BRAFV600E hot spot mutation in thyroid carcinomas: first Moroccan experience from a single-institution retrospective study

BACKGROUND

The incidence of thyroid cancer is increasing worldwide at an alarming rate. BRAF^V600E mutation is described to be associated with a worse prognostic of thyroid carcinomas, as well as extrathyroidal invasion and increased mortality.

OBJECTIVE

To our knowledge, there are no reported studies neither from Morocco nor from other Maghreb countries regarding the prevalence of BRAF^V600E mutation in thyroid carcinomas. Here we aim to evaluate the frequency of BRAF^V600E oncogene in Moroccan thyroid carcinomas.

METHODS

In this Single-Institution retrospective study realized in the Anatomic Pathology and Histology Service in the Military Hospital of Instruction Mohammed V 'HMIMV' in Rabat, we report, using direct genomic sequencing, the assessment of BRAF^V600E in 37 thyroid tumors.

RESULTS

We detected BRAF^V600E mutation exclusively in Papillary Thyroid Carcinomas 'PTC' with a prevalence of 28% (8 PTC out 29 PTC). Like international trends, Papillary Thyroid Carcinomas 'PTC' is more frequent than Follicular Thyroid Carcinomas 'FTC' and Anaplastic Thyroid Carcinomas 'ATC' (29 PTC, 7 FTC and 1 ATC).

CONCLUSION

Our finding gives to the international community the first estimated incidence of this oncogene in Morocco showing that this prevalence falls within the range of international trends (30% to 90%) reported in distinct worldwide geographic regions.

Hypertrophic cranial pachymeningitis coinfection with tuberculosis and actinomycosis

This is a rare case report about hypertrophic cranial pachymeningitis coinfection with tuberculosis and actinomycosis in a 35-year-old male. The patient presented with progressive headache, paraesthesia, and blurred vision. Dural biopsy, histology, and cultures are imperative in pachymeningitis for establishing the diagnosis and guiding treatment.

SYNCHRONOUS OCCURRENCE OF THREE DIFFERENT THYROID TUMORS

Background

Thyroid nodules are common; however, the association of two or more different tumors in the thyroid gland is unusual. We present a first case with the association of three histological types of thryroid tumors. To the best of our knowledge, this association has not been reported in the literature before. We aim here to highlight the possible coexistence of many lesions in the thyroid gland and to discuss treatment options.

Case presentation

We report the case of a female patient who presented with a multinodular goiter. The final pathology after total thyroidectomy found the association of a multifocal papillary thyroid microcarcinoma arising within a Hurthle cells adenoma in a lobe and a noninvasive follicular thyroid neoplasm with papillary nuclear features in the other lobe. Due to the very low risk of recurrence, the patient was not treated with radioactive iodine.

Conclusions

Many controversies remain about the management of Hurthle cells tumors and many variants of papillary thyroid carcinoma. Although the management of our case did not change, more studies are necessary to analyze the evolution of patients with multiple thyroid neoplasms. When discussing therapeutic options, the advantages and disadvantages should be considered case by case based on disease staging.

A rare tumour in the cerebellopontine angle: endolymphatic sac tumour

We present a case of a papillary tumour at the cerebellopontine angle in a 54-year-old man. He presented with right-sided ear pain associated with dizziness and hearing loss. The radiological diagnosis was in favor of acoustic neurinoma. Surgical excision was performed and the diagnosis of the endolymphatic sac tumour was made. Endolymphatic tumour is a low grade adenocarcinoma that originates from the endolymphatic sac. The definitive diagnosis requires a combination of clinical features, radiological finding and pathological correlation.

Protective Effect of Argan and Olive Oils against LPS-Induced Oxidative Stress and Inflammation in Mice Livers

