Journal of clinical, medical and experimental images, 2017
Micronodular thymoma is a rare subtype of thymoma with less than 20 cases published in the Englis... more Micronodular thymoma is a rare subtype of thymoma with less than 20 cases published in the English literature. These tumours have been reported with thymoma or thymic cyst. The authors describe a new case of micronodular thymoma in a 68-year-old-patient which is well documented and particular by its cystic degeneration which hasn't been described yet. Micronodular thymoma is a rare variant of thymoma with a challenging diagnosis. Clinicians must be aware of this entity in order not to confuse it with a thymic cyst.
Iranian Journal of Clinical Infectious Diseases, Aug 27, 2016
Hydatidosis is an infectious disease resulting from the development of the larval form of the par... more Hydatidosis is an infectious disease resulting from the development of the larval form of the parasite Echinococcus granulosus in humans. The invasion of the chest wall by echinococcosis is rarely described. Methods: The current study reported all cases of chest wall hydatidosis treated in the department of cardiothoracic surgery from January 1990 to December 2011. The mean age of the patients was 41.3 ± 16.8 years. Males and females were equally affected. The cysts mostly were located at ribs (13 cases) and ribs with vertebrae (10 cases). The chest wall muscles, the sub-cutaneous tissue and the sternum were involved in four, three and two cases, respectively. A costal resection was performed in 13 cases (one to three ribs; mean, 1.5 ribs) and a costovertebral resection was performed in 10 cases (transverse process three, vertebral body four and both three). The other surgical procedures were partial resection of the sternum (two cases) and cystectomy with resection of parietal soft tissue (nine cases). The outcome was favorable for 29 patients. A recurrence was observed in two patients who presented costovertebral and sternal involvements. The chest wall localization of the hydatid cyst is rare. In the costovertebral involvements, this parasitic disease behaves locally as a bone malignancy. The treatment is surgical and the resection should be large and radical to avoid recurrences.
Journal of Immunoassay & Immunochemistry, Jul 29, 2016
ABSTRACT Multidisciplinary concertation is mandatory in order to assess interstitial pneumonias. ... more ABSTRACT Multidisciplinary concertation is mandatory in order to assess interstitial pneumonias. The study of the bronchoalveolar lavage helps evoking a diagnosis according to the lavage profile. In lymphocytic alveolitis, immunocytochemistry, or in flux cytometry are necessary in order to identify the different clusters of lymphocytes implicated. Our objective was to evaluate the profile of 31 lymphocytic alveolitis using 2 different techniques which are the immunocytochemistry and the in flow cytometry in order to evaluate the efficacy of each technique and to compare the different results to the final diagnoses. We describe a retrospective study about 31 patients admitted to our hospital in order to explore an interstitial pneumonia between January and July 2014. Bronchial endoscopy and bronchoalveolar lavage were performed in all cases. The sensitivity of the in flow cytometry was estimated to 53% and its specificity reached 33%. On the other hand, the immunocytochemistry presented a specificity of 42.8% and a sensitivity of 42.8%. The final diagnoses retained consisted in sarcoidosis in 12 cases, infectious pneumonia in 10 cases, hypersensitivity pneumonia in 3 cases, cryptogenic pneumonia in 3 cases, idiopathic fibrosis in 2 cases, and adenocarcinoma in 1 case. The relevance of both techniques depends on many factors. They necessitate an available material, well-trained technicians, and experimented pathologists.
