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Ilhame Naciri - Top 30 Publications

Adenocarcinoma of the ampulla of Vater revealed by prurigo.

Chronic prurigo may reveal several internal diseases. Its association with a solid neoplasia is rare. We report an exceptional case of chronic prurigo revealing surgically curable adenocarcinoma of the ampulla of Vater. Our study involved a 70-year old patient, with no particular previous history, who was hospitalized for etiological assessment of prurigo lasting for 06 months associated with non-documented weight loss. The lesions were isolated and involved the trunk and the limbs (A); initial assessment was strictly normal. Given the lack of patient's improvement with symptomatic treatment, additional exams were performed, including thoracoabdominopelvic CT scan, which objectified a tumor of the biliopancreatic junction measuring 2 cm, suggesting the diagnosis of ampulloma (B). The patient underwent surgical excision of this adenocarcinoma of the ampulla of Vater followed by regression of the skin lesions without further treatment. At 1-year follow-up, there was no evidence of recurrence of the skin lesions and the patient achieved complete remission of adenocarcinoma.

Uncommon ulceration on the lower lip.

Cutaneous pathomimia is a self-induced disease characterized by conscious self-injury to mucocutaneous boundary or its phaneres. We report the case of a 22-year old woman, with no notable medical history, presenting with sudden onset ulceration on her lower lip evolving for 3 months in a context of preservation of patient's clinical status. The patient had previously consulted several dermatologists and had undergone two skin biopsies with non-specific histological diagnosis. Clinical examination showed painful, well-defined ulceration with clean surface and non-indurated basis, measuring 1 × 3 cm in diameter and involving the left half of the lower lip (A). Given the clinical appearance of the lesion, its chronic nature and the lack of response to local care, several diagnosis were suspected: squamous cell carcinoma, cutaneous leishmaniasis, pyoderma gangrenosum… Deep biopsy was performed showing a loss of substance revealing the chorion, without histological characters of malignancy. Syphilis and HIV tests were negative. Fifteen days after, patient's evolution was marked by the appearance of an identical lesion on the right side of the lower lip, with complete healing of the former lesion by occlusive dressing (B). The follow-up interview showed, again, manipulation with the hand as well as family conflicts. Examination by a psychiatrist compared with clinical and evolutionary data showed cutaneous pathomimia.

Chronic ulceration of the hand in a mechanic: epidermoid carcinoma should be suspected.

Cutaneous squamous cell carcinoma is a malignant tumor developed from the epidermis or the squamous mucosa. It may occur de novo or, most often, on precancerous lesions, including actinic keratoses. This tumor can sometimes be secondary to physical or chemical hazardous conditions encountered during the professional activity. We here report the case of a 40-year old mechanic presenting with ulceration of the dorsal side of his right wrist, evolving over 6 months. The lesion had first appeared as a small keratosic lesion that had transformed into an erosion and then into an ulceration increasing rapidly in size. The patient had no initial trauma and he had no particular previous history except the handling of chemicals (fuels, mineral oil, paint) without gloves for about the last 30 years. Physical examination showed a large sized ulcero-budding tumor (5 × 6 cm) on the dorsal side of his right wrist (A), associated with diffuse multiple actinic keratosis lesions on his two forearms and on the back of his hands (B). The patient also had two painless hard mobile adenopathies measuring 1.5 cm in diameter, on the ipsilateral epitrochlear and axillary regions. The remainder of the clinical examination was normal. Viral hepatitis serology test, treponemal test and retrovirus (HIV) test were negative. Histological examination of a biopsy sample confirmed the diagnosis of well differentiated and infiltrating squamous cell carcinoma. The biopsy of the axillary adenopathy objectified ganglionic metastasis with capsular break-in and extension to the periganglionar tissue. The remainder of the staging was without abnormalities. The patient underwent wide resection of the lesion with lymph node dissection followed by radiation therapy. Patient's evolution was marked by early local recurrence (two months later) requiring reoperation. The postoperative course was uneventful.

Perineal verrucous lesions.

