Though the diagnosis of actinic keratoses is most often clinical, it is sometimes necessary to use non-invasive imaging methods to confirm this diagnosis. Reflectance confocal microscopic examination of actinic keratosis may reveal hyperkeratosis (i.e., detached, isolated or scaly corneocytes), parakeratosis (i.e., nucleated cells in the stratum corneum), dilated vessels and signs of solar elastosis, including clusters of moderately reflecting material and/or undulating shiny elastic fibres that are clearly visible in the superficial dermis. Hopefully, new in vivo microscopic imaging techniques such as line-field confocal optical coherence tomography will make it possible to obtain a three-dimensional examination of the skin and, thus, to further improve diagnostic accuracy of these lesions. © 2019 Elsevier Masson SAS. All rights reserved. Cet article fait partie du numéro supplément Kératoses actiniques : comprendre et traiter réalisé avec le soutien institutionnel de Galderma International.

Actinic keratoses are epidermal preneoplastic lesions localised in photo-exposed areas. They are made of a keratosis of variable thickness overlying an erythematous area, that may be indurated. A field of cancerization is characterized by multiple actinic keratoses in a chronically sun exposed area, especially on the bald area of the scalp in aged males. In general, the diagnosis is made on clinical basis, but a biopsy is necessary in case of ulceration, induration, post-treatment recurrence or bleeding. Biopsy is also mandatory for atypical keratosis, especially the pigmented variants. Histopathology shows dysplasia of the epidermal basal layer, with irregular and hyperchromatic nuclei, parakeratosis and generally a dermal lymphocytic infiltrate. There are hypertrophic, atrophic, pigmented and lichenoid variants among the most common subtypes. The main clinicopathological issue is transformation of actinic keratosis into squamous cell carcinoma, defined by epidermal sheaths of atypical cells penetrating into the dermis. These cells are eosinophilic and show images of dyskeratosis or squamous whorls. Dermatoscopy (and other non invasive imaging techniques) might be useful to help decision making - when to perform a biopsy - and for differential diagnosis. © 2019 Elsevier Masson SAS. All rights reserved. Cet article fait partie du numéro supplément Kératoses actiniques : comprendre et traiter réalisé avec le soutien institutionnel de Galderma International.

Anti-PD-1 and anti-CTLA-4 monoclonal antibodies are used in melanoma, while anti-PD-1 are also used in Hodgkin's lymphoma. Primary central nervous system lymphoma is a rare form of non-Hodgkin's lymphoma with few effective treatments. However, several recent studies have reported multiple cases of non-Hodgkin's lymphoma and primary central nervous system lymphoma treated by anti-PD-1 antibodies with favourable responses.

We report on a case of carcinoma cuniculatum (CC) of the maxillary gingival mucosa. A 60-year-old woman presented with an exophytic gingivo-palatal mass with slow growth and osteolytic evolution. A first performed biopsy was negative for malignancy. The diagnosis of CC was established on the surgical representative biopsy. CC is a rare low-grade variant of squamous cell carcinoma that is usually found in the foot or in oral cavity. The pathognomonic microscopic feature of CC is an endo- and/or exophytic lesion composed by a well differentiated squamous epithelium infiltrating into underlying stroma forming a complex pattern of keratin cores and keratin filled "rabbit warren" crypts. CC is a locally evolutive carcinoma with a usually good prognosis usually without lymph node or distant metastatic evolution.

Propofol is an established anesthetic widely used for induction and maintenance of anesthesia. We investigated propofol for its anti-inflammatory effects on microglia and found that propofol treatment is associated with substantial lower levels of extracellular vesicles (EVs) in immune activated microglia. Importantly, EVs collected from immune activated microglia reversed propofol-mediated anti-inflammatory and neuroprotective effects, suggesting that propofol reduces proinflammatory microglia activation and microglia-mediated neurotoxicity through inhibition of EV release. These data shed new insight into a novel molecular mechanism of propofol-mediated neuroprotective and immunomodulatory effects through inhibition of EV release.

Salivary glands tumours are uncommon tumours showing a large diversity of histological types. This article presents a synthesis of patterns and paths of invasion of parotid glands tumours in order to propose an approach of the delineation of primary tumour clinical target volumes and of the selection of lymph nodes target volumes. This article does not discuss treatment indications but defines clinical target volumes to treat if radiotherapy is indicated. Postoperative situation being the most frequent, the delineation of primary tumour clinical target volume is based on an anatomical approach.