Asian Cardiovascular and Thoracic Annals, Sep 24, 2021
Introduction Tumor-infiltrating lymphocytes represent a pivotal component of the host anti-tumor ... more Introduction Tumor-infiltrating lymphocytes represent a pivotal component of the host anti-tumor response. Thus, they considerably influence the evolution of cancers including non-small cell lung carcinomas. Even if, this important role is consensual, many discordant results are published in the literature about the prognostic role of the different populations of tumor-infiltrating lymphocytes. The aim of our work was to evaluate the prognostic impact of CD8+, CD4+, and forkhead box protein P3+ lymphocytes in the tumor microenvironment of non-small cell lung carcinomas. Methods We conducted a retrospective descriptive study, which included non-small cell lung carcinomas diagnosed in the department of pathology and followed in the medical oncology department of the same hospital between 2011 and 2015. Tumor-infiltrating lymphocytes were analyzed by the immunohistochemical method for forkhead box protein P3, CD4, and CD8. Intratumoral and stromal-labeled lymphocytes were quantified by manual counting at high magnification (×400). Forkhead box protein P3+/CD8+, forkhead box protein P3+/CD4+, and CD8+/CD4+ ratios were subsequently calculated. The prognostic value of tumor-infiltrating lymphocytes was assessed in respect of overall survival, recurrence-free survival, and relapse-free survival. Results Thirty-nine patients were included. The mean age of patients was 59.6 years. A complete surgical resection ( p = 0.009), and a CD8/CD4 ratio ( p = 0.008) were prognostic factors for overall survival. Complete surgical resection ( p = 0.003), the forkhead box protein P3/CD8 ( p = 0.005), and forkhead box protein P3/CD4 ( p = 0.037) ratios were prognostic factors for recurrence-free survival. The CD8+ tumor-infiltrating lymphocytes rate ( p = 0.037) was a prognostic factor for relapse-free survival with a threshold of 67.8/high power field. Microscopic subtype ( p = 0.037) was a prognostic factor for relapse-free survival when only adenocarcinoma and squamous cell carcinoma were considered. In multivariate analysis, age ( p = 0.004) and a CD8/CD4 ratio ( p = 0.016) were independent predictors of overall survival. Conclusion Despite the limitations of our study, our results confirm the prognostic value of tumor-infiltrating lymphocytes in non-small cell lung carcinomas and the importance of the combined quantification of their different subpopulations.
Journal of Immunoassay & Immunochemistry, Feb 27, 2019
ABSTRACT Background: The positive diagnosis of MPM is based on morphologic features coupled with ... more ABSTRACT Background: The positive diagnosis of MPM is based on morphologic features coupled with immunohistochemical findings. Many antibodies have been published especially in order to differentiate between malignant tumors and atypical mesothelial hyperplasia. BAP-1 is a BRCA1-binding protein whose loss of expression was frequently reported in MPM. Our aim was to assess the diagnostic value of this antibody in comparison to the most sensitive diagnostic antibody represented by the calretinin antibody. Methods: We performed a meta-analysis using the Meta-Disc software 5.1.32. Results: According to our inclusion criteria, 19 studies with 11 studies dealing with BAP1 antibody and 8 studies dealing with calretinin antibody were included. The SEN of BAP 1 and calretinin antibodies was respectively estimated to 54.6% and 86.5%. The SPE reached respectively 95.7% and 76.6%. The dOR was estimated respectively to 23.664 and 38.8. The I-square revealed a heterogeneity of the parameters studied. The metaregression analysis revealed as covariates the amplification system and the histologic subtype as causing effects of heterogeneity for BAP1 antibodies and histologic subtype and chromogene as causing effects of heterogeneity for calretinin antibody. Conclusion: This meta-analysis revealed that BAP1 antibody should be associated with more sensitive antibodies in order to assess the diagnosis.
9623 Background Telomerase is a key enzyme in the process of immortalization of cancer cells and ... more 9623 Background Telomerase is a key enzyme in the process of immortalization of cancer cells and as such it holds a pivotal role in carcinogenesis. The catalytic subunit of telomerase, hTERT is expressed in 85–90% of pancreatic cancers. We have previously demonstrated that vaccination of inoperable pancreatic cancer patients with the telomerase peptide GV1001 in combination with GM-CSF, results in a high frequency of immune responders (75%). Recently it has been focus on imiquimod, an immune modulator, as a potential new adjuvant for peptide vaccination. Imiquimod acts via stimulation of Toll-like receptor 7 on antigen presenting cells, resulting in production of the cytokines IL-12, INF- α and INF-β, and thus creates a broader inflammatory response than GM-CSF. Methods The present study was performed to determine safety and immunogenecity of GV1001 using imiquimod as an adjuvant. Fourteen patients with non-resectable pancreatic cancer, were recruited into a phase I trial. The patients were vaccinated eig...
Extramedullary hematopoiesis in the posterior mediastinum is rare. Our case interested a 28‐year‐... more Extramedullary hematopoiesis in the posterior mediastinum is rare. Our case interested a 28‐year‐old man with a history of eosinophilia with FIP1L1‐PDGFRA fusion gene who had a mediastinal mass surgically excised. Pathological examination concluded to an extramedullary erythropoiesis. This case is original by its location and the presence of only the erythroblastic line rearrangement.
