The term pheochromocytoma, a catecholamine-secreting tumor arising from the chromaffin cells of the sympathoadrenal system, was coined by Poll in 1905 to describe the dusky color of the cut surface of the tumor when exposed to dichromate (1).The vast majority of pheochromocytomas arise from the adrenal medulla where the largest collections of chromaffin cells are found (2). No imaging features can reliably distinguish common benign from rare malignant pheochromocytomas unless the evidence of direct local invasion into the liver, kidney or pancreas or distant metastases. Diagnosis, localization and Familial pheochromocytoma syndromes are related to mutations in the genes encoding mitochondrial succinate dehydrogenase subunit B (SDHB), subunit D (SDHD) and also rarely subunit C (SDHC) (7). pheo chromocyt om a: Increasing importance for cl inic al de cision malignant Tumori 1996;82:480-4. MIBG scintigraphy showed in all the patients a remarkable affinity for the adrenal medullary tissue (in 3 cases) and in hepatic tissue ( in one case presenting hepatic metastases). PATIENTS AND METHODS Tumor cell spindling wasn’t noted. In this study, the mean age was 43 years. Tunisia Document type Regulation Date 2011 Source FAO, FAOLEX Subject Livestock Keyword Animal health Quarantine Pests/diseases Hygiene/sanitary procedures Geographical area Africa, Northern Africa Abstract. Independent factors associated with HAI occurrence were SAPSII score ≥ 33 with OR 1.047; CI 95% [1.015-1.077], p=0.003 and recent hospitalization with OR 4.14 CI 95% [1.235-13.889], p=0.021. hereditary tumor when the age at onset is < 45 years (15). An adrenal cortical carcinoma have not the same architecture, the cells tend to contain eosinophilic cytoplasm and have vesicular cytoplasm with more mitotic activity; metastatic tumors, which are more frequent than primary one,should be ruled out by immunohistochemical studies. Pass score Gao B, Meng F, Bian W, et al. Important: Jump-Start Your Practice Order the Official SAT Subject Test Study Guide in Biology and get two full-length practice tests, detailed answer explanations, tips, and more. Poll H. Die vergleichende Entwicklung der nebennierensysteme. Score (PASS) to separate benign from malignant neoplasms. Although special studies weren’t included in the PASS, the S-100 protein reaction was of interest in the diagnosis of MPA. A summary of the clinical information on the patients in this series is provided in table 1. In the second case, the histology of the recurrence was different from the primary tumor and was characterized by the presence of features predictive of malignancy. Neumann HP, Bausch B, Mc Whinney SR, et al. 2009;10:764-71. Informiere dich hier: www.bewusster-ernaehren.de Noch ein Grund zur Freude: Wir kaufen Kakao, der zu 100% UTZ-zertifiziert ist, um den nachhaltigen Kakaoanbau zu verbessern. First, we find and analyze health-related information from high-quality sites across the web. Next, teams of doctors carefully review and refine the information, and licensed medical illustrators create visuals. Tunisia is ranked 17th in the category of "quality of the [higher] educational system. Rarely, metastases are reported in the pericardium, the brain and spleen (16). Ist Fresenius Medical Care der richtige Arbeitgeber für Dich? In general, varied-sized suprarenal masses were identified, often displacing the kidneys. Minerva Endocrinol 2009;34:107-21. Scott HWJ, Reynolds V, Green N, et al. The detection of germline mutations will improve postoperative management by providing the clinicians with information on which to base frequency, length of follow up and the most appropriate follow up investigations. Necrosis, identified in individual cells (piknosis), focal and confluent or diffuse was identified in no cases. The records of 11 patients with tumors diagnosed as “pheochromocytoma”, “malignant pheochromocytoma” and “atypical pheochromocytoma” were identified from 1970 to 2010 in the files of the pathology, intern medicine and biochemistry departments of the Charles Nicolle hospital and Pasteur Institute. (Pass score) tests to separate benign from malignant neoplasms, PASS