Tubular carcinoma of the breast is a distinct, relatively rare low-grade neoplasm, accounting for... more Tubular carcinoma of the breast is a distinct, relatively rare low-grade neoplasm, accounting for approximately 1 to 2% of invasive breast cancers. It is composed of well-differentiated tubular structures with open lumina, typically one layer thick surrounded by abundant stroma.[1] Because of its nonaggressive, histologic appearance, its low propensity to recur locally, spread to axillary lymph nodes, and metastasize distantly, pure tubular carcinoma carries a favorable prognosis.[2][3] Its diagnosis is established based on histopathological examination of the surgical specimen.
Resume Introduction Les kystes cœlomiques intrathoraciques sont des tumeurs benignes tres rares d... more Resume Introduction Les kystes cœlomiques intrathoraciques sont des tumeurs benignes tres rares d’origine embryonnaire tapissees par un mesothelium. Ils sont le plus souvent asymptomatiques, decouverts de facon fortuite sur une radiographie thoracique et sont principalement localises dans l’angle cardiophrenique realisant les kystes pleuropericardiques. Observation Un homme âge de 50 ans a ete adresse pour des douleurs thoraciques gauches atypiques depuis deux ans. L’examen physique et la radiographie thoracique etaient sans particularite. La tomodensitometrie thoracique a montre la presence d’un kyste du mediastin superieur et posterieur au niveau de la gouttiere costovertebrale gauche. Compte tenu de sa localisation atypique et de son caractere symptomatique, une kystectomie par thoracotomie posterolaterale a ete realisee permettant de poser le diagnostic de kyste cœlomique ectopique. Le patient rapporte une disparition des douleurs thoraciques apres la resection chirurgicale, avec un recul de 3 ans. Par ailleurs, le scanner thoracique a visualise une artere sous-claviere retro-œsophagienne qui est une anomalie des arcs aortiques d’origine congenitale de decouverte fortuite. A notre connaissance, l’association de ces deux anomalies congenitales n’a jamais ete rapportee auparavant dans la litterature. Conclusion La localisation ectopique du kyste cœlomique dans le mediastin posterieur et superieur au niveau de la gouttiere costovertebrale gauche est tres rare, imposant sa resection chirurgicale a la fois a visee diagnostique et therapeutique d’autant plus qu’il est symptomatique.
Introduction Chez l’enfant, l’atteinte hydatique pulmonaire vient en premier plan avant l’atteint... more Introduction Chez l’enfant, l’atteinte hydatique pulmonaire vient en premier plan avant l’atteinte hepatique. Vu l’elasticite et la compliance du parenchyme pulmonaire, le kyste hydatique peut atteindre des dimensions enormes. Comme pour toute hydatidose pulmonaire, la chirurgie demeure « le gold standard » du traitement curatif du kyste hydatique geant du poumon chez l’enfant (KHGPE). La difficulte de la chirurgie du KHGPE consiste dans le choix de la technique chirurgicale en privilegiant si c’est possible le traitement conservateur par apport a une resection reglee. Methodes Il s’agit d’une etude retrospective, entre 1998 et 2019, incluant 7 enfants d’âge inferieure a 15 ans operes pour un kyste hydatique geant du poumon dont la taille est superieure ou egale a 10 cm, au service de chirurgie thoracique et cardiovasculaire de l’hopital Abderrahmane Mami de l’Ariana. Resultats Il s’agissait de 5 garcons et 2 filles, d’âge moyen de 10,14 ans. La symptomatologie est dominee par la do...
BACKGROUND the critical appraisal of scientific publications is a mainstay step in the evidence-b... more BACKGROUND the critical appraisal of scientific publications is a mainstay step in the evidence-based-practice. This study aimed to assess the utility of using a checklist in implementing this practice. METHODS medical students in the third year that were performing a training period in a department of pathology were randomly assigned to two groups. A computerized random number allocation was used. The same manuscript was given to both groups. All the students spent the same period of training in the department and they received the same training session about critical appraisal of scientific publications. The intervention group (n=26) performed a critical appraisal of the article using the checklist of a Pubmed-indexed journal and the control group (n=25) performed a free critical appraisal. The individual critical appraisal forms were evaluated using a scoring-based-checklist. A one-way ANOVA test was used to compare the scores between both groups using SPSS software (version 11.0...