BACKGROUND Medical teaching is usually centred on an objective-based approach and influenced by a... more BACKGROUND Medical teaching is usually centred on an objective-based approach and influenced by a flexnerian approach inducing an emphasis on abilities and skills more than the know-how. The know-how is usually under taught and assessed. AIM To assess the competencies in announcing bad news of students in medicine in addition to their satisfaction about the methods used which were serious games. METHODS Students in the third-pregraduate year of medicine who performed their externship in a Department of Pathology of a university Hopsital were included during the year 2018-2019. Seven groups including 4 externs performing a 3-week-period were included. The training started with a pre-test, which consisted in an Objective-Structured-Clinical situation with a simulated patient and a evaluator with a checklist. The students were asked to perform a serious game, then they assisted to a lecture-based learning about the rules of announce of bad news. The serious game was screened then watched by all the students. After a debriefing session, the students were asked to fulfill a post test and a questionnaire-test. RESULTS Twenty-eight students were included. The mean score accounted for 6,76 +/- 2,78 over 20 for the pre-test and 13,17 +/- 1,99 over 20 for the post-test. A significant difference was observed between the pre and post test (p<0.0001). All the students expressed their satisfaction. 27 students wished to repeat the experience. All the students put emphasis on the importance of the peer and auto-evaluation phase using videos. 14 students suggested to integrate this teaching method to the curriculum of the Faculty before their internship. CONCLUSION Inspite of some limits, this study highlighted the improvement of the students' relational competences in addition to their satisfaction related to the use of role play in the acquisition of relational competences related to particular situation such as the announce of bad news.
Immunotherapy in lung cancer has been playing a key role. This role can be explained by the gain ... more Immunotherapy in lung cancer has been playing a key role. This role can be explained by the gain in term of survival without progression. The place of the PD-L1 testing is important to know. Because of the multiple clones available and the differrent systems available in pathology labs, it was important to present the last recommendations concerning PD-L1 testing in order to make pathologists and treating doctors aware of the major principles and the different limits.
A causal relationship between the thymus gland and myasthenia gravis (MG) has been assumed for de... more A causal relationship between the thymus gland and myasthenia gravis (MG) has been assumed for decades. However, this relationship is still a matter of conjecture and speculations and awaits definitive proof. Recently, myoid cells have been considered as effectors in the pathogenesis of MG as well as thymic enlargement (thymolipoma, true thymic hyperplasia). Our objective is to discuss the role of myoid cells in the pathogenesis of MG associated with thymic enlargement. we report a retrospective study about 6 cases of thymic enlargement with 4 cases of true thymic hyperplasia (TTH) and 2 cases of thymolipoma (TL). The majority of our patients were men with a sex ratio of 4/2. Only 2 patients had a past medical history consistent for MG. Myoid cells were found in all cases. Through our small study, the implication of myoid cells in the pathogenesis of the association MG-TL or TTH remains unproved.
BACKGROUND Team-based learning (TBL) is an active method of learning aiming to the promotion of t... more BACKGROUND Team-based learning (TBL) is an active method of learning aiming to the promotion of the teamwork and improvement of critical thinking. Students of our university weren't used to TBL. We tried to implement a learning session combining TBL and lectures. METHODS The study included residents in pathology. The learning scenario consisted in lectures followed by a TBL. Four steps characterized the learning scenario: an individual preparation based on resources made available in the internet by the tutors, an individual readiness assurance test (iRAT) performed during the first 15minutes of the session, a team readiness assurance test (tRAT) and a peer evaluation step. The final students' score was calculated by summing score A (iRAT weighted to 70%) and score C (derived by multiplying the score B [tRAT weighted to 30%] with percentage of peer evaluation). Anova test and Pearson coefficient were used to perform the statistical analyses. RESULTS Forty-one residents were included. We assessed an improvement of the tRAT in comparison to iRAT. The only correlations established were between the iRAT and the tRAT and the tRAT and the students' scores. CONCLUSION Implementing TBL in medical universities may induce an improvement of the individual knowledge and a change in behaviourism.
Background: Endometrial hyperplasia represents a heterogeneous group of lesions in response to th... more Background: Endometrial hyperplasia represents a heterogeneous group of lesions in response to the unopposed growth-promoting action of estrogen. WHO classified endometrial hyperplastic lesions into Benign Hyperplasia (BH) and atypical hyperplasia/ endometrial intraepithelial neoplasia AH/EIN. Phosphatase and tensin homolog (PTEN) is one of the earliest and most common genetic abnormalities detected in endometrioid adenocarcinoma (type I) and even in its precursors. This study aimed at histological evaluation of hyperplastic endometrial lesions according to WHO 2014 and investigating the role of PTEN expression in highlighting the precancerous group (AH/EIN). Patient and Method: This study included a series of 70 Egyptian patients suffered from hyperplastic endometrial lesions. They were previously diagnosed according to WHO1994 schema simple endometrial hyperplasia without atypia (n=18), simple endometrial hyperplasia with atypia (n=2), complex hyperplasia without atypia (n=25), complex hyperplasia with atypia (n=5) and hyperplastic endometrial polyps (n=20). Results: Cases were histologically re-evaluated according to WHO 2014 classification; BH (62 cases) and eight cases of AH/EIN. A significant difference in PTEN expression (regarding percentage and intensity of staining) in relation to histopathological diagnosis was detected (P-value 0.02 and &lt;0.05, respectively). The sensitivity and specificity of the absence of diffuse PTEN protein expression (&gt;50%) to detect AH/EIN were 100% and 77.4%, respectively. Conclusion: Diffuse, dim or loss of immunohistochemical expression of PTEN protein is significantly correlated with the new WHO classification segregation of AH/EIN as precancerous lesions. However, further studies are recommended to confirm this association.