score, pheochromocytoma, prognosis, microscopy. Genetic aspects of pheochromocytoma. Treatment modalities are based on surgical resection followed in some cases by chemotherapy and/or radiation therapy. Laboratory tests reveal remarkably elevated levels of serum and/or urine catecholamines, norepinephrine, epinephrine, metanephrine, normetanephrine, dopamine, MEN2 was observed in our study in one patient with malignant pheochromocytoma. It is currently accepted that the biologic behavior of these tumors can’t be predicted based on prospective diagnosis. NF is the most common familial cancer syndrome with a risk of pheochromocytoma estimated to 2%. The management of malignant pheochromocytoma remains challenging because of the absence of reliable diagnostic histologic features of malignancy. Van Nederveen FH, Gaal J, Favier J, et al. Two patients had what was considered to be a non sporadic tumor: an association with a syndrome known to include an increase incidence of adrenal pheochromocytoma. Endocrinol Metab 2009;94:2817-27. IARC Press Lyon, 2004:147-151. management of pheochromocytoma: pitfalls and follow up in 41 Clinical experience with mutations: a retrospective and prospective analysis. In general, the pheochromocytomas associated with syndromes behave in a benign fashion (21, 22). Ces années sont composées de 2 ans en PCEM ou premier cycle des études médicales, 3 ans en deuxième cycle ou DCEM et les deux dernières années en internat obligatoires. Al Zahrawi Medical Services Co. WLL Bin Hamoodah Building, On ground floor: Abu Dhabi Coop Society, Floor No. review of the literature. Cancer Table 1: Patients characteristics The prevalence of malignant pheochromocytoma in familial syndromes varies depending on the familial syndrome and the follow -up period. Keywords: Apricot, ‘Candidatus Phytoplasma prunorum’, restriction fragment length polymorphism. A PASS score was performed in all cases identifying presumably benign tumors with a PASS score less than 4 and malignant ones with a PASS score equal or superior to 4. Some universities also offer online courses through which students can apply for distance learning and get an online degree in certain fields. When pain was encountered, it was lumbar in all cases. The table 2 shows the different results in benign and malignant pheochromocytoma. Qin Y, Yao L, King E, et al. Clinical demographics and presentation Focal vascular invasion was noted in 3 cases. The first one presented MEN2 syndrome and a malignant recurrence with abdominal lymph nodes and liver metastases after 5 years of follow up. In our study, it was confusing to find For example, Qin and coworkers reported mutations in TMEM127 tumor suppressor gene in 30% of familial tumors and 3% of sporadic-appearing pheochromocytomas (10). Table 2: Urine levels of catecholamines The first one presented a malignant recurrence discovered after 11 years of follow up. Both tumors were highly cellular with cellular monotony. With a population of 10,982,754, Tunisia is the northernmost country in Africa which covers 165,000 square kilometres. It has been suggested that dopamine values may correlate with malignant pheochromocytoma (23). Tumor cell monotony was identified in 3 cases. Patients with apparently sporadic pheochromocytoma may have germline mutations including RET, VHL, SDHD and SDHB estimated to be as high as 15% to 24% (8, 9). The surgery included adrenalectomy in 6 cases, double adrenalectomy in 1 case, adrenalectomy and partial liver resection in one case, adrenalectomy, lymph node dissection and partial liver dissection in one case. One hundred cases of pheochromocytoma (107 tumors) see table-1 As 24-hour urine measurements seem to be more reliable than plasma catecholamine measurements, we analyzed their values and compared them with the normal rates. Burnichon N, Rohmer V, Amar L, et al. 1993;114:1160-6. The tumors were of low to medium cellularity with 3 tumors showing high cellularity. results. According to many authors, a PASS < 4 identified potential benign tumors and a PASS> =4 identified potentially malignant tumors. La tunisie medicale : Article medicale Prognostic value of Pheochromocytoma of the adrenal gland scaled score (Pass score) tests to separate benign from malignant neoplasms par Mona Mlika , Nadia Kourda , Mohamed Majdi Zorgati , Sonia Bahri , Slim Ben Ammar , Rachida Zermani The second one presented a benign pheochromocytoma with a benign recurrence after 24 months of follow up. Pyknosis was noted in 1 case and focal, central, confluent or diffuse necrosis was noted in 1 case. Bilateral disease is generally associated to syndromic presentation. Diagnosis, localization, and All the patients were symptomatic with hypertension being the most frequent symptoms (100%). susceptibility to pheochromocytoma. that the levels in malignant pheochromocytoma were lower than those in benign pheochromocytoma. The recognition of a germline mutation is an important part of the overall management of a patient since it directs investigation for other tumors such as hemangioblastoma and renal cell carcinoma in VHL syndrome. Nebennierentumor und gleichzeitiger Nephritis mit Veranderungen am What’s in store for students after graduation. In our study, both MPA showed liver metastases. Privacy Policy -Terms & Conditions - Bone scan and radiographs are useful for the evaluation of skeletal metastases or I-metaiodobenzylguanidine (MIBG) is useful for the detection of metastatic or locally recurrent disease (3). The diagnosis is made in the presence of two or more of these criteria: six or more café au lait macules, the greatest diameter of which is more than 5 mm in pre-pubertal patients and more than 15 mm in post-pubertal patients, two or more neurofibromas, axillary or inguinal freckling, optic glioma, two or more lisch nodules, a distinctive osseous lesion such as sphenoid dysplasia or pseudoarthrosis, a first-degree relative with NF1 according to the preceding criteria (3). This is due to the rarity of comprehensive analyses with complete clinical, radiographic, histologic and follow up information. A well-formed tumor capsule was present in both cases. We here report three clinical cases of DIC characterized by several etiologies: pros … In our study, the cutoff value of 4 showed a low sensitivity and specificity. A pathologist blinded to clinical outcome, reviewed the histopathologic characteristics of all cases using the PASS system. Medicine School of Tunis(arabic: كلية الطب بتونس) (french: faculté de médecine de Tunis) (FMT) is one of the four medical schools in Tunisia. Lancet Oncol. und der Wirbeltiere. In two cases, hypervascular masses in the liver and lymph nodes were noted and presumed by the radiologist to represent metastatic disease. Performance Liquid Chromatography Detection of SDHB, SDHD, and Both patients were managed by surgery followed by chemotherapy and no patients died after a follow up period of 3 years and 1 year. Biocare is a leading supplier and developer of primary antibodies and automated IHC medical equipment for lab testing. Unlike other medical imaging core labs, Bioclinica has both depth and breadth of experience in GI imaging. Receiver operating characteristics (ROC) curve analysis was performed to evaluate the diagnostic performance of PASS. There are study abroad and exchange programs offered in order to promote language development skills while giving students the opportunity to interact with other cultures around the world. These patients were 2 women aged respectively 31 and 34 years. Surgery Frankel F. Ein Fall von doppelseitigem, vollig latent verlaufenen the original description of classic pheochromocytoma. Tumours of endocrine organs. Extensive studies on the genetics of pheochromocytomas confirmed the definite death of the 10% rule concerning the genetics of pheochromocytomas. One tumor was described as bilateral and occurred in a patient with syndromic association (neurofibromatosis). One tumor occurred in a patient with syndromic association. Back. A score >4 has a sensitivity of 32% and a specificity of 99%. Malignant tumors are defined as tumors with metastases at referral or follow up. This fact may be secondary to the few number of cases and the low surface area under the ROC curve. 8 patients presented sporadic pheochromocytoma and 1 patient presented hereditary pheochromocytoma. 