[Cutaneous melanoma: About 200 cases]

To analyze the clinical and pathological aspects of cutaneous melanoma and to determine the prognostic factors. This is a retrospective study about 200 cases of cutaneous melanoma collected in Salah Azaiz Institute over a period of 36 years [1969-2005]. The mean age was 55.4 years, with a slight female predominance. The tumour was developed on a pre-existent lesion in 31.5% of cases. The average delay of consultation was 18 months. The mean tumor size was 37 mm [10-180 mm]. The ulcero exophytic appearance represented 45% of the cases. The tumor was metastatic in 19.5% of cases. Hands and feet represented 53% of the tumour localizations. The treatment was curative in 71% of cases and palliative in 13% of cases. The lymph node dissection was performed in 59% of the patients. Histologically, nodular melanoma and Grade V of Clark represented 43.5 and 35% of the cases, respectively. The mean tumoral thickness was 14 mm. Chemotherapy, immunotherapy and radiotherapy were performed in 5.5%, 3.5% and 5.5% of cases respectively. The lymph node recurrences were noted in 43.6% of the patients treated with curative intent. The mean recurrence free survival was 76 months. Tumour size > 2 cm, the localization on the leg, Clark level invasion IV and the involvement of the tumour margin were significant prognostic factors for the recurrence free survival. The prognostic factors for the metastasis free survival were: tumour size, tumour localization, type of resection and finally the lymph node dissection. The 5-year overall survival was 28.5% and was influenced significantly by the tumour size, tumour localization, type of resection, involvement of the tumour margins, Clark grade, tumour thickness and finally the lymph node involvement. The dismal prognosis can be improved by early diagnosis and especially the prevention based on the photo protection and surveillance of patients at high risk

Borderline tumors of the ovary

Borderline tumors of the ovary [BOT] were described for the first time by Taylor in 1929. These lesions have a more favorable outcome than do other ovarian cancers. Their prognosis and treatment are still subject of discussion since they occurred more often in young women where the sparing fertility surgery is always considered primarily. Evaluate the management of patients with borderline ovarian tumors. A retrospective study was conducted in 40 patients with borderline ovarian tumors treated between January 1, 1991 and December 31, 2004. Median follow-up was 43 months, mean age was 44 years. Initial surgery was conservative in 17 patients and radical in 23 cases. Six patients had residual disease. Serous, mucinous and mixte tumors were observed in 18, 21 and 1 cases respectively. Staging was I, II, III in 26, 5, and 9 cases respectively with two pseudomyxomas. Adjuvant Chemotherapy was given in 3 patients. There was a recurrence in 13 patients and seven died. The 5-year overall survival rate was 78 %. Prognostic factors with an impact on survival rate were age, stage of the disease, histological subtype and residual tumor. Factors with a negative impact on recurrence were age, type of surgery and residual disease. With Cox multivariate analysis, residual tumor is an independent factor for overall survival, on the other hand age and type of surgery were significant for recurrence free survival. Careful staging followed by complete and radical surgery is mandatory. Unilateral salpingo-oophorectomy with omentectomy and multiple peritoneal biopsies and washing could be indicated in patients with child bearing age. Radical surgery after pregnancy is advised

[Inflammatory myofibroblastic tumor of the larynx: a case report]

Inflammatory myofibroblatic tumor is a recently caracterized solid mesenchymal tumor. They are frequently localised in the lung. However, the head and neck forms are uncommon. To report a new case of inflammatory myofibroblastic tumor of the larynx. This 47-year old man presented with dysphonia without dyspnea. Laryngoscopy showed a tumor of anterior vocal cord. CT scan of larynx confirmed diagnosis. The patient had a cordectomy. Histology concluded to the diagnosis of inflammatory myofibroblastic tumor. No relapses have been noted after 4 months. Only a few cases of laryngeal inflammatory myofibroblastic tumor have been reported in the literature. Clinical presentation depends of tumor location. Radiological images are not specific and diagnosis is based on histology. The expected course is essentially marked by the risk of local recurrences. Surgical excision seems to be the treatment of choice

[Clinicopathological characteristics of synchronous bilateral breast carcinomas. Report of 30 patients]