Introduction La classification de l’OMS 2015 a fait suite a la classification de 2014 et a apport... more Introduction La classification de l’OMS 2015 a fait suite a la classification de 2014 et a apporte de nombreuses modifications au groupe heterogene des adenocarcinomes (Adc) pulmonaires. Ces-derniers sont desormais classes en fonction du sous-type architectural predominant. L’impact pronostique de cette classification qui a permis d’identifier le sous-groupe lepidique predominant comme etant de bon pronostic, les sous-type solide et micro-papillaire predominants comme etant de mauvais pronostic et le sous-type acinaire predominant comme etant de pronostic intermediaire, a ete controverse. Une nouvelle proposition de grading des adenocarcinomes a ete publiee par l’IASLC en 2020. Selon cette nouvelle proposition, les adenocarcinomes pouvaient etre subdivises en 3 grades, un grade 1 incluant l’adenocarcinome lepidique, un grade 2 incluant les adenocarcinomes acinaire ou papillaire avec ou sans un contingent agressif representant moins de 20 % du volume tumoral et un grade 3 incluant tout sous-type associe a un pattern agressif representant plus de 20 % du volume tumoral. Le pattern de haut grade etant represente par les sous-types solide, micro-papillaire, glandulaire et complexe. Notre objectif etait de verifier l’impact pronostique de cette classification a travers une experience uni-institutionnelle. Materiel et methodes Nous decrivons une etude retrospective portant sur 99 patients presentant des Adc pulmonaires operes dans un service de chirurgie thoracique et colliges dans un service d’anatomie et de cytologie pathologique du meme hopital. Les adenocarcinomes diagnostiques sur des pieces operatoires durant la periode allant de 2008 a 2018 dont les dossiers medicaux renfermant les differents items relevant de l’histoire clinique, les antecedents, l’imagerie, les procedures diagnostiques et therapeutiques ainsi que le suivi ont ete consignes. L’etude statistique a ete realisee a l’aide du logiciel SPSS (version 23.0). Les courbes de survie de Kaplan–Meier ont ete comparees en utilisant le test de Log-Rank. Une difference a ete consideree statistiquement significative quand p Resultats Selon les criteres d’inclusion, 99 cas ont ete inclus dans notre serie. Ces cas ont ete repartis en Adc de grade 1 dans 3 cas, de grade 2 dans 56 cas et de grade 3 dans 40 cas. La survie moyenne etait de 8,33 mois, IC95 % [6,605–10,062] pour les Adc de grade 1, 16,84 mois IC95 % [13,58–20,105] pour les Adc de grade 2 et 17,33 mois IC95 % [13,15–21,510] pour les Adc de grade 3. Il n’y avait pas de difference statistique en termes de survie entre les differents groupes d’adenocarcinomes (p > 0,05). Conclusion Nos resultats n’ont pas demontre de difference statistique en termes de survie ente les differents groupes d’adenocarcinomes selon la proposition de l’IASLC. Ce resultat doit etre considere avec prudence vu l’effectif reduit de notre serie.
The role of the pathologist has been highlighted by the medias since the recent years and the Tun... more The role of the pathologist has been highlighted by the medias since the recent years and the Tunisian law system suffers from a huge and there are no rules or jury verdicts concerning the e responsability of the doctors in general with emphasis on pathologists. One might think that the lack of laws benefits to the pathologist, on the other hand, we can consider this as dangerous either for the patients or the pathologists. This lack of laws makes the judge dependant on the expert view. Other countries like European ones and the United States, has available data furnished by the insurance bodies that enrich the jury verdicts and the different laws that are available. Our aim was to help the pathologists understand their legal responsibilities and the law system. The latter may seem as complex for the pathologist as a pathologic report for a judge.
The American journal of forensic medicine and pathology, 2017
Drug-induced eosinophilic myocarditis is uncommon with few cases reported in the literature. It i... more Drug-induced eosinophilic myocarditis is uncommon with few cases reported in the literature. It is a rare but potentially life-threatening disease.We report the case of an 11-year-old girl without medical history who developed an acute malaise and chills, followed by severe shortness of breath and a cardiopulmonary arrest 1 hour after an intramuscular injection of penicillin.At autopsy, we observed in the external examination nonspecific asphyxia signs, an injection mark, and the absence of traumatic signs. The organs examination showed a heart with a normal shape and a transmural, diffuse, tannish discoloration of the myocardium. The lungs were severely congested with a diffuse edema. Histological examination of the ventricular walls and septum revealed suggestive signs of eosinophilic myocarditis. Immunohistochemical analysis for the phenotypic characterization of the inflammatory cells revealed the positivity of the CD3 antibody without any stain for CD20.The diagnosis of fulmina...
