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Worldwide, Bladder cancer is the most frequent male malignancy. It is the third most common male malignancy in Morocco. The risk factors for developing bladder cancer are multiples including dietary conditions, environmental exposure and oxidative stress. GPX1 gene encoding for the human cellular antioxidant enzyme glutathione peroxidase1 is a key factor in the cell detoxification process. GPX1 Pro198Leu polymorphism is associated with a decrease of enzyme activity and may contribute to bladder cancer susceptibility. The present case-control study was planned to assess the presence of GPX1 Pro198Leu polymorphism in Moroccan population to determine whether it is associated with the risk of developing bladder cancer in Moroccan patients. A total of 32 patients with bladder cancer and 40 healthy controls were enrolled. Genotyping of the GPX1 Pro198Leu polymorphism was carried out by PCR amplification and DNA sequencing. Pro198Leu polymorphism was observed in both bladder cancer patients and healthy controls. No significant association between the polymorphism and bladder cancer occurrence was found (Pro/Leu vs. Pro/Pro: p=0.425; Leu vs. Pro: p=0.435). For the analysis of Pro198Leu polymorphism and progression of bladder cancer, no association was observed neither for stages (Pro/Leu vs. Pro/Pro: p=0.500; Leu vs. Pro: p=0.500) nor grades (Pro/Leu vs. Pro/Pro: p=0.415; Leu vs. Pro: p=0.427). Our results clearly showed no significant association between Pro198Leu polymorphism and risk of bladder cancer in our population, suggesting that the effect of this polymorphism on bladder cancer development might be a result of a combination with other genetic alterations and/or non-genetic variables such as diet and lifestyle factors.

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Breast cancer is usually associated with metastases to lungs, bones and liver. Breast carcinoma metastasizing to the gallbladder is very rare. We report the case of 45-year-old female with clinical presentation of acute Cholecystitis, who underwent cholecystectomy in emergency. The Gallbladder showed a nodule on the Gallbladder wall. Histological examination disclosed a metastasis from a lobular breast carcinoma with positive hormone receptors. The patient had received three months previously a right mastectomy with axillar dissection followed by chemotherapy and radiotherapyfor lobular breast cancer stage III, PT3N1M0, showing hormone receptors. We present a rare case of acute cholecystitis from metastatic breast cancer three months after management of primary cancer.

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Induced sarcoïdosis during therapy with interferon for chronic viral hepatitis C involves mainly by isolated cutaneous lesions or with lung lesions. Systemic forms are very rare. We report an observation. A 50-year-old patient developed a systemic sarcoïdosis two months after the end of treatment for hepatitis C with pegylated interferon and ribavirin with lung, joint and hepatic manifestations. After starting corticosteroid therapy, the evolution was favourable. Induced sarcoïdosis by interferon therapy is rare, treatment necessitates stopping interferon, and sometimes corticosteroid therapy.

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INTRODUCTION: Synovial sarcoma is a malignant soft tissue neoplasm which occurs most of the time in teenagers and young adults. Facial, and especially parotid gland localization, is very uncommon. CASE REPORT: A 15-year-old male patient, with no prior history, was hospitalized for swelling in the left parotid area noted 5 months before. The mass was painful and there was no facial paralysis. A CT scan revealed a tumoral process of mixed density in the left parotid gland. The thorax and abdominal CT scan was normal. The patient was initially treated by surgery and adjuvant chemotherapy. He died, 8 months after this multimodal therapy. DISCUSSION: Five percent of salivary gland primitive tumors are of mesenchymatous origin, 0.3 to 1.5% of which are sarcomas. The diagnosis of parotid gland synovial sarcoma is confirmed by immune-histochemistry and cytogenetic tests. Surgery combined to radiotherapy seems to be the best treatment.

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Genital metastases are very rarely indicative of breast cancer; they are exceptionally located at the cervix. These atypical locations are more common when it comes to a metastatic breast cancer or a histological infiltrating lobular type. The simultaneous association of a lobular and a ductal infiltrating cancer under a synchronous bilateral breast cancer still remains a rare entity. In this work, we report the observation of a woman aged 48 who has a synchronous bilateral breast cancer, of different histological types, and who reported at first a genital bleeding which is caused by a metastasis in the cervix of the uterus.

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The CpG promoter methylation has been reported to occur frequently in bladder cancer. Moreover, analysis of gene methylation has been shown to be feasible from voided urine and can be detected with a high degree of sensitivity. The aim of this present study is to determine how methylation patterns of APC, RARβ and Survivin genes change during bladder carcinogenesis and to evaluate whether DNA methylation could be detected in urine sediment. Using the sensitive assay of MSP, we explored the promoter methylation status for the three genes in tumor specimens and urine sediment DNA from 32 bladder cancer patients. Methylation frequencies of the tested genes in tumor specimens were 100%, 75% and 84.4% for APC, RARβ and Survivin, respectively. Hypermethylation of APC was found in all pathological grades and stages of bladder cancer. More frequent promoter hypermethylation of RARβ and Survivin was observed in high grade tumors and the hypermethylation increased from low to high stages, but there was no significant correlation between stages/grades and hypermethylation of these two gene promoters. In order to investigate clinical usefulness for noninvasive bladder cancer detection, we further analyzed the methylation status in urine samples of bladder cancer patients. Methylation of the tested genes in urine sediment DNA was detected in the majority of cases that were hypermethylated in tumor samples (93.7%) and the frequencies were 79.3% 70.8% and 96.3% for APC, RARβ and Survivin, respectively. Our results indicate that methylation of APC, RARβ and Survivin gene promoters is a common finding in patients with bladder carcinoma. The ability to detect methylation not only in bladder tissue, but also in urine sediments, suggests that methylation markers are promising tools for noninvasive detection of bladder cancer.

