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Stevens‐Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute, life‐threatening and rare severe cutaneous adverse reactions induced by drugs in most cases. The drugs most often reported to be implicated in inducing TEN/SJS are allopurinol, antibacterial sulfonamides, antiepileptic drugs and oxicam. Pristinamycin is an oral streptogramin antibiotic with bactericidal activity against Gram‐positive bacteria that is rarely linked to TEN. Typically, this condition develops 4‐28 days after drug exposure, Herein, we report a case of a 71‐year‐old female who developed TEN within 3 days of administration of pristinamycin and was managed successfully with supportive care, including intravenous fluids, pain control, prophylactic antibiotics and intravenous methylprednisolone. This case of rapidly developing SJS/TEN after administration of pristinamycin highlights the possibility that these complications can develop within only a few days following ingestion of drugs thought to be probably safe. [ABSTRACT FROM AUTHOR]

Aims: Interferon‐beta (IFNβ), the most widely prescribed medication for multiple sclerosis, is generally considered safe. Nevertheless, rare serious and/or life‐threatening side effects have been reported such as thrombotic microangiopathy. A few mechanisms have been proposed to explain how interferon causes thrombotic microangiopathy, but immunological studies have been unable to pin this phenomenon down to a single pathophysiologic pathway. The aim of this article was to report a new mechanism explaining Interferon beta related thrombotic microangiopathy. Methods: We report thrombotic microangiopathy in a 28‐year‐old male receiving interferon‐beta treatment for multiple sclerosis. Results: After three years of starting interferon beta therapy, the patient presented with malignant hypertension causing seizures, rapidly progressive renal failure requiring haemodialysis and haemolytic anaemia. Corticosteroid and plasma exchange sessions permitted haemolysis control. Nonetheless, the patient remained hemodialysis‐dependent. Exploration of the complement system found a complement factor I deficiency whose activity normalized at the control carried out after 2 years. Conclusion: IFNβ treatment may cause complement factor I deficit, which can lead to thrombotic microangiopathy and severe renal failure. [ABSTRACT FROM AUTHOR]

The sarcoid-like reaction is a rare autoinflammatory disease that can affect lymph nodes or organs but does not meet the diagnostic criteria for systemic sarcoidosis. Several drug classes have been associated with the development of a systemic sarcoid-like reaction, which defines drug-induced sarcoidosis-like reactions and can affect a single organ. Anti-CD20 antibodies (rituximab) have rarely been reported as responsible for this reaction and this adverse effect has mainly been described during the treatment of Hodgkin's lymphoma. We report a unique case of a sarcoid-like reaction complicating rituximab following the treatment of a mantle cell lymphoma and interesting only the kidney. The 60-year-old patient presented with severe acute renal failure 6 months after the end of his r-CHOP protocol and the urgent renal biopsy revealed acute interstitial nephritis rich in granulomas without caseous necrosis. After ruling out other causes of granulomatous nephritis, a sarcoid-like reaction was retained since infiltration was limited to the kidney. The temporal relationship between rituximab administration and the sarcoid-like reaction onset in our patient supported the diagnosis of a rituximab-induced sarcoidosis-like reaction. Oral corticosteroid treatment led to rapid and lasting improvement in renal function. Clinicians should be warned of this adverse effect and regular and prolonged monitoring of renal function should be recommended during the follow-up of patients after the end of treatment with rituximab. [ABSTRACT FROM AUTHOR]

Acute interstitial nephritis (AIN) is a relevant cause of acute renal failure. Drugs are the predominant cause, followed by infections and idiopathic lesions. AIN, as a form of hypersensitivity reaction, is an uncommon manifestation in the setting of human parasitic infections. We report a case of a polyparasitic infection (Giardia lamblia, Entamoeba coli, and Endolimax nana) resulting in a severe biopsy-proven AIN in a 61-year-old male patient. Despite the antiparasitic treatment followed by corticosteroid therapy, and during the 6-month follow-up period, the patient remained dialysis-dependent, and he developed autoimmune hemolytic anemia. Extensive search for another infection or neoplasia was negative. Immunological tests were also negative. The resulting hypersensitivity reaction to the triple parasite infection would have led to fatal evolution for the kidneys affected by this unusual type of AIN. [ABSTRACT FROM AUTHOR]