Background: clinical reasoning is a mandatory competency in medical curriculum. Many techniques h... more Background: clinical reasoning is a mandatory competency in medical curriculum. Many techniques have been reported in order to teach it. The authors focused on 2 student-centered techniques, SNAPPS and collaborative critical reasoning learning (CCRL) technique, and compared their efficiency in order to improve the clinical reasoning competencies of third year medical education students.Methods: the authors performed a prospective randomised, controlled, non blinded crossover trial including year-3 undergraduate medical students. Judgement criteria consisted in the scores attributed to a structured summary performed by the students after each session. Besides, a satisfaction likert-scale questionnaire was fulfilled by the students. Statistical analysis was performed using SPSS software (version 20.0).Results: 72 students were included with a mean age of 21 years. The mean scores of CCRL reached 4.62 versus 4.99 for SNAPPS. No significant statistical difference was observed between th...
Abstract Idiopathic pulmonary fibrosis (IPF) is a chronic, devastating and fatal disease characte... more Abstract Idiopathic pulmonary fibrosis (IPF) is a chronic, devastating and fatal disease characterized by aberrant fibroblasts proliferation, oxidative stress and collagen accumulation in the interstitial tissue. We aimed to evaluate in the present study the efficacy of Thymus vulagris extract (TVE) on an experimental model of pulmonary fibrosis induced by bleomycin (BLM). Wistar rats were given a single dose of BLM (4 mg/kg, intratracheal), while TVE (50, 100 and 200 mg/kg, intraperitoneal) was administered 3 days later and continued for 4 weeks. We reveled by HPLC analysis an important amount of phenolic bioactive compounds such as rosmarinic and vanillic acids. Our results showed a significant decrease of catalase and superoxide dismutase activities and an increase in lipid peroxidation compared to control group after BLM injection. Treatment with TVE (200 mg/kg) was able to normalize the level of these oxidative markers and to decrease collagen accumulation compared to BLM group. Moreover, this high dose of TVE have no renal or hepatic cytotoxic effects. This study allowed us to conclude that thyme extract has a strong antioxidant and antifibrotic activities due to its high content of polyphenols.
Tubular carcinoma of the breast is a distinct, relatively rare low-grade neoplasm, accounting for... more Tubular carcinoma of the breast is a distinct, relatively rare low-grade neoplasm, accounting for approximately 1 to 2% of invasive breast cancers. It is composed of well-differentiated tubular structures with open lumina, typically one layer thick surrounded by abundant stroma.[1] Because of its nonaggressive, histologic appearance, its low propensity to recur locally, spread to axillary lymph nodes, and metastasize distantly, pure tubular carcinoma carries a favorable prognosis.[2][3] Its diagnosis is established based on histopathological examination of the surgical specimen.
Resume Introduction Les kystes cœlomiques intrathoraciques sont des tumeurs benignes tres rares d... more Resume Introduction Les kystes cœlomiques intrathoraciques sont des tumeurs benignes tres rares d’origine embryonnaire tapissees par un mesothelium. Ils sont le plus souvent asymptomatiques, decouverts de facon fortuite sur une radiographie thoracique et sont principalement localises dans l’angle cardiophrenique realisant les kystes pleuropericardiques. Observation Un homme âge de 50 ans a ete adresse pour des douleurs thoraciques gauches atypiques depuis deux ans. L’examen physique et la radiographie thoracique etaient sans particularite. La tomodensitometrie thoracique a montre la presence d’un kyste du mediastin superieur et posterieur au niveau de la gouttiere costovertebrale gauche. Compte tenu de sa localisation atypique et de son caractere symptomatique, une kystectomie par thoracotomie posterolaterale a ete realisee permettant de poser le diagnostic de kyste cœlomique ectopique. Le patient rapporte une disparition des douleurs thoraciques apres la resection chirurgicale, avec un recul de 3 ans. Par ailleurs, le scanner thoracique a visualise une artere sous-claviere retro-œsophagienne qui est une anomalie des arcs aortiques d’origine congenitale de decouverte fortuite. A notre connaissance, l’association de ces deux anomalies congenitales n’a jamais ete rapportee auparavant dans la litterature. Conclusion La localisation ectopique du kyste cœlomique dans le mediastin posterieur et superieur au niveau de la gouttiere costovertebrale gauche est tres rare, imposant sa resection chirurgicale a la fois a visee diagnostique et therapeutique d’autant plus qu’il est symptomatique.
