Chronic vulvar Paget’s disease: a therapeutic challenge with a review of the literature

Vulvar Paget’s disease is an uncommon adenocarcinoma of the female genital tract, occuring more often in postmenopausal Caucasian women and accounting for 1-2% of all vulvar malignancies. A 39-year-old female patient was examined for the erythematous and pruritic vulvar lesion, with biopsy and histological examination revealing vulvar Paget’s disease. We did not diagnose any associated neoplasm. The patient underwent four surgical resections for relapsed disease, varying from local excision to extended excision, including radical vulvectomy, with esthetic coverage. The margins were involved. Due to the extended target volumes, radiotherapy was rejected and the patient underwent a local topical therapy with Imiquimod 5%. The patient was free of disease, with three years of regular follow-ups. This case was challenging due to the long recurrence of the disease for approximately 26 years and due to the therapeutics issues that occurred

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

Deletion and Grammatical Appreciation in the Nouns Mentioned in (Sharh Al-Radi on Al-Kafia, 686 A.H.

The research is to show and clarify the term grammatical assessment by one of the prominent Arab grammarians, namely Al-Radhi in his book ``Sharh Al-Radhi on Al Kafiah,'' which is an explanation of the sufficient text by Ibn Al-Hajeb. Either it is nominative, accusative, or protracted, and here we have devoted our research to studying the grammatical estimation in the accusative nouns only, whether or not he has two rights. Keywords: deletion, appreciation, grammar, Radhi, Shafiy

Chronic vulvar Paget’s disease: a therapeutic challenge with a review of the literature

Vulvar Paget’s disease is an uncommon adenocarcinoma of the female genital tract, occuring more often in postmenopausal Caucasian women and accounting for 1-2% of all vulvar malignancies. A 39-year-old female patient was examined for the erythematous and pruritic vulvar lesion, with biopsy and histological examination revealing vulvar Paget’s disease. We did not diagnose any associated neoplasm. The patient underwent four surgical resections for relapsed disease, varying from local excision to extended excision, including radical vulvectomy, with esthetic coverage. The margins were involved. Due to the extended target volumes, radiotherapy was rejected and the patient underwent a local topical therapy with Imiquimod 5%. The patient was free of disease, with three years of regular follow-ups. This case was challenging due to the long recurrence of the disease for approximately 26 years and due to the therapeutics issues that occurred

Pure dysgerminoma of the ovary: a study of 31 cases

Malignant germ cell tumors of the ovary are rare tumors characterized by their heterogeneity and occurring mostly in young women. Dysgerminoma is the most common type of these tumors. This was a retrospective study of 31 patients with pure dysgerminoma of the ovary diagnosed in Salah Azaiez institute of Tunis in Tunisia between 1970 and 2012.The median age was 22 years old. Abdominal pain was the most complaint in 45.1% of cases. An abdomino-pelvic mass was found in 83.8% of cases. Surgery was performed in all patients. The median tumoral size was 13.7 cm. Sixty four-point five percent of the patients underwent a conservative surgery. The tumor was classified stage I in 51.6% of the cases, stage II in 9.7% of the cases, stage III in 35.5% of the cases and stage IV in 3.2% of the cases. Fourteen patients received platinum-based adjuvant chemotherapy, and 10 patients had a radiotherapy. We have noticed 2 cases of recurrence and 2 cases of metastasis. Five-year and ten-year overall survival was 89.4%. Five-year disease free survival was 85.2% and ten-year disease free survival was 66.3%. Dysgerminomas of the ovary have a good prognosis. The two significant prognostic factors are the stage and the postoperative residual disease

Synergistic effects of Ruta montana (Clus.) L. essential oil and antibiotics against some pathogenic bacteria

