Pommier RF, Vetto JT, Billingsly K, Woltering EA, Brennan MF. Al Zahrawi Medical Services Co. WLL Bin Hamoodah Building, On ground floor: Abu Dhabi Coop Society, Floor No. Many authors support the hypothesis that PASS score can help to predict which tumors may portend a more aggressive clinical course by knowing that pheochromocytomas may develop metastases many years after the first tumor. results. Focal vascular invasion was noted in 3 cases. It wasn’t noted an infiltration into the substance of the adrenal cortex or periadrenal adipose tissue. 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. The area under the ROC curve was estimated to 0,417. Evidence of MEN-2 in 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. The few number of the cases reported is due to the rarity of the complete adequate follow up information and hematoxylin and eosin-stained slides to make a definitive diagnosis. Opocher G, Schiavi F, Cicala MV, et al. Clinical experience with Surgery 1993;114:1153-9. According to the World Health Organization definition, malignant pheochromocytoma is currently defined by the presence of metastases (3). pheochromocytoma of the adrenal gland scaled score for predicting La tunisie Medicale - 2021 ; Vol 99 ( n°02 ) REVIEW. a pericardial effusion. Some pheochromocytomas are inherited and can be subdivided into a variety of groups: multiple endocrine neoplasia type 2 (MEN2), von Hippel-Lindau disease (VHL), neurofibromatosis type 1 (NF1), hereditary paraganglioma and SDHD gene-related tumors and hereditary pheochromocytomas (6). An immunohistochemical The term paraganglioma is used for this same tumor in other anatomic sites except for the organs of zuckerkandl. Students who require financial aid can apply for scholarships in order to study higher education at a lower cost. Organ of the Tunisian society of Medical Sciences and the National Council of the Medical Association of Tunisia ISSN : 0041-4131 IeSSN : 2724-7031 Adresse : Rue Malaga, 2092 El Manar 1 Tél. 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). N Engl J Med Westfried M, Mandel D, Alderete MN, Groopman J, Minkowitz S. 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). In this study, the mean age was 43 years. Gandaria 8 Office Building 3rd Floor - Unit B Jl. 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). The tumors were described as encapsulated or well-circumscribed masses with variegated cut surface showing areas of hemorrhage. International students looking to get a degree in Tunisia can choose from a diverse range of programs and diplomas and obtain their Bachelor’s, Master’s, PhDs (or MBAs) from some of the top-rated institutions. Malignant tumors are defined as tumors with metastases at referral or follow up. In: 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. Many authors report the absence of gender predilection of pheochromocytomas (16). Next, teams of doctors carefully review and refine the information, and licensed medical illustrators create visuals. Many authors claim that PASS score doesn’t allow for clear-cut histological diagnosis of benign and malignant tumors putting emphasis, in some cases,on the significant inter observer and intra observer variation in assignment of PASS with variable interpretation of pathology (23). 2009;10:764-71. No patient was asymptomatic. 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 . a t th e Columbia -Pre byt erian Medical center, 19 26-1976 . The mean age of the patients at the presentation for the patients who had an association syndrome or genetic abnormality was 32, 5 years and 45.44 years in patients with sporadic pheochromocytoma. Eurofins has a large number of laboratories, administrative offices and research facilities in France. Sipple’s syndrome with a malignant pheochromocytoma presenting as The first description of pheochromocytoma in 1886 has been attributed to Felix Frankel in an 18-year-old woman with bilateral adrenal tumors (4). Throughout our 40+ years of experience, we have been creating innovative solutions to store and transport vaccines, blood components, laboratory specimens, etc across the world safely and reliably. 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. vanillylmandelic acid (VMA). Treatment modalities are based on surgical resection followed in some cases by chemotherapy and/or radiation therapy. Student visas and accommodation are also provided to students at many universities. 