An uncommon subtype of breast carcinoma in a man: The pure mucinous carcinoma

Aim: Our purpose is to describe a new case of pure mucinous carcinoma in a man, to put emphasis on the rarity of this histologic subtype and the problems of management due to the fewer reported cases in the literature and to compare it with the female counterpart. Observation: We report the case of a 79- year-old man presenting as a nodular mass of the right breast. The clinical symptoms weren’t specific and the diagnosis was based on histological and immunohistochemical findings. Conclusion: Male breast carcinoma is rare compared to its female counterpart representing less than 2% of male breast carcinomas and 1% of all breast carcinomas. Pure mucinous carcinoma in male is an extremely rare histological subtype. It is a variety of carcinoma of the breast which is characterized by the production of an abundant extra-cellular and/or intra-cellular mucin. It has been regarded as one of the more benign forms of breast carcinomas. To our knowledge, about 30 cases of mucinous breast carcinoma in male have been reported in the English literature and only 10 cases of pure mucinous carcinoma have been described. In general, pure mucinous carcinomas have a favorable prognosis. Numerous studies have shown that breast carcinomas in male behave more aggressively compared to those in females. Further research is needed on male carcinomas as they are becoming more frequent

The inter-connection between fibrosis and microvascular remodeling in idiopathic pulmonary fibrosis: Reality or just a phenomenon

Background: Idiopathic pulmonary fibrosis is the most frequent interstitial disease with the worst prognosis. It is characterized by an uncontrolled fibrosis which is difficult to manage. The pathogenesis of this disease remains unclear with many theories resulting in multiple target therapies. The relation between fibrosis and vascular remodeling has been debated in the literature with different results that may seem contradictory. Aim: We target to evaluate the connection between fibrosis and vascular remodeling in usual interstitial pneumonia. Material and methods: 26 cases of idiopathic pulmonary fibrosis were reviewed by 2 pathologists and the diagnosis of UIP was retained according to the American Thoracic Society's criteria. Fibrotic changes and vascular remodeling were evaluated blindly. The fibrotic changes were classified as severe, intermediate and mild. Vascular occlusion was graded in 4 grades extending from medial hypertrophy (grade 1) to plexiform lesions of the vascular wall (grade 4). Results: We noticed that severe degrees of fibrosis were correlated with severe grades of vascular obstruction. In fact, our 26 cases were classified as severe fibrosis in 11 cases with grade IV vascular lesions in 6 cases, intermediate fibrosis in 12 cases with grade II vascular lesions in 8 cases and mild fibrosis in 3 cases with grade I vascular lesions in all cases. Conclusion: Many theories have been reported concerning the UIP's pathogenesis. Recently, many authors reported that the primum movens of these lesions was an epithelial/endothelial injury which induces uncontrolled fibrosis and microvascular remodeling using different pathways. This puts emphasis on the necessity of multi-target therapies in order to improve the management of this fatal disease

Teaching clinical reasoning among undergraduate medical students: A crossover randomized trial

Background & Objective: Many clinical reasoning teaching techniques have been reported in the literature. The authors focused on 2 teaching techniques of clinical reasoning, the technique Summarize, Narrow, Analyze, Probe the preceptor, Plan, Self-selected topic (SNAPPS) and the Clinical Reasoning Technique (CRT), and compared their efficiency to improve the clinical reasoning competencies of third-year undergraduate medical students. Materials & Methods: The authors performed a prospective randomized, controlled, non-blinded crossover trial including year-3 undergraduate medical students. Judgment criteria consisted of the scores attributed to a test assessing the cognitive competencies of the participants which was a structured summary performed by the students after each session. Besides, a satisfaction Likert-scale questionnaire was fulfilled by the students. Statistical analysis was performed using SPSS software (version 20.0). Results: Seventy-two students were included with a mean age of 21.03 (SD:2,30) years. The mean scores of the students allocated to the CRT arm reached 4.62 (SD:2.93)versus 4.99 (SD:2.93) for the SNAPPS arm. No significant statistical difference was observed between the mean scores according to the method used. The analysis of the satisfaction questionnaire revealed that 75% of the students preferred CRT because of the collaborative work performed. Conclusion: This study highlights the need for varying techniques to improve the critical reasoning skills of medical students. Besides, it pointed out students' preference for collaborative approaches illustrating socio-constructivist theories of learning

How to differentiate mucinous eccrine carcinoma from cutaneous metastasis of breast carcinoma?

ccrine skin tumors are rare and represent only 0,05% of all cutaneaous neoplasms. They represent a pitfall especially with cutaneous metastases of carcinoma which are more frequent. We report the case of a 60-year-old woman presented with a frontal scalp mass whose histologic and immunohistochemical features concluded initially to a cutaneous metastasis of breast carcinoma. The diagnosis was reviewed because of the absence of a breast lesion. The final diagnosis was primary sweet gland carcinoma. Histologic distinction between cutaneous metastatic breast carcinoma and primary cutaneous adnexal neoplasms can be very challenging or even impossible. This case illustrates this difficulty and puts emphasis on the necessity of keeping in mind the distinctive features between these two entities

Quelle technique adopter pour le phénotypage des alvéolites lymphocytaires : immunocytochimie ou cytométrie en flux ?

