Primary mucinous thyroid carcinoma (PMTC) are extremely rare lesions that are histologically indistinguishable from mucinous carcinoma of other sites. We describe the clinicopathological, histological and immunohistochemical features of this rare tumour with a review of the literature. We describe a case of thyroid tumour, in 56-year-old Tunisian man, composed of small nests and sheets of malignant epithelial cells associated with extensive extracellular mucin that entrapped the follicular parenchyma of thyroid. Thyroglobulin and thyroid-specific-transcription factor 1 (TTF1) were focally positive. Follow-up did not reveal another neoplasm at other sites. Based on these features, we classified this tumour as PMTC. Mucinous carcinoma of the thyroid gland can be a cause of pitfall in differential diagnosis. For correct diagnosis, complete clinical history, restricted histological criteria and immunohistochemical panel are necessary.

This study assessed the human epidermal growth factor receptor-2 (HER2) protein expression in urothelial bladder carcinoma and its relationship with p53 and p63 expression. In 151 patients, paraffin-embedded tissues of transurethral resection or cystectomy were evaluated by immunohistochemistry (IHC), using antibodies against HER2, p53 and p63. HER2 overexpression (score 3+), p53 overexpression and decreased expression of p63 were detected in 14 (9.3%), 48 (31.8%) and 58 (38.4%) tumors, respectively. HER2 overexpression, p53 overexpression and decreased expression of p63 were associated with high tumor grade (p=0.0002, p=0.0002 and p=0.046, respectively) and advanced TNM stage (p=0.017, p=0.012 and p=0.001, respectively) of urothelial bladder carcinoma. In univariate analysis HER2 overexpression was significantly associated with decreased expression of p63 (p=0.037). In multivariate analysis, only tumor grade was correlated with HER2 overexpression (p=0.006). In this study, HER2 is overexpressed in 9.3% of urothelial bladder carcinomas. HER2 overexpression was strongly correlated with tumor grade but not with TNM stage, p53 and p63. The development of target therapies using anti-HER2 and the identification of patients which who benefit from those therapies need further studies.