Current Respiratory Medicine Reviews, Sep 12, 2019
Background: Lymphoblastic lymphomas (LL) of the mediastinum are rare tumours that present a chall... more Background: Lymphoblastic lymphomas (LL) of the mediastinum are rare tumours that present a challenging diagnosis. The positive diagnosis is based on microscopic findings. Our aim was to highlight the diagnostic difficulties in such situations. We conducted a descriptive retrospective study including 31 patients presenting mediastinal LL. Results: Radiologic features consisted in all cases in a mediastinal infiltrating mass. Microscopic examination showed in all cases a crowded tumour with many artefacts made of diffuse tumour cells. Immunohistochemial study was performed in all cases. It was quite difficult to interprete in the samples used for extemporaneous examination and repeated in 10 cases. The diagnosis of LL is based on the microscopic examination which is usually performed on small samples with crowding artefacts. Thus, this pathology must be managed by a trained team that is used to deal with such a specimen in order to avoid repeating the biopsy and inducing diagnostic delay.
International journal of healthcare and medical sciences, 2015
Background : During the conference of ASCO 2015, there was no consensus about TIL role in beast c... more Background : During the conference of ASCO 2015, there was no consensus about TIL role in beast cancer and no recommendations concerning the microscopic assessment of TIL. In fact, the patients could be put on anti-PD1 drugs without the necessity of highlighting PD1 positive cells by using immunohistochemistry. Nevertheless, many questions about the prognostic impact of TIL, the methods of assessment, the type of TIL to count remain unresolved. Material and Methods : We performed a review of the literature on the sites : Pubmed and Cochrane. We used the key-words : i?½TIL in canceri?½; i?½TIL in breast canceri?½ and i?½prognostic impact of TIL in breast canceri?½. Results : According to our inclusion and exclusion criteria, thirty eight articles were retained. Our review of the literature showed that assessing TIL in high grade tumors seem unnecessary. They seem available in intermediate graded tumors. In neo-adjuvant and adjuvant conditions, CD3+ lymphocytes seem to be correlated to a good response to chemotherapy. After a chemotherapy, quantification T reg lymphocytes CD4 + FOXP3+ seems helpful because the decrease of their number is correlated to a good prognosis. Conclusion : The role of TIL in breast cancer is clearly established. The mechanisms of immune escape induced to discovery of immune therapy. The role of the microscopic examination and the subtyping of TIL using immunohistochemistry hasni?½t been clearly established. Through this review of the literature, we tried to establish a diagram highlighting the different subtypes of TIL to evaluate and their prognostic impact.
Journal of Immunoassay & Immunochemistry, May 4, 2018
Background: malignant pleural mesothelioma (MPM) is a rare tumor with a challenging diagnosis. Ev... more Background: malignant pleural mesothelioma (MPM) is a rare tumor with a challenging diagnosis. Even if, clinical data are mandatory to suspect the diagnosis, the positive diagnosis is based on microscopic features. Morphologic features are still the port of call of the diagnosis but their non specific character and the multiplicity of differential diagnoses made the immunohistochemical markers mandatory for the diagnosis. Many antibodies with a positive diagnostic value including claretinin, mesothelin, WT1 and antibodies with a negative diagnostic value including TTF1, EMA, CD15 are recommended by the scientific societies. This is due to the diagnostic limits of every antibody which necessitate the association of multiple antibodies. In the diagnostic demarch, pathologists deal with different antibodies and clones. Even if many recommendations are available, every pathology lab has to experiment its own antibodies in order to optimize the routine diagnostic demarch especially in low-income country. Our aim was to assess the diagnostic value of different antibodies available in our lab and to recommend a decisional flowchart.
