Les tumeurs du systeme nerveux central a Antananarivo Madagascar

Les tumeurs du système nerveux central (SNC) sont longtemps considérées comme exceptionnelles en Afrique, et à Madagascar peu d’études sont effectuées. Notre but a été de décrire les aspects épidémiologique et histo-pathologique des tumeurs cérébrales. Il s’agit d’une étude rétrospective bicentrique de 117 cas de tumeurs du SNC observés à l’Unité Paraclinique de Formation et de Recherche (UPFR) d’Anatomie et Cytologie Pathologiques (ACP) du Centre Hospitalier Universitaire d’Antananarivo – Joseph Ravoahangy Andrianavalona (CHU-JRA), et au laboratoire d’Anatomie pathologique du Sampan’Asa Loterana momban’ny FAhasalamana (SALFA) Andohalo, sur une période de 10 ans, allant de Janvier 2007 à Décembre 2016. Nous avons colligé 117 cas. L’âge moyen de nos patients a été de 37,83 ans avec des extrêmes de 9 mois et 79 ans. Les enfants ont représenté 19,65 % et les adultes 80,35 % des cas. Le sex ratio a été 0,64. Les signes révélateurs sont dominés par l’hypertension intracrânienne (18,8 %) et le syndrome cérébelleux (13,67 %). Les principales localisations ont été la région sus-tentorielle (23,93 %) et la fosse postérieure (18,80 %). Histologiquement, nous avons observés une prédominance des tumeurs bénignes (53,80 %). Les méningiomes ont représenté la majorité des cas (47,86 %), suivies par le médulloblastome (11,17%). Nous n’avons recensé que 117 cas de tumeurs cérébrales sur une période de 10 ans, soit 0,29 % de tous les prélèvements adressés pour examen histologique. L’incidence est estimée à 0,51/100 000 habitants, chiffre nettement au-dessous de celui observé dans les pays développés.Mots-clés: Fosse postérieure, médulloblastome, méningiomes, tumeurs cérébralesEnglish Title: The central nervous system tumours at Antananarivo MadagascarEnglish AbstractTumors of the central nervous system have been considered rare in Africa, and in Madagascar few studies have been carried out. Our aim was to describe the epidemiological and histopathological aspects of brain tumors. This was a two centre retrospective study of 117 cases of central nervous system tumors observed at the surgical and cytopathology laboratory of JRA-UHC and SALFA Andohalo, during 10 years, from January 2007 to December 2016. We collected 117 cases. The average age of our patients was 37.83 years with extremes of 9 months and 79 years. Children represented 19.65 % and adults 80.35 % of cases. The sex ratio was 0.64. The presenting signs were predominantly raised intracranial pressure (18.8 %) and cerebellar syndrom (13.67 %). The main localization were the supratentorial area (23.93 %) and the posterior fossa (18.80 %). Histologically, we observed a predominance of benign tumors (53.80 %). Meningiomas accounted for the majority of cases (47.86 %), followed by medulloblastoma (11.17 %). We have identified 117 cases of brain tumors during 10 years, representing 0.29 % of all samples submitted for histological examination. The incidence is estimated at 0.51/100.000 peoples, which is lower compare with developed countries. Meningiomas and medulloblastoma are the most commonly observed tumors.Keywords: Brain tumors, medulloblastoma, meningiomas, posterior foss

Intérêts De L’échographie Au Cours Des Traumatismes Oculaires

Objectifs : justifier la place de l’échographie oculaire au cours des lésions traumatiques de l’œil et par la suite préciser ses intérêts.Matériels et méthodes : étude rétrospective au service d’ophtalmologie du CHU JRA sur une période de 4 ans, de 2008 à 2011 .Elle s’est portée sur 36 traumatismes oculaires ayant bénéficiés  d’une échographie. Des sondes à haute fréquences de 10Mhz ont été utilisées.Résultats : La moyenne d’âge était de 25 ans avec une nette prédominance masculine à 91,33%. Les circonstances des traumatismes sont dominées par les accidents domestiques. Le mécanisme lésionnel était surtout les plaies lamellaires et les contusions. L’échographie oculaire a permis de mettre en évidence des cataractes (58,77%) ,des hémorragies intra-vitréennes (58,77%), des désorganisations vitréennes (8,33%), des décollements de la vitré(2,77%), des décollements de la choroïde (13,8%) , des décollements  rétiniens partiel (19,44%) et total (l5,55%), une endophtalmie (2,77%), et des corps étrangers intraoculaires(8,33%).Conclusion :  L’échographie est un examen non invasif et accessible, permettant de faire le bilan initial en cas de traumatisme oculaire dans le cas de trouble des milieux transparents pour évaluer surtout le segment postérieur, ceci afin de guider les décisions thérapeutiques et le suivi

Hémangiome choroïdien circonscrit : difficulté diagnostique : à propos d’un cas

L’hémangiome choroïdien circonscrit est la tumeur vasculaire la plus fréquente de l’uvée. Il concerne surtout les sujets masculins dans la tranche d’âge de 40 à 60 ans. La maladie peut évoluer lentement et simuler d’autres pathologies. Nous rapportons le cas d’une femme de 60ans présentant un syndrome maculaire de l’œil droit dont la tomographie en cohérence optique au vert d’indocyanine a montré une séquence caractéristique d’un hémangiome choroïdien circonscrit. La patiente a été traitée par la thérapie photodynamique au vetéporfine avec de bons résultats anatomique et fonctionnel

Global Retinoblastoma Presentation and Analysis by National Income Level.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs

Travel burden and clinical presentation of retinoblastoma: analysis of 1024 patients from 43 African countries and 518 patients from 40 European countries

BACKGROUND: The travel distance from home to a treatment centre, which may impact the stage at diagnosis, has not been investigated for retinoblastoma, the most common childhood eye cancer. We aimed to investigate the travel burden and its impact on clinical presentation in a large sample of patients with retinoblastoma from Africa and Europe. METHODS: A cross-sectional analysis including 518 treatment-naïve patients with retinoblastoma residing in 40 European countries and 1024 treatment-naïve patients with retinoblastoma residing in 43 African countries. RESULTS: Capture rate was 42.2% of expected patients from Africa and 108.8% from Europe. African patients were older (95% CI -12.4 to -5.4, p<0.001), had fewer cases of familial retinoblastoma (95% CI 2.0 to 5.3, p<0.001) and presented with more advanced disease (95% CI 6.0 to 9.8, p<0.001); 43.4% and 15.4% of Africans had extraocular retinoblastoma and distant metastasis at the time of diagnosis, respectively, compared to 2.9% and 1.0% of the Europeans. To reach a retinoblastoma centre, European patients travelled 421.8 km compared to Africans who travelled 185.7 km (p<0.001). On regression analysis, lower-national income level, African residence and older age (p<0.001), but not travel distance (p=0.19), were risk factors for advanced disease. CONCLUSIONS: Fewer than half the expected number of patients with retinoblastoma presented to African referral centres in 2017, suggesting poor awareness or other barriers to access. Despite the relatively shorter distance travelled by African patients, they presented with later-stage disease. Health education about retinoblastoma is needed for carers and health workers in Africa in order to increase capture rate and promote early referral