Surgical management of primary tumors in metastatic breast cancer review of literature

The local control of the primary breast cancer in metastatic patients yields a survival benefit attributed to the reduction of the tumor cell load and activation of the immune system. Clinical studies do not firmly support this theory and oncologists and oncological surgeons are facing dilemmas in the management of these patients. In this paper, we review the optimal patient profile as well as the type and timing of surgery for primary tumor resection of metastatic breast cancers

Epidemiology and survival analysis of gastrointestinal stromal tumors in lebanon: real-life study from a hospital tumor registry 2000-2015

Background: We report, to our knowledge, one of the largest studies concerning gastrointestinal stromal tumors [GIST] in the Middle East. We also present a survival analysis of GIST in our 15-year real-life experience

Methods: We studied demographic, epidemiologic and survival characteristics of 70 patients with confirmed GIST in a cross-sectional study between 2000 and 2015

Results: The .median age of our patients was 62 +/-12.8 years [range, 25-84] with a male to female ratio of 1.7. The gastric and the small intestine GIST were the most frequent primary sites. The majority of our patients had localized disease at diagnosis [81.4%]. Metastasis m limited to the abdominal cavity and lymph node spreadinc occurred in 14.3%. After a median follow up of 838 dap [range 48-4309 days] with only two patients reporte dead, two and five-year overall survival rates were 98% and 95% respectively. Median overall survival was not reached

Conclusion: In the light of our results, molecular profili of Lebanese patients with GIST would be of interest t detect the particularities responsible for the increase! overall survival and lymph node spreading

Gastric Adenocarcinoma Secondary to Primary Gastric Diffuse Large B-cell Lymphoma

Despite the decreasing incidence and mortality from gastric cancer, it remains a major health problem worldwide. Ninety percent of cases are adenocarcinomas. Here, we report a case of gastric adenocarcinoma developed after successful treatment of prior primary gastric diffuse large B-cell lymphoma (DLBCL). Our patient was an elderly man with primary gastric DLBCL in whom complete remission was achieved after R-CHOP (cyclophosphamide, adriamycin, vincristine, prednisolone plus rituximab) chemotherapy. Helicobacter pylori infection persisted despite adequate treatment leading to sustained chronic gastritis. The mean time to diagnose metachronous gastric carcinoma was seven years. We believe that a combination of many risk factors, of which chronic H. pylori infection the most important, led to the development of gastric carcinoma following primary gastric lymphoma. In summary, patients who have been successfully treated for primary gastric lymphoma should be followed up at regular short intervals. H. pylori infection should be diagnosed promptly and treated aggressively.

Management of metastatic colorectal cancer current treatments and new therapies

Colorectal cancer represents 8% of metastatic cancers. For decades, the gold standard therapy has been infusional chemotherapy with 5-Fluorouracil [5-FU] associated to folinic acid. The discovery of irinotecan, oxaliplatin and oral forms of 5-FU in the nineties is considered a milestone in the treatment of this disease. Since 2004, targeted therapy with monoclonal antibodies including anti-EGFR and angiogenesis inhibitors showed superiority in terms of mortality compared to conventional therapy. Metastatic colorectal cancer, however, remains an incurable disease. We present the current treatments of metastatic colorectal cancer, the clinical development of these emerging treatments, and their position in the Lebanese health care system

[Insertion des chambres a catheter implantables sous guidage echographique et scopique. Etude prospective portant sur 120 cas]

We compare our results of a prospective study, on 120 totally implantable venous access ports [TIVAP] inserted at angiographic unit, under ultrasound and fluoroscopic guidance, with those of the literature. The 120 AP data, placed under ultrasound and fluoroscopic control for chemotherapy treatment, were prospectively analyzed. The detailed technique of insertion is noted. Data related to the technical success rate and to complications were classified into major, minor, early or late, according to the recommendations of the interventional radiology society. The technical success rate is 100% with no major complication noted. Eight [6.6%] TIVAP were withdrawn because of infection in 4 cases [3.3%], and end of treatment in the other four. The withdrawals took place in chemotherapy clinics. Three [2.5%] are classified as early infections, within two months of the procedure, two of which were associated to wound non-healing. Four patients [3.3%] presented early minor complications [hematoma surrounding TIVAP insertion site]. Our results correspond to previously published data. The insertion of AP at the angiographic unit under ultrasound and fluoroscopic control has lower risk of complications and a success rate higher than that being inserted following anatomical location. Collaboration with a specialized care nurses team is of paramount importance

