Extra medullar Granulocytic sarcoma: a case report of an exceptional localization

Granulocytic sarcoma is a rare type of tumor composed of extramedullary immature cells. The breast location is very rare; it accounts for less than 8% of cases. The present study reports the case of a 36-year-old female with a medical history of myelodysplastic syndrome. She was referred because of a lump in the left breast. We have diagnosed a case of granulocytic sarcoma of the breast by core biopsy. Histology and immunohistochemistry showed hypercellular smears with immature myeloid cells. The blast cells were myeloperoxidase positive. The patient underwent a lumpectomy. Five months later, she developed a contralateral recurrence, treated by lumpectomy and radiotherapy. Three years later, she developed a recurrence in the left knee. We report this case for its rarity and as a note of caution to a physician to consider myeloid sarcoma in the differential diagnosis of a breast lump, to provide the correct diagnosis and avoid incorrect treatment of a curable disease

Epidemiology of resistance and phenotypic characterization of carbapenem resistance mechanisms in Klebsiella pneumoniae isolates at Sahloul University Hospital-Sousse, Tunisia

Objective: To assess the prevalence of ESBL producing and carbapenem resistant Klebsiella pneumoniae isolated from in-come and out-come patients at Sahloul-university hospital.Methods: A retrospective study over a 3 years period (January 2012 and December 2014) focused on 2160 strains of Klebsiella pneumoniae. Statistical analysis was carried out using SPSS program. ESBL detection was performed using a double disc diffusion method and carbapenemase detection was realized by Rosco-Disk kit.Results: A total of 2160 Klebsiella pneumoniae strains were isolated during the period of the study, 26.2% (n=566) were ESBL-producers and 15.8% (n=342) showed resistance to carbapenem. The wards most affected by these strains were basically urology and intensive care units. Eighty four percent of studied strains (203/241) were resistant to temocillin, which correlate with the production of a class D (OXA-48-like) carbapenemase and 7% (17/241) showed sensitivity to EDTA and dipicolinic acid, which indicate the production of metallo-enzyme. The rate of resistance to colistin remains low.Conclusion: Resistance of Enterobacteriaceae, including K. pneumoniae, to third generation cephalosporins (3rd GC) and carbapenem through the mechanism of ESBL and carbapenemases production is becoming increasingly worrying. This suggests a morerational use of antibiotics, as well as the rigorous application of hygiene measurement.Keywords: Klebsiella pneumoniae, epidemiology, ESBL, carbapenemase, phenotypic screening

Clinicopathological and therapeutic features of metaplastic carcinoma of the breast: a study of 15 cases

Background: Metaplastic carcinoma of the breast is a rare entity containing a mixture of malignant epithelial and mesenchymal elements. The World Health Organization only recognized it as a distinct pathological entity since 2000. The aim of this study is to better characterize this rare disease.Methods: We reviewed retrospectively 15 cases of metaplastic carcinoma of the breast treated in our institute between 1994 and 2015. We analyzed clinical, histological, therapeutic and evolutive data.Results: All patients were females ranging from 29 to 75 years old (median, 50). Tumor size ranged from 20 to 150 mm (median, 72 mm). The Treatment consisted of radical mastectomy in 14 cases, often combined with post-operative radiation and/or chemotherapy. There were 8 cases of carcinosarcoma, 4 cases of spindle cell carcinoma and 3 cases of squamous cell carcinoma. Follow-up data were available on 12 patients. The median follow-up was 47 months (range, 10 to 146 months). Definitive nodal metastases were identified in 6 cases. One patient developed a local recurrence. Extranodal metastases occurred in 3 patients. Three patients died at median interval of 20 months (range, 13-30). Eight patients were alive with no evidence of recurrent or metastatic disease (median, 47 months) and one patient was alive with metastatic disease.Conclusions: Based on this series, metaplastic breast carcinoma is characterized by a large tumor size at presentation, a low frequency of nodal metastases and a high proportion of triple negativity. Our series is consistent with the literature

Epidemiology of resistance and phenotypic characterization of carbapenem resistance mechanisms in Klebsiella pneumoniae isolates at Sahloul University Hospital-Sousse, Tunisia

