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Breast cancer is the most frequently diagnosed cancer in women and is caused by the uncontrolled proliferation of breast cells. Metastases from breast cancer to the central nervous system have been described frequently in the literature, but dural metastases without cerebral parenchymal involvement are rarely reported. The latter condition is known as isolated pachymeningeal metastasis (IPM). Herein, we report the case of a 52-year-old female patient who presented left homonymous hemianopia secondary to a right occipital lobe injury which was compressed by a dural thickening identified on brain MRI. Etiological investigations revealed suspicious breast lesions on chest CT scan. Anatomopathological examination of these lesions was consistent with luminal breast cancer. The diagnosis of IPM following breast cancer was confirmed, and the patient underwent chemotherapy treatment.

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Tuberculosis (TB) is a common infectious disease that most often affects the lungs, but it can also affect any other organ with a wide range of clinical manifestations. There are three forms of hepatic involvement: diffuse hepatic tuberculosis combined with pulmonary tuberculosis; diffuse hepatic tuberculosis without pulmonary involvement; and nodular or focal/local hepatic tuberculosis, which is a very rare form and presents a diagnostic challenge. We here report the case of a young Moroccan man presenting with biliary colic that had been evolving for a month, associated with a forme fruste of tuberculous impregnation. CT scan and magnetic resonance imaging (MRI) of the liver showed nodular hepatic lesions. The diagnosis of focal hepatic tuberculosis was confirmed based on anatomopathological examination of biopsies obtained during laparoscopy. The patient received antitubercular treatment with good clinical-biological outcome.

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Introduction: Primary squamous cell carcinoma of the liver (SCC) is a rare and challenging pathology. As an aggressive cancer, the prognosis is extremely poor with less than 12 months overall survival. In view of its low prevalence, we report the case of an elderly patient with primary squamous cell carcinoma of the liver. Case description: A 74-year-old female, with no pathological history, presented with acute right hypochondrium pain associated with shivering, asthenia and weight loss. We diagnosed primary hepatic squamous cell carcinoma by pathological analysis. Conclusion: Primary hepatic squamous cell carcinoma represents a rare malignant tumour with extremely poor prognosis. There is no established treatment protocol for this disease and a multidisciplinary approach is needed to choose the best therapeutic option. LEARNING POINTS: Primary squamous cell carcinoma of the liver (SCC) is extremely rare, making each case report valuable to the medical community. Documentation and analysis of these cases are crucial to enriching knowledge of this rare disease.The absence of established treatment protocols for primary SCC of the liver highlights the need for a multidisciplinary approach to determine the best therapeutic options, which could include innovative treatments and clinical trials.The importance of documenting cases like this can help build a knowledge database. This can help identify trends, improve diagnostic and treatment strategies, and potentially lead to standardized treatment protocols.

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Dermal nonneural granular cell tumor is a rare neoplasm of uncertain histogenesis that Le Boit and colleagues originally described in 1991. It arises commonly from the back, extremities and head and neck. To the best of our knowledge, only 50 cases have been reported in adults in the English literature. A 42-year-old man presented with a polypoid skin nodule of the front side of the chest wall, measuring 1,8 × 1,5 cm. The lesion was removed completely with tumor-free margins. Microscopically, the tumor was composed of a diffuse infiltrate of polygonal cells, S 100 negatives, with abundant granular cytoplasm and vesicular nuclei. The diagnosis of dermal nonneural granular cell tumor was retained. No recurrence was noted during follow up of 6 months. The prognosis is good.

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Originally recognized by Cushing and Bailey, hemangioblastoma is a developmental vascular neoplasm that is predominantly found in the posterior fossa. It is a highly vascularized tumor, with well-differentiated histologic features. Although rare, it remains the most common primary tumor of cerebellum in adults, along with metastases. MRI is the gold standard, allowing a precise characterization of the lesion's features, and its relationship with the surrounding structures. We report the case of a patient with a cerebellar symptomatology, in whom brain MRI raises the diagnosis of hemangioblastoma, which was then confirmed by histopathologic examination.

