Impact on survival of nuclear atypia in epithelioid malignant mesothelioma

Introduction: Malignant pleural mesothelioma is a rare tumour with a bad prognosis. The only consensual prognostic factorsare represented by the stage and the histologic type. Concerning the histologic type, epithelioid mesothelioma is known to havebetter prognosis in comparison with the sarcomatoid and biphasic types. Epithelioid mesotheliomas have been reported to bea heterogeneous prognostic group. Our aim was to assess the impact on the survival of different characteristics of epithelioidmesothelioma, including nuclear atypia, mitotic count, MIB-1 index, inflammatory host response, stromal desmoplasia, necrosis,vascular emboli and invasion depth. Material and methods: We performed a study of survival of 30 malignant pleural mesotheliomas according to the differentparameters studied. Results: The study included 26 women and 4 men. The mean age of the patients was 61 years. The microscopic exam concludedto an epithelioid mesothelioma in 17 cases, sarcomatoid mesothelioma in 4 cases and biphasic mesothelioma in 9 cases. The 17cases of epithelioid mesothelioma developed severe nuclear atypia in 6 cases and mild nuclear atypia in 11 cases. The mitoticcount and the MIB-1 score were respectively inferior to 5 mitoses/50 HPF and inferior to 10% in 11 cases and were superior to5 mitoses/50 HPF and superior to 10% in 6 cases. No vascular emboli were recorded. Tumour necrosis was reported in 1 case.The inflammatory host response was severe in 4 cases and mild in 13 cases. The tumoral stroma was desmoplastic in 4 cases.The invasion depth was superior to 0.5mm in 16 cases. The median overall survival amounted to 180 days. Nuclear atypia wasthe only feature that had impact on survival in the group of epithelioid mesothelioma. Conclusion: Our results highlight the correlation of nuclear atypia with survival

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

A Primary Testicular Diffuse Large B-cell Lymphoma Belonging to the Germinal Center B-cell-like Group

Testicular lymphoma was first reported by Malassez and Curling in 1866. Primary testicular lymphoma constitutes only 1 - 7% of all testicular neoplasms and less than 1% of all non Hodgkin lymphoma. The authors report a new case of primary testicular lymphoma and highlight its diagnostic and therapeutic challenge. We report the case of a 26-year old man without a particular past medical history, who presented with a painful right testicular swelling that he has noticed for several weeks. Radiological findings consisted in multiple hypoechoic masses that corresponded in histological examination to a diffuse intratubular lymphomatous infiltration situated away from the spermatic cord, the epididymis, ductuli efferentes and rete testis. Immunohistochemical study showed positivity for leukocytic common antigen (CD45), B-cell marker (CD20) and bcl 6. The patient underwent full staging for lymphoma showing no evidence of extra-testicular involvement by lymphoma and no lymph nodes. The diagnosis of stage I primary testicular large B-cell lymphoma of germinal center B-cell-like group was made. The patient is now treated by chemotherapy. Primary testicular lymphoma is a rare tumour whose diagnosis is based on histological findings. There are non consensual etiological or predisposing factors. Treatment modalities consist in surgical excision, chemotherapy and radiation therapy but the accurate procedures are not standardized. Factors that have been linked to more favorable outcomes include younger patient age, localized disease, presence of sclerosis at pathologic analysis, smaller tumour size, lower histological tumor grade and lack of epididymal or spermatic cord involvement

About A Rare Cause Of Primary Hyperparathyroidism

Introduction: Primary hyperparathyroïdism is observed in 35 to 44 subjects/ 100000 persons. The increased production of parathyroid hormones is secondary to primary glandular modifications consisting mainly in adenomas. The authors report a clear-cell hyperplasia causing primary hyperparathyroidism. Observation: We report the case of a 25-year-old man who was admitted to explore pathologic fractures of the left arm and a malignant hypercalcaemia. Complementary laboratory tests revealed primary hyperparathyroidism. A multiple endocrine neoplasia was excluded by radiologic examinations. Cervical ultra-sound examination revealed 2 parathyroid adenomas and per-operative exploration showed 3 « adenomas ». Microscopic examination of the 4 parathyroid glands specimen concluded to a clear cell hyperplasia. Conclusion: Clear cell hyperplasia is a benign cause of primary hyperparathyroidism. The diagnosis is based upon histologic findings and examination of the 4 glands

Graphical Models of Psychosocial Factors in Chronic Somatic Diseases

AbstractIn this paper we describe a graph, tree and forest model of psychosocial factors dependencies of chronically ill patients, called graphical models. Foundation of the study was the theory of meaningfulness of suffering by V. E. Frankl. 181 patients with either arterial hypertension or neoplasms with bad prognosis were examined thrice: 0-10 days from the time of diagnosis (stage I), about 5 weeks from the diagnosis (stage II) and at a follow-up about 5 months since stage II (stage III). 75 factors were available for consideration: 17 in stage I, 28 in stage II, 27 in stage III and 4 sets of data that describe populations: age, gender, education, number of stages executed. For both diseases graphs and trees are built under assumption that factors are vertices and significant correlations are edges, leading to model of dependencies between factors. Usefulness of this approach to analysis of difference between diseases is discussed

