Sternal or parasternal involvement from breast cancer: a misleading clinical sign

Sternal arch is a nonspecific clinical signs wich may arise during following of breast cancer, this sign reveals an involvement of internal mammary nodes secondary to breast cancer. To report a rare event such as a loco-regional sternal or parasternal invasion secondary to locally advanced cases of breast cancer [BC] about a Tunisian series. We collected retrospectively from 1988 to 2012, 11 cases of BC treated at the Institut Salah Azaiez [ISA] of Tunis, with presence during the disease evolution [initial or at relapse] of a sternal or parasternal swelling. We analyzed their clinical history, clinical and imaging data [CT-scan and/or MRI], stage, time of occurrence, treatment and evolution. All patients were females and their mean age was 46 years varying from 24 to 75 years. The sternal or parasternal swelling was found at diagnosis in 5 cases and on recurrence in 6 patients after a mean free interval of 24 months, > 12 months in 5 cases. The mean clinical tumor size of the primitive BC was 38 mm [24-75 mm] and lesions located in external quadrants in 3 cases and internal or central in 6 cases. Sternal involvement related to large Intrammmary Chain [IMC] adenopathies was diagnosed by CT-scan. 7 patients had synchronous metastases. 9 out of the 11 patients received a locoregional RT and two received chemotherapy [CT]. Sternal or parasternal swelling is a clinical apparent symptom of advanced internal mammary lymph nodes in breast cancer. The first etiologic diagnosis in this context is an advanced internal mammary chain [IMC] node involvement from breast cancer

[Radiation therapy in extra abdominal desmoid tumours]

Desmoid tumours are rare benign tumours that have local 'malignity'. They can be locally aggressive by infiltrating adjacent vascular, nervous and bony structures. To define the role of radiotherapy in the management of desmoid tumours. Retrospective study of six extra-abdominal desmoid tumours treated with surgery and radiation therapy. Median age was 26.8 years [16-35 years]. The tumor was located in the arm [1 case], in the legs [2 cases] and in the body [3 cases]. Median tumoral sizes were 86.6 mm [60-100 min]. Five patients had local recurrence after surgical resection. Radiation therapy included Cobalt 60 in five cases and photons associated to linear acceleration in one case. Total dose was between 54 and 62 Gy. At the end of radiation therapy, tumoral control was obtained in five cases after a median follow-up of 26 months [1-83 months]. Surgery is the main treatment of desmoids tumours but local recurrence rates remain high even after complete resection. The role of adjuvant radiation therapy is controversial

Clear cell carcinoma of the uterus

The aim of this study was to determine the characteristics and outcome of patients presenting with clear cell carcinoma [CCC] of the endometrium treated in a single institution. We reviewed the records of patients treated in the Salah-Azaiz institute for CCC of the endometrium. A histopathological stage was retrospectively assigned to these patients according to the FIGO classification and was compared to the clinical stage. Pathological features were studied in order to determine predictive factors of extrauterine disease extention and failure patterns. 12 patients were included in the study. The mean age at diagnosis was 64 years [50 to 84 yrs]. Upstaging after surgery was found in 9 patients. 9 patients had extrauterine extension. Deap myometrial invasion was not correlated with extrauterine extension. After a median follw up of 32 months, 4 patients presented with recurrences: one vaginal recurrence, two cases of pelvic and abdominal recurrence and abdominal recurrence in one patient. All recurrences occurred during the first year after surgery. Tumor recurrence was located within the radiation field in one case. Two paients with abdomino-pelvic recurrences progressed despite the association of surgery, radiation therapy and chemotherapy. Extrauterine extension is frequent at diagnosis and not correlated to classical risk factors observed in endometrioid carcinoma. A comptlete surgical staging is necessary for adjuvant treatment. Locoregional and distant recurrences are frequent and have a poor outcome

[Internal mammary lymph node invasion in breast cancer: myth or reality]

The internal mammary nodes are often underestimated as breast cancer lymphatic pathway spread. It is yet the first site of lymphatic invasion in central or internal tumors and the second site in external tumors. The intra-thoracic situation of internal mammary nodes explains partly, the difficulty of its exploration. To evaluate the risk of internal mammary node invasion, some predictive factors are established [tumor size, internal or central tumor location, axillary node invasion and young age]. Prognostic and therapeutic impact of invasion justifies its systematic research. Without exploring internal mammary nodes status, TNM classification remains, incomplete. CT scanner, magnetic resonnance imaging, positron emission tomography scanner and sentinel node exploration technique are helpful to explore this region and to adapt its irradiation

[Skin cancer in Tunisia: a retrospective study: 1379 cases and risk factors]

The aim of this study was to determine the clinical and epidemiological aspects of skin cancer in Tunisia. We analysed the clinical files of all cases of skin cancer registrated at the ISA institute between 1975 and 1984. 1379 cases of skin cancer were referred to ISA, representing 9.02%of all cancer cases referred to the institute during the same period. Basal cell carcinoma [CBC] was the most frequent type [57.5%] followed by squamous cell carcinoma [CSC]: 32.6%and melanomas: 4%. The sex ratio was 1.7 with a mean age of 61 years in men and 60 years in women. The face was the most frequent involved sites in CBC [92%]. This region is usually exposed to the sun. The distribution of CSC in the body was different. The lesions were multiple in 11%of the cases. 13.7%of the CSC were developped on a burn scar. 21 cases were radio-induced and 45 patients had a xeroderma pigmentosum. Skin cancer is relatively frequent in Tunisia. However, our incidence is inferior to other countries. Sun exposure is the main risk factor