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Primary angiosarcoma of the pleura is an extremely rare tumour arising from arterial or venous pulmonary vessels of various size. It is characterized by an aggressive course and a poor prognosis. The early diagnosis is challenging due to diverse clinical and radiological manifestations. We report a case of a 70 year old male with primary right pleural epitheloid angiosarcoma. The patient had a history of a two week's progressive dyspnea. CT-scan showed a prominent thikening of the right pleura associated with pleural effusion and atelectasis. CT-scan guided by biopsy was performed and histological examination showed a tumor proliferation consisting of sheets of polygonal and epitheloid cells showing rudimentary vascular differentiation. Immunohistochemically, tumor cells were strongly positive for CD31 and Factor VIII-related antigen, negative for CD34, weakly and focally positive for EMA and Cytokeratine. The overall pathological and immunohistochemical features of the pleural specimens supported the diagnosis of epitheloid angiosarcma. The patient died after a week of discharge by pulsless ventricular tachycardia arrest. In addition, we also present a brief litterature review on pleural angiosarcoma. Our experience with this case suggests that comprehensive and sufficient sample collection and meticulous histological examination aided with immunohistochemical stains, particulary the endothelial markers, are required for accurate diagnosis of this rare malignancy.

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Chondrosarcoma is a rare malignant bone tumor. It can arise de novo or secondary to a malignant transformation of a benign underlying cartilage tumor. Secondary chondrosarcoma arising from solitary benign osteochondroma is extremely rare and data show that the reported incidence of osteochondroma of the pelvis is very low. We here report the case of a 20-year old patient with chondrosarcoma secondary to malignant transformation of an osteochondroma of the right wing of ilium, adjacent to the sacroiliac joint.

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BACKGROUND: Urinary schistosomiasis is a common parasitic disease in endemic countries. CASE PRESENTATION: We report the case of a patient who was on a working trip to Mauritania. This parasitosis, suspected in the presence of hematuria and the notion of stay in an endemic zone, was confirmed by the presence of Schistosoma heamatobium eggs during the histological examination of the bladder biopsy performed after cystoscopy, highlighting a bilharzial granuloma and of course, the diagnosis was confirmed by the presence of eggs during the direct examination of the freshly collected urine. CONCLUSIONS: It should be pointed out that the diagnosis of schistosomiasis must be evoked with the association of hematuria and the particular inflammatory aspect of the vesical mucosa and, of course, the notion of stay in an endemic zone.

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BACKGROUND: The extraskeletal myxoid chondrosarcoma (CME) is a rare tumor of the soft tissue, with clinically distinguishable clinical, histological, immunohistochemical, cytogenetic and evolutionary characteristics with an unfavorable long-term prognosis. CASE: We reported the case of a young patient of 18 years, accusing pelvic pain for 5 months with a poor general condition, an MRI was performed immediately, objective infiltrative mass endopelvic evoking several etiologies. The histology of the biopsy extraskeletal myxoid chondrosarcoma reveals a (CME). 's Staging came back normal. We performed an incomplete surgical resection due to the deep location of the pelvis in the tumor followed by radiotherapy. CONCLUSION: The CME is a tumor diagnosis very difficult and often delayed, despite a mostly local aggressiveness and prolonged survival, it is considered a low-grade sarcoma malignancy or intermediate malignancy. Treatment consists of complete surgical resection with a potential adjuvant radiotherapy . Chemotherapy is not very effective.

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OBJECTIVE: We assessed the contribution of a dynamic surgical guidance (DSG) probe in the accurate placement of thoracic and lumbar pedicle screws (PSs) in patients with spinal deformity. METHODS: A retrospective review was performed of 98 patients (104 procedures) with various spinal deformities, who had received posterior instrumentation with PSs inserted using either DSG or the conventional free-hand (FH) technique. A total of 882 PSs were inserted using DSG (DSG group) and 603 using the FH technique (FH group). The DSG probe was preferably chosen for large osteosyntheses and severe deformities. Two neurosurgeons, unaware of the surgical groups, reviewed all the intraoperative computed tomography scans and assessed all the PS placements. RESULTS: Of the PSs used, 95.4% in the DSG group and 92.2% in the FH group were correctly placed (P = 0.0136). The difference in screw placement accuracy was greater at the thoracic level (DSG group, 92.5%; vs. FH group, 87.0%; P = 0.0310) than at the lumbar level (DSG group, 98.0%; vs. FH group, 95.4%; P = 0.0385). Severe (>4 mm) lateral breaches occurred in 24 cases (4.0%) in the FH group but in only 5 (0.6%) in the DSG group (P < 0.0001). No severe medial breach was observed in either group. CONCLUSIONS: Despite having more patients with severe deformities in the DSG group, PS insertion was significantly more accurate with DSG. This technique also reduced the severe unacceptable lateral misplacement rate (>4 mm) and, consequently, the incidence of intraoperative screw revisions even in patients with severe deformities.