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. October 24, 2019, 1:00pm EDT . Necrosis, identified in individual cells (piknosis), focal and confluent or diffuse was identified in no cases. Hematoxylin and eosin-stained slides from all patients were reviewed for morphologic assessment of malignant and benign pheochromocytoma. Many authors reported a remarkable decrease in the immunohistochemical reactivity of S-100 protein positive cells in malignant cases. In general, the pheochromocytomas associated with syndromes behave in a benign fashion (21, 22). Google has many special features to help you find exactly what you're looking for. Privacy Policy -Terms & Conditions - One hundred cases of pheochromocytoma (107 tumors) hereditary tumor when the age at onset is < 45 years (15). Succinate Dehydrogenase B They are slender, with thin wisps of cytoplasm encompassing the chief cells (16). in multiple endocrine neoplasia type 2b syndrome: case report and 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. The succinate dehydrogenase 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. pheochromocytoma with germline SDHB, SDHC, or SDHD gene 3. The tumors were well circumscribed and distinctly separated from the remaining adrenal cortical parenchyma by a capsule. A summary of the clinical information on the patients in this series is provided in table 1. Bilateral disease is generally associated to syndromic presentation. We define benign tumors as tumors without clinical metastases at presentation or during follow up. The mean tumor size was 7.54 cm. Box: 52193, Abu Dhabi, UAE Tel: +971 2 627 5772 Fax: +971 2 627 4559 Email: azmsc@zahrawigroup.com Web: www.zahrawigroup.com The positive diagnosis is based on histologic examination. It is considered to be the only full democracy in the Arab World. It is reported that chemotherapy and radiation therapy (including treatment with I-MIBG) are only of benefit in palliation by improving the hypertensive effects and not in cure or complete remission (16).The management of pheochromocytoma varied according to the genetic evolution. S100 protein Immunoreactivity was identified in both the nucleus and cytoplasm of the sustentacular cells surrounding the chromaffin cells. Diagnosis, localization and 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. making. La tunisie Medicale - 2020 ; Vol 98 ( n°012 ) COVID DOSSIER : REFLEXION. Lancet Oncol. Tunisie-Formation.com est un moteur de recherche et un annuaire dédié à la formation initiale, formation professionnelle et continue en Tunisie. The second population is the sustenticular cell which is thought to be a supporting cell similar to the glial cells in the central nervous system. All rights reserved. susceptibility to pheochromocytoma. Additionally, each university/college has ratings based on student reviews and are ranked below accordingly. Malignant adrenal pheochromocytoma. 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. MEN2 was observed in our study in one patient with malignant pheochromocytoma. Table 4 shows the different PASS scores. Vol 91 ( n°03 ) : 209-215, [ VHL Germline Mutations in Pheochromocytoma. Seven patients had adrenalectomy alone without adjuvant therapy and 2 patients with malignant pheochromocytomas had surgery followed by chemotherapy. Amar L, Berthera t J, Baudin E, et al. Surgery Tunisia is ranked 17th in the category of "quality of the [higher] educational system. Tumours of endocrine organs. In the three cases of recurrent tumors, the PASS score was constant in 1case of malignant pheochromocytoma. 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). No focal spindle cell architecture was found. These metastases may be present at referral or during the follow-up. 3-1 Macroscopic findings Orchard T, Grant CS, Van Heerden JA, Weaver A. Pheochromocytoma: Melicow MM. B Medical Systems is a global manufacturer and distributor of medical-grade devices. Survival was analyzed as the number of months from the diagnosis of the first metastasis to last follow up. The prevalence of malignant pheochromocytoma in familial syndromes varies depending on the familial syndrome and the follow -up period. Pathology The tumors were soft, gray-tan with calcification. Receiver operating characteristics (ROC) curve analysis was performed to evaluate the diagnostic performance of PASS. Please contact our Customer Service Department at custserv@biomeddevices.com. Qin Y, Yao L, King E, et al. Denaturing High The closing plenary of our conference presents the important issue of Physiopathological mechanisms of thrombotic events linked to COVID-19 . Circulationsapparat und Retinitis. In our study, a female predominance was noted. This fact points out the absence of relevant importance of these markers to make the difference between benign and malignant pheochromocytomas. Performance Liquid Chromatography Detection of SDHB, SDHD, and Other non consensual prognostic factors have been studied such as the expression of the 3 angiogenesis, metastasis related genes VEGF, Cox-2 and MVD, immunostaining of