Leiomyosarma of the urinary bladder

It is a rare malignancy that represents less than 1% of the bladder malignant tumors. It affects children and adults with a maximal incidence beyond 60 years. The predominance of male was marked with a sex ratio 3/1. The treatment consists on a surgical exeresemonoblocsometimes preceded by chemotherapy when complete surgery is impossible. 80 years old patient with the history of lithotomy, presented a total hematuria with stones since 3 years in a context of general state deterioration. The etiologic investigation reveals a bladder mass. The complete transurethral resection was in favour of a pseudo-sarcoma. A year and a half later, the patient was admitted with a palpable pelvic mass and hematuria. Biopsy was this time in favour of a leiomyosarcoma. The scan showed a very locally advanced tumor for which the patient was treated by anterior pelvic exenteration and cutaneous ureterostomy. The anatomopathological exam confirmed the diagnosis of urinary bladder leiomyosarcoma grade1. It is a chemo-responsive tumor. Neoadjuvant chemotherapy is recommended to shrink the tumor when it is locally advanced not easily completely removed or to avoid mutilating surgery. The quality of resection is the most important prognostic factor for local recurrence. Histological grade correlates with metastatic potential. New drugs of chemotherapy such as gemcitabine have recently demonstrated efficacy inleiomyosarcoma. This is a rare entity whose treatment must be integrated into a multidisciplinary approach in an expert center. We aim, through this observation to analyze mainly the clinical, molecular and therapeutic characteristics

Management of bone painful metastases

Bone is the thirdmost common site of metastatic cancer after lung and liver. It becomes painful in 70% and may significantly impair the cancer patient's quality of life. The pathophysiology of pain due to bone metastasis in now better understood. The character of painful bone includes both inflammatory and neuropathic features.Different and many therapeutic options are available. It is important to know the different options of treatment in order to select the appropriate treatment for the individual patient. However multimodal approach is often necessary and includes medical treatment [analgesics, bisphosphonates anddenosumab] and non-medicalsuch us radiotherapy and cementoplasty Analgesics include three levels of WHO and will be indicated depending on the pain intensity. Bisphosphonates and denosumab decrease bone resorption by acting on osteoclasts and have demonstrated analgesic effect particularly in prostate cancer with bone metastases. Radiotherapy provides an analgesic effect resulting from the radiotoxic effect directly on tumor cells and inflammatory reaction of the boneenvironment. While external beam radiotherapy is the treatment of choice to treat pain from localized bone metastases, Radiopharmaceuticals by their systemic action is better suited in case of extensive metastases. Cementoplasty consist in injecting cement into the injured vertebral body injured but its analgesic role remains unproven. Anti-cancer therapy should be reviewed when the tumor is responsive. The therapeutic approach should be individualized for each patient and requires an understanding of the mechanisms of cancer pain. At present, there is no algorithm of choice between the different therapeutic modalities. The treatment must be discussed within a multidisciplinary working team with specialists of cancer, a nuclear physician, an intensivist, a surgeon and a palliative care physician

Imaging of pseudoangiomatous stromal hyperplasia of the breast

Rare benign breast lesion that commonly affects premenopausal women. It is a myofibroblastsproliferation around optically empty slots giving a false appearance of vascular network of its name [pseudoangiomatous] hyperplasia where there is absolutely no vascular injury. It appears as a single mobile breast nodule, firm, usually unilateral and as a net opacity with regular contours and without microcalcifications.]V1. We present two lesions that were classified as malignant in the initial control by mammography, wich led to a needle biopsy.But no any histological sign of malignancy was shown. The diagnosis requires ultrasound-guided percutaneousbiopsy or stereotacticbiopsy for histological study. The false appearance of vascular network can mimic on a first reading a low-grade angiosarcoma. Then, immunohistochemistryis needed to demonstratemyofibroblastic origin. The resection must be complete with a long-term surveillance because of the risk of recurrence of up to 20% of cases when resection is not total. The diagnostic alternative is currently provided by the ultrasound guided percutaneous biopsy or stereotactic biopsy, which determines the nature of the lesion and rules out malignancy, such as angiosarcoma, in order to avoid unnecessary surgical biopsies