Adénocarcinome du col utérin au Gabon : caractéristiques clinico-pathologiques d’une série des cas

Contexte et objectifs. L’adénocarcinome du col utérin a fait l’objet de peu de publications notamment en Afrique. L’objectif de la présente étude était de décrire les aspects cliniques, pathologiques et évolutifs de ce cancer au Gabon puis d’évaluer la reproductibilité du pattern d’invasion (PI) afin d’améliorer le choix thérapeutique. Méthodes. Il s’agissait d’une série des cas d’adénocarcinomes du col utérin confirmés histologiquement en 8 ans. Les données clinico-pathologiques et le suivi ont été enregistrés à partir des dossiers médicaux. 3 pathologistes ont évalué le PI de chaque cas puis, la reproductibilité a été réalisée. Résultats. Sur les 378 cas recensés, 16 ont été retenus. Leur âge moyen était de 57 ans. Les femmes étaient de grandes multipares (68,7 %) et ayant consulté pour des métrorragies (87,5 %). Elles étaient récués à un stade clinique avancé (62,5 %) et l’évolution était défavorable dans 81,25 % des cas. Le type endocervical et le grade intermédiaire étaient les plus fréquents. Le niveau de concordance du PI était faible (28,6 %). Conclusion. L’adénocarcinome du col utérin au Gabon survient chez la femme d’âge jeune, grande multipare, est de diagnostic tardif et d’évolution péjorative d’où l’intérêt d’assurer un dépistage précoce et une prévention. Par ailleurs, la reproductibilité du PI devrait être réévaluée par des études supplémentaires. English title: Adenocarcinoma of the uterine cervix in Gabon: clinico-pathological characteristics of serial cases Context and objective. Little has been published on cervical adenocarcinoma, especially in Africa. The objective of the present study was to describe the clinical, pathological and follow-up aspects of this cancer in Gabon, then to evaluate the reproducibility of the invasion pattern (IP) in order to improve the therapeutic choice. Methods. It was a series of histologically confirmed cases of cervical adenocarcinoma over 8 years. Clinicopathological data and follow-up information were collected from medical records. 3 pathologists evaluated the IP of each case and then the reproducibility was carried out. Results. Of the 378 cases identified, 16 were selected. The average age was 57 years. The women were large multiparous (68.7 %), consulted for metrorrhagia (87.5%), had an advanced clinical stage (62.5 %) and evolution was often unfavourable (81.25%). Endocervical type and intermediate grade were the most frequent. The level of concordance of the IP was low (28.6 %). Conclusion. Adenocarcinoma of the uterine cervix in Gabon occurs in young, multiparous women, is diagnosed late and has a poor outcome, hence the interest of prevention. In addition, the reproducibility of the IP should be reevaluated by additional studies. Keywords : adénocarcinoma- clinico pathological aspects- uterine cervix Gabo

Intérêt de l’inspection visuelle à l’acide acétique et au soluté de Lugol avec colposcope dans le dépistage des lésions du col utérin au Gabon

Introduction: Au Gabon, le dépistage des lésions précancéreuses et cancéreuses du col de l'utérus n'est pas systématique. La vulgarisation de ce dépistage suppose l'utilisation d'un test efficace et adapté aux réalités locales. Méthodes: L'objectif de cette étude était de comparer les performances du frottis cervico-vaginal (FCV)  conventionnel et de l'inspection visuelle à l'acide acétique (IVA) et au soluté de  Lugol (IVL) couplée à la  colposcopie, dans la détection des lésions du col utérin au Gabon. Des tests IVA/IVL et FCV ont été effectués chez 309 femmes gabonaises âgées de 18 à 75 ans. Des biopsies ont été réalisées en cas de résultat positif. Résultats: 5 cancers épidermoïdes (1,6%) et 4 lésions précancéreuses (1,3%) ont été confirmées par   l'histologie. L'IVA/IVL a présenté une meilleure sensibilité (100%) que le FCV (89%). Toutefois, le FCV est  apparu plus spécifique (100% versus 92%). Avec une valeur prédictive (VP) négative de 100%, l'IVA/IVL a  permis d'exclure avec certitude la présence de cancer du col lorsque le résultat était négatif, contrairement au FCV (92%). L'IVA/IVL et le FCV ont présenté des VP positives respectivement de 90% et 100%. Conclusion: Cette étude montre que l'IVA/IVL avec colposcope couplée à l'histologie en cas de résultat  positif apparaît plus performante que le FCV.Key words: Col de l´utérus, lésions précancéreuses, cancer, IVA/IVL, FCV, Gabo