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The thrombotic microangiopathy is a syndrome characterized by the combination of mechanical hemolytic anemia, peripheral thrombocytopenia, and organ failure of variable severity. In addition to the idiopathic form, several cases are identified as secondary to pregnancy, infections, disease systems, organ transplants, and cancer. Other forms are secondary to drugs including antimitotics. We report the case of a patient followed for acute myelogenous leukemia. She received induction chemotherapy combining daunorubicin and cytarabine, complicated by thrombotic thrombocytopenic purpura.

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INTRODUCTION: Primary nasal T/NK cell lymphoma is a very rare pathological clinical entity; it was defined by the WHO in 2001, thanks to immunohistochemistry. The treatment combines radiotherapy and chemotherapy. We report a case. CASE REPORT: A 20-year-old male patient was admitted for ulceration of the vestibular mucosa from tooth 20 to 26, in June 2008. The lesion had appeared four months before, with a painful ulceration close to tooth 25. The lesion evolved progressively, it eroded the alveolar bone, exposing the roots of teeth 24, 25, and 26. CT scan revealed lysis of the external maxillary sinus wall. The diagnosis of T/NK cell lymphoma was obtained by immunohistochemistry of the biopsy. The tumor was staged IeA according to the Ann Arbor classification. After four courses of CHOP chemotherapy and two years of follow-up there was no recurrence. DISCUSSION: Maxillary T/NK cell lymphoma is extremely rare. The diagnosis is based on immunohistochemistry. The treatment associates chemotherapy and radiotherapy. Recent studies suggest that radiotherapy at an early stage could improve the prognosis. But there is no consensus on therapeutic protocols.

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INTRODUCTION: Acquired ichthyosis is a rare condition that usually reveals malignant diseases. CASE REPORT: A 70-year-old man was admitted with weight loss, diffuse ichthyosis, lymphadenopathy of the inguinal lymph nodes and elevated inflammatory markers in peripheral blood. Histology of the lymph node revealed mixed-cellularity Hodgkin disease. The evolution was fatal in spite of the chemotherapy. DISCUSSION: Acquired ichthyosis is a cutaneous paraneoplastic syndrome, generally related to hematologic malignancies. A possible pathomecanism is the stimulation of epidermal growth secondary to the production of epidermal growth factor (EGF) by tumour cells. Acquired ichtyosis can rarely reveal systemic or infectious diseases. It can also be drug-induced or idiopathic.

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Desmoplastic ameloblastoma is a benign, locally aggressive neoplasm of proliferating odontogenic epithelial origin. It is seen among old patients from 17 to 72 years with an average age 42 years and without predilection of sex. We report the case of a 7 year old child, having presented since the 5 years age, a gingival tumefaction on the left higher incisivo-canin group which increased volume gradually. The stomatologic examination showed a gingival tumefaction covered with a healthy mucous membrane, ovoid form and measuring 3 cm on its horizontal axis. The tomodensitometry of the jawbone showed in front of the 21st and the 22nd tooth, the presence of an osseous lesion associating of the hearths of osteolysis and osteocondensation with rupture of cortical and invasion of the soft tissue. A curetting of the lesion was carried out and the anatomopathologic examination retained the diagnosis of desmoplastic ameloblastoma. The characteristic of our observation is the youth of the patient. In addition, the desmoplastic ameloblastoma is relatively rare, is characterized by an anatomical distribution, a radiological appearance and a morphological aspect differents from the traditional ameloblastoma. A radical surgical treatment is suggested for this tumour to avoid recurrency.

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Blastomycosis is a systemic fungal infection caused by a thermally dimorphic fungus, Blastomyces dermatitidis. The incidence in immunocompromised patients has increased in the last two decades. A 55-year-old man consulted for inflammatory nodules on the forearm. Biopsy of one nodules showed a pseudoepitheliomatous hyperplastic epidermis overlaying a dense agranulomatous inflammatory infiltrate containing free-formed ovoid bodies enclosing giant macrophageous cells. These findings were consistent with blastomycosis. After a month of treatment cutaneous lesions regressed partially but the patient's general status continued to deteriorate with the appearance of an edematous-ascitic syndrome and icterus. Laboratory blood testing demonstrated cholestasia and abdominal ultrasound showed hepatosplenomegaly. Needle liver biopsy revealed giant B-cell lymphomatous infiltration of the hepatic ducts. The patient's condition worsened rapidly and he died five months after diagnosis despite four rounds of chemotherapy. Blastomycosis is rare in Morocco. Primary infection is usually a pneumonic process. Isolated cutaneous infection is possible but uncommon. To our knowledge the association of blastomycosis and intravascular lymphoma has not been previously reported. In immunocompromised patients, clinical findings can be alarming and the outcome can be rapidly fatal.