The objective of this study is to determine the clinicopathologic characteristics; incidence and prognosis value of synchronous bilateral breast carcinoma [SBBC]. This is a retrospective study done in Salah Azaiz Institute of Tunis about 30 patients with synchronous bilateral breast carcinomas diagnosed and treated over a 21-years period going from 1977 to 1997. The definition of synchronous breast lesions is the development of the contralateral breast cancer within 6 months. Median age was 49 years. The incidence of SBBC was 0.52%. History family was noted in 3% of our population. Mean tumor size was 40 mm [15-145]. Breast conserving therapy was done in 16% of cases [9 patients]. Five-year overall survival was 40%. Five year survival rates were 72 and 17% for stage II and III, respectively. Main prognostic factors for survival were lymph node involvement [P=0.004] and disease stage [P=0.02]. Synchronous bilateral breast carcinoma is a rare entity, with a problem of definition concerning the delay of bilaterlisation. Their prognosis is similar to that of unilateral breast carcinoma patients of equal stage. Hence, breast conserving therapy can be used safely if indicated

[Epitheloid leiomyosarcoma of the uterine cervix. About two cases]

The epithelioid Ieiomyosarcoma of the uterine cervix is a rare tumor. Usually, the presenting symptoms are vaginal bleeding and pelvic pain. Surgery is the standard treatment. To present the characteristic of this rare pathology by mean of two cases handled in the Institut Salah AzaIz. Two patients, aged 51 and 42 years, were referred to our institution for vaginal bleeding. Tumors were classified stage II proximal and H distal [FIGO classification modified by Gustave Roussy Institute].The patients had total hysterectomy with pelvic lymph node dissection. Histological exams confirmed the diagnosis of epitheloid leiomyosarcoma of the uterine cervix. Adjuvant external radiotherapy was performed. At 12 and 36 months, the patients are alive with no evidence disease

Breast carcinoma arising within fibroadenomas. Report of four observations

Fibroadenoma is a frequent benign breast tumor affecting young woman. The incidence of a carcinoma within adenofibromas is estimated at 0,1 to 0,3%

Aim: The purpose of this study was to evaluate the outcome of patients with breast carcinoma arising within adenofibroma and to determine the clinical characteristics and the prognosis of this rare entity

Observations: We retrospectively report on four cases of carcinomas arising in mammary fibroadenomas

The mean age was 41 years [26-53]. In two cases, fibroadenomas was complex, containing cysts, adenosis and apocrine metaplasia. The adjacent parenchyma contained fibrocystic dystrophy lesions associated in one case to intralobular neoplasia lesions. The treatment consisted of a conservative treatment in two cases and a mastectomy plus axillary node dissection in the two others. Radiotherapy was indicated in all cases and chemotherapy done in three cases. All patients are alive with a mean follow up of 4.25 years [3-7] without any sign of recurrence

Conclusion: Every benign mammary nodule must necessarily be verified surgically to avoid misdiagnosing any carcinomatous area because at this stage its prognosis is better

Primary carcinoid tumours of the ovary. about three cases

Carcinoides tumours are a rare type of ovarian tumours which anatomoclinical behaviour differs a little from epithelial type. Report of three new cases. We report 3 observations of ovarian carcinoid tumours in patients aged 50, 23 and 28 years. All our patients were operated in emergency for twisting of appendix in two patients and for acute peritonitis in the third one. Treatment was a one-sided salpingo- oophorectomy. The diagnosis of carcinoid tumour was retained on to the definitive histological exam then the patients were re operated to complete the resection

Dermatofibrosarcoma Protuberans of the Breast

Dermatofibrosarcoma protuberans is a superficial mesenchymal cutaneous tumor of essentially local malignancy, located more often in the trunk and extremities. This tumor is usually diagnosed after multiple recurrences. We report two cases of rare mammary localisations of dermatofibrosarcoma protuberans in 2 patients aged 39 and 43 years respectively, the two lesions sized 35 x 45 mm were treated by wide excision and reconstruction with a dorsal flap; in the second case

[Juvenile granulosa cell tumor of the ovary: a case report]

Juvenile granulosa cell tumors of the ovary [JGCTs] are a rare form of neoplasm that makes up less than 5% of ovarians tumors in childhood and adolescence. About 90% are diagnosed in stage I [FIGO] with a favorable prognosis, whereas those at higher stages have a less favorable outcome. The authors describe a juvenile granulosa cell tumor expressed by an early pseudopuberty occurring in a 6 year old child. Clinically, an endocrine syndrome was associated with a pelvic mass. Hyperoestrogenia and serum alphafoetoprotein level were biologically detected. Tumor was localized strictly to the ovary, so conservative surgery was applied and proved sufficient to remove all tumor tissue. Histological examination showed typical microscopic aspect of a juvenile.granulosa cell tumor. The patient is well, 14 years after surgery with a normal growth and mental development