Triple-negative breast cancer (TNBC) is a very heterogeneous disease and refers to a subgroup of breast cancer. The purpose of this study was to describe the clinical, pathological and molecular features of TNBC. We conducted a retrospective analysis of 56 cases of TNBC diagnosed in the Department of Pathology at the Farhat Hached University Hospital over a period of three years (2018-2020). The incidence of TNBC was 5.62% and the mean age of the patients was 50.36 years. The most frequent reason for consultation was the discovery of breast nodules (98.21%). The diagnosis of TNBC was confirmed in 24 cases (42.86%) based on the analysis of mastectomy specimens. Invasive carcinoma of no special type (NST) was the most common histological type (47 cases; 82.5%). Mean tumor size was 35.5 mm. SBR grading was only specified in 42 cases (73.68%). Grade III was the most predominant type (78.6%, n = 33). The notion of lymph node metastasis was found in 44 reports and lymph node invasion was reported in 19 patients (43.2%). Immunohistochemical study showed that all patients were hormone receptornegative (RO and RP) with no Her2 overexpression (n = 56; 100). This study results are generally in agreement with literature data. Despite recent molecular classifications, there is no clinically verified diagnostic test allowing for clear therapeutic standardization. [ABSTRACT FROM AUTHOR]

Background: Thyroid metabolism involves iodine, which allows us to use radioactive iodine for diagnostic and therapy purposes. The efficiency of radioiodine therapy depends on several parameters; the ability of thyroid tissue to uptake radioactive iodine is one of them.Objective: The objective of this work is to quantify the radioactive iodine uptake on thyroid tissue.Methods: In this work, we developed a method to quantify the in vivo uptake of iodine-131 on sections of thyroid glands removed by thyroidectomies. We performed an analysis of histological sections of the thyroid tissue by beta imaging. We had the opportunity to quantify the fixed radioactivity and to analyze its distribution in the thyroid gland, thanks to the good spatial resolution available with the type of detector used.Results: The results gave a high image resolution showing the heterogeneity of iodine-131 fixation by the thyroid tissue. We were able to quantify the tissue radioactivity in mega Becquerel (MBq) per volume unit.Conclusion: This work has shown that the direct quantification of the thyroid tissue uptake is possible using the beta imaging system. [ABSTRACT FROM AUTHOR]

Squamous cell carcinoma of the nail bed is a rare malignant tumor. The highest incidence occurs in the fingernails of the hand, but involvement of the toenails is also possible. Subungual squamous cell carcinoma often resembles to other more common benign lesions, such as fungal infections, onychomycosis, or viral warts, which explains the frequently delayed diagnosis of this tumor. We report the case of a mason with a subungual squamous cell carcinoma of the right hallux that had developed in a chronic post-traumatic lesion, without bone invasion. Treatment consisted of toe amputation. Further attention to chronic non-healing nail bed lesions is needed. [ABSTRACT FROM AUTHOR]

• Metastases to gallbladder from renal cell carcinoma are very rare. • Most of the cases are diagnosed incidentally, and both clinical presentation and physical examination are unspecific. • Imaging although its specificity can't make the difference between primary gallbladder carcinoma and metastasis from RCC. • Only pathological examination of the specimen after cholecytectomy with immunochemistery can assess the diagnosis. Metastatic tumors to the gallbladder are uncommon. Metastases from renal cell carcinoma (RCC) to the gallbladder are exceptional. Frequencies of less than 0.6% reported in large autopsy reviews and few cases have been reported in the literature. Herein we present a case of a 50-year-old man that developed four years after radical nephrectomy for RCC, a gallbladder metastasis, discovered incidentally on Computed Tomography (CT) scan. It was described as an intraluminal gallbladder polyp. Radiological features were very suggestive of primary gallbladder carcinoma, thus the patient had a laparoscopic cholecystectomy. The pathological examination of the surgical specimen concluded to a RCC metastasis. Immunochemistry with vimentin and pancytokeratin were supportive of this diagnosis. The clinical course was uneventful after 18 months period of follow up. At the time of presentation, almost one-third of the patients with RCC are metastatic. Metastases to the gallbladder are extremely rare. Clinical presentation and physical examination are unspecific. Radiological findings can raise information and orient the diagnosis although the difference between both diagnoses remains difficult. Usually, it is a pedunculated and not associated with gallstones with enhancement on CT scan. The treatment remains surgical with R0 cholecystectomy, and prognosis is mainly related to disease free interval and single site metastasis. We highlight here the challenge to make the difference between a primary gallbladder carcinoma and metastasis from RCC. Diagnosis is made on pathological examination and immunochemistry. [ABSTRACT FROM AUTHOR]