CD-44, p53, Bcl2, mdm2, cyclin D1, P21, p27, MIB-1 or CGH (23). Disseminated intravascular coagulation (DIC) is a life-threatening event during resuscitation. Burnichon N, Rohmer V, Amar L, et al. One patient presented a tumor of the right adrenal gland and the second the left adrenal gland. Minerva Endocrinol 2009;34:107-21. The informed and written consent was obtained from all patients. Clinical therapy and patient outcome Some universities also offer online courses through which students can apply for distance learning and get an online degree in certain fields. Laboratory tests reveal remarkably elevated levels of serum and/or urine catecholamines, norepinephrine, epinephrine, metanephrine, normetanephrine, dopamine, Samaan NA, Hickey RC, Shutts PE. Current Issue December 2020. The second one presented a benign pheochromocytoma with a benign recurrence after 24 months of follow up. The tumor cells were arranged in the characteristic “zellballen” architecture in 3 cases whereas, 6 cases demonstrated diffuse architecture. Moreover, in pheochromocytoma with diffuse spindle cell formation, the diagnoses of malignant peripheral nerve sheath tumors, which express also S-100 protein must be ruled out. Pathol 2002;26:551-66. pheo chromocyt om a: Increasing importance for cl inic al de cision Mitotic figures were inconspicuous or absent in all cases. According to the histologic features, a PASS score was performed for each tumor, primary as well as recurrent ones. Its performance was evaluated by calculating the area under the ROC curve and comparing it with that of the PASS. Biocare is a leading supplier and developer of primary antibodies and automated IHC medical equipment for lab testing. 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. Nebennierentumor und gleichzeitiger Nephritis mit Veranderungen am Pheochromocytomas, whether benign or malignant, have nonspecific symptoms and signs (16). A pathologist blinded to clinical outcome, reviewed the histopathologic characteristics of all cases using the PASS system. Current practice recommends the offering of genetic testing to all patients with pheochromocytoma with the following features: relevant family history, younger than 30 y of age, multiple tumors, malignancy and extra-adrenal pheohromocytoma (26). 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. Clinical experience with DISCUSSION malignant pheochromocytoma. The main cell is the chief cell or pheochromocyte which can be detected on routine hematoxylin and eosinestained slides. 1. Many authors studied the prognostic importance of the size and weight of the tumors and many of them proved the absence of difference in patient outcome based in these parameters (16). A number of different tumors need to be considered in the differential diagnosis. see table-1 3-2 Microscopic findings Malignant 2. radiographic study In our study, both MPA showed liver metastases. 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. You may also contact us by filling out the form below: Please Fill out the form below. Education is given a high priority and accounts for 6% of GNP. malignant Profound nuclear pleomorphism was found in 1 case. Diagnosis, localization, and Hertwig O, ed. the normal range (Table 2). Pheochromocytomas are made up of a dual cell population. The logistic model was developed using the 11 predictive variables. 1886;103:244-63. Malignant recurrence was defined as the appearance of metastasis after complete tumor eradication. The true incidence of MPA is difficult to determine but they seem to account for 6.5% of all adrenal gland tumors (11-14). Laboratory values were available in the 2 cases. Prognostic value of Pheochromocytoma of the adrenal gland scaled score Benign La Tunisie Médicale's journal/conference profile on Publons, with 106 reviews by 13 reviewers - working with reviewers, publishers, institutions, and funding agencies to turn peer review into a … Ann N Y Acad Sci 2006;1073:94. that the levels in malignant pheochromocytoma were lower than those in benign pheochromocytoma. These patients were 2 women aged respectively 31 and 34 years. management of pheochromocytoma: pitfalls and follow up in 41 8 patients presented sporadic pheochromocytoma and 1 patient presented hereditary pheochromocytoma. In general, the lesion was described as heterogeneous, demonstrating an increased signal on T2-weighted images. RESULTS In MEN2 and VHL-related pheochromocytomas, about 25% are reported as malignant on up to 25 year follow up (6). According to the ROC curve analysis, a PASS equal or superior to 4 identifies malignant pheochromocytoma with a sensitivity of 50% and a specificity of 45%. Keywords: Apricot, ‘Candidatus Phytoplasma prunorum’, restriction fragment length polymorphism. Germ-line mutations Koch CA, Vortmeyer AO, Huang SC, Alesci S, Zhuang Z, Pacak K. On follow-up a score >3 over an average of 614 days had a significantly higher mortality. Van Nederveen FH, Gaal J, Favier J, et al. 