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INTRODUCTION: Angiolymphoid hyperplasia with eosinophilia is a rare affection. CASE REPORT: A 36 years-old woman presented an angiolymphoid hyperplasia with eosinophilia manifesting by erythematous nodular lesions on the face and the forearms, severe neuropathy, visual loss and eosinophilia. Corticosteroids, immunosuppressive drugs and interferon-alpha were unsuccessful. DISCUSSION: Angiolymphoid hyperplasia with eosinophilia is a dermatological disease with possible systemic features. Differential diagnosis with Kimura disease is based on clinical presentation and histological findings. Etiopathology remains unknown and the treatment is not codified.

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We report a case of primary pulmonary Hodgkin's disease in a 20 year-old woman. The chest x-ray showed a chronic alveolar syndrome. The diagnosis was established from a pulmonary biopsy. The radiological features and the options for diagnosis of primary pulmonary Hodgkin's disease are discussed.

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INTRODUCTION: Granular cell tumors (GCT) are rarely located in the perianal area. OBSERVATION: Over the past 3 years, a 56 year-old man presented a papule of the right margin of the anus that had progressively increased in size (1.5 cm). Cell proliferation was located in the dermis and strongly expressed the S100 protein. It was covered by a pseudo-epitheliomatous hyperplasia of the overlying epidermis. Forty months after local surgical excision, there was no sign of recurrence. COMMENTS: Granular cell tumors are rare and usually benign. When cutaneous or mucosal, the pseudo-epitheliomatous hyperplasia of the overlying epithelium may, on superficial samples, be mistakenly diagnosed as squamous cell carcinomas. Malignant GCT may, histologically, appear identical to a benign GCT and only the appearance of metastases (generally after local recurrence) permits the subsequent diagnosis of malignancy.

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This report describes a case of primary leiomyosarcoma of the testis in a 70-year-old man. Treatment consisted in orchidectomy by the inguinal route with no adjuvant treatment. The patient developed pulmonary metastasis 14 months after surgical treatment. Few reports have been published on primary leiomyosarcoma of the testis. Most reported cases have been in small series in association with germ cell tumors. Surgical treatment is the most effective therapeutic modality. The standard surgical technique is orchidectomy by the inguinal route. Retroperitoneal lymph node dissection is not always performed. The prognosis of isolated testicular sarcoma is better than that of sarcoma associated with germ cell components.

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Aglomerular segmental hypoplasia of the kidney is a disease that is uncommon in the adult; the average age at appearance of symptoms is between ten and 15 years. A clear female predominance has been noted, and this disease is often misdiagnosed as chronic pyelonephritis. However, the radiological and pathological characteristics are different to the latter. The etiology of aglomerular segmental hypoplasia has not yet been determined. It is important to acquire further knowledge regarding this disease, as in certain cases this information could help to avoid unnecessary nephrectomy.

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Nodular fasciitis is a benign neoplastic and reactive proliferation of fibroblasts of soft tissues, which is often mistaken for a sarcoma because of its rapid growth, rich cellularity and mitotic activity. A case is reported that provides the opportunity to discuss the specific clinical and pathological features of nodular fasciitis.

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Spontaneous retroperitoneal hemorrhage is an uncommon affection, the diagnosis was recognized by sonography and CT scan, but the etiology remains unknown and exploration for diagnosis may become necessary. In the absence of an apparent etiology, patients with spontaneous renal bleeding should undergo radical nephrectomy, because of the extremely high incidence of small undetectable occult tumors. Three further cases were reported by the authors, who made a review of the literature.

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If the neoplastic extension with the higher vena cava can be observed during the evolution of the invasive thymomes, the tumoral extension in the right auricle, remains on the other hand an exception. We report an invasive case of thymome to higher intracellar extension, right intraatrial and pleuropulmonary revealed by a syndrome undermines higher and a left pleurisy. The transthoracic echocardiography supplemented by the echocardiography transoesophageal pose the cardiac diagnosis of tumor, and it is the thoracic tomodensitometry which highlights a tumoral process mediastinal of malignant pace invading the left inominal venous trunk, the higher vena cava and extending in the right auricle. The diagnosis of certainty is carried by the endobronchial biopsy and the puncture tomodensitometric biopsy under control of the mediastinal mass after anatomopathological examination. Under chemotherapy, the evolution over 18 months is marked by the absence of cardiovascular complications in spite of the non regression of the tumoral mass. This observation stresses the importance of the realization of the echocardiography especially transoesophageal in front of all invasive thymome and the reliability of the puncture biopsy scanoguided like diagnoses technique not very invasive in the forms not extirpables. The forecast of this affection depends on the effectiveness of the processing. The surgery when it is possible, remains the principal therapeutic measurement which really proved reliable.

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