Stage I germ-cell tumors are rare and highly curable diseases. As such, management of these tumours should carefully follow guidelines. Initial management is based on orchiectomy and several options as adjuvant therapy. Pro's and con's should be discussed with the patient for a personalized management. Patients with stage 1 germ-cell tumours should be addressed to expert centers.

Vulvar cancer is a rare neoplastic disorder accounting for less than 5% of female genital cancers. This study aims to describe the epidemiological, clinical, paraclinical, therapeutic and evolutionary profile of vulvar cancer in the population of the eastern region of Morocco. We conducted a retrospective study of all patients treated for vulvar cancer in the Oncology Center, University Hospital Mohammed VI in Oujda, Morocco from June 2007 to January 2014. The study included 34 patients with an average age of 65.7 years, of whom 52.9% were multiparous. The most frequent reason for consultation was pruritus (94.1% of cases). The median of consultation time was 16 months, ranging from 2 months to 8 years. Ignorance and modesty were the major causes of diagnostic delay, since 73.5% of patients already had locally advanced disease at diagnosis. Surgical treatment was proposed to 61.4% of cases and was based on radical vulvectomy associated with bilateral inguinal lymphadenectomy in 68.5% of cases. Adjuvant radiotherapy was indicated in 41.2% of cases, 5.9% of patients underwent neo-adjuvant radiotherapy while 20.6% underwent exclusive radiotherapy associated with concomitant chemotherapy. Palliative chemotherapy was proposed to 8.8% of patients. The overall survival rate at 3 years was 65%, locoregional or distant recurrence rate was 17.3%. Cultural and social characteristics of patients of the eastern region of Morocco treated for vulvar cancer are factors influencing treatment and outcomes. Additional prevention and awareness efforts should be made in order to reduce the rates of locally advanced tumors and to enable curative treatment for this population.

STUMP (smooth muscle tumor of uncertain malignant potential) are smooth muscle tumors that cannot be diagnosed as either benign or malignant due to their morphological characteristics. We here report the case of a 44 year old patient with no notable medical history presenting with an increase in the abdominal volume. Pelvic ultrasound and CT TAP scan were performed showing voluminous mass with tissue and fluid-filled component in the uterus. The patient underwent exploratory laparotomy during which two masses were detected, one in the uterus and the other in the retroperitoneal area. Anatomopathologic examination showed uterine myoma associated with a STUMP.

We here report the case of a 1-year old infant admitted to Hospital with left inguinoscrotal swelling evolving over the last 4 months, gradually increasing in volume and becoming painful. Clinical examination showed conscious, afebrile patient with stable hemodynamic and respiratory status but with left, soft, inguinoscrotal, transilluminable swelling painful to palpation. Inguinal doppler echocardiogram objectified 30 mm multiloculated mass. Abdominopelvic CT scan showed cystic lymphangioma: (A) shows the clinical image of the swelling; (B) shows the abdominopelvic CT scan image of a cystic lymphangioma; (C) shows the lymphangioma after exploration via the inguinal route which was in close contact with the spermatic cord and reaching the scrotum; resection of the cyst was performed after careful dissection, while preserving the noble elements; (D) shows patient's outcome after 3 months. Anatomo-pathologic study confirmed the diagnosis of cystic lymphangioma. After 6-months' follow-up contralateral swelling developed.

The study involved a 54-year old female patient admitted with severe renal failure. She had a 1-month history of progressive stage II dyspnoea associated with chest pain, bone pain and anuria. Clinical examination showed hypertension (160/80mmHg), glomerular disease (urinary protein excretion 2+, blood 2+ and diuresis 300 cc). Pleuropulmonary examination showed diffuse bilateral lower-chest crackling sounds. Laboratory tests objectified severe renal failure with creatinine level 107mg, urea 1.65g/l, hyperkalaemia 7.8 mmol/l, CRP value 78mg/l, normochromic normocytic anemia with hemoglobin concentration 5.7g/dl and leukocytosis 13570 without thrombocytopenia, hyperprotidemia 144g/l, normal serum albumin concentration 33g/l, hypercalcemia 116mg/l and hyperphosphataemia 120mg/l. Serum protein electrophoresis showed monoclonal gamma globulin peak 60 g/l. Immunoelectrophoresis of plasma proteins showed IgG kappa gammapathy. Bence-Jones protein urine test was negative. Myelogram showed plasmocytosis 10%. Profile skull x-rays objectified multiple pre-existing geodes. The patient underwent CDT1 protocol with dexamethazone thalidomide 100 mg and oral endoxan.