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. Table 2: Urine levels of catecholamines Both patients were managed by surgery followed by chemotherapy and no patients died after a follow up period of 3 years and 1 year. Br J Surg 1979;66:456-65. These results are illustrated in the table 5. In two cases, hypervascular masses in the liver and lymph nodes were noted and presumed by the radiologist to represent metastatic disease. 2005;23:8812. ©2011 LA TUNISIE MEDICALE. Prior to 2002, germline mutation testing in patients with apparently sporadic pheochromocytoma was not strongly recommended. Tumor cells were seen transgressing the capsule in 1 case. malignant pheochromocytomas. Laboratory values were available in all patients. Genetics of adrenal tumors. With a population of 10,982,754, Tunisia is the northernmost country in Africa which covers 165,000 square kilometres. First, we find and analyze health-related information from high-quality sites across the web. After ruling out these differential diagnoses, the most difficult distinction is between benign versus malignant pheochromocytoma. Recorded Webinar. Organ of the Tunisian society of Medical Sciences and the National Council of the Medical Association of Tunisia ISSN : 0041-4131 IeSSN : 2724-7031 Adresse : Rue Malaga, 2092 El Manar 1 Tél. Most patients presented with other findings as noted in the Table 1. Table 4: PASS scores of the different tumors Scopsi L, Castellani MR, Gullo M, et al. Amar L, Baudin E, Burnichon N, et al. The mean age in patients with syndromic presentation is generally younger than in patients with sporadic forms. Surg Gynecol Obstet 1982;154:801-18. The levels were often elevated to>4 and 1,5 times Others, suppose that tumors with PASS score >= 4 should be followed closely for recurrence and those with PASS score >= 6 are potentially malignant (23). Hum pheochr o m o cytoma or functiona l para g angli o m a. J C lin Oncol Clinical demographics and presentation The first one presented MEN2 syndrome and a malignant recurrence with abdominal lymph nodes and liver metastases after 5 years of follow up. C'est un outil de recherche riche, simple et efficace mis à la disposition des entreprises , des salariés et des étudiants à la recherche de formations et de perfectionnement. Jena: Gustave Fischer, 1905:443-8. In our study, the difference wasn’t statistically significant. In addition, we reviewed radiographic, surgical pathology and obtained follow up information when available. Pheochromocytomas in 72 This confers a PPV and NPV of 88%. statistical analysis Nevertheless, in our study one patient with MEN2 presented a malignant recurrence after a follow up period of 11 years. Thompson LDR. According to many authors, a PASS < 4 identified potential benign tumors and a PASS> =4 identified potentially malignant tumors. (Pass score) tests to separate benign from malignant neoplasms, PASS score, pheochromocytoma, prognosis, microscopy. Moreover, some of them believe that there is a lack of an intermediate category in this classification (tumors with intermediate malignant potential) which may be a potential drawback to its application in the clinical setting. 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). patients. La tunisie Medicale - 2018 ; Vol 96 ( n°010 ) : 731 - 736 [ 5018 times seen ] First Name : * ... (15%). It is currently accepted that the biologic behavior of these tumors can’t be predicted based on prospective diagnosis. The courses took place in the human and social sciences faculty of Tunis in that year. Table 1: Patients characteristics Ist Fresenius Medical Care der richtige Arbeitgeber für Dich? Urology 2006;68:282-6. It was diagnosed in our study in one patient with benign pheochromocytoma. Score Australasia Pty Limited. Genetic tes ting in und der Wirbeltiere. 1993;114:1160-6. 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. Cancer 1988;62:2451-60. It is a public institution that belongs to the Tunis El Manar University History. Both patients had increased levels in either their serum or urine of catecholamines, norepinephrine, epinephrine,metanephrine, dopamine, vanillylmandelic acid or other metabolites. 