The transformation chronic lymphocytic leukemia (CLL) into Richter syndrome represents aggressive clinical evolution of CLL. In most cases, this transformation corresponds to diffuse large B-cell lymphoma, but in very rare cases it can lead to Hodgkin’s Disease Variant of Richter’s Syndrome. We report a case of CLL transformed into Hodgkin’s disease type of Richter’s Syndrome in a 70-year-old male patient. Microscopic examination showed the presence of large tumor cells with the morphological and immunophenotypic features in favor of classical Hodgkin and Reed-Sternberg cells. The transformation of CLL into Hodgkin’s disease poses a problem of histogenetic diagnosis. According to the literature, the clonal relationship between CLL and Hodgkin’s disease is likely with prognostic value. Two forms of Hodgkin’s Disease Variant of Richter’s Syndrome are described with different prognoses: a form that corresponds to a true transformation of the CLL into a Hodgkin’s disease, a poor prognosis and a second form that corresponds to the co-existence of CLL and Hodgkin’s disease with better prognosis.
Our study aims to determine the reference values of the CBC in an adult and healthy moroccan population. This is a study of 996 cases including 874 men and 122 women whose samples were analyzed by the Coulter LH 750 controller then entered and analyzed by SPSS statistical software. The reference values obtained for the main parameters are: GB between 5,10×109- 11,58 x 109/L for women and 4,60 x 109- 13,81 x 109/L for men, PNN between 2,05 x 109 – 9,46 x 109/L for women and 1,60 x 109 – 9,80 x 109/L for men and the LYM between 0,42 x 109 – 4,18 x 109/L for women and 0,59 x 109 – 4,41 x 109/L for men. The HB between 10.10 to 16.97 g / dL for women and 13.8 to 20.21 g / dL for men, PLQ between 121,13 x 109 – 341,00 x 109/L for women and 108,00×109-327,25 x 109 /L for men. Comparing our results with those of literature or other studies revealed the existence of several dissimilarities. They are mainly due to ethnicity, smoking and habits of individuals. This preliminary study has achieved the baseline blood counts for a Moroccan sample and detects potential differences among populations, often involving diagnostic decisions; hence the need for the establishment of our own intervals reference through more extended studies in different regions of Morocco. This must be done under the responsibility of the health authorities and the values obtained must be validated to be applied to the disparities revealed by our study.
Avulsion fractures of the calcaneal tuberosity remains rare; they usually caused by forced ankle dorsiflexion; direct trauma occur infrequently; it must be treated immediately; to avoid the skin necrosis of the posterior heel; the treatment approach is of interest in this rare injury and the operative management is based on a review of the literature. ; Non operative treatment is classically associated with bad results. Hence the surgical intervention is generally the treatment of choice. The authors report two cases of unusual avulsion fractures of the calcaneal tuberosity treated by open reduction and internal fixation with a good functional result.