Schwannomas are benign tumors mostly arising from the head and neck. Retroperitoneal schwannomas are rare as only 0.7–2.6% of schwannomas occur in the retroperitoneal space, and approximately 1–6% of retroperitoneal tumors are schwannomas. Most retroperitoneal schwannomas are benign; approximately 1.2% of cases are malignant. They are diagnosed in patients with an average age of 48 years with mild female predominance. Given the large loose areolar space available in the retroperitoneum, tumors in this location often present late with vague complaints related to compression of surrounding structures and often develop degenerative changes inside them. Size at diagnosis is usually large with a median of 9cm. Imaging is not specific and diagnosis remains histological. In lights of the two observations, we will discuss the clinical, radiological and pathological features of this tumor. We report two cases of retroperitoneal schwannoma in a 17 year-old man and a 39 year-old woman. In the first case, the patient had a two years lasting mass of the left flank. The second patient consulted for a lower back pain. The radiological examination showed a retroperitoneal mass. Macroscopically, these masses were nodular, well defined, measuring respectively 8.5 and 12 cm with a firm, yellowishcut-section. Histological examination showed, in both cases, fusocellular, encapsulated proliferation made of a compact spindle cells component with focal nuclear palisadingwhich was altering with a loosely textured, histiocyte-rich component. There were numerous thick-walled vessels with fibrinoid and hyaline changes as well as a marked lymphoid infiltrate. Foci of ischemic necrosis were noted in the first case but without atypia or increased mitotic activity. Both tumors were stained positively and strongly with S100 protein. Diagnosis of benign retroperitoneal schwannomas was made. Retroperitoneal schwannoma was rare and preoperative diagnosis was difficult. Most of retroperitoneal schwannoma were benign and the surgical treatment was the first choice.

La tumeur myofibroblastique inflammatoire est une tumeur dont le contexte clinicobiologique et histologique prête souvent à confusion avec un processus d’origine infectieuse. Plusieurs aspects sont encore obscurs notamment les circonstances de survenue. Nous rapportons trois cas cliniques dans un contexte de post-partum (précoce dans deux cas et lointain dans un cas), celle d’une patiente de 28 ans qui présentait à j1 du post-partum un psoïtis gauche dans un contexte fébrile et chez laquelle une tumeur myofibroblastique inflammatoire de siège mésovarien était découverte. L’autre patiente, âgée de 40 ans, présentait à j4 du post-partum un état de choc hémorragique secondaire à la rupture d’un hématome sous capsulaire du foie et chez laquelle la tumeur myofibroblastique inflammatoire se localisait au foie gauche. Le troisième cas concernait une patiente de 32 ans qui avait présenté, cinq mois après son accouchement, une tumeur myofibroblastique inflammatoire pulmonaire ayant été opérée mais ayant récidivé dix ans après la chirurgie. Ces cas cliniques illustrent la survenue possible des tumeurs myofibroblastiques inflammatoires dans le cadre particulier du post-partum et mettent l’accent sur les difficultés de diagnostic dans ce contexte.

BACKGROUND:Gastric heterotopia is a rare congenital lesion, described everywhere in the body, but involves predominantly the digestive tract. Diagnosis is based on histologic examination and requires the presence of gastric mucosa, especially fundic. This diagnosis is usually easy, but sometimes it can be misinterpreted as gastric metapalsia . This latter is an acquired and frequent lesion of the gastrointestinal tract.AIMS:To determine the relationship between this affection and the other digestive malformations, to describe the clinical characteristics and the evolution of this lesion and to discuss the differential diagnosis particularly the gastric metaplasia.METHODS:Twelve cases of gastric heterotopia were diagnosed over a 12-year period at Habib Thameur Hospital. Clinical data was obtained and all the slides were reviewed.RESULTS:Nine cases were found in Meckel's diverticulum (75%), one case in intestinal duplication, one case in the esophagus and another in the gallbladder. The mean age of patients at diagnosis was 16 years with a peak of incidence at the first decade of life. Intestinal obstruction and digestive bleeding were the most presenting features. Heterotopic gastric mucosa complicates other congenital anomalies such as common mesentery, vestigial polyp of the liver, appendiceal agenesis and heterotopic pancreas. Differential diagnosis consists in gastric metaplasia was found extensively in a patient with Crohn's disease associated with Meckel's diverticulum.CONCLUSION:Gastric heterotopia is frequently associated with congenital anomalies especially with Meckel's diverticulum and digestive duplication. Diagnosis relies on histology, mainly on finding heterotopic fundic glands in normal organizational structure. Sometimes, differentiating between gastric heterotopia and gastric metaplasia requires clinical confrontation.