Sulfonamide non-antibiotics have less risk of cross reactivity, but it remains possible.7 The rate of allergic reaction is likely not dependent on the medication, but rather an intrinsic predisposing factor to hypersensitivity reactions. Glimepiride is an antidiabetic sulfonylurea agent that is generally well tolerated. Skin adverse reactions related to glimepiride are rare and include rash, pruritis, photosensitivity and lichenoid eruption.1 However, severe cutaneaous adverse reactions may occur with glimepiride, including toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome.2 Several publications indicate that cross-reactivity between sulfonamide antimicrobials (sulfamethoxazole-trimethoprim [SMX-TMP]) and sulfonamide non-antimicrobials including antidiabetic sulfonylurea agent (glimepiride) is unlikely.3 Herein, we report a case of fatal TEN probably related to glimepiride in a patient with a previous medical history of hypersensitivity to SMX-TMP. [Extracted from the article]

Background: Soft tissue leiomyosarcomas are rare, accounting for almost 5%–10% of all soft tissue sarcomas; they account for almost 1% of all sarcomas. They are aggressive tumors where location, size, and management require a multidisciplinary approach. Since there are few series published, we here analyze epidemiological pattern, clinical and pathologic features of soft tissue leiomyosarcomas. Methods: We conducted a retrospective study of 29 consecutive cases of histologically proven soft tissue leiomyosarcoma extracted from the database of the Cancer Registry of the Center of Tunisia and the Department of Pathology of Farhat Hached University Hospital of Sousse of Tunisia, during a 10-year period (from January 1996 to December 2005). Epidemiologic details, clinico-pathological features, and treatment modalities were assessed with focus on patients' 5-year overall survival, tumor relapse, and metastases. Results: Soft tissue leiomyosarcoma accounted for 17.5% of all soft tissue sarcomas diagnosed at our pathology department. Most of patients were of advanced age (median: 52 years), with extremes ranging from 12 and 87 years. There was a slight male predominance (sex-ratio = 1.07). Tumors were located mostly in the lower limbs (45%). Deep sites as retroperitoneum was found only in two cases. Tumor size was more than 5 cm in 83% of cases (average size = 9.4 cm). Five cases had metastasis on initial staging. For 24 patients, the disease was locally limited at the moment of diagnosis. Palliative chemotherapy was indicated for four patients and surgery was performed for 20 patients. Local recurrence occurred in 11 patients (55% of operated patients) and metastasis in 6 patients. Overall, 5-year survival was about 24%. Conclusion: Our study results highlight the scarcity of soft tissue leiomyosarcoma. Unfortunately, unusual tumor sites, disease's advanced stages, and intralesional resection made the prognosis poorer than in other series. Clinical course of soft tissue leiomyosarcoma was highly marked by local recurrence and metastasis. [ABSTRACT FROM AUTHOR]

Introduction Ossifying fibromyxoid tumor (OFMT) is a rare lesion that generally occurs in the soft tissues of proximal limbs, head or neck and presents as a slowly growing mass. Abdominal or trunk locations are extremely rare. Presentation of case We report a case of 50-year-old man who presented with a painless, slow growing epigastric mass for 5 years. Radiologic assessment revealed a well circumscribed median subcutaneous parietal mass lesion present in front of the xiphoid process suspicious of a calcified hydatid cyst. Diagnosis of OFMT was made on histopathological examination of the resected specimen. Discussion OFMT most often presents as a single swelling arising from the subcutaneous soft tissues or skeletal muscles of the extremities. Multifocal presentation is exceedingly rare. Radiologically, a peripheral shell of bone is seen in more than 50% cases. On MRI, myxofibrous stroma appears isointense to muscle on T1 and of intermediate to high signal intensity on T2. Surgical excision is the mainstay of treatment. Histologically, the tumor has a thick fibrous capsule with a complete or partial underlying layer of metaplastic woven or lamellar bone. Tumor is composed of uniform round, ovoid, or spindle-shaped cells arranged in nests and cords embedded in a variably myxoid and collagenous Alcian blue-positive stroma. On immunochemistry, the tumor cells are positive for S100 protein and desmin in 90% and 50% cases respectively. Conclusion OFMT is a rare soft tissue tumor with malignant potential often misdiagnosed as a benign lesion. Complete surgical excision should be performed to prevent local recurrence. [ABSTRACT FROM AUTHOR]

