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Cases of bullous pemphigoid following Covid-19 vaccines have been recently reported. We describe herein an atypical case of acral bullous pemphigoid after Pfizer BionTech vaccine. Clinicians should be aware of this reaction and encourage full vaccination as the disease displays a rapid improvement treatment.

Malakoplakia is an uncommon granulomatous disease that occurs in immunocompromised individuals. It’s thought to be caused by macrophagic bactericidial defect. We report a rare case of breast malakoplakia in a pregnant 35 ears-old woman that mimicked malignancy.

A granular cell tumor (GCT) is a rare neoplasm occurring usually in submucosal and subcutaneous tissues anywhere in the body, affecting mainly the head and neck. GCTs at unusual anatomic sites, such as the breast or the axillary extension, could be taken for invasive carcinoma. We report the case of a 30-year-old male who presented himself with an axillary nodule. A physical examination revealed a firm and painless subcutaneous tumor on ulcerated skin. Lymphoma and lymph node metastasis were suspected. An imaging survey was negative outside the axillary nodule. The tumor was surgically removed. A microscopic examination showed the typical features of a benign GCT. Surgical margins were negative. No recurrence has been observed within a 6-month follow-up period. A GCT can mimic a malignancy since it presents itself as an axillary nodule, and requires complete surgical resection with clear margins.

Chordoma is a rare malignant tumor of the spine. We report the case of a 26-year-old man who presented with facial paralysis and upper limbs paresthesia. Cerebral CT-scan and cerebro-spinal MRI revealed a 58mm locally advanced middle clival mass with deviation of median cerebral structures. Endoscopic biopsy concluded to a chondroid chordoma. Skeletal survey and thoraco-abdomino-pelvic CT-scan were normal. Treatment consisted in complete surgical removal of the tumor followed by adjuvant radiotherapy. The patient is alive free of disease with a follow up of 12 months.

We report an exceptional case of transitional cell carcinoma of the bladder in a 14-years old boy without personal nor family history who consulted for a total hematuria. Work-up showed a bladder lesion sized 5cm with histology of urothelial cancer. Treatment consisted of a transurethral surgery with carcinologic complete resection. Patient is alive, free of disease with a follow-up of 36 months.

Mammary analogue secretory carcinoma is a rare new entity of low-grade malignant tumor of salivary glands. It shared the same histologic features and the chromosomal translocation t(12;15)(p13;q25) as secretory carcinoma of the breast.To highlight the diagnosis approaches and the attitude of management in a case of MASC which is the first case reported in Tunisia. Reported case: A case of MASC of the lower left jugal mucosa was reviewed for its microscopic and immunohistochemical features. Fluorescence in situ hybridization (FISH) for the ETV6-NTRK3 translocation was performed. Surgery was the only treatment required in this case. No signs of local or regional recurrence during the one-year follow-up were noticed.Secretory carcinoma was confused with other salivary gland tumors especially acinic cell carcinoma due to their morphological similarities, making diagnosis dilemma. Fluorescence in-situ hybridization (FISH) is the one definitive finding to confirm the diagnosis of MASC and to differentiate it from the other types of salivary gland tumor. At the present time, no specific therapy is available for patients with MASC.

Background: Spinal angiolipomas are rare benign tumors composed of mature adipose tissue and anomalous vascular channels. The sacral localization is extremely rare. To the best of our knowledge, there have been only two cases reported in the literature. Herein, we present an additional case of sacral angiolipoma. Case Description: We present a case of a 54-year-old woman who presented with the right lumbosciatica and distal crural weakness. Spinal MRI showed an epidural lesion at the level of L5-S1 extending to the first right sacral foramen. The patient had total resection of the tumor and the histological study concluded to an angiolipoma. The patients’ neurologic symptoms improved postoperatively and follow-up revealed no signs of tumor recurrence. Conclusion: Despite the rarity of sacral localization in angiolipomas, it is a diagnosis to be considered in the case of an epidural tumor with foraminal extension. Magnetic resonance imaging is important for detecting and characterizing spinal angiolipomas despite diagnosis is not always obvious. After surgical removal, the functional prognosis is generally favorable.

Squamous cell carcinoma of the prostate is rare and represents 0.5% to 1% of prostatic carcinomas. Transformation of prostatic adenocarcinoma into squamous cell carcinoma after LH-RH agonist intake has been reported in only 8 cases in the literature. To our knowledge, our case is the second pure squamous cell carcinoma observed after hormonotherapy and radiotherapy. We reported a case of a patient with prostatic adenocarcinoma treated by radical prostatectomy followed by radiotherapy. Eleven years later, he had a vesical recurrence of prostatic adenocarcinoma. Our patient had an endoscopic resection followed by injections of Triptorelin. Six months later, he developed a local recurrence of a squamous cell carcinoma.

