Métastase atypique du cuir chevelu et surrénalienne d’un carcinome urothelial de la vessie

Les métastases du cuir chevelu et surrénaliennes d'un carcinome urothélial de la vessie sont rares, peu de cas ont été rapportés dans la littérature, et la chimiothérapie est le traitement de choix. Nous rapportons le cas d'une femme de 60 ans qui présente un carcinome urothélial stade IV avec métastases surrénaliennes,  pulmonaire et osseuses (cotes et scapula). Deux lignes de chimiothérapies ont été instaurées et la patiente  bénéficia d'une radiothérapie palliative antalgique sur la scapula. Après la première ligne de chimiothérapie, une masse du cuir chevelu augmentant progressivement de volume apparue, une biopsie fut faite et le  diagnostic de métastase d'un carcinome urothélial de la vessie fut confirmé par l'histologieKey words: Métastase atypique, surrénalienne, carcinome urothelia

Facial palsy and diplopia revealing idiopathic intracranial hypertension in a child

Idiopathic intracranial hypertension is rare in the pediatric population. It’s characterized by increased intracranial pressure in the absence of any evident underlying neurologic disease. Abducens nerve palsy is the most common cranial nerve deficit related to that condition. The association of sixth and seventh cranial nerve damage is uncommon. In this report, we describe the case of an 8-year-old girl who presented with headache, diplopia and peripheral facial palsy related to idiopathic intracranial hypertensio

A rare case of locally advanced fibrosarcoma of diaphysal humerus managed successfully with limb-sparing procedures after neoadjuvant chemotherapy

Fibrosarcomas (FS) of bone are a rare malignancy accounting for less than 5% of all primary malignant bone neoplasms. Diagnosis and treatment approaches of this entity are complex and require a skilled and experienced multidisciplinary team

Deep Brain Stimulation in Moroccan Patients With Parkinson's Disease: The Experience of Neurology Department of Rabat

Introduction: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is known as a therapy of choice of advanced Parkinson's disease. The present study aimed to assess the beneficial and side effects of STN DBS in Moroccan Parkinsonian patients.Material and Methods: Thirty five patients underwent bilateral STN DBS from 2008 to 2016 in the Rabat University Hospital. Patients were assessed preoperatively and followed up for 6 to 12 months using the Unified Parkinson's Disease Rating Scale in four conditions (stimulation OFF and ON and medication OFF and ON), the levodopa-equivalent daily dose (LEDD), dyskinesia and fluctuation scores and PDQ39 scale for quality of life (QOL). Postoperative side effects were also recorded.Results: The mean age at disease onset was 42.31 ± 7.29 years [28–58] and the mean age at surgery was 54.66 ± 8.51 years [34–70]. The median disease duration was 11.95 ± 4.28 years [5–22]. Sixty-three percentage of patients were male. 11.4% of patients were tremor dominant while 45.71 showed akinetic-rigid form and 42.90 were classified as mixed phenotype. The LEDD before surgery was 1200 mg/day [800-1500]. All patients had motor fluctuations whereas non-motor fluctuations were present in 61.80% of cases. STN DBS decreased the LEDD by 51.72%, as the mean LEDD post-surgery was 450 [188-800]. The UPDRS-III was improved by 52.27%, dyskinesia score by 66.70% and motor fluctuations by 50%, whereas QOL improved by 27.12%. Post-operative side effects were hypophonia (2 cases), infection (3 cases), and pneumocephalus (2 cases).Conclusion: Our results showed that STN DBS is an effective treatment in Moroccan Parkinsonian patients leading to a major improvement of the most disabling symptoms (dyskinesia, motor fluctuation) and a better QOL