International audienceBackground : Diffuse interstitial pneumonias are considered as a group of multiple affections characterized by challenging diagnoses because of the lack of specific clinical signs. Radiologic investigations highlight the diagnoses in most of the cases but bronchoalveolar lavage plays a key role in the diagnostic diagram. We aim to compare the immunocytochemical technique and the flow cytometry in the phenotyping of lymphocytic alveolitis.Methods : We described a series of 32 lymphocytic alveolitis, which were analyzed using immunocytochemistry and flow cytometry.Results : We found a good reproducibility between the immunocytochemistry performed on smears and cytoblocks (kappa = 0.7) and a poor reproducibility between immunocytochemistry and flow cytometry (kappa = 0.35).Conclusion : Our study emphasized on the poor reproducibility between immunocytochemistry and flow cytometry. Further studies about the reliability of both techniques are needed especially in discordant cases.Introduction : Les pneumopathies interstitielles diffuses sont considérées comme un groupe d’affections multiples diverses et de diagnostic difficile vu la non-spécificité des signes cliniques. Les moyens d’imagerie orientent dans la plupart des cas vers le diagnostic, cependant, le lavage bronchoalvéolaire garde toute son importance dans les cas peu spécifiques. Notre objectif est de comparer l’immunocytochimie et la cytométrie en flux dans le phénotypage des alvéolites lymphocytaires.Matériel et méthodes : Nous avons colligé 32 cas d’alvéolites lymphocytaires diagnostiquées et prises en charge au service d’anatomie pathologique pour l’analyse cytologique du LBA et le marquage immunocytochimique et dans le département d’hématologie (unité de cytométrie en flux) pour le phénotypage par cytométrie en flux.Résultats : Nous avons mis en évidence une bonne reproductibilité entre l’immunocytochimie sur étalements et sur cytoblocs (kappa = 0,7) tandis que l’immunocytochimie et la cytométrie en flux semblaient peu comparables (kappa = 0,35).Conclusion : Notre étude met l’accent sur la mauvaise reproductibilité entre l’immunocytochimie et la cytométrie en flux. Nous projetons de nous référer aux diagnostics cliniques retenus afin d’asseoir les résultats discordants entre les 2 techniques et de mettre en évidence leur fiabilité et justesse

An intriguing case of a paravertebral extramedullary erythropoiesis presenting as tumor‐mimicking lesion in a patient with eosinophilia with FIP1L1‐PDGFRA rearrangement

Abstract Extramedullary hematopoiesis in the posterior mediastinum is rare. Our case interested a 28‐year‐old man with a history of eosinophilia with FIP1L1‐PDGFRA fusion gene who had a mediastinal mass surgically excised. Pathological examination concluded to an extramedullary erythropoiesis. This case is original by its location and the presence of only the erythroblastic line rearrangement

Interstitial pneumonia in a glassblower: think to chronic beryllium disease!

Chronic beryllium disease (CBD) is an occupational illness with varying severity. In this report, we describe a 27 year old man, glassblower, who developed a fatal CBD after six months of unknown Beryllium's exposure. The diagnosis was suspected on histological examination and then consolidated by confirmation of Beryllium's exposure at the working area. Physicians should be aware of the potential risk to develop CBD in glassblowers. These workers should benefit from early medical surveillance using the Beryllium lymphocyte proliferation test (BeLPT) and therefore from suitable management

Blastomycose pulmonaire

La blastomycose est une maladie fongique rare en Afrique, due souvent à l´inhalation de « Blastomyces dermatitidis ». La forme pulmonaire est la manifestation clinique la plus fréquente, pouvant aller de la forme asymptomatique jusqu´à la forme rapidement mortelle. Nous rapportons l´observation d´un patient tunisien âgé de 35 ans sans antécédents médicaux, hospitalisé pour une toux chronique, des douleurs basithoraciques bilatérales, fièvre et un amaigrissement. L´examen clinique a objectivé la fièvre ainsi qu´une tuméfaction sous cutanée para-vertébrale gauche en regard de la dixième vertèbre thoracique (T10). L´imagerie thoracique a objectivé des opacités alvéolaires et nodulaires bilatérales excavées par endroit. La recherche de bacille de Koch (BK) dans les expectorations était négative à l´examen direct et à la culture. La fibroscopie bronchique était normale. L´étude anatomopathologique de la biopsie de la masse dorsale a conclu à une blastomycose et le diagnostic a été confirmé par le résultat des cultures des fragments biopsiques de la masse sus décrite. Un traitement antifongique à base d´itraconazole a été instauré avec une amélioration clinique et radiologique. Ce cas illustre la difficulté diagnostique que peut poser la blastomycose, notamment, avec la tuberculose dans notre pays, d´où le retard thérapeutique