3. Gandaria 8 Office Building 3rd Floor - Unit B Jl. The Business Model Canvas (BMC) is a one-page business plan that … Pheochromocytoma of the Adrenal Gland Scaled Student visas and accommodation are also provided to students at many universities. If recurrent disease was present, it was established whether it was histologically similar to the primary tumor. The levels were often elevated to>4 and 1,5 times 4. © Edarabia.com - All Rights Reserved 2021    | This confers a PPV of 33% but a NPV of 99%. Widespread of this called score with complete clinical data will help to validate these findings and to add other prognostic factors of value that could be a part of this scaled score such as immunohistochemical findings. Tunisie-Formation.com est un moteur de recherche et un annuaire dédié à la formation initiale, formation professionnelle et continue en Tunisie. Malignant recurrence was defined as the appearance of metastasis after complete tumor eradication. The histology of the recurrence and of the metastatic tumor deposits was identical to the primary tumor in one patient. La tunisie Medicale - 2020 ; Vol 98 ( n°012 ) COVID DOSSIER : REFLEXION. Capsular invasion was noted in one case while invasion into the periadrenal soft tissue was not noted in any tumors. Atypical mitotic forms weren’t found. Evidence of MEN-2 in The mean age of the patients at presentation was 47, 44 years. Below is a comprehensive list of all universities in Tunisia (Agareb, Ain Djeloula, Ain Draham, Ajim (Djerba), Akouda, Alaa, Amiret El Fhoul, Amiret El Hojjaj, Amiret Touazra, Aousja, Ariana, Azmour, Bargou, Beja, Bekalta, Bembla-Mnara, Ben Arous, Ben Gardane, Benen Bodher, Beni Hassen, Beni Khalled, Beni Khedache, Beni Khiar, Beni M'Tir, Bir Ali Ben Khelifa, Bir El Hafey, Bir Lahmar, Bir Mcherga, Bizerte, Borj El Amri, Bou Arada, Bou Argoub, Bou Hajla, Bou Merdes, Bou Mhel el-Bassatine, Bou Salem, Bouficha, Bouhjar, Carthage, Cebalet, Chebba, Chebika, Chenini Nahal, Cherahil, Chihia, Chorbane, Dahmani, Dar Allouch, Dar Chaabane, Degache, Dehiba, Den Den, Djebel Oust, Djedeida, Djemna, Douar Hicher, Douz, Echrarda, El Ain, El Alia, El, Aroussa, El Battan, El Bradaa, El Djem, El Fahs, El Golaa, El Guettar, El Hamma, El Haouaria, El Hencha, El Kef, El Krib, El Ksar, El Ksour, El Maagoula, El Maamoura, El Masdour, El Mida, El Mourouj, Enfidha, Essouassi, Ettadhamen-Mnihla, Ezzahra, Ezzouhour, Fernana, Foussana, Gaafour, Gabes, Gafsa, Ghannouch, Ghar al Milh, Ghardimaou, Ghenada, Ghomrassen, Ghraiba, Tunisia, Goubellat, Gremda, Grombalia, Haffouz, Haidra, Hajeb El Ayoun, Hamet Jerid, Hammam Chott, Hammam Ghezeze, Hammam Lif, Hammam Sousse, Hammamet, Hebira, Hergla, Houmt El Souk (Djerba), Jebiniana, Jedelienne, Jemmal, Jendouba, Jerissa, Jilma, Kairouan, Kalaa Kebira, Kalaa Seghira, Kalaat el-Andalous, Kalaat es Senam, Kalaat Khasba, Kasserine, Kebili, Kelibia, Kerkennah, Kerker, Kesra, Khalidia, Khniss, Kondar, Korba, Korbous, Ksar Hellal, Ksibet El Mediouni, Ksibet Thrayet, Ksour Essef, La Goulette, La Marsa, La Soukra, Le Bardo, Le Kram, Lemta, M'saken, Magel Bel, Abbes, Mahares, Mahdia, Majaz al Bab, Maktar, Manouba, Mareth, Mateur, Matmata, Mdhila, Medenine, Megrine, Meknassy, Mellouleche, Menzel Abderrahmane, Menzel Bourguiba, Menzel Bouzaiane, Menzel Bouzelfa, Menzel Chaker, Menzel Ennour, Menzel Farsi, Menzel Hayet, Menzel Horr, Menzel Jemil, Menzel Kamel, Menzel Mehiri, Menzel Salem, Menzel Temime, Messaadine, Metlaoui, Metline, Metouia, Mezzouna, Midoun (Djerba), Mohamedia-Fouchana, Moknine, Monastir, Mornag, Mornaguia, Moulares, Nabeul, Nadhour, Nafta, Nasrallah, Nebeur, Nefza, Nouvelle Matmata, Oudhref, Oued Ellil, Oued Melliz, Ouerdanin, Oueslatia, Ouled Chamekh, Ouled Haffouz, Rades, Raf Raf, Raoued, Ras Jebel, Redeyef, Regueb, Rejiche, Remada, Rouhia, Sahline Mootmar, Sakiet Eddaïer, Sakiet Ezzit, Sakiet Sidi Youssef, Sayada, Sbeitla, Sbiba, Sbikha, Sejnane, Sened, Sers, Sfax, Sidi Ali Ben Aoun, Sidi Alouane, Sidi Ameur, Sidi Bennour, Sidi Bou Ali, Sidi Bou Rouis, Sidi, Bou Said, Sidi Bouzid, Sidi El Hani, Sidi Hassine, Sidi Thabet, Siliana, Skhira, Soliman, Somaa, Souk