Background: Neurofibromatosis type 1 is a relatively common inherited disorder. Patients with neurofibromatosis type 1 are at high risk of developing neurogenic, neuroendocrine and mesenchymal intra-abdominal tumors. Although coexistence of multiple tumors of different types is frequent in neurofibromatosis type 1, simultaneous occurrence of abdominal tumors of three types in very rare.Case Presentation: A 66-year-old lady with neurofibromatosis type 1 presented with painless progressive jaundice for six months. Laboratory investigations revealed iron deficiency anemia and conjugated hyperbilirubinemia. Tumor markers were normal. Abdominal computed tomography showed a 3 × 2 cm heterogenous mass in the periampullary region with mild dilation of the common bile duct and another 2 × 1.7 cm mass in the fourth portion of the duodenum. Endoscopic biopsy confirmed the diagnosis of periampullary carcinoid. At surgery, multiple small nodules were detected at the hepatic hilum. Frozen section suggested them to be neurofibromas. Patient underwent pancreatoduodenectomy and had uneventful recovery with no recurrence at two months. Microscopic examination of the resected specimen confirmed presence of three tumors: periampullary well differentiated neuroendocrine tumor, gastrointestinal stromal tumor of the fourth part of duodenum and plexiform neurofibroma at the hepatic hilum.Conclusion: Patients of neurofibromatosis type 1 with abdominal symptoms should be treated with high index of clinical suspicion and thoroughly evaluated to rule out multiple tumors. [ABSTRACT FROM AUTHOR]

Introduction Bronchogenic cysts are congenital cysts arising as an abnormal budding from primitive tracheobronchial tree. They are lined by pseudostratified columnar or cuboidal ciliated epithelium and contain smooth muscle fibers, submucosal bronchial glands and/or cartilage. They are most frequently located in the mediastinum or the lung parenchyma. Intramural occurrence of bronchogenic cyst in the gastric wall is very rare. Presentation of case We present a case of 65-year-old lady with a 7 × 8 cm lesion in the gastric cardia suspicious of gastrointestinal stromal tumor. Because of the large size, total gastrectomy with Roux-en-Y esophagojejunal anastomosis was performed. The postoperative course was uneventful. Histopathological examination revealed a sub-mucosal cyst lined by PCCE with presence of smooth muscle fibers and focal mucous glands. Final diagnosis of bronchogenic cyst was made. On the last follow up at one year, she was symptom free. Discussion On extensive Medline/Pubmed search, only 38 cases of gastric bronchogenic cysts were found to be reported till date. They are typically located in the posterior gastric wall close to the gastric cardia. On radiological imaging, they appear as well defined intramural cystic lesion without any characteristic features. Surgical resection is considered in symptomatic cases or in case of diagnostic dilemma. Conclusion Gastric bronchogenic cysts often mimic gastrointestinal stromal tumor on preoperative imaging. They should be included in the differential diagnosis while dealing with an intramural gastric lesion close to the cardia or gastroesophageal junction. [ABSTRACT FROM AUTHOR]

Introduction Castleman’s disease (CD) is an angio-follicular lymph node hyperplasia presenting as a localized or a systemic disease masquerading malignancy. The most common sites of CD are mediastinum, neck, axilla and pelvis. Unicentric CD in the peripancreatic region is very rare. Presentation of case We report a case of the 34-year-old lady presenting with epigastric pain for 3 months. Abdominal imaging revealed a retroperitoneal mass arising from the pancreas suspected to be neuroendocrine tumor. Tumor markers were not elevated. Complete surgical excision was performed and patient had uneventful recovery. Pathologic findings demonstrated localized hyaline-vascular type of Castleman’s disease. Discussion CD is a very rare cause for development of retroperitoneal mass. It is more frequent in young adults without predilection of sex. It can occur anywhere along the lymphoid chain. Abdominal and retroperitoneal locations usually present with symptoms due to the mass effect on adjacent organs. CD appears as a homogeneously hypoechoic mass on ultrasound and non-specific enhancing homogeneous mass with micro calcifications on computed tomography. Histologically, the hyaline vascular type demonstrates a follicular and inter-follicular capillary proliferation with peri-vascular hyalinization, with expansion of the mantle zones by a mixed inflammatory infiltrate of numerous small lymphocytes and plasma cells. The standard therapy of localized form is en bloc surgical excision as performed in our case. Conclusion Unicentric CD in the peripancreatic region is difficult to differentiate from pancreatic neoplasm preoperatively. However, preoperative biopsy in cases of high clinical suspicion can help in avoiding extensive surgery for this benign disease. [ABSTRACT FROM AUTHOR]