Introduction Chez l’enfant, l’atteinte hydatique pulmonaire vient en premier plan avant l’atteint... more Introduction Chez l’enfant, l’atteinte hydatique pulmonaire vient en premier plan avant l’atteinte hepatique. Vu l’elasticite et la compliance du parenchyme pulmonaire, le kyste hydatique peut atteindre des dimensions enormes. Comme pour toute hydatidose pulmonaire, la chirurgie demeure « le gold standard » du traitement curatif du kyste hydatique geant du poumon chez l’enfant (KHGPE). La difficulte de la chirurgie du KHGPE consiste dans le choix de la technique chirurgicale en privilegiant si c’est possible le traitement conservateur par apport a une resection reglee. Methodes Il s’agit d’une etude retrospective, entre 1998 et 2019, incluant 7 enfants d’âge inferieure a 15 ans operes pour un kyste hydatique geant du poumon dont la taille est superieure ou egale a 10 cm, au service de chirurgie thoracique et cardiovasculaire de l’hopital Abderrahmane Mami de l’Ariana. Resultats Il s’agissait de 5 garcons et 2 filles, d’âge moyen de 10,14 ans. La symptomatologie est dominee par la do...
BACKGROUND the critical appraisal of scientific publications is a mainstay step in the evidence-b... more BACKGROUND the critical appraisal of scientific publications is a mainstay step in the evidence-based-practice. This study aimed to assess the utility of using a checklist in implementing this practice. METHODS medical students in the third year that were performing a training period in a department of pathology were randomly assigned to two groups. A computerized random number allocation was used. The same manuscript was given to both groups. All the students spent the same period of training in the department and they received the same training session about critical appraisal of scientific publications. The intervention group (n=26) performed a critical appraisal of the article using the checklist of a Pubmed-indexed journal and the control group (n=25) performed a free critical appraisal. The individual critical appraisal forms were evaluated using a scoring-based-checklist. A one-way ANOVA test was used to compare the scores between both groups using SPSS software (version 11.0...
Introduction La classification de l’OMS 2015 a fait suite a la classification de 2014 et a apport... more Introduction La classification de l’OMS 2015 a fait suite a la classification de 2014 et a apporte de nombreuses modifications au groupe heterogene des adenocarcinomes (Adc) pulmonaires. Ces-derniers sont desormais classes en fonction du sous-type architectural predominant. L’impact pronostique de cette classification qui a permis d’identifier le sous-groupe lepidique predominant comme etant de bon pronostic, les sous-type solide et micro-papillaire predominants comme etant de mauvais pronostic et le sous-type acinaire predominant comme etant de pronostic intermediaire, a ete controverse. Une nouvelle proposition de grading des adenocarcinomes a ete publiee par l’IASLC en 2020. Selon cette nouvelle proposition, les adenocarcinomes pouvaient etre subdivises en 3 grades, un grade 1 incluant l’adenocarcinome lepidique, un grade 2 incluant les adenocarcinomes acinaire ou papillaire avec ou sans un contingent agressif representant moins de 20 % du volume tumoral et un grade 3 incluant tout sous-type associe a un pattern agressif representant plus de 20 % du volume tumoral. Le pattern de haut grade etant represente par les sous-types solide, micro-papillaire, glandulaire et complexe. Notre objectif etait de verifier l’impact pronostique de cette classification a travers une experience uni-institutionnelle. Materiel et methodes Nous decrivons une etude retrospective portant sur 99 patients presentant des Adc pulmonaires operes dans un service de chirurgie thoracique et colliges dans un service d’anatomie et de cytologie pathologique du meme hopital. Les adenocarcinomes diagnostiques sur des pieces operatoires durant la periode allant de 2008 a 2018 dont les dossiers medicaux renfermant les differents items relevant de l’histoire clinique, les antecedents, l’imagerie, les procedures diagnostiques et therapeutiques ainsi que le suivi ont ete consignes. L’etude statistique a ete realisee a l’aide du logiciel SPSS (version 23.0). Les courbes de survie de Kaplan–Meier ont ete comparees en utilisant le test de Log-Rank. Une difference a ete consideree statistiquement significative quand p Resultats Selon les criteres d’inclusion, 99 cas ont ete inclus dans notre serie. Ces cas ont ete repartis en Adc de grade 1 dans 3 cas, de grade 2 dans 56 cas et de grade 3 dans 40 cas. La survie moyenne etait de 8,33 mois, IC95 % [6,605–10,062] pour les Adc de grade 1, 16,84 mois IC95 % [13,58–20,105] pour les Adc de grade 2 et 17,33 mois IC95 % [13,15–21,510] pour les Adc de grade 3. Il n’y avait pas de difference statistique en termes de survie entre les differents groupes d’adenocarcinomes (p > 0,05). Conclusion Nos resultats n’ont pas demontre de difference statistique en termes de survie ente les differents groupes d’adenocarcinomes selon la proposition de l’IASLC. Ce resultat doit etre considere avec prudence vu l’effectif reduit de notre serie.