Journal of clinical, medical and experimental images, 2017
Micronodular thymoma is a rare subtype of thymoma with less than 20 cases published in the Englis... more Micronodular thymoma is a rare subtype of thymoma with less than 20 cases published in the English literature. These tumours have been reported with thymoma or thymic cyst. The authors describe a new case of micronodular thymoma in a 68-year-old-patient which is well documented and particular by its cystic degeneration which hasn't been described yet. Micronodular thymoma is a rare variant of thymoma with a challenging diagnosis. Clinicians must be aware of this entity in order not to confuse it with a thymic cyst.
Iranian Journal of Clinical Infectious Diseases, Aug 27, 2016
Hydatidosis is an infectious disease resulting from the development of the larval form of the par... more Hydatidosis is an infectious disease resulting from the development of the larval form of the parasite Echinococcus granulosus in humans. The invasion of the chest wall by echinococcosis is rarely described. Methods: The current study reported all cases of chest wall hydatidosis treated in the department of cardiothoracic surgery from January 1990 to December 2011. The mean age of the patients was 41.3 ± 16.8 years. Males and females were equally affected. The cysts mostly were located at ribs (13 cases) and ribs with vertebrae (10 cases). The chest wall muscles, the sub-cutaneous tissue and the sternum were involved in four, three and two cases, respectively. A costal resection was performed in 13 cases (one to three ribs; mean, 1.5 ribs) and a costovertebral resection was performed in 10 cases (transverse process three, vertebral body four and both three). The other surgical procedures were partial resection of the sternum (two cases) and cystectomy with resection of parietal soft tissue (nine cases). The outcome was favorable for 29 patients. A recurrence was observed in two patients who presented costovertebral and sternal involvements. The chest wall localization of the hydatid cyst is rare. In the costovertebral involvements, this parasitic disease behaves locally as a bone malignancy. The treatment is surgical and the resection should be large and radical to avoid recurrences.
Journal of Immunoassay & Immunochemistry, Jul 29, 2016
ABSTRACT Multidisciplinary concertation is mandatory in order to assess interstitial pneumonias. ... more ABSTRACT Multidisciplinary concertation is mandatory in order to assess interstitial pneumonias. The study of the bronchoalveolar lavage helps evoking a diagnosis according to the lavage profile. In lymphocytic alveolitis, immunocytochemistry, or in flux cytometry are necessary in order to identify the different clusters of lymphocytes implicated. Our objective was to evaluate the profile of 31 lymphocytic alveolitis using 2 different techniques which are the immunocytochemistry and the in flow cytometry in order to evaluate the efficacy of each technique and to compare the different results to the final diagnoses. We describe a retrospective study about 31 patients admitted to our hospital in order to explore an interstitial pneumonia between January and July 2014. Bronchial endoscopy and bronchoalveolar lavage were performed in all cases. The sensitivity of the in flow cytometry was estimated to 53% and its specificity reached 33%. On the other hand, the immunocytochemistry presented a specificity of 42.8% and a sensitivity of 42.8%. The final diagnoses retained consisted in sarcoidosis in 12 cases, infectious pneumonia in 10 cases, hypersensitivity pneumonia in 3 cases, cryptogenic pneumonia in 3 cases, idiopathic fibrosis in 2 cases, and adenocarcinoma in 1 case. The relevance of both techniques depends on many factors. They necessitate an available material, well-trained technicians, and experimented pathologists.