[Breast cancer: nomograms to predict pathologic response after preoperative chemotherapy]

If the benefit of adjuvant chemotherapy may be determined at the level of a population, to determine the real chemosensitivity of a tumor at the individual level is impossible. The concept of neoadjuvant chemotherapy in patients with localized breast cancer is interesting because it helps to know the chemosensitivity of a tumor "in vivo". It is possible to use a single criterion to predict the effectiveness of targeted therapies. The chemotherapy is not a targeted therapy, and to determine a biological predictive marker of the response has been impossible so far. The development of mathematical models and use of molecular biology may help to predict chemosensitivity. Initial results are promising. The validation of published works is necessary, but applications are numerous

[Skin sparing mastectomy: a revisited technique]

Skin-sparing mastectomy [SSM] is an appealing treatment option for patients with early-stage breast carcinoma. This article is a review of the literature concerning this innovative technique. Surgery consists in a total mastectomy with preservation of the cutaneous envelope of the breast. This is done by performing the smallest incision possible, e.g. periareolar incision, with ablation of the nipple-areola complex. Mastectomy is followed by immediate reconstruction with a prosthesis and/or flap. Besides complications of reconstruction, the principal postoperative concern is necrosis of the skin flap. SSM seems oncologically safe as studies didn't find any difference in terms of relapse, metastasis and survival when comparing SSM to non-SSM. Nevertheless, the use of this technique remains controversial in advanced stage breast cancer [2B and 3]. Finally, SSM is associated with improved aesthetics with a high level of surgeons' and patients' satisfaction

[Adjuvant endocrine therapy in breast cancer. Management of early-risk relapse]

The goal of adjuvant endocrine therapy for early breast cancer is to prolong overall survival and improve the quality of life of patients. Studies on breast cancer show an early peak of recurrence at two years after surgery and distant recurrences that are responsible for a significant reduction in overall survival. Tamoxifen has been the standard of adjuvant endocrine therapy in breast cancer for years, however only about half of relapses are prevented and there is an early occurrence of serious adverse events due to agonistic estrogenic activity of tamoxifen, such as an increase in the risk of endometrial hyperplasia and venous thromboembolism. The use of aromatase inhibitors is changing this standard with studies covering various clinical settings. They have shown a benefit in many situations, such as an extension of endocrine therapy by tamoxifen, sequential hormonotherapy or up-front adjuvant therapy with aromatase inhibitors

[Male breast cancer. Report of eight cases]

Male breast cancer is relatively rare. We report herein 8 cases with clinical, biological and therapeutic characteristics. A retrospective study included all male breast cancers in our institution between 1998 and 2004. Mean age of the 8 patients was 67 years [52 to 81 years]. Patients presented with a breast lump [n=4], nipple discharge [n=2], Paget disease's [n=1], and on physical exam in patient with colon cancer [n=1]. The cancer localized in the right side [n=7] or the left side [n=1]. The tumor localized in subareolar region [n=7] or in the right lower outer quadrant [n=1]. The tumor size was between 1 and 2 cm [n=2], or between 2 and 5 cm [n=6]. One patient had pleuro-pulmonary metastases. The surgical treatment consisted of modified radical mastectomy [n=6], total simple mastectomy [n=1], and lumpectomy [n=1]. The final pathology showed infiltrating ductal carcinoma [n=6], infiltrating papillary carcinoma [n=1], and ductal carcinoma in situ with mini-invasion [n=1]. The lymph nodes were positive in 83.3% of cases. The estrogen and progesterone receptors were positive in 100% and 83.3% of cases respectively. Adjuvant chemotherapy, hormonal therapy or both was given in 2 cases, 1 case, and 5 cases respectively. The follow-up ranged from 6 to 72 months. The patient with metastases died 7 months after the diagnosis. The other patients [n=7] remained free of disease. Male breast cancer is relatively rare with predominance of infiltrating ductal carcinoma. Modified radical mastectomy remains the optimal surgical treatment. Hormone receptors were positive in all our patients and hormonal therapy with Tamoxifen remains the cornerstone of adjuvant therapy