Morphologic criteria associated with trichomonas vaginalis in liquid-based Cytology

Objective: To evaluate the morphologic criteria associated with Trichomonas vaginalis on Cytyc (Marlborough, Massachusetts, U.S.A.) liquid-based cytology and to compare results between 2 types of liquid-based cytology - Cytyc and SurePath (BD Diagnostics-TriPath, Burlington, Vermont, U.S.A.). Study Design: Forty thousand Cytyc liquid-based cytology cases were tested between January 2005 and 2008. Among these, 80 cases (0.2%) had a T vaginalis infection without intraepithelial lesions or other associated infectious organism. The 80 ThinPrep (Cytyc) slides were reexamined, and for each case, morphologic characteristics associated with the parasite were listed. Concerning the SurePath technique, only 1 paper has been found in the literature based on 60,104 cases with 88 cases of T vaginalis (0.17%). Results: Among the 80 T vaginalis patients ,the most frequent features associated with the infection were the presence of cannonballs (93%), perinuclear halo (90%), reactive nuclear changes (88%) and attachment of T vaginalis to squamous cells (86%). Moreover, the presence of ghost cells was significantly more frequent in SurePath than Cytyc liquidbased cytology (p = 0.00001), and the presence of neutrophils, reactive nuclear changes, dirty background and karyorrhexis and the predominance of coccobacilli were significantly more frequent in Cytyc than SurePath liquid-based cytology (p < 0.05). Conclusion: On the basis of these results, we conclude that SurePath and Cytyc, which are the both commonly used liquid-based cytologic techniques, are useful and have the same efficacy in the detection of T vaginalis infection (p = 0.99). © The International Academy of Cytology.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Immediate surgical resection of residual microcalcifications after a diagnosis of pure flat epithelial atypia on core biopsy: A word of caution

The entity of pure flat epithelial atypia remains a challenge due to controversy of the surgical management of residual microcalcifications after core needle biopsies. This study aims to assess the morphological data observed in immediate surgical resection specimen of residual microcalcifications after a diagnosis of pure flat epithelial atypia on mammotome core biopsy. Sixty-two mammotome core biopsy with a diagnosis of pure flat epithelial atypia (flat epithelial atypia without associated atypical ductal hyperplasia, in situ and/or invasive carcinoma) were identified. From these 62 cases, 20 presented residual microcalcifications and underwent an immediate surgical excision after mammotome. Of the 20 patients with excised microcalcifications, 8 (40%)cases had residual pure flat epithelial atypia, 4 (20%) cases had atypical ductal hyperplasia, 4 (20%) cases had lobular in situ neoplasia, no lesions were retrieved in 4 (20%) case. None of the patients had either in situ ductal carcinoma and/or invasive carcinoma. Surgical resection of residual microcalcifications after the diagnosis of pure flat epithelial atypia on core needle biopsy remains still a debate. The present study shows no cases of in situ ductal and/or invasive carcinoma on immediate excision of residual microcalcifications after mammotome core biopsies. © 2009 Elsevier Ltd. All rights reserved.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Estrogen receptor, progesterone receptor, and glucocorticoid receptor expression in normal breast tissue, breast in situ carcinoma, and invasive breast cancer

