Histopathological diagnosis of arrhythmogenic right ventricular cardiomyopathy: A review of three autopsy cases

INTRODUCTION

Arrhythmogenic right ventricular cardiomyopathy is an underdiagnosed myocardial disease which commonly presents with sudden cardiac death in young people. It is considered as a challenge for forensic pathologist due to its pathological changes. Here, we presented three cases of postmortem diagnosis of arrhythmogenic right ventricular cardiomyopathy with involvement of other subtypes.

CASE REPORT

Here, we report autopsy cases of sudden cardiac death as the first clinical manifestation observed in three patients with different ages and with no medical history, nor previous family history of sudden death or heart diseases. The postmortem investigations were performed and the diagnosis of arrhythmogenic cardiomyopathy with three expression forms was later confirmed by histopathological examination, this latter showed fibroadipose tissue infiltrations of the myocardium. The diagnosis of arrhythmogenic cardiomyopathy was discussed with review through the literature.

CONCLUSION

We presented special characteristic and histopathology features of arrhythmogenic cardiomyopathy cases, discovered in our usual forensic practice. This may be helpful for forensic pathologists to make a reliable diagnosis even in the absence of clinical history.

Primary carcinoma of the larynx in females: A case series

Background and aim

In north Africa, laryngeal carcinomas remain a predominately male pathology. While in many countries the gap between men and women is narrowing. This study aimed to examine the epidemiological, clinical, therapeutic, and follow up data of a case series of 23 female patients treated for laryngeal carcinoma.

Patients and methods

Medical records of a case series of 23 patients for primary carcinoma of the larynx at the Department of Head and Neck Surgery of the 20 August Hospital of Casablanca, between January 2012 and September 2016, were reviewed. Demographic, clinical, endoscopic, radiological, surgical, and follow-up data were collected.

Results

7% of all the patients treated for LC were women, The most affected age group was between 60 and 79 years (52%), 52% had no major risk factor, all patients had an epidermoid carcinoma, 48% of patients had T2 tumors. T1, T3, and T4a were found in respectively 17%, 22%, and 13%. N1 in 43% of the cases (n = 10), N0 in 35% (n = 8), N2b in 17% (n = 4), N2c in 4% (n = 1). All patients were M0. All the patients in this series have undergone surgical treatment. At 5 years, the survival rate was 83%.

Conclusion

Since the proportions of women in published studies are limited, there are still many controversies about gender differences in laryngeal cancer. Therefore, further studies should seek a clearer understanding of factors involved in female laryngeal cancer to adopt more appropriately the measures of prevention and early diagnosis.

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Larynx cancer is among the neoplasms with greatest gender differences found in most populations worldwide.

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Controversies and limited studies about gender differences in laryngeal cancer.

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Many studies emphasize that its impact seems to be higher for female patients as opposed to males.

AB0794 CONTRIBUTION OF LABIAL SALIVARY GLAND BIOPSY: EXPERIENCE OF THE DEPARTMENT OF RHEUMATOLOGY OF THE UNIVERSITY HOSPITAL OF IBN ROCHD (ABOUT 57 CASES)

Background:

Labial salivary gland biopsy (LSGB) is a histological examination indicated for the diagnostic workup of systemic diseases such as Sjogren’s syndrome, amyloidosis, or sarcoidosis.

Objectives:

To study the contribution of LSGB to the diagnosis of Sjogren’s syndrome, amyloidosis, and sarcoidosis.

Methods:

We conducted a retrospective study of LSGB histopathological reports and clinical data of patient medical records collected in the Department of Rheumatology of the University Hospital of Ibn Rochd, Casablanca, between January 2019 and June 2020. Histology assessed Chisholm and Masson’s sialadenitis score, looked for amyloidosis, and sarcoidotic granulomas.

Results:

A total of 57 LSGBs were performed, of which 2 were excluded from our study because of lack of clinical data. The sex-ratio M/F was 0.1, and the median age was 53 (22 – 85). The indications were subjective eyes and mouth dryness in 40% of cases, the search for sarcoidosis and amyloidosis in 23.6% of cases, the assessment of a dryness syndrome in the context of chronic inflammatory rheumatism in 18.2% of cases, isolated dryness of the mouth in 14.5% of cases, and the search for amyloidosis in the context of a known primary Sjögren syndrome in 3.6% of cases. The stages of Chisholm and Masson for sialadenitis found were: stage I at 56.6%, stage II at 24.5%, stage III at 11.3%, and stage IV at 7.5%. Among the LSGBs performed for dryness syndrome, stages III and IV were found in 18.2% of cases among subjective eyes and mouth dryness, in 12.5% of cases among isolated mouth dryness, and in 20% of cases among chronic inflammatory rheumatisms. Three cases of AA amyloidosis (5.5%) were diagnosed. No sarcoidosis granulomas were found.

