Darier-Ferrand Dermofibrosarcoma: A Case Report of a Cervical Localization

Darier-Ferrand dermatofibrosarcoma (DFS) is a cutaneous mesenchymal tumor of intermediate malignancy. It is a rare but not exceptional tumor, accounting for 0.1% of malignant skin tumors. Histological examination is essential for diagnosis. Wide surgical excision is the standard treatment. DFS is a tumor whose prognosis and evolutionary risk are mainly linked to the delay in diagnosis and the quality of the first excision. Late diagnosis makes excision and reconstruction surgery difficult. The chances of recovery in the case of well-performed primary surgery are significantly greater than in the case of salvage surgery. To improve prognosis, early, codified, multidisciplinary management is essential. In our African context, and especially in the case of patients living in rural areas, errant diagnoses are often found hence the importance of raising awareness and providing information to healthcare personnel. We report a case of an enlarged left supraclavicular Darier-Ferrand dermatofibrosarcoma. The patient had come for a late consultation at a stage when the tumour was large. The CT scan was a great help in the pre-operative phase. The patient underwent complete surgical excision, the postoperative course was straightforward and the histology of the surgical specimen confirmed the diagnosis. The resection margins were healthy. The patient is alive at one year with no recurrence or metastasis.

CT Scans and Delays in Diagnosis of Stroke in Senegal’s Regional Hospitals: A Multicenter Study of 655 Cases

Stroke represents the 2nd cause of mortality and 1st cause of physical disability in the adult population. In Senegal, it represents 30% of hospitalization and 2/3 of the mortality in the department of neurology in the capital city, Dakar. Objective: To specify the types of stroke and to evaluate diagnostic delays in Senegal’s regional hospitals. Materials and Methods: This was a retrospective, cross-sectional, descriptive, multicentric study for 4 years (from 2014 to 2017) including any patient presenting a clinical suspicion with a CT scan confirmation of stroke in one of the 9 regional hospitals in Senegal with a recruitment period of 6 months per hospital. CT scans were performed with a 16 slices machine in 6 hospitals, 4 slices in 2 hospitals and 2 slices in 1 hospital. We studied the types and location of strokes, the associated signs and the time from stroke onset to admission and the time from admission to CT scan. Results: 655 patients were retained including 322 men and 333 women for an M/F ratio of 0.96. The average age was 63 years (range: 7 years, 112 years). High blood pressure was noted in 59.2% of patients and diabetes in 10.7% of patients. Strokes were ischemic in 76% of cases involving the middle cerebral artery in 73% of cases and hemorrhagic in 24%, of which 80.7% were deep localized. A mass effect was noted in 7.5% of cases, an engagement in 6.9% of cases and ventricular hemorrhage in 2.7% of cases. The delay between the onset of the deficit and admission was less than 6 hours in 10.6% of patients. The time between the onset of stroke and admission to hospital was specified in 416 patients (63.5%) of the study population, it was less than 6 hours in 10.6% of patients, between 6 hours and 24 hours for 29.3% and more than 24 hours for 60.1%. Between admission and the CT scan, the time was precise in 459 patients (70%), it was less than 6 hours in 37.9%, between 6 hours and 24 hours in 43.6 % and more than 24 hours in 18.5%. Conclusion: CT is central to the diagnosis of stroke in rural areas. However, there is a significant delay in diagnosis and management.