A Four-Axis-Method to Evaluate a Part of an Undergraduate Medical Students’ Curriculum

Introduction: The evaluation of programs in faculties of medicine enables them to adequately reach their mission objectives, and social responsibilities and to correct their potential lacune. Fewpublications have described the process of internal evaluation of a program performed by the organizational members. The authors aimed to describe a practical method called the four-axis method to assess curriculum using a practical example.Methods: The authors performed a descriptive study, highlighting the application of a particular method of evaluation of a program called the four-axis method. It consisted of the assessment of the pedagogical alignment [1], teaching techniques and evaluation tests [2], students’ viewpoints and needs [3], and the teachers’ opinions and needs [4]. To contextualize this method, the authors described a practical experience of the assessment of a multidisciplinary theme (theme 16), which is taught during the second year of medical education. Was performed the evaluation from January 2020 to January 2021. The population studied consisted of the tutors implicated in the teaching of the theme and the students in the second year of medical education who accepted to answer the satisfaction questionnaires. The students and tutors who did not fill out the questionnaires were excluded. No statistical tests were needed because of the descriptive nature of the study. Results: The most relevant results highlighted that 48.4% of the teachers did not systematically use bioclinical cases involving interactions between students; also, 42.4% of the students believedthat the teaching sessions didn’t introduce practical examples giving rise to interactions between them. Therefore, the 4-axisbased analysis indicated that weaknesses were mostly attributedto the lack of homogeneity in the teaching methods and techniques which showed the teachers’ difficulties in integrating clinical data into their teaching so that they can help the students to assimilate the fundamental data.Conclusion: The authors’ used a particular approach since it focused both on an objective evaluation of the teaching methods and the evaluation tests and the students’ and teachers’ viewpoints and needs. The major limitation of this approach was the fact that itcould not integrate the educational environment that could impact the students’ performances

Report of a Case

ABSTRACT Micronodular thymoma is a rare subtype of thymoma with less than 20 cases published in the English literature. These tumours have been reported with thymoma or thymic cyst. The authors describe a new case of micronodular thymoma in a 68-year-old-patient which is well documented and particular by its cystic degeneration which hasn't been described yet. Micronodular thymoma is a rare variant of thymoma with a challenging diagnosis. Clinicians must be aware of this entity in order not to confuse it with a thymic cyst

Review of the literature about Thymic Carcinomas

Background: Thymic carcinomas (TC) are rare tumors with challenging diagnosis and management. We aimed to describe the clinical and microscopic characteristics of TC through a literature review.Results: 82 articles and abstracts were retained about 2913 TC. Our study contained 1760 men and 1153 women with a mean age of 55.32 years. The delay of diagnosis was specified in 10 cases and varied between 8 months and 2 years. Symptoms consisted mainly in chest pain and dyspnea. The Computed Tomography-scan&nbsp; (CT-scan) findings&nbsp; were&nbsp; specified&nbsp; in&nbsp; 63&nbsp; cases.&nbsp; Microscopic findings&nbsp; were&nbsp; noticed&nbsp; in 1766&nbsp; cases.&nbsp; They&nbsp; consisted&nbsp; mainly&nbsp; in&nbsp; squamous&nbsp; cell&nbsp; carcinoma&nbsp; in&nbsp; 1297&nbsp; cases&nbsp; and&nbsp; undifferentiated carcinoma in 239 cases. The patients presented stage 1 tumors in 165 cases, stage II in 362 cases, stage III in 1011 cases and stage IV in 1166 cases. The treatment modalities were noticed in 2803 cases. There was no consensus of the regimen of chemotherapy or the place of the radiation therapy but all studies highlighted the key role of the complete surgical resection when possible.Conclusion: Our&nbsp; results&nbsp; highlight&nbsp; the&nbsp; lack&nbsp; of&nbsp; consensual&nbsp; management&nbsp; of&nbsp; TC.&nbsp; The&nbsp; chemotherapy regimen,&nbsp; the&nbsp; second-line&nbsp; chemotherapy&nbsp; and&nbsp; the&nbsp; indications&nbsp; of&nbsp; radiation&nbsp; therapy&nbsp; seem&nbsp; non-consensual and&nbsp; need&nbsp; further&nbsp; studies.&nbsp; Many&nbsp; interrogations&nbsp; remain&nbsp; concerning&nbsp; the&nbsp; management&nbsp; of&nbsp; these&nbsp; tumors according&nbsp; to&nbsp; their&nbsp; histologic&nbsp; grade.&nbsp; The&nbsp; real&nbsp; place&nbsp; of&nbsp; targeted&nbsp; therapy&nbsp; remains&nbsp; to&nbsp; assess&nbsp; and&nbsp; the&nbsp; rare opinions published are based on rare and non-representative cases.</p

Cystic Micronodular Thymoma. Report of a Case

Micronodular thymoma is a rare subtype of thymoma with less than 20 cases published in the English literature. These tumours have been reported with thymoma or thymic cyst. The authors describe a new case of micronodular thymoma in a 68-year-old-patient which is well documented and particular by its cystic degeneration which hasn&rsquo;t been described yet. Micronodular thymoma is a rare variant of thymoma with a challenging diagnosis. Clinicians must be aware of this entity in order not to confuse it with a thymic cyst