Glucocorticoids (GCs) are used in cancer treatment to induce programmed cell death in transformed cells of the hematopoietic system and to lessen side effects. Moreover, GCs have been described not only as inhibitors of some chemotherapy or radiation-induced apoptosis, but also as inhibitors of cancer progression by down-regulation or up-regulation of different gene expressions. Recently, it has been suggested that GCs can attenuate estrogen responses through induction of expression and activity of the sulfotransferase. The presence or absence of glucocorticoid receptor (GR) in normal and abnormal breast tissue is thus interesting, and the aim of this study was to analyze the expression of GR during the progression of breast tissue. We tested by immunohistochemistry the expression status of estrogen receptor (ER), progesterone receptor (PR), and GR in normal breast parenchyma (n=49), ductal intraepithelial neoplasia (DIN) 1a (n=9), DIN 1b-1c (n=15), DIN 2-3 (n=21), and invasive breast carcinoma (n=39). The evaluation of GR expression was made by using the Allred score. All the normal parenchyma, DIN 1a, DIN 1b, and DIN 1c were ER-positive (ER) and PR-positive (PR). Seventeen of 21 DIN 2-3 and 30 of 39 invasive carcinomas were ER/PR. The other samples were ER-negative (ER) and PR-negative (PR). Moreover, all the ER/PR samples were GR-negative. Interestingly, we found a significant correlation between the histologic grade and the GR-negative tumors, and a percentage of positive patients presented with nuclear immunoreaction to GR, which decreases significantly with tumor histologic grade. Understanding the role of GCs in breast carcinoma is thus essential before continuing the widespread use of GCs combined with antineoplastic drugs or agents in the clinical management of women with breast cancer. Copyright © 2010 by Lippincott Williams & Wilkins.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Multiple epitheloid plexiform tumourlet leiomyoma of the uterus with focal vascular invasion

We report the first case of multiple plexiform tumourlets showing focal vascular invasion suggesting that, unlike what the common and accepted opinion would advocate, these tumours may have a more aggressive behaviour. However, the prognosis of this variant of epithelioid leiomyoma remains unknown, due to its rarity. The main differential diagnosis of this entity are discussed, including endometrial stromal sarcoma exhibiting epitheloid cytomorphology, intravenous leiomyomatosis of epitheloid variant.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Low-grade adenosquamous carcinoma of the breast-A case report with a BRCA1 germline mutation

Breast cancers occurring in women with germline BRCA1 mutations tend to fall into the category of triple-negative or basal-like phenotypes, such as metaplastic carcinoma. Low-grade adenosquamous carcinoma of the breast is a rare variant of metaplastic carcinoma. We present the case of a 49-year-old woman with a past medical history of invasive ductal breast carcinoma 13 years ago, and who was recently diagnosed as having a low-grade adenosquamous carcinoma in the same breast. Genetic analysis of blood DNA revealed a BRCA1 mutation. To our knowledge, BRCA1 mutation in association with a low-grade adenosquamous carcinoma of the breast has not yet been reported. Thus, it may be important to consider the possibility of an association, but supplemental studies are needed. © 2010 Elsevier GmbH.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Lymph node involvement in multicystic peritoneal mesothelioma

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Primary ovarian carcinoid tumor with luteinized stromal cells

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Angiolipoma of the breast in a male: A case report and review of the literature

Objective: Angiolipoma is an unusual variant of lipoma involving subcutaneous tissues on trunk and extremities. This tumor is rarely described in the breast and particularly in breast male.Case report: We report here the case of angiolipoma of the breast in a 55-year-old man complained of tenderness in the left breast. Ultrasonography showed a homogenously, well circumscribed, hyperechoic mass in the internal quadran of breast. The surgically resected tumor showed mature fat cells separated by proliferating branched vessels and intravascular hyaline thrombi.Conclusion: The existence of angiolipoma of the breast in the male must not to be forgotten because this tumor may be confused clinically, radiologically and pathologically with a malignant tumor. © SAGE Publications 2011.SCOPUS: re.jinfo:eu-repo/semantics/publishe