Introduction Gastrointestinal stromal tumors (GIST) are tumors of mesenchymal origin commonly detected in stomach and small bowel. GIST arising primarily from the anal canal is extremely rare. Due to the malignant potential, these tumors are treated with radical surgery like abdominoperineal resection. But with the advent of imatinib therapy and a better understanding of the tumor biology, some cases have been successfully treated with wide local excision. Presentation of case We describe a case of a 70-year-old lady presenting with a 2 cm mass in the anal canal. Endoanal ultrasound revealed a well-circumscribed solid nodule in the intersphincteric space. The patient was successfully treated by wide local excision and adjuvant therapy with imatinib mesylate. Discussion Only 14 confirmed cases of primary anal GIST have been reported in the literature. It appears as a well circumscribed hypoechoic mass arising from the intersphincteric space encroaching into the lumen on endorectal ultrasound. Lymphadenopathy is absent. Anal sphincters get involved as the lesion increases in size. Treatment is often planned based on the extent of the disease, the mitotic rate, patient’s general condition and willingness for a permanent colostomy. Conclusion Small lesions (<2 cm) with low mitotic rate may be successfully managed by local excision. Radical surgery should be reserved for large, aggressive tumors. [ABSTRACT FROM AUTHOR]

Pityriasis rosea is a common, acute, self limiting inflammatory skin disease. Pityriasis rosea‐like eruptions (PR‐LE) have been reported after drugs. The clinical presentation of PR‐LE can be distinguished from pityriasis rosea. We reporte a 41‐year‐old woman who developed PR‐LE 5 days after administration domperidone. The clinical presentation of Pityriasis rosea‐like eruptions (PR‐LE) can be distinguished from pityriasis rosea. Herald patch and prodromal systemic symptoms are absent in PR‐LE, and lesions are more confluent forming large itchy lesions. [ABSTRACT FROM AUTHOR]

Cross-reactivity between NSAIDs occurs frequently in patients with skin reactions and has been linked to NSAIDs with chemically related structures.3 Herein we describe a patient with FDE induced by mefenamic acid with unusually cross-reactivity to a chemically distinct NSAID diclofenac and has not been reported before. Fixed drug eruption (FDE) is a common drug side effect constituting about 10% of all skin drug eruptions.1 Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most common causes of FDE.2 Mefenamic acid (anthracitic acid derivative) and diclofenac (phenylacetic acid) both have a chemically distinct structures. Fixed drug eruption (FDE) induced by mefenamic acid with unusually cross-reactivity to diclofenac: A case report. [Extracted from the article]

Enalapril-lercanidipine combination induced leukocytoclastic vasculitis: A case report Leukocytoclastic vasculitis (LCV) is a hypersensitivity vasculitis. It can occur in association with drugs, infection, collagen-vascular diseases, haematologic disorders, and malignancy.1 Drug-induced LCV accounts about 10% of all vasculitis cases.2 Several drugs are implicated as causes of drug-induced vasculitis.3 Herein we describe a case of LCV probably induced by enalapril-lercanidipine combination. [Extracted from the article]

Abstract Hydatidiform moles (HM) are characterized by an abnormal proliferating trophoblast with a potential for a malignant transformation. Similar to other human tumors, trophoblastic pathogenesis is likely a multistep process involving several molecular and genetic alterations. The study was performed to investigate the expression patterns of c-erbB-2 and Bcl-2 oncoproteins, p53, p21WAF1/CIP1 and p63 tumor suppressor proteins and Ki-67 cell proliferation marker in HM. We conducted a retrospective study of 220 gestational products, including 39 hydropic abortions (HA), 41 partial HM (PHM) and 140 complete HM (CHM). The expression of c-erbB-2, Bcl-2, p53, p21WAF1/CIP1, p63 and Ki-67 was investigated by immunohistochemistry on archival tissues. c-erbB-2 expression was observed in three PHM and 10 CHM. Bcl-2 immunostaining was significantly higher in PHM (61%) and CHM (70.7%) compared with HA (7.7%, p = 0.001 and p < 0.0001, respectively). p53 expression was stronger in CHM (73.6%) compared with PHM (24.4%, p < 0.0001) and HA (12.8%, p < 0.0001). p21WAF1/CIP1 staining was observed as well in molar and non-molar gestations (p > 0.05). p63 immunoexpression was significantly described in CHM (85.7%) and PHM (78%) compared with HA (10.2%, p < 0.0001 and p = 0.0001, respectively). Ki-67 was significantly expressed in CHM (72.1%) compared with HA (46.2%, p = 0.005). Altered expression of Bcl-2, p53, p63 and Ki-67 reflects the HM pathological development. Immunohistochemical analysis is beneficial to recognize the HM molecular and pathogenic mechanisms. Furthermore, it could serve as a useful adjunct to conventional methods for refining HM diagnosis. [ABSTRACT FROM AUTHOR]