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Background Angiosarcoma of the breast is a rare tumor, which may be primary or secondary to breast surgery or irradiation. It is characterized by polymorphic and nonspecific clinical and radiological features. A pathologist plays a key role in positive and differential diagnosis and in establishing the prognosis: only a histological examination can confirm the diagnosis, and the histologic grade is the most important prognostic factor. In fact, angiosarcomas of the breast constitute a very heterogeneous group and they are classified into three grades based on the degree of differentiation. We will illustrate diagnostic challenges through this new case of primary angiosarcoma of the breast. Microscopic findings were initially interpreted as a benign vascular tumor. We will also discuss the relevant medical literature. Case presentation A 56-year-old Arabian woman presented with a palpable right breast mass that had been enlarging for 2 months, measuring 5 cm, without axillary lymphadenopathy. She had no personal or family history of breast surgery or breast irradiation. A mammography showed no evidence of spiculation. No suspicious calcifications were seen. A needle core biopsy was performed. Microscopic findings were initially interpreted as a benign vascular tumor. However, as the mass measured 5 cm, the diagnosis of angiosarcoma was more appropriate, and mastectomy without axillary dissection was performed. Microscopic examination found mild to moderately scattered pleomorphic cells, and scattered mitotic figures. It also showed papillary formations, solid foci of spindle cells, and hemorrhagic necrosis. The margins of the tumor were infiltrative. The diagnosis of primary intermediately differentiated angiosarcoma of the breast (grade II) was made. No distant metastases were found. Our patient was lost to follow-up and further treatment after mastectomy until she developed local tumor progression 4 months later. Conclusions Through this case report, we emphasize the importance of clinicopathological confrontation in angiosarcoma of the breast.

La tuberculose osseuse est une maladie infectieuse qui constitue un véritable problème de santé publique dans les pays en voie de développement où elle sévit de manière endémique. L'atteinte ostéo-articulaire représente 1 à 5% des cas de tuberculose toutes localisations confondues, l'atteinte de l'épaule reste très rare et représente 1 à 2% des localisations ostéo-articulaires. Nous présentons ici un nouveau cas exceptionnel d'une infection tuberculeuse de l'omoplate, atteignant le corps de l'omoplate. La tuberculose est encore un diagnostic différentiel important des maladies rares ou chroniques des os, notamment tumorales. Le diagnostic a été redressé par l'étude anatomopathologique.

Renal cell carcinoma is infrequent in children; consequently it is important to communicate its diagnosis and follow up. The behaviour of this type of tumor is better characterized in adults and in this setting the treatment of choice is surgical resection. However, the place of chemo- and radiotherapy has not been well defined. Here, we present a 9-year-old boy with renal cell carcinoma demonstrating only hematuria without any pathological physical examination findings. The mass was described by abdominal ultrasonography and computed tomography in the left kidney. After the left nephroureterectomy, the patient was given no adjuvant therapy.

La biopsie radioguidée constitue une alternative à la biopsie chirurgicale invasive et à la cytologie pour le diagnostic des tumeurs pédiatriques. L'intérêt de notre étude est d’évaluer la valeur diagnostique des biopsies radioguidées examinées au laboratoire d'anatomopathologie de l'hôpital d'Enfants de Rabat (HER). L’étude a porté sur 78 biopsies radioguidées recueillies dans notre laboratoire entre janvier 2008 et décembre 2011. l’âge moyen des patients était de 5 ans et 10 mois avec une prédominance masculine (65,4%). La tumeur était abdominale dans 80% des cas, thoracique dans 15% cas, thoracique et abdominale dans 2,5% et sacrée dans 1,2%. Les biopsies étaient écho-guidées dans 90% des cas et scannoguidées dans 10% des cas. Le diagnostic histopathologique était posé dans 89% des cas. L'immuno-histochimie a été indiquée dans 35% des cas. Les diagnostics les plus fréquents étaient: tumeurs neuroblastiques (42 cas), lymphomes non hodgkiniens (10 cas), rhabdomyosarcomes (6 cas), autres (sarcome d'Ewing, néphroblastomes, tumeur myofibroblastique inflammatoire, maladies de Hodgkin, leucémie aiguë, hépatoblastome et ostéosarcome). Dans notre série, la biopsie radioguidée a permis un diagnostic histopathologique certain dans 89% des cas. Elle nécessite une étroite collaboration entre clinicien, radiologue et anatomopathologiste pour discuter son indication, afin de diminuer le nombre de biopsies peu ou non représentatives.

Study of histological and clinical correlations of 30 cases of renal amyloidosis AA diagnosed between November 2010 and December 2012.The main causes associated with amyloidosis AA were represented by chronic infectious diseases (60%). Nephrotic syndrome and renal failure were observed in 94% and 73% respectively. The distribution of amyloid deposits: 90% of patients had a glomerular form and 10% had a vascular form. Inflammatory reaction associated with AA renal amyloidosis was present in 50% of cases. This inflammation was observed near amyloid deposits associated with a deposition of immunoglobulin chains and/or complement factors.Our study confirms the predominance of AA amyloidosis complicating chronic infectious diseases, especially tuberculosis. Our data point out a relationship between the morphology of renal AA amyloidosis, its clinical presentation and prognosis.

