[Undifferentiated Carcinoma of the Nasopharynx in Dakar, an Area Supposed to be Non-Endemic: about 13 Cases]

Undifferentiated carcinoma of the nasopharynx (UCNT) has variable incidence throughout the world. Senegal is supposed to be a non-endemic zone. There is a constant connection with the Epstein-Barr virus. In this work, the authors study and discuss the pathological aspects of undifferentiated carcinoma of the nasopharynx in 13 cases. They also seek to make the link between this cancer and the presence of an Epstein-Barr virus infection in these patients. This is a retrospective series of cases involving patients with UCNT, diagnosed on histological basis in Dakar and confirmed by immunohistochemistry. An EBV search was performed on these cases through in situ hybridization by the EBER probe. 15 cases diagnosed on histological basis were able to benefit from immunohistochemistry, and 13 cases were confirmed, ie 87%. The mean age was 28.37 years with extremes of 5 and 56 years. The male sex predominated, with a sex ratio of 8/3. The macroscopic lesions were of ulcerous-budding type for cases revealed by a mass of the cavum. The histological aspect resulted in a proliferation of atypical undifferentiated cells, with large, clear, strongly nucleated nuclei, with eosinophilic cytoplasm, scarcely abundant. The stroma was of the lymphoid type. In situ hybridization with the EBER probe showed moderate or intense diffuse scarring of the tumor cells for 10 cases, ie 77%. The number of cases noted in our study taking into account the period of 10 years considered, is indicative of the rare nature of this type of cancer in Dakar. While globally, Epstein-Barr Virus is consistently associated with UCNT, for some of our cases we have not been able to highlight EBV, suggesting the possible involvement of other risk factors, such as HPV.

[Laryngeal Tuberculosis Diagnosed in a Pathological Laboratory in Senegal (2011-2015)]

Laryngeal tuberculosis (LT) is a rare disease. The therapy for LT is easy but the diagnosis remains a challenge for the pathologist and the laryngologist because of the absence of specific signs. The objective was to analyze the epidemiological and pathological profiles of LT cases in Dakar (Senegal) with a view to better understand this pathology. This study was a retrospective and descriptive of LT cases diagnosed in pathology laboratories in Senegal during five years (2011-2015). The LT was found in 9 cases. The mean age at diagnosis was 41.9 years (18/58) without sex predominance (sex-ratio = 0.8). Tobacco intoxication (3/9), tuberculosis contagion (1/9), HIV immunodepression (2/9), and diabetes (1/9) were the various risk factors found. Dysphonia was a constant symptom (9/9) associated with dysphagia (2/9) and cervical adenopathy (1/9). The macroscopic presentation was tumoral-like (7/9) and erythematosus and fibrinoid (2/9). The LT was of glottic seat in all the cases (9/9) with participation on top-glottic in two of the cases. The biopsy was performed in all patients. It reported tuberculous granuloma in four cases (4/9), tuberculoid granuloma in one case (1/9), and chronic lymphocytic laryngitis in four cases (4/9). CT-scan of the lungs was pathological in five patients (5/9). Evolution was favorable in all cases under "conventional tuberculosis treatment" over a period of six months. The diagnosis of LT requires a high collaboration between the laryngologist and the pathologist.

Cervical Cancer: What Vaccine in Senegal?

