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Ilhame Naciri - Top 30 Publications

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.