Most masses encountered within the scrotal sac are neoplastic and occur within the testis; however a subset (2-3%) of these tumours is extra-testicular and usually arises from paratesticular tissue. Although uncommon, these tumours have a high incidence of malignancy reaching 30%, mainly represented by sarcomas (90%). Tumours occurring in the paratesticular region may be clinically indistinguishable from testicular tumours, thus resulting in initial misdiagnosis. In addition, the clinical findings are by no means specific to a tumour type and cannot distinguish between a benign and a malignant tumour, which results in difficulty in diagnosis and management. All paratesticular tumours are amenable to adequate surgical resection. Definite diagnosis is determined by histological evaluation.Leiomyosarcoma, the second most common paratesticular sarcoma after liposarcoma, is represented in the literature primarily as case reports. We report a case of LMS arising from the epididymis and focus on clinical presentation and differential diagnosis of such tumours.

Amyloidosis is an abnormal extracellular deposit, which can occur in several tissues. The mechanism is not clearly defined. In systemic amyloidosis, all the organs can be infiltrated, but amyloid goiter as the initial manifestation of systemic amyloidosis is an exceedingly rare condition. We report a rare case of a patient who presented an amyloid goiter as the first manifestation of systemic amyloidosis. This patient had a known Crohn's disease. He developed a goiter without compressive complications. Histologic examination revealed a diffuse amyloid deposition surrounding thyroid follicles. The gland was enlarged with an eosinophilic and amorphic deposit. Confirmation of amyloid was made by the presence of congophilia and apple-green birefringence under polarized-light microscopy. An immunoreactivity was seen with AA protein. Amyloid goiter is a rare manifestation of amyloidosis. About 250 cases of amyloid goiter have been reported in the literature. The goiter enlarges rapidly and progressively, often becoming compressive like thyroid cancer. The prognosis depends on the treatment of the amyloidosis and the underlying chronic disease.

Anaplastic large cell lymphoma (ALCL) is a distinct clinicopathological entity that has been individualized in the Revised European American Lymphoma (REAL) classification. 1 This entity is defined as a T-cell or null-cell lymphoma expressing CD30 (Ki-1 antigen). Three different subtypes of ALCL have recently been identified: primary systemic anaplastic lymphoma kinase-positive (ALKϩ) ALCL, ALKϪ ALCL, and primary cutaneous ALCL. 2 ALK expression is the consequence of chromosomal translocations involving the ALK gene at 2p23 and the protein is detectable by immunohistochemistry. 2 The most frequent variant of the translocations implicating ALK is the t(2;5) translocation, which juxtaposes the ALK gene at 2p23 with the nucleophosmin (NPM) gene at 5q35. 2 Recently, it has been shown that the NPM/ALK chimeric protein activated the phosphatidylinositol 3-kinase/Akt (Pl-3K/ Akt) anti-apoptotic pathway. 3 Therefore, in case of NPM/ ALK expression, one would expect the Bcl-2 protein to be overexpressed in association with other anti-apoptotic factors. In a previous report published in the Journal, 4 we found in a short series of cases of NPM/ALKϩ ALCL that the Bcl-2 protein was not expressed. The recent demonstration by Bai et al 3 prompted us to extend our previous series of cases and to look for a possible correlation between Bcl-2 and ALK expression. To do so, we retrieved 75 cases of ALCL that had been diagnosed in the Hematopathology Department at Purpan Hospital during 1998 and 1999 (reviewed by G. D.). Seventy cases were lymph node biopsies (primary systemic ALKϩ and ALKϪ ALCL) and five cases corresponded to primary cutaneous ALCL (ALKϪ). Tissue samples were processed routinely, ie, fixed in Duboscq-Brasil and/or formalin and embedded in paraffin. In all cases, a staining was performed with anti-Bcl-2 (clone 124; DAKO, Trappes, France) and anti-ALK (ALK1 kindly provided by Prof. D. Y. Mason, Oxford, UK) monoclonal antibodies on paraffin-embedded sections using microwave heating. 5 Among the 70 cases of primary systemic ALCL, 58 tumors expressed ALK and 12 tumors were ALK-negative. All but one case of ALKϩ primary systemic ALCL were negative for Bcl-2 (57/58). In only one case, there was a faint staining in rare lymphoma cells compared to the strong staining observed in the surrounding small reactive lymphocytes. These results are in keeping with those published by Nakamura et al. 6 In their series, they failed to detect Bcl-2 in 31 cases of p80

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We report a case of a dirofilariasis manifesting as a breast nodule in a 32-year-old Tunisian woman. It appeared as a relatively well-circumscribed and slightly dense nodule on mammography and was hypoechogenic with enhanced through transmission on ultrasonographic examination. The patient was treated by surgical resection. Histopathologic analysis could identify viable female and male worms as Dirofilaria repens. Dirofilaria is rare in Tunisia and this is the second human case reported. The patient lived all her life in Tunisia and had never been abroad.