Asian Cardiovascular and Thoracic Annals, Sep 24, 2021
Introduction Tumor-infiltrating lymphocytes represent a pivotal component of the host anti-tumor ... more Introduction Tumor-infiltrating lymphocytes represent a pivotal component of the host anti-tumor response. Thus, they considerably influence the evolution of cancers including non-small cell lung carcinomas. Even if, this important role is consensual, many discordant results are published in the literature about the prognostic role of the different populations of tumor-infiltrating lymphocytes. The aim of our work was to evaluate the prognostic impact of CD8+, CD4+, and forkhead box protein P3+ lymphocytes in the tumor microenvironment of non-small cell lung carcinomas. Methods We conducted a retrospective descriptive study, which included non-small cell lung carcinomas diagnosed in the department of pathology and followed in the medical oncology department of the same hospital between 2011 and 2015. Tumor-infiltrating lymphocytes were analyzed by the immunohistochemical method for forkhead box protein P3, CD4, and CD8. Intratumoral and stromal-labeled lymphocytes were quantified by manual counting at high magnification (×400). Forkhead box protein P3+/CD8+, forkhead box protein P3+/CD4+, and CD8+/CD4+ ratios were subsequently calculated. The prognostic value of tumor-infiltrating lymphocytes was assessed in respect of overall survival, recurrence-free survival, and relapse-free survival. Results Thirty-nine patients were included. The mean age of patients was 59.6 years. A complete surgical resection ( p = 0.009), and a CD8/CD4 ratio ( p = 0.008) were prognostic factors for overall survival. Complete surgical resection ( p = 0.003), the forkhead box protein P3/CD8 ( p = 0.005), and forkhead box protein P3/CD4 ( p = 0.037) ratios were prognostic factors for recurrence-free survival. The CD8+ tumor-infiltrating lymphocytes rate ( p = 0.037) was a prognostic factor for relapse-free survival with a threshold of 67.8/high power field. Microscopic subtype ( p = 0.037) was a prognostic factor for relapse-free survival when only adenocarcinoma and squamous cell carcinoma were considered. In multivariate analysis, age ( p = 0.004) and a CD8/CD4 ratio ( p = 0.016) were independent predictors of overall survival. Conclusion Despite the limitations of our study, our results confirm the prognostic value of tumor-infiltrating lymphocytes in non-small cell lung carcinomas and the importance of the combined quantification of their different subpopulations.
Journal of Immunoassay & Immunochemistry, Feb 27, 2019
ABSTRACT Background: The positive diagnosis of MPM is based on morphologic features coupled with ... more ABSTRACT Background: The positive diagnosis of MPM is based on morphologic features coupled with immunohistochemical findings. Many antibodies have been published especially in order to differentiate between malignant tumors and atypical mesothelial hyperplasia. BAP-1 is a BRCA1-binding protein whose loss of expression was frequently reported in MPM. Our aim was to assess the diagnostic value of this antibody in comparison to the most sensitive diagnostic antibody represented by the calretinin antibody. Methods: We performed a meta-analysis using the Meta-Disc software 5.1.32. Results: According to our inclusion criteria, 19 studies with 11 studies dealing with BAP1 antibody and 8 studies dealing with calretinin antibody were included. The SEN of BAP 1 and calretinin antibodies was respectively estimated to 54.6% and 86.5%. The SPE reached respectively 95.7% and 76.6%. The dOR was estimated respectively to 23.664 and 38.8. The I-square revealed a heterogeneity of the parameters studied. The metaregression analysis revealed as covariates the amplification system and the histologic subtype as causing effects of heterogeneity for BAP1 antibodies and histologic subtype and chromogene as causing effects of heterogeneity for calretinin antibody. Conclusion: This meta-analysis revealed that BAP1 antibody should be associated with more sensitive antibodies in order to assess the diagnosis.
9623 Background Telomerase is a key enzyme in the process of immortalization of cancer cells and ... more 9623 Background Telomerase is a key enzyme in the process of immortalization of cancer cells and as such it holds a pivotal role in carcinogenesis. The catalytic subunit of telomerase, hTERT is expressed in 85–90% of pancreatic cancers. We have previously demonstrated that vaccination of inoperable pancreatic cancer patients with the telomerase peptide GV1001 in combination with GM-CSF, results in a high frequency of immune responders (75%). Recently it has been focus on imiquimod, an immune modulator, as a potential new adjuvant for peptide vaccination. Imiquimod acts via stimulation of Toll-like receptor 7 on antigen presenting cells, resulting in production of the cytokines IL-12, INF- α and INF-β, and thus creates a broader inflammatory response than GM-CSF. Methods The present study was performed to determine safety and immunogenecity of GV1001 using imiquimod as an adjuvant. Fourteen patients with non-resectable pancreatic cancer, were recruited into a phase I trial. The patients were vaccinated eig...
Extramedullary hematopoiesis in the posterior mediastinum is rare. Our case interested a 28‐year‐... more Extramedullary hematopoiesis in the posterior mediastinum is rare. Our case interested a 28‐year‐old man with a history of eosinophilia with FIP1L1‐PDGFRA fusion gene who had a mediastinal mass surgically excised. Pathological examination concluded to an extramedullary erythropoiesis. This case is original by its location and the presence of only the erythroblastic line rearrangement.