Primitive malignant pancreatic non-Hodgkin's lymphoma (NHL) is an extremely rare site of extranodal NHL, accounting for less than 0.7% of all NHLs and less than 0.5% of malignant pancreatic tumors. It mainly affects the elderly and very rarely the young subject (hence the interest in our case). Clinical diagnosis is difficult because it mimics pancreatic adenocarcinoma and chronic pancreatitis. We report the case of a 25 year old patient, treated for diffuse primary pancreatic large B-cell NHL revealed by epigastralgia with fulminating jaundice characterised by acute onset associated with alteration of the general state. NHL was diagnosed by biopsy of the duodeno-pancreatic cavity. Diagnosis and early treatment of these aggressive tumors enable remarkable improvements in prognosis.

Lipomas localization in the parotid region is very rare. We here report a new case of a 55-year old patient, presenting with a mass in the parotid region that had progressed over the past 4 years and a literature review. A soft, mobile and painless mass was detected on palpation. The patient underwent imaging examinations (ultrasound and MRI), that enabled to retain the diagnosis of parotid lipoma. The patient decided to have conservative treatment.

Amygdaloid cysts are benign dysembryologic cystic tumors developing in the anterolateral portion of the neck. They account for 2% of all neck tumors located in the laterocervical region. They mostly result from branchial cleft abnormalities, accounting for 6.1-85.2% of all second branchial cleft abnormalities. They are due to the persistence of the cervical sinus during the differentiation of the branchial apparatus. They manifest as a laterocervical swelling in the anterior edge of the sternocleidomastoid muscle. The diagnosis of cyst is confirmed by ultrasound and CT scan. Treatment is based on surgical resection. We here report the case of a 24-year old woman presenting with voluminous left laterocervical swelling evolving over the past 3 years without any associated symptoms. Exploratory cervicotomy with anatomopathological examination were performed. The histologic diagnosis of amygdaloid cyst with no sign of malignancy was retained. This study aims to analyze the anatomoclinical features and to discuss the therapeutic options for the management of this disease.

Meningiomas are frequently encountered tumours in neurosurgery. However, there is a paucity of data concerning their epidemiology, their clinical characteristics and their treatment compared to gliomas. This study aims to identify the epidemiological profile and to assess the quality of treatment of intracranial meningiomas (ICM) at the National Hospital Center in Nouakchott, Mauritania. We conducted a retrospective study of patients who had undergone surgery for the treatment of ICM between September 2013 and September 2016. Thirty-two patients had undergone surgery for the treatment of ICM (26.6%). The average age was 45.12 (± 13.8 years) among whom 75% were women. The average length of stay in hospital had been 13 days (± 7 days). The mean time between symptom onset and diagnosis had been 10 months (±5months). The mean size of ICM had been 5.07cm (±2.00cm) ranging from 2.5cm to 10.5cm. Complementary MRI had been performed in 46.8% of patients after brain CT scan. In our series, 38% of ICM had grown on brain convexity. The mean surgical time had been 23.91 days (±17days). The quality grade of surgical resection assigned according to Simpson score was Grade I (66%), Grade II (19%), Grade III (6%), Grade IV (9%). The histological grade assigned according to the 2007 WHO classification was Grade I (93%), Grade II-III (7%). The overall operative mortality was (n=3, 9.4%). The development of technical equipment in the department of neurosurgery, radiology and of equipment in anesthesia and intensive care will contribute to improve outcomes and to reduce mortality rates.

Esthesioneuroblastoma (ENB) is a rare malignant tumor accounting for 3% of all sinonasal cancers. It arises from the olfactory epithelium and usually affects subjects aged 30-50 years. It is uncommon in children. It is often diagnosed late because tumor remains confined to its original site for long and prognosis depends on locoregional extension (in particular to the brain and the orbital regions). We report the case of a 3-year old child with sphenoidal esthesioneuroblastoma discovered after early onset blindness. This study aims to highlight the clinical, radiological, anatomopathological, therapeutic and prognostic peculiarities of this disease while insisting on the importance of early diagnosis affecting prognosis. Unfortunately, diagnosis is still pejorative due to high recidivism rates as well as to the occurrence of distant metastases (in particular lung and bone metastases).