Verrucous lichen planus (VLP), is a chronic inflammatory dermatosis mainly involving the lower limbs. It rarely affects the perineal area, where it occurs in association with other mucocutaneous lichen lesions. We here report the case of a 51-year old patient with isolated perineal verrucous lichen planus. The patient, who had no significant medical history, presented with painless, verrucous, slightly itchy lesions in the perineal area that had gradually increased in volume over the past 8 years. Clinical examination revealed the presence of multiple firm grayish budding lesions with a rough surface, measuring 1-4 cm in diameter, in the perianal and scrotal area (A). The remainder of the somatic examination was normal. Histology showed verrucous acanthotic epidermis associated with mainly lymphocytic inflammatory infiltrate penetrating the basement membrane and pigmentary incontinence with the formation of apoptotic bodies in the basal layer of epidermis, without signs of viral infection or malignant transformation (B). The diagnosis of verrucous lichen planus was retained. Hepatitis C serology, lipid assessment as well as abdominal ultrasound were normal. A very strong local corticosteroid therapy was prescribed. The patient had a favorable outcome without recidivism at 18-months' follow-up.

Unusual location of giant seborrhoeic keratoses.

Seborrhoeic keratoses (SK) are benign tumors that mainly occur in the head and in the trunk. Their size generally varies from a few millimeters up to a few centimeters. Giant lesions are very rare but pose a problem in terms both of treatment and transformation. Their occurrence in the genital area is even more rare, posing a problem in differential diagnosis of genital warts. Differentiation is only based on histopathology. We report the case of a 80-year old man, with no particular past medical history, who presented with asymptomatic abdominal and genital lesions evolving over the last twenty years. Clinical examination showed four hyperpigmented, humped, well-defined tumors, with warty surface measuring 2-10 cm along its longer axis (A). Dermoscopic examination showed cerebriform convolutions appearance suggesting seborrhoeic keratoses (B). Histology confirmed the diagnosis, without signs of viral infection or malignant transformation. The patient underwent surgical resection resulting in permanent scar.

Shoulder tumor of startling appearance.

Chondrosarcoma is a malignant tumor of bone of mesenchymal origin which usually occurs in people after age 40 at the level of the pelvis and the shoulder. We report the case of a 65-year old female patient, with no particular past medical history, with impaired general condition, hospitalized for exploration of a large tumor of the right shoulder, evolving over 3 years. Clinical examination showed giant, humpbacked, hard, adherent tumor measuring 44 × 32 cm along its longer axis, with inflammatory signs associated with signs of vasculo-nervous compression. Radiological evaluation showed expansive, epiphyseal, metaphyseal, diaphyseal, heterogeneou, multilobulated, poorly differentiated, calcified tumoral process with complete destruction of the glenohumeral joint that extensively invaded the soft tissues with loco-regional extension. Histological examination of a deep biopsy specimen was in favor of poorly differentiated chondrosarcoma. Staging evaluation objectified bilateral axillary lymphadenopathies and multiple metastatic subpleural and hepatic nodules. The patient died after 2 months. This study highlights the role of awareness campaigns for early diagnosis and management.

Exophytic tumor of the scalp.

Proliferating trichilemmal tumor (PTT), still referred to as proliferative trichilemmal cyst (TC), is an uncommon malignant adnexal tumor originating from the cells of the outer root sheath of the hair follicle or, more often, from a trichilemmal cyst, following multiple trauma and/or recurrent inflammation. We report the case of a 64-year old female patient, with no particular previous history, presenting with tumor of the scalp gradually evolving over 18 months. Clinical examination showed a painless, firm, adhering ulcero-budding tumor mass measuring 12 cm along its longer axis at the level of the vertex. The patient had clinically negative lymph nodes. Histological examination showed malpighian cell proliferation arranged in clumps and coalescing lobules with focal areas of abrupt trichilemmal keratinization, with very marked atypies cyto-nuclear and an infiltrated fibrous stroma, suggesting proliferating trichilemmal tumor. Staging evaluation showed no metastase. The patient underwent wide surgical resection followed by in depth removal of extra tissue, without recurrence at 3-months' follow-up.