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BACKGROUND: A wide spectrum of treatment choices is proposed for poor-prognosis patients with vertebral metastases. The continuous increase of this population and the propagation of less invasive techniques necessitate further study concerning which patients could benefit from palliative surgery. METHODS: All patients with a Tokuhashi score ≤8 who had undergone palliative surgical treatment for vertebral metastasis within 4 years were retrospectively reviewed. Demographics, clinical characteristics, and data concerning the disease and the operation were recorded. Patients were assessed on discharge and at 2 months concerning eventual benefit from surgery, based on pain measurements, motor function (Frankel grade), spinal stability assessment, and complications. Statistical analysis was performed to detect possible interrelations. RESULTS: Eighty-eight patients were reviewed. The average age was 56.5 years. The mean Tokuhashi score was 5.9, and the mean Karnofsky score was 56.4. Thirty-six patients experienced immediate improvement, 12 were lost to follow-up, and 42 were found to have benefited from surgery 2 months later. High Karnofsky score, radicular pain, morphine use, absence of complications, and immediate improvement predicted benefit from surgery. CONCLUSIONS: Decision making for a patient with poor prognosis concerning eventual surgery for a vertebral metastasis should be based mainly on the patient's clinical presentation; the primary cancer site is of less importance.

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We here report the case of a 58-year old patient admitted with respiratory distress, oxygen desaturation 65% while breathing ambient air and fever 38.5°C. Blood count showed pancytopenia. Ionogram objectified slight hepatic cytolysis and chest X-ray showed bilateral miliaria. BK research using sputum was negative as well as Genexpert TB test. Anatomopathological examination of the osteomedullar biopsy revealed epitheliogigantocellular granuloma without caseous necrosis and polymerase chain reaction (PCR) showed mycobacterium tuberculosis in osteomedullary biopsy. Liver biopsy showed epithelioid granuloma without caseous necrosis. The diagnosis of multifocal tuberculosis with pulmonary, hematopoietic and hepatic impairment was retained. Miliary Tuberculosis is a severe form of tuberculosis. Bacilloscopies are often negative and the diagnosis can be retained based on other sampling, including cerebrospinal fluid sampling and osteomedullary biopsy. Different kinds of biopsies enable diagnosis in rare cases. PCR, a technique used in molecular biology, has enabled to shorten the window period from disease onset to diagnosis as well as treatment implementation. Miliary tuberculosis can be life-threatening; therefore, sometimes, treatment must be administered before certain diagnosis.

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BACKGROUND: Inflammatory myofibroblastic tumour (IMT) is a mesenchymal neoplasm of intermediate biological potential that may affect a wide range of anatomic sites but has a particular predilection for the lung and intra-abdominal soft tissues. CASE PRESENTATION: We report here an exceptional case of inflammatory myofibroblastic tumor arising in the lacrimal gland and presenting as an orbital mass in a 24-year-old male. CONCLUSION: This report aims to discuss the importance of histopathological and immunohistochemical findings in arriving at the diagnosis, which helps dictate the management, treatment and prognosis of the patient.

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BACKGROUND: Urothelial bladder carcinoma (UBC) is one of the most prevalent cancers in men worldwide. Human epidermal growth factor receptor 2 (HER2) expression has been detected in a wide range of urothelial carcinoma. Despite many reports in the literature, the prognostic significance of this overexpression remains unclear. The aim of this study was to assess the expression of HER2 in urothelial bladder carcinomas and its association with clinical and pathological parameters. METHODS: 103 cases of UBC were diagnosed in our department between January 2014 and December 2015. The tumor specimens obtained by transurethral resection or cystectomy were evaluated by immunohistochemistry using HER2 antibody. RESULTS: HER2 protein overexpression was present in 11.7% of cases and associated with tumor grade (p = 0.003) and pathological stage (p = 0.015). In multivariate analysis, HER2 overexpression was associated only with tumor grade (P = 0.04). CONCLUSION: HER2 protein overexpression is noted in patients with high grade cancer. This expression may select patients for anti HER2 targeted therapy. Future larger and prospective studies will verify the frequency of HER2 alteration and the role of HER2 in the aggressive behavior.