Objectifs. – Le carcinome épidermoïde hypopharyngé est associé à un pronostic défavorable, auquel l'envahissement ganglionnaire cervical et les métastases à distance contribuent. L'objectif de cette étude était d'évaluer la fréquence, le mode et la signification pronostique de ses métastases régionales et à distance.Patients et méthodes. – Les auteurs rapportent une étude rétrospective portant sur 271 carcinomes épidermoïdes de l'hypopharynx, colligés au service de chirurgie carcinologique cervicofaciale et ORL de l'institut Salah-Azaïz de 1977 à 2002. La fréquence et les caractères histocliniques des métastases régionales et à distance ont été évalués, ainsi que leur signification pronostique chez les 155 patients traités dans un but curatif.Résultats. – 39,1 % des cancers étaient classés N0, 24,4 % N1, 10,7 % N2 et 25,8 % N3 (UICC 2002). Les adénopathies cervicales étaient significativement plus fréquentes pour les tumeurs classées T3T4 que pour les T1T2 (soit, pour les tumeurs des sinus piriformes, celles de la région rétrocricoaryténoïdienne, celles de la paroi postérieure et celles étendues de l'hypopharynx, respectivement : p = 0,001, p = 0,007, p = 0,047, et p = 0,0005). Trente-deux patients ont bénéficié d'un évidement ganglionnaire cervical. Parmi ceux dont le cancer a été classé N0, il a été trouvé 46,9 % d'atteintes ganglionnaire (N+) ; les fréquences de la rupture capsulaire n'étaient pas significativement différentes pour les cancers classés N0N1 et pour ceux qui étaient N2N3 (p = 0,11). Les taux de survie globale à deux et à cinq ans étaient respectivement de 32,5 et 20,5 % pour les patients dont la tumeur était classée N0, 10,9 et 0 % si elle était N3. Les différences de taux de survie à deux et à cinq ans entre les patients dont la tumeur était N0N1 et ceux dont elle était N2N3 étaient significatives (p = 0,04). Un échec ganglionnaire cervical a été constaté chez 18,5 % des patients. Le site tumoral n'influençait pas significativement le taux d'échec ganglionnaire (p = 0,98), non plus que le statut clinique N (p = 0,34). La rupture capsulaire était un facteur significatif de prédiction d'un échec ganglionnaire (p = 0,007). Le taux de dissémination métastatique à distance était de 2,6 % au premier examen, et secondairement de 12,3 %. Les métastases à distance étaient significativement plus fréquentes chez les patients dont le cancer était initialement classé N2N3 que chez ceux dont il était N0N1 (p = 0,03), ainsi qu'en cas de rupture capsulaire (p = 0,0009).Conclusion. – Le carcinome épidermoïde de l'hypopharynx est caractérisé par une grande lymphophilie, qui est liée à l'extension locale, et par la grande fréquence des métastases ganglionnaires occultes. Le statut clinique ganglionnaire ne semble pas influencer la probabilité de survie ; cependant, la rupture capsulaire constitue un facteur de prédiction d'un échec ganglionnaire cervical et de métastases à distance. Les métastases à distance sont fréquentes, particulièrement en cas de tumeur étendue aux plans local ou régional, et la probabilité de survie est dans ce cas nulle à un an.Purpose. – Lymph nodes and distant metastases contribute to the poor prognosis of hypopharyngeal squamous cell carcinoma. The purpose of this study is to estimate the frequency, mode and prognosis factors related to regional and distant metastasis.Patients and method. – The authors' report is based on a retrospective study concerning 271 hypopharyngeal squamous cell carcinoma, compiled in the service of Surgery of Head and Neck Cancers of the Salah-Azaïz Institute (1977–2002). Frequency and histoclinical characters of cervical and distant metastases have been assessed, as well as their prognosis factors among 155 patients treated in a curative purpose.Results. – 39.1% of the tumours were classified N0, 24.4% N1, 10.7% N2 and 25.8% N3 (UICC 2002). The cervical nodal invasion was significantly more frequent for the classified tumors T3T4 than for the T1T2 (for pyriform sinus, postcricoid esophagus, posterior wall, and total hypopharynx, respectively : P =0.001, P =0.007, P =0.047 and P =0.0005). A cervical lymphatic evidement was preferred in thirty two patients. Among N0, 46.9% were N+; The frequencies of the capsular effraction were not significantly different for the N0N1 from for the N2N3 (P =0.11). The two and five years survival rates were respectively 32.5 and 20.5% for N0, and 10.9% and zero for N3. The survival differences after two and five years between the N0N1 and the N2N3 were significant (P =0.04). A regional failure was noticed for 18.5% of the patients. The tumoral site did not influence significantly the rate of nodal failure (P =0.98), neither the clinical status N (P =0.34). Capsular effraction was a significant factor for the regional failure (P =0.007). Distant metastasis significantly occured more frequently among the patients initially classified N2N3 than those classified N0N1 (P =0.03), and in case of capsular effraction (P =0.0009).Conclusion. – Hypopharyngeal squamous cell carcinoma has a hight rate of lymph nodes metastasis, correlated to the local extension, and a high rate of occult nodal metastasis. Lymph node clinical status does not seem to have influenced the patients survival ; however, capsular effraction constitutes a major prognosis factor of regional failure and distant metastasis. Distant metastases are frequent, particularly in case of wide local and regional tumoral extension.

Cardiac hyclaticyst is a rare condition and accounts for only 0.5 to 2% of all visceral locations of hydatid disease. The objective of this study was to point out the main clinical, radiological, and disease-course characteristics of this rare and serious pathology. We report a 13-year-old patient with a hydatid pulmonary embolism caused by a hydatid cyst of the interauricular septum. The diagnosis was established by transthoracic echocardiography, thoracic CT scan, and hydatid serology. Surgery was performed without delay and the outcome was good after 15 months of follow-up. This case underlines the need for rapid diagnosis and surgery before complications of cardiac hydatid cyst. (C) 2011 Elsevier Masson SAS. All rights reserved.