Mucormycosis is a rare opportunistic fungal infection with clinical polymorphism and is rapidly extensive and destructive. It is caused by fungi of the mucorales group in the environment and generally arises in the context of immunosuppression. Often difficult and late, diagnosis is based on mycological and histological examination. We report the case of a 10-year-old patient admitted for a pruritic erythematous scaly eruption located in the right inguinal area associated with satellite lymphadenopathy and lymphedema of the right lower limb. The histological study of the cutaneous biopsy revealed a granulomatous reaction with filaments. The mycological examination of the collection of the cutaneous lesion showed mucorales filaments and a stump of Absidia corymbifera was isolated. Abdomino-pelvic CT showed muscular extension with vascular and ureteral englobement. The diagnosis of cutaneous mucormycosis was made. Immunological investigations were normal. Treatment included itraconazole for 3months followed by IV amphotericin B for 1month, with favorable clinical and radiological progression. Mucormycosis is an uncommon fungal infection whose cutaneous localization is rare. It occurs exceptionally in immunocompetent patients and is clinically manifested by a vesicular and pustular rash progressing to ulceration. The diagnosis is confirmed by mycological and histological studies. Treatment consists of antifungal therapy associated with surgical excision of necrotic and infected tissue.

We report on a rare case of botryoid Wilms tumor extending into the duodenum. This uncommon macroscopic form of nephroblastoma consists entirely of a polypoid renal intrapelvic mass. The main differential diagnosis of this unusual tumor is botryoid rhabdomyosarcoma. A 14-month-old boy presented with a painful abdominal mass. Radiology revealed a large heterogeneous mass in the renal calyx, protruding into the ureter. A right radical nephroureterectomy was carried out. The tumor was found to extend into the 2nd portion of the duodenum. The pathologic diagnosis was mixed type nephroblastoma, SIOP 2001 stage III. The patient was given a course of postoperative chemotherapy. No local recurrence or metastatic spread has been detected after 2 years. Only few such cases have been previously reported, some of them extending into the bladder. To our knowledge, botryoid nephroblastoma has not previously been described as extending into the digestive system.

Clear cell sarcoma or melanoma of soft tissues is a rare tumor in young adults, mainly located in the extremities. We report a new case observed in a 15-year-old teenager who had injured her left knee 1 month before hospitalization. The patient consulted for deformation of the left knee with pain and limitation in flexion. A CT scan of the knee showed a hypodense mass of the anterior compartment of the left leg. The histological and immunohistochemical study of the biopsy fragment concluded in clear cell sarcoma of the soft tissue. The histogenesis of this tumor continues to be debated and raises diagnostic challenges for the pathologist who must eliminate melanoma metastases, whose prognosis is different.

Mesenchymal hamartoma of the liver is a rare, benign tumor that presents mostly before the age of 2 years. Its pathogenesis is poorly understood. We present the case of a 2.5-year-old female patient who had a large cystic mass of the liver of which the hamartomatous nature was confirmed by the pathological examination of the surgical specimen. We discuss the clinicopathological, imaging, and histological features of this unusual tumor through a review of the literature.

Chondromyxoid fibroma is a rare benign tumor that is typically found in the metaphyseal ends of long tubular bones, such as the tibia. The radiographic appearances are those of a single, lytic lesion with lobulated margins, septations, cortical expansion and a sclerotic rim. The classic histological feature of a chondromyxoid fibroma is stellate or spindle-shaped cells arranged in lobules in a myxoid or chondroid background. Two cases are presented here: 8, and 12-year-old patients, both with lesions in the proximal tibia. The first case showed an unusual feature: it was diaphyseal chondromyxoid fibroma. In the second case, the lesion was metaphyso-diaphyseal. The differential diagnosis includes chondroblastoma, myxoma, aneurysmal cyst as well as chondrosarcoma. A surgical conservative treatment with complete excision is recommended even in case of recurrence.

Thymic hyperplasia in response to stress is a well known phenomenon. Thymic hyperplasia has also been described after chemotherapeutic treatment for malignancies in children.A three-year-old girl was followed up from the age of 18 months for a left kidney nephroblastoma treated by combination of chemotherapy (vincristin, actinomycin and adriamycin) and surgery. Assessment at the end of treatment was normal. Four months after the end of treatment, pulmonary radiography showed mediastinal enlargement, which was shown to originate in the thymus at thoracic CT scan. A recurrence of the disease was suspected. Biopsy showed thymic hyperplasia without evidence of tumor cells. Mediastinal enlargement then disappeared spontaneously 2 months later.Thymic hyperplasia occurring during remission of a cancer treated by chemotherapy is a diagnostic dilemma as it suggests mediastinal reccurence of the disease. Needle aspiration cytology is an appropriate investigation in thymic hyperplasia. No steroid therapy should be used before histologic diagnosis of thymic hyperplasia.