Paraganglioma is a rare neuroendocrine tumor that arises from the autonomic nervous system. The urinary bladder paraganglioma accounts for less than 0.1% of bladder tumors. It remains a challenging entity to diagnose and treat due to its rareness and the lack of specific symptoms. Treatment modalities include transurethral resection and cystectomy (partial or total). The authors report a new case of an isolated paraganglioma of the urinary bladder in a 52-year-old female patient that underwent partial cystectomy. This case aims to remind the clinical, histological and therapeutic features of this rare tumor.

We report a rare case of paratesticular angiolipoma in a young male. The patient is a 21-year-old male who presented with a palpable firm right intrascrotal mass of 21 mm. Ultrasound findings demonstrated that it is a solid mass. Under the diagnosis of an intrascrotal solid mass, a right inguinal radical orchiectomy was performed. Histopathological examination concluded to a paratesticular angiolipoma. Angiolipoma is a rare benign form of paratesticular tumour and its diagnosis is based on histological findings of the surgical specimen with no recurrence risk. This mesenchymal tumour should be distinguished from liposarcoma, which has malignant or aggressive clinical course.

A 69-year-old patient treated for infiltrating bladder transitional carcinoma many years ago presented with a submandibular nodule. The last was fortuitously discovered by the patient a month before he presented to consultation. Physical examination showed a firm subcutaneous nodule of 0.5 cm in diameter in the right submandibular region. At this level skin was inflamed/red and swollen. Otherwise physical examination was within normal. The described nodule above was biopsied. Microscopic examination showed infiltration of the dermis by a carcinomatous proliferation (Fig. 1). Tumor cells were arranged in small nests and clusters surrounded by a fibrous stroma. Tumor cells showed moderate nuclear atypia. Immunohistochemical staining showed positivity of tumor cells for Cytokeratin 7 and P63 (Fig. 2). Therefore, taking into consideration patient’s medical history, microscopic and immunohistochemical findings the diagnosis of CM from urothelial carcinoma was retained. The first case of CM from bladder carcinoma was reported in 1909 [3]. Since then many case have been reported [1,2]. According to cases reported in literature so far, the mean interval of time between the setting of bladder cancer and the appearance of CM is of 18 months approximately. Large tumor size and deep infiltration of the bladder wall are predictive factors of CM. However, cases of CM associated with superficial bladder carcinomas were reported [3]. The certain diagnosis is based on microscopic examination [1,3]. Pathologists should be aware of patient’s medical history to facilitate the diagnosis and choosing appropriate immunostains if necessary especially in front of a poorly differentiated carcinoma[3]. Urothelial carcinomas express Cytokeratin 7 and Cytokeratin 20 antibodies [3]. The occurring of CM in case of bladder cancer darken the prognosis [1,2]. Median survival rates are less than 12 months in published cases so far [1,3]. Treatment consists of chemotherapy if the patient could bare it [1]. Total recovery was detected in 70% of cases of CM treated with chemotherapy. Yet, it does not improve global survival rates [3].

Histological Gleason score grading is a main determinant of prostate cancer treatment. However, the final histological examination may reveal that concordance rates between biopsy and pathological Gleason sums are inadequate.To evaluate the concordance of Gleason score between prostate biopsy and radical prostatectomy specimen and to study factors predictive of up-grading of Gleason score at radical prostatectomy.We conducted a descriptive and retrospective study including cases of patients who underwent prostatectomy between 2008 and 2015. We proceeded to a histological examination of 30 cases of radical prostatectomy and 17 corresponding biopsies. The data of the remaining 13 prostate biopsies, not performed in our hospital, have been picked from detailed histological reports.Our results showed that the concordance in the Gleason score was 43% (kappa = 0.11, poor agreement).Gleason score was upgraded in 54% of the cases. At radical prostatectomy, it increased by two points in one case and by one point in 14 cases. The Gleason score was under-graded on prostatic biopsies in an only 1 case. Using the new classification ISUP 2014, the concordance rate was 26% (kappa = 0.04, very poor agreement). Gleason score was upgraded in 78% of the cases for Group 1 (SG 3 + 3) and 63% for group 2 (SG 3 + 4). The concordance rate was highest for Group 4 (4 + 3). Variables as age, serum PSA (prostate specific antigen) , numbre of cores, percentage of positive cores, or prostate volume were not significant predictors of upgrading of Gleason score on radical prostatectomy specimen.Thus, the high rate of discordance of Gleason score between prostate biopsy and radical prostatectomy specimen implies an understanding of factors predictive of discordance of this score allowing urologists, pathologists and oncologists to support patients in a more suitable way, choosing the appropriate therapeutic modality for each patient.

The angiomyofibroblastoma-like tumor of the male genital tract is a rare benign tumor. A total of 34 cases have been reported in the literature. We herein report an exceptional case of solidocystic form in its paratesticular location, in a 79-year-old man. Clinical examination objectified a right testicular induration. Macroscopic examination of the orchidectomy objectified a paratesticular solidocystic tumor formation. Microscopically, the solid area was composed of vessels with small caliber and turgidity of endothelial cells. These vessels were surrounded by clusters of epithelioid cells, sometimes having the appearance of giant cells. They were associated with spindle cells. The cystic area was uncoated. Immunohistochemically, the fusiform cells expressed Desmin and Smooth Muscle Actin. Endothelial cells and clusters of cells surrounding large vessels expressed CD34. The expression of receptors for estrogen and progesterone was negative. To our knowledge, this is the second solidocystic case of angiomyofibroblastoma-like tumor of male genital tract.