Une surexpression protéique en immunohistochimie (IHC) et/ou une amplification génique en hybridation in situ (HIS) de HER2 (human epidermal growth factor receptor 2) a été détectée dans 4 à 28 % des cancers gastriques ou de la jonction œsogastrique (JOG). La plupart des études ont montré que les cancers gastriques surexprimant HER2 étaient de plus mauvais pronostic. Le trastuzumab est un anticorps monoclonal humanisé dirigé contre HER2 qui a été démontré efficace chez des patientes atteintes d'un cancer du sein précoce ou métastatique HER2+. L'essai randomisé international ToGA a montré la supériorité de l'association trastuzumab à la bichimiothérapie par fluoropyrimidines (5-fluoro-uracile [5-FU] ou capécitabine) plus cisplatine (FP) toutes les trois semaines par rapport à la chimiothérapie seule en termes de survie globale : 13,8 vs 11,1 mois (HR : 0,74 ; IC 95 % : [0,60-0,91] ; p = 0,004 6) dans les cancers gastriques ou de la JOG avancés HER2+. Le bénéfice était encore plus important dans le sous-groupe (16 % de la population screenée) avec une surexpression HER2 définie comme IHC3+ ou IHC2+ confirmée par un test d'HIS. Le trastuzumab plus la chimiothérapie FP est maintenant un standard chez les patients avec un adénocarcinome gastrique ou de la JOG métastatique non prétraité surexprimant HER2. Tous ces cancers doivent être testés pour HER2 sur bloc en paraffine de pièce opératoire ou de biopsies de la tumeur primitive ou de métastases. Les biopsies endoscopiques gastriques doivent être multiples. L'IHC doit être le test initial. Le score standardisé d'IHC est différent de celui recommandé pour les cancers du sein, compte tenu de l'hétérogénéité du marquage HER2 et de la fréquence du marquage membranaire incomplet dans les cancers gastriques. Les tumeurs IHC2+ doivent être testées par HIS avec deux techniques possibles : sondes fluorescentes (fluorescent in situ hybridization [FISH]) ou non fluorescentes (BrISH [bright field in situ hybridization]). Les perspectives sont l'évaluation du trastuzumab en situation périopératoire ou adjuvante, le développement de nouveaux agents anti-HER2 et la recherche des mécanismes de résistance et de marqueurs moléculaires prédictifs.HER2 protein overexpression by immunohistochemistry (IHC) and/or erB2 gene amplification by in situ hybridization (ISH) was detected in 4-28% of gastric or gastro-oesophageal junction (GOJ) cancers. Most studies have shown that HER2-overexpressing gastric cancers were worse prognosis. Trastuzumab is a humanized monoclonal antibody directed against HER2 with known efficacy in patients with HER2+ early or metastatic breast cancer. The international randomized trial ToGA study showed the superiority of the combination of trastuzumab with chemotherapy doublet fluoropyrimidine (5-FU or capecitabine) plus cisplatin (FP) every three weeks compared with chemotherapy alone in terms of overall survival : 13.8 versus 11.1 months (HR: 0.74, 95% CI: 0.60-0.91, P = 0.0046) in HER2+ advanced gastric cancers. The benefit was even greater in the subgroup with HER2 overexpression (16% of the screened population) as defined by IHC3+ or IHC2+ confirmed by positive ISH test. Trastuzumab plus FP chemotherapy has become the standard treatment for patients with HER2+ non-pretreated metastatic adenocarcinoma of the stomach or GOJ cancer. All these cancers should be tested for HER2 on paraffin block resection or biopsy specimens of the primary tumour or metastases. Endoscopic gastric biopsies should be multiple. The IHC should be the initial test. The standardized immunohistochemical scoring system differs from that recommended for breast cancer given the heterogeneity of HER2 expression and the frequency of incomplete membranous staining in gastric cancers. Equivocal IHC2+ tumours should be tested by ISH with two tools: fluorescence in situ hybridization (FISH) or bright field in situ hybridization (SISH). The perspectives are the assessment of trastuzumab in the perioperative and adjuvant setting, the development of novel anti-HER2 drugs and research into mechanisms of resistance and predictive molecular markers.