The role of the pathologist has been highlighted by the medias since the recent years and the Tun... more The role of the pathologist has been highlighted by the medias since the recent years and the Tunisian law system suffers from a huge and there are no rules or jury verdicts concerning the e responsability of the doctors in general with emphasis on pathologists. One might think that the lack of laws benefits to the pathologist, on the other hand, we can consider this as dangerous either for the patients or the pathologists. This lack of laws makes the judge dependant on the expert view. Other countries like European ones and the United States, has available data furnished by the insurance bodies that enrich the jury verdicts and the different laws that are available. Our aim was to help the pathologists understand their legal responsibilities and the law system. The latter may seem as complex for the pathologist as a pathologic report for a judge.
The American journal of forensic medicine and pathology, 2017
Drug-induced eosinophilic myocarditis is uncommon with few cases reported in the literature. It i... more Drug-induced eosinophilic myocarditis is uncommon with few cases reported in the literature. It is a rare but potentially life-threatening disease.We report the case of an 11-year-old girl without medical history who developed an acute malaise and chills, followed by severe shortness of breath and a cardiopulmonary arrest 1 hour after an intramuscular injection of penicillin.At autopsy, we observed in the external examination nonspecific asphyxia signs, an injection mark, and the absence of traumatic signs. The organs examination showed a heart with a normal shape and a transmural, diffuse, tannish discoloration of the myocardium. The lungs were severely congested with a diffuse edema. Histological examination of the ventricular walls and septum revealed suggestive signs of eosinophilic myocarditis. Immunohistochemical analysis for the phenotypic characterization of the inflammatory cells revealed the positivity of the CD3 antibody without any stain for CD20.The diagnosis of fulmina...
Background: clinical reasoning is a mandatory competency in medical curriculum. Many techniques h... more Background: clinical reasoning is a mandatory competency in medical curriculum. Many techniques have been reported in order to teach it. The authors focused on 2 student-centered techniques, SNAPPS and collaborative critical reasoning learning (CCRL) technique, and compared their efficiency in order to improve the clinical reasoning competencies of third year medical education students.Methods: the authors performed a prospective randomised, controlled, non blinded crossover trial including year-3 undergraduate medical students. Judgement criteria consisted in the scores attributed to a structured summary performed by the students after each session. Besides, a satisfaction likert-scale questionnaire was fulfilled by the students. Statistical analysis was performed using SPSS software (version 20.0).Results: 72 students were included with a mean age of 21 years. The mean scores of CCRL reached 4.62 versus 4.99 for SNAPPS. No significant statistical difference was observed between th...
Abstract Idiopathic pulmonary fibrosis (IPF) is a chronic, devastating and fatal disease characte... more Abstract Idiopathic pulmonary fibrosis (IPF) is a chronic, devastating and fatal disease characterized by aberrant fibroblasts proliferation, oxidative stress and collagen accumulation in the interstitial tissue. We aimed to evaluate in the present study the efficacy of Thymus vulagris extract (TVE) on an experimental model of pulmonary fibrosis induced by bleomycin (BLM). Wistar rats were given a single dose of BLM (4 mg/kg, intratracheal), while TVE (50, 100 and 200 mg/kg, intraperitoneal) was administered 3 days later and continued for 4 weeks. We reveled by HPLC analysis an important amount of phenolic bioactive compounds such as rosmarinic and vanillic acids. Our results showed a significant decrease of catalase and superoxide dismutase activities and an increase in lipid peroxidation compared to control group after BLM injection. Treatment with TVE (200 mg/kg) was able to normalize the level of these oxidative markers and to decrease collagen accumulation compared to BLM group. Moreover, this high dose of TVE have no renal or hepatic cytotoxic effects. This study allowed us to conclude that thyme extract has a strong antioxidant and antifibrotic activities due to its high content of polyphenols.
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