Case Report: Rapidly fatal Askin’s tumor: a case report and literature review

An 18-year-old male presented with a mass in the right anterior chest wall. Chest Computed tomography  revealed a heterogenous mass of 19X13 cm in the right hemithorax with areas of necrosis. There was  associated pleural effusion and infiltration of the soft parts of the chest wall. Bronchoscopy showed a tumor in middle lobe bronchus. CT guided biopsy of the mass was performed. Histological examination showed small round tumor cells with scanty cytoplasm, the nuclei are large and hyperchromatic. The tumor cells were  positive for CD99 and neuron specific enolase, negative for cytokeratin, leukocyte common antigen and  myogenin. Based on these histologic and immunohistochemical findings, the diagnosis of askin's tumor was made. The extension assessment was negative and the patient was given chemotherapy. Two months later, our patient died. Askin's tumor is a rare, highly malignant tumor affecting children and young adults. It is classified as primitive neuroectodermal tumor of the thoracopulmonary region. Prognosis remains poor. In our case, several prognostic factors may explain the shirt 'term survival, despite no distant metastasis were found: important tumor size, impossibility of surgical treatment and pleural effusion.Key words: Askin tumor, chest wall, primitive neuroectodermal tumor, Ewing sarcoma, malignanc

Maladie de Kikuchi-Fujimoto: à propos d’un cas

La maladie de Kikuchi-Fujimoto ou lymphadénite histyocytaire nécrosante constitue une cause rare et bénigne d’adénopathies cervicales. C’est une entité anatomoclinique d’étiologie inconnue. La confirmation du diagnostic est toujours apportée par l’étude histologique ganglionnaire. L’évolution est généralement favorable avec guérison spontanée au bout de quelques semaines. Nous rapportons l’observation d’une fille de 9ans ayant consultée pour des adénopathies cervicales associées à une fièvre. La biopsie ganglionnaire cervicale a conclu à une maladie de Kikuchi. L’évolution était marquée par la régression des adénopathies sans aucun traitement.Mots clés: Maladie de Kikuchi-Fujimoto, lymphadénite histiocytaire nécrosante, adénopathiesEnglish Title: Kikuchi-Fujimoto disease: about a caseEnglish AbstractKikuchi-Fujimoto disease or histiocytic necrotizing lymphadenitis is a rare cause of benign cervical adenopathies. It is an anatomoclinic entity of unknown cause. Diagnosis is based on histologic examination of the lymph nodes. Patient’s evolution is generally favorable with spontaneous healing after a few weeks. We here report the case of a 9-year old girl presenting with cervical lymphadenopathy associated with fever. Cervical lymph node biopsy showed Kikuchi-Fujimoto disease. Patient’s evolution was marked by regression of adenopathies without receiving any treatment.Keywords: Kikuchi-Fujimoto disease, histiocytic necrotizing lymphadenitis, adenopathie

Advanced Non-small Cell Lung Cancer: EGFR Mutation Analysis Using Pyrosequencing and the Fully Automated qPCR-Based Idylla System

Background Epidermal growth factor receptor (EGFR) mutation status is of a major clinical significance in non-small cell lung cancer (NSCLC) management, as it guides therapeutic decision making to target patients for a better response to therapy. This implicates the introduction of EGFR mutation analysis as the standard of care for Moroccan NSCLC patients, which in itself entails the implementation of targeted methods for routine EGFR mutation analysis in our laboratories. In this study, we aimed to present 2 targeted methods for EGFR mutation identification and to determine the prevalence and spectrum of EGFR mutations in NSCLC Moroccan patients. Methods A retrospective investigation of a cohort of 340 patients was undertaken to analyze somatic EGFR mutations in exons 18 to 21 using pyrosequencing and the Idylla TM system. Results Of the enrolled patients, 70.9% were males and 29.1% were females. Predominately, 92% of cases had adenocarcinoma, and 53.7% of patients self-reported a history of smoking. Overall, 73 patients (21.7%) harbored an EGFR mutation, the most prevalent of which were the exon 19 deletions (53.4%) followed by exon 21 substitutions (31%). Exon 18 mutations and exon 20 alterations occurred in 8.1% and 6.7% of the positive EGFR mutation cases, respectively. Of the analyzed cases, all of the EGFR-mutated patients had adenocarcinoma. EGFR mutation prevalence was significantly higher in females (females vs males: 38.4% vs 14.5%, P < .001) and non-smokers (non-smokers vs non-smokers: 36% vs 10.3%, P < .001). The featured pyrosequencing and the Idylla TM system are targeted methods endowed with high sensitivity and specificity as well as other compelling characteristics which make them great options for routine EGFR mutation testing for advanced NSCLC patients. Conclusion These findings underline the imperious need for implementing quick and efficient targeted methods for routine EGFR mutation testing among NSCLC patients, which is particularly useful in determining patients who are more likely to benefit from targeted therapy