21399 times seen ]. Back. In our study, the cutoff value of 4 showed a low sensitivity and specificity. This publication was reviewed by Hartmut and colleagues who assessed the patient’s relatives and demonstrated that the original patient and her family had multiple endocrine neoplasia type 2 by providing molecular evidence (5). Many prognostic factors have been studied in the literature without a real consensus. Gao B, Meng F, Bian W, et al. Heitz PU, Eng C.World Health Organization Classification of tumours: The histology of the recurrence and of the metastatic tumor deposits was identical to the primary tumor in one patient. The tumors were of low to medium cellularity with 3 tumors showing high cellularity. Malignant Laboratoire LAB2M Tunis - Medical laboratory et de biologie Tunisie - Résultats en ligne Webolabo Thursday, 26 November 2020 . management of pheochromocytoma: pi tfalls and follow-up in 41 Germline mutations in TMEM127 confer Distant metastases were documented by histology in all cases. Comparison of means between groups was made with bilateral student test. 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. © Edarabia.com - All Rights Reserved 2021    | Laboratory tests seem unreliable in making this difference. All the patients were symptomatic with hypertension being the most frequent symptoms (100%). Nature genetics 2010;42:229-35. Laboratoire LAB2M. procedure to detect patients with p araganglioma and Topics: info:eu-repo/classification/ddc/610, Medicine(all), Medizin, Allgemeine medizinische Zeitschriften This fact was attested by the histologic examination. 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. Tumori 1996;82:480-4. No patients died during the follow up period with a mean follow up period of 16 months Some authors reported that tumors with SDHB mutations are associated with shorter survival (24). It is estimated that hereditary tumors are observed in 30 to 40% of cases (15), in the other side, sporadic tumor have a 10 to 15% risk of developing a Pheochromocytomas are divided into hereditary and sporadic tumors. pheochromocytomas or paragangliomas. Other germline mutations have been identified. Current Issue February 2021. Pheochromocytoma of the Adrenal Gland Scaled Both patients were female. 5. N Engl J Med 2002;346:1459. Cardiology 1978;63:305-11. Moreover, many authors suppose that the absence of sustenticuar cells in pheochromocytoam is indicative of a greater potential for malignant behavior. Genetic te sting in Cancer Monsieur le président de la Fédération Arabe de Biologie Clinique (AFCB) ... the News on the diagnosis and management of acute coronary syndromes and a Professional view on the new nomenclature of medical biology tests in Tunisia. 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. Medicine School of Tunis(arabic: كلية الطب بتونس) (french: faculté de médecine de Tunis) (FMT) is one of the four medical schools in Tunisia. In benign tumors, The PASS score was <4 in 3 cases and >=4 in 6 cases. Level 3, 247 Adelaide Street, Brisbane QLD 4000, GPO Box 2453, Brisbane QLD 4000. IARC Press Lyon, 2004:147-151. 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). 4. Our understanding of the pathogenesis of pheochromocytomas has tremendously grown during the last years along with the increasing advances of molecular genetics. A score >4 has a sensitivity of 32% and a specificity of 99%. La tunisie Medicale - 2013 ; For some unknown reason, pheochromocytomas, whether benign or malignant, seem to be more commonly found in the right adrenal gland, a finding also noted in our study (16, 11, 17,20, 25). One tumor occurred in a patient with syndromic association. J Clin Unlike other medical imaging core labs, Bioclinica has both depth and breadth of experience in GI imaging. Arch Pathol Anat Physiol Klin Med The mean age of the patients at presentation was 47, 44 years. CONCLUSION VHL disease is an autosomal inherited tumor syndrome with mutations in the VHL tumor suppressor gene. Contact Us. We have supported clinical trials using the full range of GI imaging modalities, from video endoscopy to MRI and intestinal ultrasound. Sultan Iskandar Muda Kebayoran Lama Utara Kebayoran Lamaa Jakarta Selatan 12240 Indonesia Tel: +62 21 2903 6545 Fax: +62 21 2930 4142. Tunis; Campus Universitaire, Tunis El-Manar, 2092 Tunis, Tunisia. The majority of tumors showed areas of degenerative changes, including cyst formation, hemorrhage and fibrosis. Tunisia is ranked 17th in the category of "quality of the [higher] educational system. It increased in one case of malignant pheochromocytoma and decreased in one case of benign pheochromocytoma. En Tunisie, les étudiants qui suivent cette voie doivent au moins finir 7 ans d’études pour exercer en tant que médecin généraliste. Bornstein SR, Gimenez- Roqueplo AP. 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. Capsular invasion was noted in one case while invasion into the periadrenal soft tissue was not noted in any tumors. Tumor cell spindling wasn’t noted. Frankel F. Ein Fall von doppelseitigem, vollig latent verlaufenen All microscopic findings are illustrated in table 3.