Lahad, Sousse, Tabarka, Tajerouine, Takelsa, Tamerza, Tataouine, Tazerka, Teboulba, Tebourba, Teboursouk, Testour, Thala, Thelepte, Thyna, Tinja, Touiref, Touza, Tozeur, Tunis, Zaghouan, Zahret Medien, Zaouiet Djedidi, Zaouiet Kontoch, Zaouiet Sousse, Zarat, Zarzis, Zeramdine, Zriba). The true incidence of MPA is difficult to determine but they seem to account for 6.5% of all adrenal gland tumors (11-14). Table 3: Histologic characteristics of the different tumors Westfried M, Mandel D, Alderete MN, Groopman J, Minkowitz S. Cancer 1988;62:2451-60. One patient presented a tumor of the right adrenal gland and the second the left adrenal gland. Tunisia Medical publishes original articles, clinical radiology or endoscopy, original works of experimental or biological, editorials, general reviews, tune-ups, assumptions, controversies, short notes, letters to the editor, the analysis of press tours and records of working sessions of the Tunisian Society of Medical Sciences and specialty societies. Box: 52193, Abu Dhabi, UAE Tel: +971 2 627 5772 Fax: +971 2 627 4559 Email: azmsc@zahrawigroup.com Web: www.zahrawigroup.com Succinate Dehydrogenase B Edarabia showcases all universities and colleges in Tunisia which can be filtered by courses and tuition fees. The mean age at presentation was 26 years. Education is given a high priority and accounts for 6% of GNP. B Medical Systems is a global manufacturer and distributor of medical-grade devices. The ROC curve is represented in figure 1. Contact Us. PCR and sequencing analysis of a gene of interest remains the current gold standard for the detection of mutations but other less expensive methods have been reported such as the denaturing high performance liquid chromatography (dHPLC) (7). According to the histologic features, a PASS score was performed for each tumor, primary as well as recurrent ones. A number of macroscopic and histologic observations were recorded for each tumor as follows : tumor size, encapsulation (present or absent), capsular invasion, vascular invasion defined by direct extension into the vessel lumen, intravascular attached tumor thrombi, and/or tumor nests covered by endothelium identified in a capsular or extra capsular vessel with no distinction between veins and lymphatic channels, extension into the periadrenal adipose tissue, cell nests ( small, zellballen type nests to large, confluent nests which are defined as 3 to 4 times the size of a zellballen or the normal size of the medullary paraganglia nests or diffuse growth, necrosis identified in the center of large nests, fibrosis,degenerative changes, calcifications, cellularity, cytoplasmic quality (clear, basophilic, eosinophilic, amphophilic), tumor spindling, cellular pleomorphism, cellular monotony, nuclear hyperchromasia, piknosis, macronucleoli (defined as >4 um in diameter, eosinophilic-magenta or irregular in shape),intranuclear cytoplasmic inclusions, mitotic figures (number of mitoses per 10 higher power fields with magnification at x40 using a Zeiss microscope), atypical mitotic figures ( present or absent and defined by abnormal chromosome spread, tripolar or quadripolar forms, circular forms or indescribably bizarre). Malignant Pathol 2002;26:551-66. RESULTS They are slender, with thin wisps of cytoplasm encompassing the chief cells (16). 2 Unité de phytopathologie, Département de Biochimie et de Biologie Appliquées-FUSAGX Passage des déportés, 2; B-5030 Gembloux, Belgium. In fact, in our study, we found some features predictive of a malignant behavior such as the extension to the adipose tissue or vascular invasion only in benign pheochromocytomas. The mean age in patients with syndromic presentation is generally younger than in patients with sporadic forms. VHL Germline Mutations in Pheochromocytoma. Additionally, each university/college has ratings based on student reviews and are ranked below accordingly. Handbuch der Entwicklungsgeschichte des Menschen ©2011 LA TUNISIE MEDICALE. Help: Soccer results service at Soccer 24 offers an ultimate soccer resource covering major leagues as well as lower divisions for most of popular soccer countries. In malignant tumors, the PASS score was >=4 in both cases. Current Issue December 2020. All the patients had abdominal ultra-sound