BACKGROUND Medical teaching is usually centred on an objective-based approach and influenced by a... more BACKGROUND Medical teaching is usually centred on an objective-based approach and influenced by a flexnerian approach inducing an emphasis on abilities and skills more than the know-how. The know-how is usually under taught and assessed. AIM To assess the competencies in announcing bad news of students in medicine in addition to their satisfaction about the methods used which were serious games. METHODS Students in the third-pregraduate year of medicine who performed their externship in a Department of Pathology of a university Hopsital were included during the year 2018-2019. Seven groups including 4 externs performing a 3-week-period were included. The training started with a pre-test, which consisted in an Objective-Structured-Clinical situation with a simulated patient and a evaluator with a checklist. The students were asked to perform a serious game, then they assisted to a lecture-based learning about the rules of announce of bad news. The serious game was screened then watched by all the students. After a debriefing session, the students were asked to fulfill a post test and a questionnaire-test. RESULTS Twenty-eight students were included. The mean score accounted for 6,76 +/- 2,78 over 20 for the pre-test and 13,17 +/- 1,99 over 20 for the post-test. A significant difference was observed between the pre and post test (p<0.0001). All the students expressed their satisfaction. 27 students wished to repeat the experience. All the students put emphasis on the importance of the peer and auto-evaluation phase using videos. 14 students suggested to integrate this teaching method to the curriculum of the Faculty before their internship. CONCLUSION Inspite of some limits, this study highlighted the improvement of the students' relational competences in addition to their satisfaction related to the use of role play in the acquisition of relational competences related to particular situation such as the announce of bad news.
Immunotherapy in lung cancer has been playing a key role. This role can be explained by the gain ... more Immunotherapy in lung cancer has been playing a key role. This role can be explained by the gain in term of survival without progression. The place of the PD-L1 testing is important to know. Because of the multiple clones available and the differrent systems available in pathology labs, it was important to present the last recommendations concerning PD-L1 testing in order to make pathologists and treating doctors aware of the major principles and the different limits.
A causal relationship between the thymus gland and myasthenia gravis (MG) has been assumed for de... more A causal relationship between the thymus gland and myasthenia gravis (MG) has been assumed for decades. However, this relationship is still a matter of conjecture and speculations and awaits definitive proof. Recently, myoid cells have been considered as effectors in the pathogenesis of MG as well as thymic enlargement (thymolipoma, true thymic hyperplasia). Our objective is to discuss the role of myoid cells in the pathogenesis of MG associated with thymic enlargement. we report a retrospective study about 6 cases of thymic enlargement with 4 cases of true thymic hyperplasia (TTH) and 2 cases of thymolipoma (TL). The majority of our patients were men with a sex ratio of 4/2. Only 2 patients had a past medical history consistent for MG. Myoid cells were found in all cases. Through our small study, the implication of myoid cells in the pathogenesis of the association MG-TL or TTH remains unproved.
BACKGROUND Team-based learning (TBL) is an active method of learning aiming to the promotion of t... more BACKGROUND Team-based learning (TBL) is an active method of learning aiming to the promotion of the teamwork and improvement of critical thinking. Students of our university weren't used to TBL. We tried to implement a learning session combining TBL and lectures. METHODS The study included residents in pathology. The learning scenario consisted in lectures followed by a TBL. Four steps characterized the learning scenario: an individual preparation based on resources made available in the internet by the tutors, an individual readiness assurance test (iRAT) performed during the first 15minutes of the session, a team readiness assurance test (tRAT) and a peer evaluation step. The final students' score was calculated by summing score A (iRAT weighted to 70%) and score C (derived by multiplying the score B [tRAT weighted to 30%] with percentage of peer evaluation). Anova test and Pearson coefficient were used to perform the statistical analyses. RESULTS Forty-one residents were included. We assessed an improvement of the tRAT in comparison to iRAT. The only correlations established were between the iRAT and the tRAT and the tRAT and the students' scores. CONCLUSION Implementing TBL in medical universities may induce an improvement of the individual knowledge and a change in behaviourism.
Background: Endometrial hyperplasia represents a heterogeneous group of lesions in response to th... more Background: Endometrial hyperplasia represents a heterogeneous group of lesions in response to the unopposed growth-promoting action of estrogen. WHO classified endometrial hyperplastic lesions into Benign Hyperplasia (BH) and atypical hyperplasia/ endometrial intraepithelial neoplasia AH/EIN. Phosphatase and tensin homolog (PTEN) is one of the earliest and most common genetic abnormalities detected in endometrioid adenocarcinoma (type I) and even in its precursors. This study aimed at histological evaluation of hyperplastic endometrial lesions according to WHO 2014 and investigating the role of PTEN expression in highlighting the precancerous group (AH/EIN). Patient and Method: This study included a series of 70 Egyptian patients suffered from hyperplastic endometrial lesions. They were previously diagnosed according to WHO1994 schema simple endometrial hyperplasia without atypia (n=18), simple endometrial hyperplasia with atypia (n=2), complex hyperplasia without atypia (n=25), complex hyperplasia with atypia (n=5) and hyperplastic endometrial polyps (n=20). Results: Cases were histologically re-evaluated according to WHO 2014 classification; BH (62 cases) and eight cases of AH/EIN. A significant difference in PTEN expression (regarding percentage and intensity of staining) in relation to histopathological diagnosis was detected (P-value 0.02 and &lt;0.05, respectively). The sensitivity and specificity of the absence of diffuse PTEN protein expression (&gt;50%) to detect AH/EIN were 100% and 77.4%, respectively. Conclusion: Diffuse, dim or loss of immunohistochemical expression of PTEN protein is significantly correlated with the new WHO classification segregation of AH/EIN as precancerous lesions. However, further studies are recommended to confirm this association.