La métaplasie oncocytaire du nasopharynx est une lésion exceptionnelle dont l’étiopathogénie, longuement débattue, reste à ce jour controversée. Le but de ce travail est de présenter les caractéristiques épidémiologiques et cliniques de cette lésion, d’en étudier la pathogénie ainsi que la prise en charge. Nous rapportons deux cas survenus chez des femmes âgées respectivement de 53 et 60ans. La première présentait une irritation pharyngée et auriculaire. L’examen endoscopique révélait un bombement irrégulier de la paroi postérieure du cavum. La seconde patiente consultait pour un bourdonnement d’oreille, une otalgie gauche et une hypoacousie bilatérale. L’examen endoscopique révélait un tympan remanié des deux côtés. À l’histologie, une métaplasie oncocytaire focale de la muqueuse rhinopharyngée était observée dans les deux cas. L’évolution chez les deux patientes était favorable après biopsie-exérèse. La métaplasie oncocytaire du nasopharynx semble être liée à la stimulation des fibres nerveuses neuropeptidiques sympathiques dont les cibles sont les cellules épithéliales, conjonctives, endothéliales et lymphoïdes.

The inflammatory myofibroblastic tumour has clinical, biological or histological features sometimes misleading with a septic condition. Presenting symptoms are variable and arising circumstances remain obscure. We report three cases occurring in a postpartum context. The first patient, a 28-year-old female, had left psoitis with a sepsis the first day postpartum in relation with an inflammatory myofibroblastic tumour of the meso-ovary. The second patient, a 40-year-old woman, had a hepatic inflammatory myofibroblastic tumour revealed by a ruptured sub-capsular haematoma of the liver in the forth day postpartum. The third patient, a 32-year-old woman, had a pulmonary inflammatory myofibroblastic tumour, diagnosed 5 months after a delivery and which recurred 10 years after surgical treatment. These cases illustrate the difficulty to diagnose inflammatory myofibroblastic tumour, particularly in postpartum.

Oncocytic metaplasia of the nasopharynx is an exceptional lesion which exact etiopathogenesis, although largely discussed, still remain controversial. The purpose of this paper is to present the epidemiological characteristics and clinical signs of this lesion and to study its pathogenesis and its therapeutic modalities. We report two cases that occurred respectively in a 53- and 60-year-old woman. The first presented with pharyngeal dysesthesia and otalgia. The endoscopic examination revealed an irregularity of the posterior wall of the nasopharynx. The second patient presented with tinnitus, discomfort of the left ear and bilateral hearing loss. Endoscopic exam revealed a bilateral structural abnormality to the eardrum. Microscopy showed focal oncocytic metaplasia of the nasopharynx mucosa in both cases. There was a positive outcare for both patients after excisional biopsy. Oncocytic metaplasia seems to be in relation to the stimulation of sympathic neuropeptidergic nerve fibers which target epithelial, connective, endothelial and lymphoid cells. (C) 2011 Elsevier Masson SAS. All rights reserved.

BACKGROUND:The salivary gland tumors are rare (less than 3% of all tumors) and poorly known. In fact, they are numerous and histologically difficult to diagnose.AIM:This work aims to point at the different histological types of salivary gland tumors, to draw out the principal epidemiological, clinical, radiological and histological characteristics, and to compare our cases to those of the literature.METHODS:Accordingly, we performed a descriptive type study about 180 cases of salivary gland tumors from the departments of pathology and oto-rhino-laryngology of Habib Thameur hospital during 25 years, extending from April 1979 to December 2004.RESULTS:Benign tumors were predominant (88%), while malignant ones represented 12% of our cases dominated by carcinomas. The sex-ratio was 0.96. Parotid gland location was the most frequent one, and pleomorphic adenoma was the most frequent tumor (62%).CONCLUSION:Histological diversity of salivary tumors results in difficulties for differential diagnosis. These problems can be solved by a precise diagnostic approach and sometimes by an immunohistochemistry study.

Le carcinome indifferencie primitif des glandes salivaires est rare. Son association avec le virus Epstein Barr, initialement decrite chez les esquimaux, est retrouvee dans la majorite des cas publies. Nous rapportons un nouveau cas tunisien survenu chez un homme age de 64 ans, revele par une tumefaction de la glande parotide gauche. Microscopiquement se discutait le caractere primitif ou secondaire de la tumeur, etaye par les examens complementaires. Le patient etait traite par une parotidectomie suivie d’un curage ganglionnaire et d’une radiotherapie. L’evolution etait favorable apres un an de recul. Mots clès : Glande salivaire- Carcinome indifferencie- Virus Epstein Barr

Pleuropulmonary blastoma is a dysontogenetic neoplasm of childhood, histologically characterized by a primitive variably mixed blastematous and sarcomatous appearance. It presents a pattern of rapid growth and is associated with a poor prognosis. We report the case of a 13-month-old girl, consulting for wheezing, dyspnea and loss of appetite. Chest X-ray revealed a mediastinal deviation with a clear appearance of the right lung. Computed tomography showed a voluminous emphysematous bulla of the right lung and atelectasis of the lower lobe. The final diagnosis was made on the basis of histological features of a cystic tumour, showing blastematous elements associated with sarcomatous compound confirming the diagnosis of pleuropulmonary blastoma type I. Subsequent chemotherapy was performed. Four years after the operation, the child is well with no evidence of disease recurrence or metastasis.