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Synchronous primary cancers involving the pancreas and kidney are extremely rare and poorly documented. We report the first case of this association treated with chemotherapy and tyrosine kinase inhibitor. A 70-year-old woman presented with a 2-month history of epigastric pain with weight loss of 12 kg. Two weeks previously, she had presented with jaundice and pelvic pain. A computed tomography (CT) scan of the body revealed the presence of an irregular mass in the body of the pancreas, encasing the celiac trunk, with dilatation of the biliary tract. CT also revealed a heterogeneously right renal mass with bone metastasis in the left acetabular cup and the left iliac wing. A biliary metallic prosthesis was performed with a pancreatic mass biopsy. Histology revealed a moderately differentiated pancreatic ductal adenocarcinoma. Another biopsy was performed in the right iliac wing. Pathological examination with immunohistochemistry confirmed the diagnosis of bone metastasis from clear cell renal cell carcinoma. The patient was treated with a combination of gemcitabine, sunitinib, and denosumab. She had a stabilization disease and a prolonged progression-free survival of 9 months. Side effects were manageable and included grade 2 fatigue and grade 2 hypertension. The patient died at 13 months from diagnosis after disease progression. This report suggests that the appropriate treatment for this association in metastatic or unresectable disease is chemotherapy for pancreatic cancer and tyrosine kinase inhibitor for kidney cancer. We also review the appropriate literature concerning that association.

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INTRODUCTION: The association of two cancers in the same patient is unusual but has been widely reported in the literature, while triple malignancy in the same patient is exceptional. Indeed, only very rare cases have been described. CASE PRESENTATION: A 70-year-old woman treated in our institute in 2006 for a tumor of the cervix. She underwent extrafascial hysterectomy. Pathology revealed a well differentiated squamous cell carcinoma of the cervix (pT1N0M0). No external pelvic radiation or brachytherapy were done. The patient remained in good control until 2013 when she presented a tumor of the ascending colon. A right hemicolectomy was made. Pathology confirmed a colloid adenocarcinoma (pT3N0M0). No adjuvant chemotherapy was given. Three years later, a Computed tomography scan of the chest revealed a nodule of the lower lobe of the left lung. Biopsy was made. Histology with immunochemistry revealed the diagnosis of lung adenocarcinoma. Positron emission tomography scan showed abnormal fluorodeoxyglucose uptake in the lung nodule with no anomaly in mediastinal nodes and no metastasis. A left lower lobectomy was performed with lymph node dissection. Pathology confirmed the diagnosis of 2.5 cm lung adenocarcinoma without node invasion (pT1N0M0). No chemotherapy was given. After 14 months, the patient remained in good control. CONCLUSIONS: Triple malignancy in a single patient is exceptional. The management depend on stages. Surgery is the standard of care in localized cancers.

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Granular cell tumors (GCT) are uncommon tumors. They mainly occur at the level of the skin and the subcutaneous tissues. Gastric tumor is rare. We here report a new case of gastric Abrikossoff tumor as well as a brief literature review. This study aims to examine the clinical, endoscopic and therapeutic features of this rare disease.

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BACKGROUND: Hemophagocytic lymphohistiocytosis in adults is often secundary to an infection or a neoplasm. In this last case, T cell lymphomas are the most frequent causes. Hemophagocytic lymphohistiocytosis secundary to a B cell lymphoma has been rarely reported. CASE PRESENTATION: We describe a case of a hemophagocytic lymphohistiocytosis complicating a T-cell rich B-cell lymphoma treated with conventionnal chemotherapy leading to a complete remission. CONCLUSION: Prompt etiologic diagnosis and treatment of hemophagocytic lymphohistiocytosis leads to satisfactory outcome.

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Paraneoplastic syndromes are a heterogeneous group of clinical and biological manifestations caused by underling neoplasms. They can reveal ovarian teratoma which express neuroendocrine proteins, or contain mature or immature neural tissue inducing an autoimmune response. The etiological investigation is then crucial to early identification of the tumor in order to optimize the prognosis and to limit neurological sequelae. In case of ovarian teratoma, management is essentially based on surgical resection sometimes associated with immunotherapie. We report two new cases of ovarian teratoma revealed by paraneoplastic syndromes in young and menopausal woman.

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