Introduction: Cervical cancer (CC) is first cancer in terms of frequency and mortality among women in Senegal. This is a public health problem hence the urgency of preventive measures including vaccination. The choice of the vaccine cannot be made on strictly financial factors, nor on the results of the others studies, but should take into account the prevalence and distribution of HPV in the CC in Senegal. We conducted this study with the aim of determining the distribution of the genotype of the different types of HPV found in the CC in Senegal and propose a vaccine for Senegal. Methods: It was a retrospective and descriptive study carried out in cooperation with the molecular and radiobiology institute of Lyon. Sixty paraffin-embedded tissue blocks were chosen by a simple random method on 1015 blocks of CC diagnosed in pathology laboratories of public hospitals of Senegal. In Lyon, the total DNA of the tumor genome was extracted and amplified according to the multiplex PCR technique using primers MY09-MY11, GP5 + and GP6 +. β-globin was used as an internal control. Results: Of the 60 paraffin blocks examined, DNA extraction was unsatisfactory in 4 cases. HPV-HR infection was present in all other tumors. It was a monoinfection in 33 cases (59%) and a multi-infection in 23 cases (41%). In total, of the 56 validated cases, 89 HPV-HR were identified by the PCR-multiplex technique. HPV 16 and 18 accounted for about 70% of all HPV implicated in the CC in Senegal. The other HPV types found are HPV 45 (9), HPV 35 (5), HPV 58 (5), HPV 39 (3), HPV 66 (2), and one case of HPV 31, 33, 51, 59, 68. In 51 patients (91.1%), HPV 16 or 18 was at least one of the viruses involved. Conclusion: The involvement of HPV in CC was first reported by German virologist Harold Zur Hausen in 1980. Several studies have subsequently corroborated this association by finding a stronger binding of HPV to CC than that of tobacco to lung cancer. In 1996, the WHO recognized HPV-HR as the leading cause of CC. There is a variable distribution of HPV in the literature according to geographical and ethnic criteria. In Senegal, as almost everywhere else, HPV 16 and to a lesser degree HPV 18 represent the two major viruses involved in carcinogenesis of the cervix. Of twelve identified viral genotypes, HPV 16 and HPV 18 account for nearly 70% of viral infections and are involved in more than 90% of CC cases. At present, there are three types of vaccines: Cervarix (HPV 16, 18), Gardasil (HPV 6, 11, 16, 18) and Gardasil 9 (HPV 6, 11, 16, 18, 31, 33, 45, 52, 58). The authors recommend the use of Cervarix in the cancer plan of Senegal. They also advise a better sexual education to control the infection and especially the multi-infection found in 40% in the CC in Senegal. Finally, they emphasize that vaccination is not exclusive of screening but rather should accompany it.

[Pathological profiles of retinoblastoma in Senegal]

OBJECTIVES

Describe the macroscopic and microscopic profiles of retinoblastoma (RB) in Senegal and correlate histological criteria with progression to establish severity factors.

METHODOLOGY

We realized a retrospective study over 10 years (January 2005-December 2014). Only patients (n=67) who underwent histological analysis of the enucleation specimen (n=68) were followed until the end of the study.

RESULTS

The tumor measured an average of 3.8cm (2/4.5). Endophytic tumor development was observed in 55 cases (80.8%), exophytic in 6 cases (8.9%) and mixed in 7 cases (10.3%). Retinal detachment was present in 13 cases (19.2%). The RB was well differentiated in 11 cases (16.2%), moderately differentiated in 31 cases (45.6%) and undifferentiated in 26 cases. Optic nerve (ON) invasion was present in 18 cases (26.5%). The tumor was extraretinal in 37 cases (54.4%). The anterior chamber was invaded in 6 cases (8.8%). The global survival at 2 years was 84% and 70% at 5 years. On multivariate analysis, well differentiated tumors and stage pT1 were associated with remission. Retrolaminar ON invasion, massive choroidal invasion and stage pT3 were risk factors for recurrence. Poor tumor differentiation, invasion of the ON resection margin, tumor invasion through the sclera, and stage pT4 were predictive of death.

CONCLUSION

The pathologist is a principal actor in the management of RB because his account guide the post-surgical management strategy.

[Human papilloma viruses: other risk factor of head and neck carcinoma]

Head and neck carcinoma (HNC) occupy the sixth place as the most frequent type of cancer worldwide. Next to alcohol and tobacco intoxication, other risk factors (RF) are suspected, including the human papilloma viruses (HPVs). The aim of this study was to highlight the prevalence of HPVs and histo-epidemiological characteristics of HNC HPV+ in Senegal. This is a prospective, multicenter preliminary study of 18 months (January 1, 2012-June 30, 2014). The cases of HNC histologically confirmed in Senegal were then sent to the bio-pathology department of the Curie Institute in Paris to search HPVs. In the 90 included cases, the PCR technique was successful in 54 cases (60%). HPVs were found in seven cases, that is, a prevalence of 13%. HPVs were associated with 5 cases of hypopharyngeal carcinoma and 2 cases of carcinoma of the oral cavity. Patients with HNC HPV+ had a median age of 42 years against 49 years for HPV-patients. Three patients (42.8%) with HPV+ carcinomas were smokers. Of the 47 HPV-patients, 40 patients (87.1%) had alcohol intoxication and/or smoking. The concept of oral sex was refuted by all our patients. Squamous cell carcinoma was the only histological type found. HPV+ cell carcinoma showed no specific histological appearance. HPVs are another certain RF of HNC in Senegal. The major therapeutic and prognostic impact of HPVinduced cancers requires the systematic search of the viruses by the PCR technique.