Conclusion:

LSGB is a simple and frequent investigation. The Chisholm stage most often found in our series was stage I, followed by stages II, III, and IV respectively. This is consistent with the results of the study of Baeteman et al (1). In addition, amyloidosis was only found in our series in 5.5% of cases, also matching with the results of Baeteman et al. (4.2%). Their study showed that LSGB has a great diagnostic interest in these two pathologies, with a sensitivity of 52-75% and a specificity of 90-100% for Sjogren’s syndrome, and a sensitivity of 48-80% and a specificity of 93-100% for amyloidosis (2). LSGB remains a simple investigation test, contributing to the diagnosis of Sjogren’s syndrome, amyloidosis, and sarcoidosis.

References:

[1]Baeteman C, Guyot L, Bouvenot J, Chossegros C, Cheynet F, Loudot C, et al. Faut-il encore effectuer des biopsies des glandes salivaires accessoires? Revue de Stomatologie et de Chirurgie Maxillo-faciale. 2008 Jun;109(3):143–7.

[2]Scardina GA, Spanó G, Carini F, Spicola M, Valenza V, Messina P, et al. Diagnostic evaluation of serial sections of labial salivary gland biopsies in Sjögren’s syndrome. Med Oral Patol Oral Cir Bucal. 1 déc 2007;12(8):E565-568.

Disclosure of Interests:

None declared

Human immunodeficiency virus (HIV) and coronavirus disease 2019; impact on vulnerable populations and harnessing lessons learnt from HIV programmes

Coronavirus disease 2019 (COVID-19) can act as a dual prong attack against management of people living with human immunodeficiency virus (HIV); it induces harm on both individual and national levels. People living with HIV may show rapid deterioration in severe acute respiratory syndrome coronavirus 2 infection as a result of physiological or psychological vulnerability. Additionally, the spread of COVID-19-especially in low- and middle-income countries-may limit HIV control measures, delivery and linkage to HIV care and prevention. Attention should be given to pregnant women and the LGBTQI+ community for their higher susceptibility to poor outcomes. Engagement of both governmental and non-governmental organizations is encouraged for better results.

HIV epidemic in the Maghreb. Magnitude, trend and management

Over the last two decades, many progress has transformed the profile of HIV infection and improved the survival and quality of life of people living with HIV (PLHIV). In addition to individual benefits, antiretrovirals allow through viral suppression to prevent HIV transmission. The dual benefit, curative and preventive, of antiretrovirals has propel HIV testing at the forefront of the global Fast Track strategy as principle access to care and prevention. In the Maghreb countries, these achievements are impeded by a number of barriers that limit access for PLHIV, especially key populations and vulnerable populations, to appropriate care and prevention services. In order to achieve the global goals of Fast Track strategy, policy makers need to implement high-impact interventions to facilitate access to HIV testing, improve referral to care, strengthen adherence and retention to care. This can be achieved through mobile and community-based testing to target key populations, and innovative approaches such as partner notification and HIV self-testing. The establishment of robust links to care centers ensures rapid initiation of antiretrovirals in order to achieve viral suppression. Morever, these goals can be achieved by removing barriers to access to HIV testing and care. This is include specific interventions based on the respect of human rights, the fight against stigma and discrimination, the review of legislation limiting the legal age for access to voluntary testing and the removal of punitive laws against key populations.

[Cerebral primitive osteosarcoma, a radiological and histological atypia]

INTRODUCTION

Osteosarcoma is a malignant mesenchymal tumor including cells that present an osteoblastic differentiation. On the skull, it has often extra-axial development associated with bone reaction. We report an atypical and rare case of intracranial or cerebral osteosarcoma underline the radiological and pathological diagnostic difficulties.

CASE REPORT

Our case concerns a primary osteosarcoma without bone involvement in a 10-year old boy who was admitted for intracranial hypertension with progressive worsening and brachial monoparesis. Subtotal resection was performed but the postoperative course was not favorable. The child died five months after the initial surgery. Its radiological aspect prompted us evoke several diagnoses including glioma or meningioma. On the histological level, osteosarcoma, especially with poorly differentiated cells, can be deceiving with other processes, including a gliosarcoma that was revealed by simple microscopic reading before being confirmed by an immunohistochemical study.

