[Ki-67: role in diagnosis, prognosis and follow-up after treatment of breast cancers]

Aim: To evaluate the literature data about diagnostic value, prognosis value and interest in follow-up of Ki-67 antibody after treatment for breast cancer

Methods: We performed a literature search in pubmed using the keywords: Ki-67, anti-Ki-67, breast cancer, prognosis, proliferation, chemotherapy, hormone therapy

Results: Ki-67 is routinely used as a static marker of proliferative activity and in follow-up-monitoring before and after treatment by chemotherapy and more recently hormonotherapy. Ki-67 was also used at a cut-off of 14% to differentiate between luminal A and B breast cancers. A high Ki-67 expression is probably related to a poorer prognosis but also a better response to neoadjuvant chemo and/or targeted therapy. More recently, genomic analysis is more reliable to classify the molecular breast cancer subtypes avoiding the possible cases of discordant Ki-67 rate. Ki-67 is also interesting in predicting histological response to neoadjuvant chemo and hormone therapy

Conclusion: Ki-67 evaluated by immunohistochemistry is important in routine in countries without bimolecular plateforms despite technical insufficiencies. When available, genomic grading is better to classify molecular subtypes and determine breast cancer prognosis in adjuvant and neoadjuvant setting

[Audit of sterilization practices in two Tunisian hospitals: current situation and perspectives]

In most Tunisian hospitals, medical devices [MD] are sterilized at surgical or medicine departments. To overview during one month the practice of sterilization. aterial Methods: An audit of practices through direct observation was carried out at the neonatology and gynaecology departments at the Maternity and Neonatology Center of Tunis and the surgical department at the Salah Azaïz Institute. An assessment grid has been defined and the non-compliance rates have been calculated. A score has been drawn for four evaluation categories of MD treatment. 123 criteria were assessed. The level of non-compliance ranges from 53% to 62% depending on the department. Scores interpretation underlines that the present situation is behind the required level of safety. Traceability stands at the most critical position. Staff and environment safety present scores of 26/54 and 28/62 respectively for the Maternity and Neonatology Center of Tunis and the Salah Azaïz Institute. The less critical situation is that of patient safety, even if it is far below the expected level. This audit has highlighted major malfunctions in the sterilization process. This is related to the absence of a strict regulation. A corrective action plan has been implemented for the short, medium and long terms

[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

Changes in serum lipids in patients with colorectal cancer

To evaluate and assess disruptions of serum lipids at patients having a colorectal cancer. Our prospective study interested 30 patients, from 26 to 93 year old, presenting a colorectal cancer confirmed histologically, examined during the period going from March 2003 to April 2004. Thirty healthy controls were examined in parallel. All patients undergo three blood samples respectively in preoperative, 48h and 6 months after surgical operation. The analyses carried out were determination of a total serum cholesterol, HDL [high density lipoprotein] and LDL [low density lipoprotein] cholesterol, serum triglyceride and serum apoprotein [AI and B]. We noticed a decrease of total serum cholesterol level in 43% of the cases associated to the reduction of the HDL and the LDL cholesterol in respectively 30% and 76% of cases. The mean values of total serum cholesterol, HDL and LDL cholesterol rates were significantly lower for patients compared to those of controls [p respectively: 0.001; 0.04 and 0.001]. Moreover, the level of total serum cholesterol varied significantly with tumor localization [p= 0, 02]. Serum lipid disruptions affect essentially total cholesterol, HDL and LDL cholesterol. It would be therefore interesting to evaluate their rate at the basal state in order to follow their evolution after treatment in colorectal cancer

[Importance of determination of protein C reactive [CRP], carcinoembryon ic antigen [CEA] and lactic deshydrogenase [LDH] in colorectal cancer]

Evaluate and show the importance of CRP, ACE and LDH in colorectal cancer. Our prospective study interested 30 patients, from 26 to 93 years old and present a colorectal cancer, confirmed histologically, during the period going from March 2003 to April 2004, and 30 healthy controls. A blood sample was collected from each patient respectively in preoperative, 48 hours before any treatment, and 6 months after surgical operation to measure serum LDH, CRP, and ACE. The mean serum of LDH, CRP and ACE values were significant higher in patients than those in controls [p respectively: 0,01; 0,04 et 0,01]. Moreover, the level of three parameters varied significantly with stages of tumor. After follow up, we have noticed e normalisation of the mean of the level of LDH, CRP and ACE with favorable evolution. Analysis of survival at 2 years showers that survival is better in patients with normal value of CRP, ACE and LDH. CRP, LDH and ACE values have a great importance during follows up after colorectal cancer surgery

[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

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

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

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

[Isolated Crohn's disease of the stomach presented as plastic linitis. One case report]

Introduction: Crohn's disease of the stomach is rare. There is nearly always concomitant disease in the small bowel or colon. Gastric involvement occurs rarely as an isolated entity. Upper endoscopy is sensitive for detecting subtle disease but more extended lesions can mimic neoplasms such us linitis

Exegese: A 74-year old female was admitted to hospital with abdominal pain, vomiting and weight loss. Upper endoscopy and radiology aspects was suspicious of gastric linitis. Multiple endoscopic biopsies of the stomach showed one granuloma, chronic inflammation and Helicobacter Pylori. Because of the importance of obstructive syndrome, the patient underwent surgery. The resected stomach concluded to a Crohn's disease

Conclusion: Through this observation, we review clinical characteristics, diagnostic difficulties and treatment options of Crohn's disease of the stomach