[NK/T-cell Lymphoma of nasal-type: A rare affection with a poor prognosis]

INTRODUCTION

NK/T cell lymphoma of nasal-type was described in 1933 as a malignant midfacial granuloma. The diagnosis of this rare affection is clinical and immunohistopathological. We report a case of NK/T cell lymphoma diagnosed at an advanced stage.

OBSERVATION

A 60-year-old man with no particular medical history presented since seven months with a left nasal obstruction associated with a purulent and fetid rhinorrhea followed by a centrifugal midfacial necrosis. Blood tests showed an inflammatory syndrome. The CT-scan of the face showed a filling of the nose and sinus by a tissular process and a lysis of the bone walls. Three series of biopsies (le last being performed under general anesthesia) were necessary to get the diagnosis of NK/T cell lymphoma. The standard histology showed a malignant proliferation made of round and spindle-shaped lymphoid-like cells and angiocentric arrangement. The cells were CD 2+, CD 3+, CD 5+ and CD 56+. The spontaneous evolution was fatal one month after diagnosis in a context of septic shock.

CONCLUSION

NK/T cell lymphoma of nasal-type is a rare disease but should be evocated in patient with midfacial necrosis of centrifugal evolution. The diagnosis certainty is made on immunohistopathological analysis. Multiple biopsies, made at distance from necrotic areas and under general anesthesia may be necessary.

[Inflammatory pseudo-tumor of the bladder expelled through the urethral meatus in a girl]

Inflammatory pseudo-tumors of the bladder are rare benign tumors that mostly arise in the differential diagnosis of sarcomas in children. The authors report an unusual case of pedunculated inflammatory pseudo-tumor of the bladder that externalized by the urethral meatus in a 13-year-old girl. The treatment consisted of a ligation-resection of the pedicle, followed by resection of the tumor. After regular follow-up for 18 months there was no tumor recurrence.

[Appendicitis schistosomiasis: unusual lesion about two cases in Senegal]

Appendiceal schistosomiasis is a rare disease of only histopathological diagnosis. Appendectomy should be followed by treatment with praziquantel to avoid complications. We report two cases of appendiceal schistosomiasis while discussing the place of this infection in the pathogenesis of appendicitis. Finally we recommend a routine pathological examination of any part of appendectomy for better care for patients.

Solitary neurofibroma originating from the posterior nasal septum: Transnasal endoscopic resection

INTRODUCTION

The head and neck region is one of the locations of neurogenic tumors such as neurofibroma. Although mostly associated with neurofibromatosis, it can be solitary. The present study reports a very rare case of solitary neurofibroma originating from the posterior nasal septum.

CASE PRESENTATION

A 48-year-old female presented with tumor in the right nasal cavity. The tumor, originating in the posterior nasal septum, extended to the posterior sinuses and nasopharynx. Following endoscopic and radiological assessment, the tumor was resected by transnasal endoscopic surgery. Histological examination showed the tumor to be a neurofibroma. At 14months' follow-up, there was no recurrence.

DISCUSSION AND CONCLUSIONS

However rare, solitary neurofibroma must be considered in the differential diagnosis of unilateral benign tumor involving nasal and paranasal sinuses. A transnasal endoscopic approach should be considered for treatment.

Diabetes Burden in Urban and Rural Senegalese Populations: A Cross-Sectional Study in 2012

Diabetes represents a challenging global health issue in the 21st century. Data from sub-Saharan African populations are scarce and are usually restricted to urban settings. The objective of this study was to compare prevalence and risk factors of diabetes in rural and urban areas in Senegal. Methods. In a community-based survey between January and May 2012, we included 1027 adults aged ≥18 years living in northern Senegal. Sociodemographic, clinical, and biological data were collected during household visits. Multivariate logistic regression was performed to identify factors associated with diabetes. Results. Mean age of participants was 48.0 ± 16.9 years and 65.7% were female. Participants from urban area represented 55.7%. The age-standardized prevalence of diabetes was 7.6% (6.0% in men versus 9.0% in women). Prevalence of diabetes was higher in urban areas (8.1%) compared to rural areas (4.6%). Disease awareness rate was 43%. After multivariate analysis, age (OR = 1.63, p = 0.001), familial history of diabetes (OR = 1.42, p = 0.001), and abdominal obesity (OR = 1.17, p = 0.05) were associated with diabetes. Conclusion. Diabetes is frequent in urban and rural areas in Senegal. Awareness rate is very low among populations. Age, family history of diabetes, and abdominal obesity are the main risk factors identified.

