Physiology and Anatomy

An elderly patient with a history of localized cutaneous melanoma cured by surgical skin resection, no longer followed by his dermatologist, presented to the emergency departement with an acute gastro-intestinal (GI) bleeding. Oesogastroduodenoscopy (OGD) showed a protuberant and ulcerated lesion, in the duodenal bulb, with pigmented spots in its center, very evocative of a melanoma. Histological results confirmed this hypothesis. CT scan identified multiple secondary locations. Latent metastasic melanomas revealed by GI bleeding after years of remission are rare and their outcome is severe. We highlight, in this paper, the importance of a regular lifelong monitoring patient with history of cutaneous melanoma, even localized, looking for any clinical sign that could suggest a recurrence or a digestive metastasis of his melanoma, in order to carry out the necessary examinations and treat the patient without delay.

Multi-drug-resistant tuberculosis remains a significant threat in people living with HIV and promotes increased mortality rates. It is often a combination of pulmonary tuberculosis forms and extra-pulmonary forms. We report 6 cases of patients with HIV and multi-drug-resistant tuberculosis collected over a two-year period from 01/01/2018 to 31/12/2019 hospitalized for multi-drug-resistant tuberculosis at Moulay Youssef Hospital. We describe the radiological, evolutionary and therapeutic clinical characteristics of resistant TB in this patient category. The average age of our patients was 36. These are 2 women and 4 men. Of which 4 were known to carry retroviral infection, followed and treated with antiretroviral therapy, there was only one diabetic patient on insulin therapy. The signs of calls were respiratory in 3 patients, digestive in one patient, neurological in one case, and an alteration of the general state in the last case. Exclusive pulmonary involvement was noted in 4 patients, associated with neuromeningeal localization in one patient and cervical lymph node localization in the last case The radiological aspect was dominated by bilateral micronodular opacities often associated with sequellary opacities. Based on the results of the xpert Tb Rif and Hain Test 1 st line and 2 nd line 3 cases of our patients were Prexdr (resistant to injectable 1/3 cases, resistant to furoquinolone 2/3 cases), MDR in one patient, two patients were classified as RR due to the unavailability of genotypic tests. The evolution during hospitalization was marked by the occurrence of pneumocystosis in 2 patients who had progressed well under Bactrim high curative dose and systemic corticosteroids, pneumothorax in one case; we deplore the death of a patient by tuberculosis meningitis. Five patients were put individualized regimen of 20-24 months and only one case on a standardized regimen for 9-11 months, antiretroviral treatment was initiated after 1 month of the start of anti-bacillary treatment in 2 cases (CD4 rate > 500). Major adverse effects were observed in 3 patients. These were bilateral deafness, significant hepatic cytolysis, and severe cytopenia which required the permanent discontinuation of amikacin, Pza, Linezolid respectively. Minor side effects, a type of digestive intolerance, were noted in 2 patients who progressed well under symptomatic treatment. Minor side effects, a type of digestive intolerance, were noted in 2 patients who progressed well under symptomatic treatment.HIV infection increases the risk of the emergence of resistant strains of the TB bacillus in HIV-positive subjects. The combination of multi-drug-resistant tuberculosis and HIV infection is a major risk factor for morbidity-mortality.

Pulmonary sequestration is a rare congenital malformation that receives its blood supply from a systemic artery. We report a case of pulmonary sequestration initially diagnosed as a hydatid cyst of the lung, surgical findings revealed an abscessed collection related to a pulmonary sequestration of the left lower lobe. Pulmonary sequestration remains a diagnostic and therapeutic challenge.

Right atrial myxoma is a rare disease and its clinical presentation is not specific. The usual mode of revelation is heart failure. The differential diagnosis of myxoma can be a thrombus, especially in case of atrial fibrillation. Trans-thoracic echocardiography allows diagnosis. Treatment by surgical excision should be done quickly to avoid complications. We present a case of a 44-year-old woman who was admitted to intensive care unit for heart failure. The echocardiography and Computed tomography (CT) showed a right atrial mass mimicking atrial myxoma. She died a few days later.

Central nervous system cavernomas are usually supra tentorial. Cerebellar localization is rare. Imaging, especially MRI can detect these malformations and look for other associated vascular malformations. If cavernous angioma is associated with a developmental venous anomaly, the venous anomaly should be spared due to the considerable risk of venous infarction following the abolition of cerebral venous drainage. We report the case of a 39 year-old man presenting with chronic headaches indicating brain MRI which showed cerebellar cavernoma associated to developmental venous anomaly.

Visceral leishmaniasis is a vector-borne disease due essentially, at the level of the Mediterranean, to infection by leishmania infantum. Usually rare in adults, its prevalence has recently increased, including in immunocompetent person, with an annual number of new cases between 1.5 and 2 millions. The visceral form can be a diagnostic challenge because of the great variability of its clinical presentations. We describe the very atypical case of a rare form of visceral leishmaniasis (VL).

Ductus Caroticus, the embryonic dorsal aorta between points of junction with the third and fourth branchial arch arteries normally disappears in early embryonic life. If persist, it forms a thin strand of tissue without lumen, called a “ligamentum caroticum” or a short communicating vessel with lumen, a ductus, as a fair-sized artery, called the “arteria muscularis cervicis”. In anomalous condition, it persisted as a wide open vessel, between the third and fourth branchial arch arteries and it is treated as “Clinical significant anomalies” in the branchial arch arteries. The present study aimed to through insight knowledge about this unusual variant.

We report the case of a young man aged 23, victim of an accident to type up falling penetration with thorns wood at the side of the inner right thigh. A scrotal ultrasound scan with erectile body objectified a strong allure foreign body straight. A mini-incision made at the level of the symphysis pubis allowed the removal of the foreign body.

We report a case of bladder leiomyosarcoma. This is a rare infiltrating bladder tumor, highly malignant, very poor prognosis due to a very early loco regional invasion. Only the pathological examination can bring positive diagnosis. The therapeutic modalities for this histological type are not codified. However treatment is mainly based on surgical excision Solid sometimes preceded by chemotherapy when the patient's condition.

Mucinous tubular and spindle cell renal cell carcinoma is a rare tumor described in the 2004 WHO classification as a new entity with an indolent clinical course. In this study, we report the case of a 60-year-old man with a large mass involving the upper pole of the left kidney. The patient underwent left radical nephrectomy. The histological findings showed it to be a mucinous tubular and spindle cell renal cell carcinoma of grade 1 of Fuhrman’s classification with hilar infiltration. Because of the favorable outcome of this histological entity, mucinous tubular and spindle cell carcinoma must be differentiated from papillary renal cell carcinoma, especially from the variant with sarcomatoid dedifferentiation. The aim of this work is to draw the attention of pathologists and clinicians to this new entity, and the importance of its diagnosis for the patient’s prognosis.