Many case reports describe tuberculosis (TB) co-existent with a malignant neoplasm. However, the neoplasm in most of these reports is lung or breast cancer, with only two cases of liver cancer concomitant with TB reported in the literature. Although both TB and cancer are very common diseases, little attention has been given to the pathophysiologic and practical implications of their co-existence.Case report and literature review.A 73-year-old female patient with a history of hypertension and hepatitis C presented with abdominal pain of 2 mos duration. Laboratory findings showed an elevated serum concentration of α-fetoprotein. A computed tomography scan demonstrated a solitary hypodense tumor in the right lobe of the liver (segment VIII). A pre-operative chest radiograph was within normal limits. The patient underwent an uneventful tumor resection. Histologic examination of a surgical specimen of the tumor demonstrated a moderately differentiated hepatocellular carcinoma co-existent with caseating granulomas.Through this case report, the authors discuss the pathogenesis of the rare association of TB and malignant neoplasm of the liver, and present a review of the current literature on the association of TB and cancer. Further research is required to determine whether a TB infection resembles other chronic infections and inflammatory conditions in having a potential to facilitate oncogenesis.

Introduction : Le cancer du sein chez l’homme(CSH) est une pathologie rare. Peu d’études ontdécrit une analyse immunohistochimique complètedans le CSH, en particulier, concernant le statutHER2 ou l’expression du récepteur aux androgènes (RA). Objectif : Décrire les caractéristiquescliniques et anatomopathologiques de 44 cas deCSH, en portant l’accent sur l’expression en immunohistochimie des récepteurs aux œstrogènes (RE),à la progestérone (RP), et aux androgènes (RA),ainsi que le statut HER2 et l’index de proliférationKi67. Méthodes : Entre 1984 et 2010, 44hommes ont été traités à l’Hôpital Saint-Louispour un cancer du sein. Les données histologiquesont été relues par des anatomopathologistes spécialisés dans le cancer du sein et une nouvelle immunohistochimie incluant RE, RP, RA, HER2 etKi67 a été pratiquée. Les données cliniques, thérapeutiques ainsi que le devenir des patients ont étéanalysées de façon rétrospective. Résultats : Lesuivi médian a été de 70.6 mois. L’âge moyen audiagnostic était de 64.7 ans, avec un retard au diagnostic en moyenne de 18.2 mois. 50% des patientsont présenté des comorbidités; et 18% des antécédents familiaux de cancer du sein. La présentationclinique était un stade avancé avec une taille tumorale supérieure à 5cm dans 37% des cas.La principale histologie est représentée par le carcinome canalaire infiltrant (89%), de faible grade(25% de grade III). Toutes les tumeurs analyséesont exprimé les RE, 84% les RP, et 24% les RA. Lestumeurs ont été peu proliférantes (Ki67>30 dans15% des cas). Un seul patient a présenté une surexpression de HER2. De façon intéressante, parmi les8 patients exprimant les RA, 4 ont eu un Ki67 élevé(>30) et 6 un envahissement ganglionnaire axillaire.La quasi totalité des patients ont été opérés parmastectomie et curage axillaire. Le traitement adjuvant a consisté en une radiothérapie pour 70% despatients, une chimiothérapie pour 50% et une hormonothérapie pour 77% d’entre eux (essentiellement du tamoxifène 65%). Au cours du suivi, sixpatients ont eu une récidive locorégionale (15%) et12 une rechute métastatique (30%). Conclusion :Selon les données de cette cohorte de 44 CSH, l’expression de HER2 est rare, et l’expression de RAparaît associée à un profil de tumeur agressive.Chez la femme, RA semble être un facteur de bonpronostic pour les tumeurs RE+ ; cependant, chezl’homme, le rôle pronostique et physiopathologiquede RA reste à approfondir.

Biliary hamartomas or von Meyenburg complexes are uncommon benign biliary malformations, which are considered as part of the spectrum of fibrocystic diseases of the liver due to ductal plate malformation. Development of intrahepatic cholangiocarcinoma is well described in these complexes. However, only 10 cases of hepatocellular carcinoma arising in association with von Meyenburg complexes have been described in the English-language literature to date. In this paper, the authors report a peculiar case of hepatocellular carcinoma occurring on a background of von-Meyenburg's complexes and solitary unilocular bile duct cyst. It is not clear whether development of hepatocellular carcinomas is an epiphenomenon unrelated to the precursor lesion or biliary hamartomas may progress to liver cancers. Further studies are mandatory so as to elucidate and consolidate this very rare association.