Objective: To assess the prevalence of ESBL producing and carbapenem resistant Klebsiella pneumoniae isolated from in-come and out-come patients at Sahloul-university hospital. Methods: A retrospective study over a 3 years period (January 2012 and December 2014) focused on 2160 strains of Klebsiella pneumoniae. Statistical analysis was carried out using SPSS program. ESBL detection was performed using a double disc diffusion method and carbapenemase detection was realized by Rosco-Disk kit. Results: A total of 2160 Klebsiella pneumoniae strains were isolated during the period of the study, 26.2% (n=566) were ESBL-producers and 15.8% (n=342) showed resistance to carbapenem. The wards most affected by these strains were basically urology and intensive care units. Eighty four percent of studied strains (203/241) were resistant to temocillin, which correlate with the production of a class D (OXA-48-like) carbapenemase and 7% (17/241) showed sensitivity to EDTA and dipicolinic acid, which indicate the production of metallo-enzyme. The rate of resistance to colistin remains low. Conclusion: Resistance of Enterobacteriaceae, including K. pneumoniae, to third generation cephalosporins (3rd GC) and carbapenem through the mechanism of ESBL and carbapenemases production is becoming increasingly worrying. This suggests a more rational use of antibiotics, as well as the rigorous application of hygiene measurement. DOI: https://dx.doi.org/10.4314/ahs.v19i2.24 Cite as: Messaoudi A, Mansour W, Jaidane N, Chaouch C, Bouja\ue2far N, Bouall\ue8gue O. Epidemiology of resistance and phenotypic characterization of carbapenem resistance mechanisms in Klebsiella pneumoniae isolates at Sahloul University hospital-Sousse, Tunisia. Afri Health Sci.2019;19(2): 2008-2020. https://dx.doi.org/10.4314/ahs.v19i2.2

Accurate theoretical characterization of dioxygen difluoride: a problem resolved

International audienc

Accurate theoretical characterization of dioxygen difluoride: a problem resolved

International audienc

Carcinome épidermoïde du bassinet découvert par un envahissement pariétal et cutané: une présentation inhabituelle

A travers cette étude clinique nous présentons un cas rare de carcinome épidermoïde du bassinet avec envahissement cutané de la paroi abdominale chez une patiente aux antécédents d'infections urinaires hautes à répétition sur des calculs rénaux. Le motif de consultation était la découverte d'une lésion cutanée lombaire droite. L'uro-scanner montrait une masse rénale droite étendue aux parties molles adjacentes dont la biopsie a révélé un carcinome épidermoïde du bassinet. Après une revue de la littérature, c'est le premier cas d'un carcinome épidermoïde du bassinet découvert par un envahissement cutané

Germline copy number variations in BRCA1/2 negative families: Role in the molecular etiology of hereditary breast cancer in Tunisia.

Hereditary breast cancer accounts for 5-10% of all breast cancer cases. So far, known genetic risk factors account for only 50% of the breast cancer genetic component and almost a quarter of hereditary cases are carriers of pathogenic mutations in BRCA1/2 genes. Hence, the genetic basis for a significant fraction of familial cases remains unsolved. This missing heritability may be explained in part by Copy Number Variations (CNVs). We herein aimed to evaluate the contribution of CNVs to hereditary breast cancer in Tunisia. Whole exome sequencing was performed for 9 BRCA negative cases with a strong family history of breast cancer and 10 matched controls. CNVs were called using the ExomeDepth R-package and investigated by pathway analysis and web-based bioinformatic tools. Overall, 483 CNVs have been identified in breast cancer patients. Rare CNVs affecting cancer genes were detected, of special interest were those disrupting APC2, POU5F1, DOCK8, KANSL1, TMTC3 and the mismatch repair gene PMS2. In addition, common CNVs known to be associated with breast cancer risk have also been identified including CNVs on APOBECA/B, UGT2B17 and GSTT1 genes. Whereas those disrupting SULT1A1 and UGT2B15 seem to correlate with good clinical response to tamoxifen. Our study revealed new insights regarding CNVs and breast cancer risk in the Tunisian population. These findings suggest that rare and common CNVs may contribute to disease susceptibility. Those affecting mismatch repair genes are of interest and require additional attention since it may help to select candidates for immunotherapy leading to better outcomes