Complex local crosstalk amongst endocrine cells within the islet ensures tight coordination of their endocrine output. This is illustrated by the recent demonstration that the negative feedback control by delta cells within pancreatic islets determines the homeostatic set-point for plasma glucose during mouse postnatal development. However, the close association of islet endocrine cells that facilitates paracrine crosstalk also complicates the distinction between effects mediated directly on beta cells from indirect effects mediated via local intermediates, such as somatostatin from delta cells.To resolve this problem, we generated reporter mice that allow collection of pure pancreatic delta cells along with alpha and beta cells from the same islets and generated comprehensive transcriptomes for each islet endocrine cell type. These transcriptomes afford an unparalleled view of the receptors expressed by delta, alpha and beta cells, and allow the prediction of which signal targets which endocrine cell type with great accuracy.From these transcriptomes, we discovered that the ghrelin receptor is expressed exclusively by delta cells within the islet, which was confirmed by fluorescent in situ hybridization and qPCR. Indeed, ghrelin increases intracellular calcium in delta cells in intact mouse islets, measured by GCaMP6 and robustly potentiates glucose-stimulated somatostatin secretion on mouse and human islets in both static and perfusion assays. In contrast, des-acyl-ghrelin at the same dose had no effect on somatostatin secretion and did not block the actions of ghrelin.These results offer a straightforward explanation for the well-known insulinostatic actions of ghrelin. Rather than engaging beta cells directly, ghrelin engages delta cells to promote local inhibitory feedback that attenuates insulin release. These findings illustrate the power of our approach to resolve some of the long-standing conundrums with regard to the rich feedback that occurs within the islet that is integral to islet physiology and therefore highly relevant to diabetes.

La connaissance des variations physiologiques des paramètres de la numération formule sanguine ainsi que des particularités cytologiques chez l'enfant en période néonatale, constitue un prérequis pour ne pas surestimer ou sous-estimer la présence d'anomalies quantitatives et qualitatives qui ne sont que le reflet de l'hématopoïèse particulière du nouveau-né et des différents stades de son développement. Savoir identifier rapidement les situations pathologiques peut s'avérer très utile pour aider les médecins à poser le bon diagnostic dans des situations cliniques parfois critiques pour le nouveau-né. En effet, d'une part les données de l'hémogramme sont profondément modifiées au cours des premières semaines et mois de vie, d'autre part, certaines pathologies héréditaires ou acquises se révèlent dès la période néonatale et la connaissance des répercussions hématologique et cytologique qui les accompagnent, apporte une aide précieuse dans la prise en charge de cette population particulièrement vulnérable.The challenge of hematologic problems in the newborn is still present. In the present article, the main cytological characteristics of the blood cells in healthy neonates as well as the physiological blood parameters variations at birth and during the first month of life of the newborn and the preterm neonates will be reminded. Indeed, the values of many hematologic variables change markedly in the first days, weeks and months of life and a good knowledge of normal reference values according to gestational age is required to enable the proper interpretation of blood count parameters. In the second part of this article, we will focus on the main morphological alterations of the red cell, platelet and leukocyte encountered in hereditary or acquired disorders with a neonatal revelation which can lead to ever more effective interventions of neonatalogists in this vulnerable population.

Les microcalcifications ne constituent qu’un signe indirect de processus pathologiques dont certains peuvent être reconnus sur la seule morphologie. C’est le cas des microcalcifications classées typiquement bénignes par la 4e édition du lexique BI-RADS, à l’exception des microcalcifications rondes et ponctiformes. C’est aussi le cas des microcalcifications fines polymorphes et fines linéaires plus souvent associées, mais pas exclusivement, aux carcinomes canalaires in situ (CCIS) avec nécrose. Pour les autres types de microcalcifications, d’autres paramètres interviennent dans une analyse plus globale : les signes associés cliniques ou mammographiques ; le contexte, surtout génétique ; la distribution spatiale ; le nombre ; l’évolution dans le temps. Le radiologue doit confronter les images à l’anatomie de l’unité terminale ducto-lobulaire, où naissent la plupart des cancers, et pondérer le risque par le contexte clinique et les antécédents.

Introduction. Squamous cell carcinoma ex-pleomorphic adenoma (CRAP) is a malignant and rare mixed tumor. We report a new case.Observation. A seventy-year-old woman consulted for a mass in the left hemi-face having evolved over the last 20 years. The physical examination revealed a hard and large tumor invading all the palate. Computed tomography revealed a heterogeneous 8.5 cm long maxillary mass. The diagnosis of CRAP was made oil a biopsy. A histological study confirmed the diagnosis after surgical resection of the tumor, specifying its noninvasive character.Discussion. CRAP is generally located in the parotid gland; it is very rarely located in the palate. The degenerated epithelial component generally corresponds to an adenocarcinoma or all undifferentiated carcinoma: squamous-cell carcinoma is more rarely reported. The prognosis is excellent for the micro and noninvasive types. Surgery remains the treatment of choice. (C) 2009 Elsevier Masson SAS. All rights reserved.