Antibiotic resistance has been called one of the world’s most pressing public health threats. The combination of essential oils with conventional antibiotics is one of the emerging approaches that could help prevent this problem. In light of this, this study aimed to investigate the impact of combination of Ruta montana essential oil with conventional antibiotics on some pathogenic bacteria. The essential oil isolated by steam-hydrodistillation was first analyzed using GC-MS then tested alone and in combination with five recommended antibiotics against three bacterial strains by the agar disc diffusion and broth micro-dilution methods. Out of forty-nine peaks, thirty-eight components were identified representing 98.17% of the total oil composition. The major components were 2-Undecanone (63.39%), 2-Nonanone (5.65%), 2-Acetoxytetradecane (4.94%), 2-Decanone (4.47%) and 2-Dodecanone (3.35%). While R. montana essential oil showed only weak antibacterial activity compared to the antibiotics tested alone, unexpectedly, the combination of RM essential oil with antibiotics remarkably increased the antibacterial activity of the antibiotics through synergistic effects in up to 70% of cases. These results suggest that combining antibiotics with essential oils, even those with low antibacterial activity, may be effective in overcoming problems caused by increasing bacterial resistance

Resectable gastric signet ring cell carcinoma: clinicopathological characteristics and survival outcomes

Background:Gastric signet ring cell carcinoma (SRCC) appears to have clinical features and survival rates particularly different from other histological types. The aim of this study was to investigate clinicopathological features and survival outcomes of SRCC and to compare them with non-signet ring cell carcinoma (NSRCC).Methods:We retrospectively studied 145 patients with non-metastatic gastric carcinoma who underwent gastrectomy in our institute from 2005 to 2015. Among them, 36 patients (9.4%) with SRCC were compared to 109 patients (90.6%) with NSRCC.Results:Patients with SRCC presented at a younger age (p=0.001) with more advanced stage III-IV disease (p=0.005) and advanced N stages with a higher rate of pN3 (p=0.0001), a higher number of invaded lymph nodes (p=0.002) and a higher rate of patients with a lymph node ratio exceeding 25% (63.9% vs 36.7, p=0.004). After a median follow up of 35.30 months, there was no significant difference in the 5 years overall (OS) survival between SRCC and NSRCC ((36.7% vs 45.7%, p=0.206).However, the 5 years progressive free survival (PFS) was significantly decreased in case of SRCC (38.7% vs 50.9%, p=0.038) with a higher rate of metastasis in (52.9% vs 29.5%, p=0.013) and peritoneal recurrence (35.3% vs 9.5%, p<0.0001). The main prognostic factors of PFS and OS in SRCC were tumoral stenosis, hypoprotidemia, tumor size, depth of invasion (p=0.001), perineural and lymphovascular invasion, the UICC stage and complete surgical resection.Conclusion:Gastric SRCC have a particular clinicopathological behavior compared to NSRCC suggesting its more aggressive character

Determinants of surgical morbidity in gastric cancer: experience of a single center and literature review

Background:This study aimed to evaluate the severity of intraoperative and post-operative complications of gastric cancer surgery and to investigate the predictive factors correlated to surgical morbidity.Methods:We included 145 patients operated for gastric cancer. We investigated the risk factors associated with complications, length of hospital stay, operative time, and intraoperative blood transfusion (BT). Significant risk factors were analyzed by multiple logistic regression analysis.Results:Postoperative complications occurred in 32 patients (22.1 %) and the rate of major complications was 7.6%. The rate of anastomotic fistula was 6.9% and was correlated to diabetes, tumor size, operative time, surgical margin, and extended lymphadenectomy. The mean risk factors for postoperative morbidity were the presence of comorbidities and ASA score (p = 0.021), intraoperative BT (p = 0.045) and prolonged operative time (p = 0.055).Conclusion:Surgical morbidity of gastric cancer is correlated to the extent of resection as well as the clinical and histological characteristics

Extreme Idiopathic gigantomastia

Gigantomastia is a rare mastopathy of unknown cause. Due to mechanical and psychological complications related to excessive breast weights and volume, effective surgical treatment is required. Most cases of gigantomastia in the literature are associated with pregnancy or puberty and very rare cases of spontaneous gigantomastia have been reported We report a 38 years old woman with an idiopathic gigantomastia treated successfully with Thorek technique

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