Sepsis causes severe dysregulation of organ functions, via the development of oxidative stress and inflammation. These pathophysiological mechanisms are mimicked in mice injected with bacterial lipopolysaccharide (LPS). Here, protective properties of argan oil against LPS-induced oxidative stress and inflammation are explored in the murine model. Mice received standard chow, supplemented with argan oil (AO) or olive oil (OO) for 25 days, before septic shock was provoked with a single intraperitoneal injection of LPS, 16 hours prior to animal sacrifice. In addition to a rise in oxidative stress and inflammatory markers, injected LPS also caused hepatotoxicity, accompanied by hyperglycemia, hypercholesterolemia and hyperuremia. These LPS-associated toxic effects were blunted by AO pretreatment, as corroborated by normal plasma parameters and cell stress markers (glutathione: GSH) and antioxidant enzymology (catalase, CAT; superoxide dismutase, SOD and glutathione peroxidase, GPx). Hematoxylin–eosin staining revealed that AO can protect against acute liver injury, maintaining a normal status, which is pointed out by absent or reduced LPS-induced hepatic damage markers (i.e., alanine aminotransferase (ALT) and aspartate transaminase (AST)). Our work also indicated that AO displayed anti-inflammatory activity, due to down-regulations of genes encoding pro-inflammatory cytokines Interleukin-6 (IL-6) and Tumor Necrosis Factor-α (TNF-α) and in up-regulations of the expression of anti-inflammatory genes encoding Interleukin-4 (IL-4) and Interleukin-10 (IL-10). OO provided animals with similar, though less extensive, protective changes. Collectively our work adds compelling evidence to the protective mechanisms of AO against LPS-induced liver injury and hence therapeutic potentialities, in regard to the management of human sepsis. Activations of IL-4/Peroxisome Proliferator-Activated Receptors (IL-4/PPARs) signaling and, under LPS, an anti-inflammatory IL-10/Liver X Receptor (IL-10/LXR) route, obviously indicated the high potency and plasticity of the anti-inflammatory properties of argan oil.

Inflammatory myofibroblastic tumor of the lacrimal gland: case report of an exceptional location

Background

Inflammatory myofibroblastic tumour (IMT) is a mesenchymal neoplasm of intermediate biological potential that may affect a wide range of anatomic sites but has a particular predilection for the lung and intra-abdominal soft tissues.

Case presentation

We report here an exceptional case of inflammatory myofibroblastic tumor arising in the lacrimal gland and presenting as an orbital mass in a 24-year-old male.

Conclusion

This report aims to discuss the importance of histopathological and immunohistochemical findings in arriving at the diagnosis, which helps dictate the management, treatment and prognosis of the patient.

Primary leiomyosarcoma of the submandibular gland: a case report

Background

Leiomyosarcoma is a rare malignant mesenchymal tumor that represents 5–7 % of all soft tissue sarcomas. The occurrence of this tumor in the salivary glands is exceptional. Only five cases are reported in the submandibular gland.

Case presentation

A 65-year-old white Moroccan woman presented with a history of progressive right submandibular swelling which had grown over a period of 8 months. Clinical examination showed a submandibular painless, mobile and hard mass without cervical lymphadenopathy. Ultrasonography and computed tomography revealed a solid and heterogeneous mass measuring 4 × 2 cm involving the submandibular gland. A resection of the gland was performed. Pathological findings were consistent with primary leiomyosarcoma of the submandibular gland. No recurrence occurred after two months of follow-up.

Conclusion

Primary leiomyosarcoma of the submandibular gland is an extremely rare mesenchymal tumor. Clinical and radiological features are not specific. Differential diagnosis includes metastatic leiomyosarcoma and gastrointestinal stromal tumor, myoepithelioma, sarcomatoid carcinoma, melanoma and other sarcomas. Little is known about the overall biologic behavior of this tumor, but the prognosis seems to be poor.

[Skin adnexal tumors: Histological study about 96 cases]

Les tumeurs annexielles cutanées sont des tumeurs primitives cutanées à la fois rares et hétérogènes. Elles sont le plus souvent bénignes et rarement malignes. Elles sont dominées du point de vu morphologique par leur polymorphisme lésionnel. Le but de cette étude est de relever le profil épidémiologique et les différents aspects anatomopathologiques de ce groupe de tumeurs dans une cohorte de population marocaine et de les comparer avec les données de la littérature. Il s'agit d'une étude rétrospective de 96 cas de tumeurs annexielles cutanées colligées au service d'anatomie et de cytologie pathologique de l'Hôpital Militaire d'Instruction Mohammed V de rabat durant une période de 6 ans, de Janvier 2009 à Décembre 2014. Le pic de fréquence est situé entre 31 et 40 ans. L’âge moyen est de 36 ans avec une prédominance masculine (63,5%). Le siège de prédilection est la région de la tête et cou (47,9%). Les tumeurs bénignes (97,9%) sont plus fréquentes que les tumeurs malignes. La différenciation est folliculaire dans 51% des cas, eccrine/apocrine dans 44,8% des cas et sébacée dans 4,2% des cas. Le type histologique le plus fréquent est le pilomatrixome (33,4%) suivi par l'hidradénome (12,5%) et le spiradénome eccrine (11,5%). Les tumeurs annexielles cutanées sont rares et très variées. Le profil épidémiologique et les aspects anatomopathologiques qui ressortent sont globalement superposables à ceux rapportés dans la littérature. Elles sont majoritairement bénignes, à prédominance masculine et dominées par le pilomatrixome et l'hidradénome nodulaire. Les tumeurs malignes sont rares, agressives et surviennent à un âge plus avancé.