Carcinome metaplasique de sein. A propos d'un cas de type sarcomatoide et revue de la literature

Metaplastic changes are a rare entity that occurs in fewer than 5% of breast carcinomas. Their sarcomatoid variant is the rarest primary malignancy of the breast. We report a case of sarcomatoid breast cancer and insist on the diagnosis and treatment of this rare tumor. case report: A 71-year-old female patient presented for a right breast mass above the nipple, between the upper inner and upper outer quadrants, of 20 mm of diameter, highly dense on mammography with cystic and solid components on ultrasound core biopsy showed a probable sarcoma whereas the partial mastectomy revealed the sarcomatoid metaplastic breast carcinoma. The workout for distant metastasis was negative and the treatment was completed by a modified radical mastectomy and adjuvant CMF chemotherapy. Six months after treatment there was no evidence of locoregional recurrence nor distant metastases. Although metaplastic carcinoma is a rare breast malignancy, with no specific clinical or radiologic features, it should be considered as an independent entity and included in the differential diagnosis of breast tumors

Outcome of cancer patients admitted to the intensive cave unit [ICU].

This is a retrospective study aiming to determine the cause, the survival and the factors influencing survival in cancer patients admitted to an ICU. Between January 1998 and June1999, 181cancer patients were admitted to the ICU of HDF hospital [a general academic hospital of 300 beds]. One hundred fifteen patients were admitted after surgery and 66 for medical reasons. Among the non-surgical group, 37 had solid tumors and 29 had hematological malignancies. Most of non-surgical patients were admitted for respiratory or infectious complications due to their disease or treatment-related [59 patients]. Among the non-surgical group of patients, 44 required mechanical ventilation [MV]. The mortality rate was 41% during ICU recovery, 62% during the hospitalization period, 73% at 2 months from discharge and 83% at last follow-up. The duration of stay in the ICU was the only factor affecting mortality. Age, disease type and MV did not influence the mortality rate in this population

Mesotheliome - asbeste au Liban: un probleme a retenir

To estimate the incidence of pleural mesothelioma and its relationship with the occupational and environmental exposure to asbestos in Chekka region. Between 1991 and 2000, 22 cases of malignant mesothelioma were diagnosed at Hotel-Dieu de France Hospital. Eighteen cases were epidemiologically investigated. Fifteen among these 18 patients [83%] had a positive exposure history exposure was occupational in 11 cases and environmental in 4 cases.The tumor was attributable to Eternit Company in 12 cases among the exposed 15 [80%]. These 12 cases were secondary to occupational exposures in 8 and to environmental exposure in 4 cases. Mean latency period between exposition and diagnosis was 29 years. Fifteen patients died from the progression of their disease after a median survival of 8 months. The relationship between pleural mesothelioma and Eternit Company with the related occupational and environmental risk in Chekka region is obvious.The assessment of the incidence needs a national cancer registry.Despite the protective measures taken by the government since-1996, an increase in the incidence is suspected in the coming ten years because of the long latency period of the disease

Maladie de Castelman. A propos de deux cas et revue de la literature

Castelman's disease, an unusual condition of unknown cause, consisting of a massive proliferation of lymphoid tissue. Three histologic variants [hyaline vascular, plasma-cell, and mixed] and two clinical types [localized and multicentric] of Castelman's disease have been described.Localized disease can be cured with surgery or radiotherapy, but complete remission in patients with multicentric disease have been achieved only with prednisone or chemotherapy given at the time of diagnosis.The aim of this study is to report two cases of retroperitoneal Castelman's disease with review of the literature.the first patient, of 36 years old, presented for abdominal pain with anorexia and weight loss. The abdomino-pelvic CT scan showed a 6 cm retroperitoneal mass. The biopsy of this lesion suspected a lymphoproliferative disease. At laparotomy total excision of mass was made and the final histology revealed a hyaline-vascular type of Castelman's disease.The second patient, of 26 years old, presented for left lumbar pain with weight loss. The abdominopelvic CT. Scan showed a 6.5 cm retroperitoneal mass.The biopsy of this lesion showed a Castelman's disease. At laparotomy total excision of mass was made and the final histology confirmed a hyalinovascular type of Castelman's disease