Current Respiratory Medicine Reviews, Sep 12, 2019
Background: Lymphoblastic lymphomas (LL) of the mediastinum are rare tumours that present a chall... more Background: Lymphoblastic lymphomas (LL) of the mediastinum are rare tumours that present a challenging diagnosis. The positive diagnosis is based on microscopic findings. Our aim was to highlight the diagnostic difficulties in such situations. We conducted a descriptive retrospective study including 31 patients presenting mediastinal LL. Results: Radiologic features consisted in all cases in a mediastinal infiltrating mass. Microscopic examination showed in all cases a crowded tumour with many artefacts made of diffuse tumour cells. Immunohistochemial study was performed in all cases. It was quite difficult to interprete in the samples used for extemporaneous examination and repeated in 10 cases. The diagnosis of LL is based on the microscopic examination which is usually performed on small samples with crowding artefacts. Thus, this pathology must be managed by a trained team that is used to deal with such a specimen in order to avoid repeating the biopsy and inducing diagnostic delay.
International journal of healthcare and medical sciences, 2015
Background : During the conference of ASCO 2015, there was no consensus about TIL role in beast c... more Background : During the conference of ASCO 2015, there was no consensus about TIL role in beast cancer and no recommendations concerning the microscopic assessment of TIL. In fact, the patients could be put on anti-PD1 drugs without the necessity of highlighting PD1 positive cells by using immunohistochemistry. Nevertheless, many questions about the prognostic impact of TIL, the methods of assessment, the type of TIL to count remain unresolved. Material and Methods : We performed a review of the literature on the sites : Pubmed and Cochrane. We used the key-words : i?½TIL in canceri?½; i?½TIL in breast canceri?½ and i?½prognostic impact of TIL in breast canceri?½. Results : According to our inclusion and exclusion criteria, thirty eight articles were retained. Our review of the literature showed that assessing TIL in high grade tumors seem unnecessary. They seem available in intermediate graded tumors. In neo-adjuvant and adjuvant conditions, CD3+ lymphocytes seem to be correlated to a good response to chemotherapy. After a chemotherapy, quantification T reg lymphocytes CD4 + FOXP3+ seems helpful because the decrease of their number is correlated to a good prognosis. Conclusion : The role of TIL in breast cancer is clearly established. The mechanisms of immune escape induced to discovery of immune therapy. The role of the microscopic examination and the subtyping of TIL using immunohistochemistry hasni?½t been clearly established. Through this review of the literature, we tried to establish a diagram highlighting the different subtypes of TIL to evaluate and their prognostic impact.
Journal of Immunoassay & Immunochemistry, May 4, 2018
Background: malignant pleural mesothelioma (MPM) is a rare tumor with a challenging diagnosis. Ev... more Background: malignant pleural mesothelioma (MPM) is a rare tumor with a challenging diagnosis. Even if, clinical data are mandatory to suspect the diagnosis, the positive diagnosis is based on microscopic features. Morphologic features are still the port of call of the diagnosis but their non specific character and the multiplicity of differential diagnoses made the immunohistochemical markers mandatory for the diagnosis. Many antibodies with a positive diagnostic value including claretinin, mesothelin, WT1 and antibodies with a negative diagnostic value including TTF1, EMA, CD15 are recommended by the scientific societies. This is due to the diagnostic limits of every antibody which necessitate the association of multiple antibodies. In the diagnostic demarch, pathologists deal with different antibodies and clones. Even if many recommendations are available, every pathology lab has to experiment its own antibodies in order to optimize the routine diagnostic demarch especially in low-income country. Our aim was to assess the diagnostic value of different antibodies available in our lab and to recommend a decisional flowchart.
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Papers by Mouna MLIKA