Several contributions have been suggested to estimate the assumed linear elastic settlement of foundations on columnar reinforced soils. A number of authors have considered the so-called Priebe's method, which has been extensively used worldwide, and they have made suggestions especially for soft clays reinforced by stone columns. This paper first offers a critical analysis of the semi-empirical Priebe method by pointing out some inconsistencies related to assumptions made and the theoretical derivation of the settlement formula. A discussion of the limitation of Priebe's method for settlement estimation of foundations on soft soil reinforced by stone columns, with respect to other methods is included. Second, a comparison has been undertaken between predictions by Priebe's method and other design methods for three stone column projects in which some in situ data were recorded. On the basis of the studied case histories, it is concluded that recourse to other available and simple methods of design is more suitable than the use of Priebe's method.

Prerequis: Rapporter les aspects histologiques de la maladie coeliaque chez une population pediatrique (âge<15 ans) du sud Tunisien. Methodes: Il s'agit d'une etude retrospective d'une serie de biopsies duodenales concernant 114 patients porteurs d'une maladie coeliaque, diagnostiquee sur une periode de 6 ans (Janvier 1999 a decembre 2004). La confirmation diagnostique reposait sur l'etude anatomopathologique des biopsies duodenales, couplee a des tests serologiques et sur une epreuve clinique au gluten. Resultats: L'âge moyen des patients etait de 6,2 ans (avec des extremes de 6 mois et 15 ans), le sexe ratio etait de 0,71. La symptomatologie clinique etait dominee par la diarrhee chronique (48%), le retard staturo-ponderal (50%) et l'anemie (20,1%). Histologiquement, une lymphocytose intra-epitheliale (stade 1) etait retrouve dans 12,2 % des cas, un stade 2 etait present dans 1,7 % des cas et un stade 3 (atrophie villositaire) dans 86% des cas. L'instauration d'un regime sans gluten etait indique pour tous les malades ; seuls les patients n'ayant pas presente une amelioration clinique (11 cas) avaient beneficie de biopsie de controle, l'atrophie villositaire etait persistante chez 80% de ces malades. Conclusion: L'etude histologique des biopsies duodenales constitue une etape essentielle pour le diagnostic et le suivi des patients porteurs d'une maladie coeliaque.

Several contributions have been suggested for estimating the assumed linear elastic settlement of foundations on columnar reinforced soils. Especially for soft clays reinforced by stone columns suggestions have been made by Priebe (1995), Dhouib et al., (2004) and Dhouib & Blondeau (2005). These latter publications considered the so-called Priebe method which is extensively used worldwide. The paper aims to give a critical analysis of the semi-empirical Priebe method by firstly pointing out some inconsistencies related to assumptions made and the theoretical derivation of the settlement formula. The limitation of the Priebe method in settlement estimation of foundations on soft soil reinforced by stone columns, with respect to other methods, is discussed. Secondly, after presenting recorded in situ data of stone columns projects, a comparison between predictions by the Priebe method and other design methods is undertaken. Based on studied case histories, it is illustrated that the recourse to other simple methods of design is more suitable than the use of Priebe method.

INTRODUCTION:Squamous cell carcinoma ex-pleomorphic adenoma (CXAP) is a malignant and rare mixed tumor. We report a new case.OBSERVATION:A seventy-year-old woman consulted for a mass in the left hemi-face having evolved over the last 20years. The physical examination revealed a hard and large tumor invading all the palate. Computed tomography revealed a heterogeneous 8.5cm long maxillary mass. The diagnosis of CXAP was made on a biopsy. A histological study confirmed the diagnosis after surgical resection of the tumor, specifying its noninvasive character.DISCUSSION:CXAP is generally located in the parotid gland; it is very rarely located in the palate. The degenerated epithelial component generally corresponds to an adenocarcinoma or an undifferentiated carcinoma; squamous-cell carcinoma is more rarely reported. The prognosis is excellent for the micro and noninvasive types. Surgery remains the treatment of choice.

Le carcinome a` petites cellules (CPC) de la vessie est une tumeur rare repré-sentant 0,5 % de l’ensemble des tumeurs vésicales, elle est hautement agressive. Elle est caractérise é par un potentiel métastatique très important. Sa prise en charge est multidisciplinaire associant la chirurgie et la chimiothérapie et parfois la radiothérapie afin d’améliorer le pronostic de la maladie et la survie des patients.