[Management of prostate cancer in Senegal: what is being done?]

OBJECTIVE

To evaluate the management of patients with prostate cancer in Senegal.

MATERIALS AND METHODS

We performed a retrospective descriptive study, based on the medical records of patients managed for prostate cancer during a period of six years and a half from January 1, 2004, to June 30, 2010. All records of inpatients and outpatients managed for prostate cancer were collected. Data collection was performed through a standardized survey form, and included the following parameters: age, presence or absence of known history of prostate cancer in siblings, circumstances of discovery, clinical and paraclinical examination, histology and therapeutic modalities.

RESULTS

We studied the records of 164 patients with prostate cancer. The mean age of our patients was 65years, ranging from 43 to 96years. The circumstances of diagnosis were mostly due to lower urinary tract symptoms. Digital rectal examination was suggestive in 87% of cases, and PSA levels were high in 100% of cases, ranging from 5.88ng/ml to 21,660ng/ml, with a mean of 1447.57ng/ml. Half of the patients had PSA levels greater than or equal to 100ng/ml. The most common histological type was adenocarcinoma. During the study period, 49 radical prostatectomies were performed. The mean PSA levels of patients who underwent a prostatectomy were 23.4ng/ml. Radical retropubic prostatectomy was performed in 35 patients, and radical perineal prostatectomy was performed in 10 cases. Pulpectomy was the method most commonly used in metastatic prostate cancer; it was performed in 48 patients. After resistance to castration, antiandrogens were reintroduced in 13 patients, and diethylstilbestrol in four patients. Only two patients underwent a taxane-based chemotherapy regimen.

CONCLUSION

The diagnosis of prostate cancer was usually tardive in Senegal. Treatment often involves surgical castration. Prostatectomy was only very seldom indicated.

La fracture de verge à Dakar. À propos de 25 cas

Buts

Présenter les caractéristiques épidémiologiques, cliniques et thérapeutiques des fractures de verge dans le service d’urologie-andrologie de l’hôpital général de Grand Yoff de Dakar.

Matériels et méthode

Il s’agit d’une étude descriptive portant sur 25 cas de fracture de verge pris en charge dans le service d’urologie-andrologie de l’hôpital général de Grand Yoff de Dakar entre janvier 2001 et décembre 2011. Les paramètres suivant ont été étudiés: l’âge, la résidence, les antécédents, les données cliniques, les données de l’exploration chirurgicale et les résultats du traitement.

Résultats

En dix ans, 25 cas de fractures de verge ont été enregistrés soit une moyenne de 2,5 cas par an. L’âge moyen de survenue était de 36 ans avec des extrêmes de 22 et 60 ans. Les circonstances de survenue sont dominées par les manipulations forcées (52 %) et les rapports sexuels (32 %). La douleur associée à une latérodéviation controlatérale de la verge, une tuméfaction localisée de la verge ou extensive à la région sus-pubienne ou périnéale sont les principaux signes retrouvés. Une prise en charge urgente (délai moyen de prise en charge de deux heures avec des extrêmes de 45 minutes et 48 h) en milieu chirurgical avec réparation des corps caverneux et albuginorraphie a été la règle.

Conclusion

La fracture de verge est une urgence urologique relativement peu fréquente dans notre contexte. Son diagnostic reste aisé et est essentiellement clinique. Une prise en charge précoce et correcte en milieu chirurgical est garante d’un bon résultat fonctionnel et esthétique.

[Renal bilharzioma: A case report]

Renal bilharzioma is an exceptional localization that occurs as a complication of urogenital bilharzioma. The authors report the case of a renal bilharzioma, in a 7-year-old patient, being considered as a nephroblastoma. The investigations revealed a large abdominal mass with solid component. She underwent neoadjuvant chemotherapy and radical nephrectomy. The histological examination of the specimen concluded to renal bilharzioma. The authors underline the difficulty of differential diagnosis with nephroblastoma. The diagnosis is often made after surgery by histological examination of the specimen.