Pleuropulmonary blastoma is a very exceptional anatomoclinical and histological entity recently distinguished from adult pneumoblastoma. This tumor, observed in children aged less than 15, can involve the lung, the pleura, or the mediastinum and is characterized by a very poor prognosis. We report the case of a 4-year-old girl who developed pleuropulmonary blastoma which was discovered in a context of respiratory distress. Standard chest x-ray revealed an opacity covering the entire left lung. Histology and immunohistology led to the diagnosis of pleuropulmonary blastoma with several components: blastematous, malignant mesenchymatous with pluridirectional differentiation, and benign epithelial tissue. Treatment consisted in preoperative chemotherapy and radiotherapy to reduce tumor volume. This neoadjuvant treatment is not widely reported and its relatively favorable result allowed tumor resection. This approach might be useful in similar cases.

Giant cell fibroblastoma (GCF) is a rare neoplasm occurring mostly in children. It has a tendency to recur locally after treatment. We report a new case noticed in an five year-old child who developed recurrence a first time three years later with the picture of GCF and at a second time with the picture of dermatofibrosarcoma protuberans 17 months later.

Clear cell sarcoma of the kidney (CCSK) also called a "bone-metastasizing renal tumor of childhood" is the second common pediatric renal neoplasm. This tumor is associated with a higher rate of relapse and a wider distribution of metastases than Wilms' tumor.We have reviewed records of 13 cases of CCSK among 277 renal tumors (5%) diagnosed at the children's hospital of Rabat between 1990 and 2002.The median age at diagnosis was 14 months (5 months-9 years). The male to female ratio was 5.5:1.00. Abdominal mass, usually the first physical finding, was associated with hematuria in four cases. No congenital malformation syndrome or familial Wilms' tumor were observed. Imaging studies found out seven right and six left intrarenal processes. Preoperative chemotherapy was given according to the SIOP9, SIOP93-01 and GFAOP 98 protocols. Twelve of 13 children underwent nephrectomy. Tumor measurements varied through 450-3450 g and 7-26 cm. The classic morphologic pattern was seen in nine cases (69%). The distribution local stage was I: three cases; II: three cases; III: six cases; IV: one case. Postoperative chemotherapy and radiotherapy (21 600-30 600 cGy) was done in 10 cases. With a median follow up of 44 months, four patients showed bone metastases (31%), four are alive in CR, four are lost for follow up and five died.CCSK remains the pediatric renal tumor most frequently misdiagnosed. Its aggressiveness and its ability to give bone metastases need to recognize early this diagnosis for an adapted treatment.

Visceral leishmaniasis occurring in malnourished subjects can have an uncommon course, which explains difficulties in its diagnosis.A 22-month-old infant was admitted because of malnutrition and prolonged fever. The bacteriological investigation was negative. When his nutritional status improved, he developed a splenomegaly. The medullogram confirmed the diagnosis of visceral leishmaniasis. The course was then favorable with treatment by pentavalent antimonial.Malnutrition constitutes a risk factor of opportunist parasitic disease such as leishmaniasis. Its diagnosis can be very difficult.

Introduction: Many studies have indicated a causal relationship between genital human papillomavirus (HPV) infections and cervical cancer. This study aimed to determine the prevalence and genotypes of six high-risk oncogenic human papillomaviruses in cervical lesions from Moroccan women with normal and abnormal cytology. Methodology: The study included 938 women from the Children's and Mothers' Pathology Department of Ibn Sina Hospital, Rabat. Cytopathology examination was done by routine PAP smear testing. HPV DNA testing was conducted using DNA amplification by Polymerase Chain Reaction with subsequent typing by hybridization with specific probes for HPV types 16, 18, 31, 33, 35 and 45. Results: Cytopathology testing showed that only 16.3 % had an abnormal cytology, with a predominance of atypical squamous cell of undetermined significance (ASCUS) cases. The overall HPV prevalence was 15.7%. According to the cytology results, HPV infection was detected in 15.8% of normal and 14.38% of abnormal cases. Specific HPV genotyping showed a predominance of HPV 16 and 18. Double infection (HPV 16 + 18) was found in two cases whereas multiple infections (HPV 16+18+31) were detected in only one case. Evaluation of the relationship between HPV status and some environmental risk factors, including individual, socio-economic, and hygiene status, showed a significant association between HPV infection and oral contraceptive use. Conclusion: Based on these data, a combination of cytology and HPV DNA testing allows for identification of patients with a high risk of developing high-grade cervical lesions and improves cervical cancer prevention.