CONCLUSION

In the absence of any bone reaction or known extra-cranial location, it can be difficult to suggest the diagnosis of osteosarcoma based on imagery alone. Immunohistochemistry is essential for an accurate diagnosis.

[Maxillary cementoblastoma. A case report]

Cementoblastoma is a rare benign odontogenic neoplasm. Its cause is unknown. It represents less 6 % of all odontogenic tumors. The aim of our work is to present a rare case of maxillary cementoblastoma involving an included central incisor. A 32-year old man consulted for a left maxillary swelling to projection under nostril. A panoramic radiographic examination revealed an included tooth 21 with a radiopaque lesion around its root. The computed tomography revealed the included tooth 21 with a process around its root. This process is well-defined, high-dense and is surrounded by a radiolucent halo. The treatment should consist of complete removal of the lesion with the tooth 21. Histological examination concluded to the diagnosis of a cementoblastoma. The cementoblastoma occurs most frequently in young persons and predominantly among men. The mandibular premolar and molar are the more frequently reached. The maxillary localization remains rare. This tumor occurs around the roots of the posterior and lower teeth. Radiographically, the lesion is well-defined and attached to the root of the tooth, radiopaque dense and surrounded by a radiolucent halo. The cementoblastoma evolves slowly and has the tendency to blow the cortical. The prognosis is good.

Neuropathie périphérique au cours du lupus érythémateux disséminé avec vascularite épineurale et anticorps antiphospholipides

Neurological manifestations of systemic lupus erythematosus are frequent and polymorphic. Their frequency varies according to authors (24-75p.cent). Central nervous system complications predominate; peripheral features are rare, classically symmetrical polyneuropathy, multiple mononeuropathies or cranial nerve involvement. We report a case of a 48-year-old woman presenting a histologically documented sensitivo-motor polyneuropathy with severe motor involvement complicating lupus associated with antiphospholipides antibodies. Outcome was good after cyclophosphamid pulse. We discuss the frequency of peripheral involvement in systemic lupus erythematosus, pathogenic mechanisms, therapeutic possibilities and outcome of this complication.

[Nephroblastoma in adults. Three case reports]

The authors report three nephroblastoma's cases occurred in adult and treated at Ibn Rochd Oncology Center at Casablanca. The average of age was 24 years (19-29 years) and the delay of diagnosis was five months (3-8 months). The most frequent clinical sign was a lumbar fossa mass. At diagnosis, radiological exams revealed that patients presented an advanced stage and metastatic disease in one case. The treatment was a total nephrectomy with ganglioma dissection when the tumor was resectable followed by chemotherapy and radiotherapy. Two patients was in progressive disease despite treatment, and one patient was lost at follow-up. The prognosis of adult's nephroblastoma remains very severe, due to the advanced stage at diagnosis and the mediocre reply to the treatment.

Rhabdomyosarcome para vertebral : cause rare de compression medullaire

Le rhabdomyosarcome est la tumeur maligne mésenchymateuse la plus fréquente chez l’enfant. Il se voit essentiellement au niveau des extrémités et la sphère ORL. La localisation paravertébrale avec compression médullaire est beaucoup plus rare. Les auteurs rapportent un cas de rhabdomyosarcome paravertébral avec extension endocanalaire et compression médullaire. Il s’agit d’une fille âgée de 6 ans admise pour un tableau de compression médullaire. L’examen clinique retrouve une patiente paraplégique avec niveau sensitif T8, des réflexes ostéo-tendineux abolis et une contracture des muscles paravertébraux. L’IRM médullaire montre un processus tissulaire à point de départ musculaire paravertébral droit, de signal hétérogène avec extension intra-canalaire et compression médullaire. La patiente a eu une laminectomie avec biopsie chirurgicale. L’étude histologique a posé le diagnostic d’un rhabdomyosarcome alvéolaire. La patiente a été traitée par chimiothérapie suivie d’une radiothérapie. L’IRM de contrôle a montré une régression totale du processus tumoral. Après un recul d’une année, la patiente a présenté une récidive locale avec métastases pulmonaires. Malgré cette localisation rare, le rhabdomyosarcome doit être évoqué devant un processus paravertébral avec extension épidurale et compression médullaire chez l’enfant.Mots clés : Rhabdomyosarcome, IRM, compression médullaire.