sonography, CTscan and MRI before surgery. Many authors report the absence of gender predilection of pheochromocytomas (16). Arch Pathol Anat Physiol Klin Med In addition, we reviewed radiographic, surgical pathology and obtained follow up information when available. Vascular invasion wasn’t identified. I think that PASS score, despite its low sensitivity, may help to reserve the more aggressive treatment and narrow follow up for potentially malignant tumors. The succinate dehydrogenase in, nonsyndromic pheochromocytoma. pheochromocytoma: a clinicopathologic review of 60 cases. Moreover, many authors suppose that the absence of sustenticuar cells in pheochromocytoam is indicative of a greater potential for malignant behavior. La tunisie Medicale - 2011 ; Vol 89 ( n°05 ) : 479 - 484 [ Vu 19841 fois ] Prénom : * Nom : * Votre E-mail : * E-mail ami 1 : E-mail ami 2 : E-mail ami 3 : E-mail ami 4 : E-mail ami 5 : Commentaire : (* Les champs obligatoires ) Login ou S'inscrire : E-mail : Mot de passe : Si vous avez oublié votre mot de passe : cliquez ici : Résumé . Ann N Y Acad Sci 2006;1073:94. Statistical analysis proved the absence of a significant difference between the 2 means. All tumors were managed by surgery with pre-operative adrenergic blockage to decrease intraoperative hypertensive episodes. Multiple genetic alterations have been found to be associated with pheochromocytomas most often inherited than sporadic forms. Benign An Easier Way to Prepare Your Business Plan -The Business Model Canvas. Malignant pheochromocytoma malignant pheochromocytomas. This page contains contact information, location maps, and email addresses. a pericardial effusion. Patients presented with a variety of symptoms and physical findings but the most frequently identified physical finding was hypertension which was variably described as episodic, labile, paroxysmal or associated with postural changes. The tumor cells were arranged in the characteristic “zellballen” architecture in 3 cases whereas, 6 cases demonstrated diffuse architecture. Facing the difficulty in diagnosing MPH, their challenging management and the absence of consensus concerning the prognostic factors, a PASS score was developed by taking the patients whose tumors were clinically and histologically malignant and identifying the histologic features that were uniquely present or present in a greater frequency than in the patients whose tumors were clinically and histologically benign. The mean tumor size was 7.54 cm. VHL disease is an autosomal inherited tumor syndrome with mutations in the VHL tumor suppressor gene. pheochromocytomas or paragangliomas. Soccer live scores and results, cups and tournaments are also provided with goal scorers, soccer halftime results, red cards, goal alerts and soccer live score information. It is considered to be the only full democracy in the Arab World. Materials were supplemented by a review of the patient demographics (gender, age), symptoms and physical findings at presentation (diaphoresis, headaches, palpitations, weakness, syncope or dizziness, anxiety, flushing, chest pain, nausea, hypertension including paroxysmal type, vomiting and weight loss), including duration, medical and surgical history. Edarabia strives to offer the latest updates, helping you find the best university in Tunisia with information on tuition fees, accreditation details, videos, photos, location map, community reviews and ratings. 2007;92:3822-28. A summary of the clinical information on the patients is provided in table 1. genetic testing in a large series of patients with paragangliomas. Ann Chir 2005; 130:273-76. Genetics and treatment. You may also contact us by filling out the form below: Please Fill out the form below. The exploration of prognostic factors and the improvement of molecular approach to cancer will help managing these tumors by deciding prophylacting procedures, diagnostic investigations and selecting targeting therapy. Benign 1886;103:244-63. Gene Muta tions Pred ict Survival in pat ient s with malignant Only 4 patients had I-metaiodobenzylguanine (MIBG) scintigraphy. management of pheochromocytoma: pi tfalls and follow-up in 41 CONCLUSION