Myxofibrosarcoma of the thyroid gland

INTRODUCTION

Myxofibrosarcoma of the thyroid is exceptional: a Medline search found a single case report. We report a new case which raised diagnostic and therapeutic problems.

OBSERVATION

We report the case of a 74-year-old woman who presented with swelling of the left thyroid lobe and ipsilateral cervical lymphadenopathy. Total thyroidectomy with cervical lymph-node dissection was performed. Histological analysis diagnosed myxofibrosarcoma. Evolution was marked by rapid local recurrence, and chemotherapy based on doxorubicin and ifosfamide was introduced.

DISCUSSION/CONCLUSION

Head and neck myxofibrosarcoma is rare. MRI is essential and should always precede treatment. Diagnosis is histological. There is elevated risk of local recurrence after resection, accompanied by worsening tumor grade, whence the need for accurate diagnosis, appropriate treatment and regular MRI follow-up.

[Heterotopic ossification on a midline laparotomy scar after digestive surgery: etiopathogenic discussion about two cases]

Heterotopic ossification (HO) is rarely seen after abdominal surgery and usually occurs after orthopedic surgery. It is a benign affection with an unknown mechanism and an unpredictable occurrence rate; but some etiopathogenic hypotheses have been put forward. Therapeutic attitudes were not assessed in this study. We report two observations of heterotopic ossification on mid-line laparotomy scar which could support the etiopathogenic hypothesis of osteoblastic cells migration in granulation tissue from the neighbouring bone tissue, particularly from the sternum or pubian structures. The etiopathogenic mechanism and treatment of this affection are discussed with regards to previously published literature.

Colorectal juvenile polyposis in an adult with ulcerative colitis

Juvenile polyposis is a rare disorder. We report an unusual case of juvenile polyposis in a 22-yr-old woman with ulcerative colitis, apparently one of the first cases reported in the literature.

[Rare cause of severe hypoplasia: gelatinous transformation of bone marrow ]

Nous rapportons chez une patiente de 17 ans un cas rare d’hypoplasie sévère avec transformation gélatineuse de la moelle osseuse dont l’étiologie spécifique reste mystérieuse malgré un bilan diagnostique et étiologique assez détaillé. La transformation gélatineuse (encore appelée atrophie séreuse, ou moelle de déprivation) est caractérisée par l’association d’une hypoplasie médullaire et d’une infiltration interstitielle par une substance gélatineuse amorphe formée de mucopolysaccharides acides. Elle s’accompagne d’anomalies sanguines périphériques qui sont variables, souvent modérées et non corrélées à la gravité de l’atteinte centrale. Sa pathogénie, encore mal connue, est très certainement liée à la dénutrition chronique et les pathologies associées à une cachexie.

[Desmoplastic ameloblastoma in a 7 year old child]

Desmoplastic ameloblastoma is a benign, locally aggressive neoplasm of proliferating odontogenic epithelial origin. It is seen among old patients from 17 to 72 years with an average age 42 years and without predilection of sex. We report the case of a 7 year old child, having presented since the 5 years age, a gingival tumefaction on the left higher incisivo-canin group which increased volume gradually. The stomatologic examination showed a gingival tumefaction covered with a healthy mucous membrane, ovoid form and measuring 3 cm on its horizontal axis. The tomodensitometry of the jawbone showed in front of the 21st and the 22nd tooth, the presence of an osseous lesion associating of the hearths of osteolysis and osteocondensation with rupture of cortical and invasion of the soft tissue. A curetting of the lesion was carried out and the anatomopathologic examination retained the diagnosis of desmoplastic ameloblastoma. The characteristic of our observation is the youth of the patient. In addition, the desmoplastic ameloblastoma is relatively rare, is characterized by an anatomical distribution, a radiological appearance and a morphological aspect differents from the traditional ameloblastoma. A radical surgical treatment is suggested for this tumour to avoid recurrency.