carcinoma. The definitive pathological examination concluded with the CCC diagnosis for all cases. Our purpose is to report these rare cases, their diagnosis, prognosis and therapeutic management.
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http://dx.doi.org/10.11604/pamj.2019.34.87.18505DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6945664PMC
January 2020

Rare case of cavernous hemangioma of the thymus.

Respir Med Case Rep 2020 14;29:100986. Epub 2019 Dec 14.

Pulmonology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia.

Cavernous hemangioma (CH) of the thymus is an extremely rare congenital venous malformation. Related symptoms are non-specific and patients are often asymptomatic. The diagnosis is difficult to make either by non-invasive or mini-invasive procedures. Surgical resection is usually required for diagnosis and treatment. We report a case of a 46-year-old men with an incidental finding of an anterior mediastinal tissue mass on chest computed tomography scan. A complete surgical resection of the mass was performed. Histopathological examination concluded to a thymic CH.
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http://dx.doi.org/10.1016/j.rmcr.2019.100986DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6928372PMC
December 2019

[Diagnostic and therapeutic features of invasive lobular carcinoma of the breast: a study of 30 cases].

Pan Afr Med J 2019 4;34:70. Epub 2019 Oct 4.

Service de Gynécologie Obstétrique, Centre de Maternité et Néonatologie de Monastir, Tunisie.

Invasive lobular carcinoma (ILC) of the breast accounts for 5-15% of breast cancers. It is classified as the second most frequent histological type after non-specific invasive cancer (NSIC) and its prevalence has seen a marked increase. Clinical and radiological diagnosis is difficult. Usually, this cancer develops bilaterally and more slowly than non-specific invasive cancer, with best prognostic factors. The purpose of our study was to describe in detail the clinical, radiological, therapeutic and prognostic features of invasive lobular carcinoma. We conducted a retrospective descriptive study of 30 cases with ILC of the breast whose data were collected at the Center of Maternity and Neonatology, Monastir over a period of 10 years. The prevalence of ILC was 5.2%. The average age of patients was 53.43 years. Ten percent of patients had a personal history of benign mastopathies, 6.66% had a personal history of breast cancer and 3.33% had a family history of breast cancer. Late-stage diagnosis was made in 18 cases. Bifocal mass was found in 5 patients, multifocal mass in 4 patients and bilateral mass in 3 patients. Only one patient had liver metastasis at the time of diagnosis. Radical mastectomy (Patey) was immediately performed in 63.33% of patients. Anatomo-pathological examination showed multifocal lesions in 44.80% of cases. Lymph node dissection was satisfactory in 21 patients; 28 patients (93.33%) underwent radiotherapy and adjuvant hormonal therapy. Five-year overall survival was 77.3%.
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http://dx.doi.org/10.11604/pamj.2019.34.70.18780DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6884720PMC
December 2019

Primary adenoid cystic carcinoma of the tracheobronchial tree: report of two cases.

Pan Afr Med J 2019 8;34:137. Epub 2019 Nov 8.

Pulmonology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia.

Adenoid cystic carcinoma (ACC) is a rare malignant epithelial tumor that predominantly originates in the salivary glands. Primary ACC of the tracheobronchial tree is extremely rare. We report two new cases of central airways primary ACC: a 58 year-old male with an ACC of the left main bronchus who underwent a pneumonectomy with node dissection, and a 52 year-old female with proximal tracheal ACC presenting as asthma treated by surgical resection and a postoperative radiotherapy. Primary ACC of the tracheobronchial tree is often misdiagnosed given the non-specific clinical presentation. An early diagnosis is essential to ensure good outcomes. An interdisciplinary treatment is required based especially on surgery and radiotherapy.
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http://dx.doi.org/10.11604/pamj.2019.34.137.14902DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7906545PMC
March 2021

Fetal Rhabdomyomatous Nephroblastoma in a 31-Year-Old Woman: A Case Report.

Urology 2019 Nov 9;133:e5-e6. Epub 2019 Aug 9.

Department of Pathology, Fattouma Bourguiba Hospital, Monastir, Tunisia.

Fetal rhabdomyomatous nephroblastoma (FRN) is a rare variant of Wilms tumor with distinct morphologic features and biologic behavior compared to conventional nephroblastoma. It mainly occurs in patients under 4 years. In adults, extremely rare cases of nephroblastoma were reported. Among these cases, none has been interested a FRN. We report an exceptional case of a 31-year-old woman diagnosed with FRN discovered incidentally, to illustrate clinical and histopathological characteristics of this entity.
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http://dx.doi.org/10.1016/j.urology.2019.07.033DOI Listing
November 2019
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