Subdural hematoma during therapy of gastro-intestinal stromal tumor [GIST] with Imatinib mesylate

Imatinib mesylate is a widely used tyrosine-kinase inhibitor [TKI] in chronic myeloid leukemia [CML] treatment. Imatinib has contributed to complete and prolong cytogenetic responses so that it is now the standard treatment of CML. Recently, Imatinib mesylate has shown a significantly prolonged progression-free survival and overall survival in metastatic and locally advanced c-Kit positive gastro-intestinal stromal tumors [GISTs] and more recently a prolonged disease-free survival in operated high risk GIST. Imatinib is a welltolerated treatment with few side effects mainly gastro-intestinal symptoms [nausea, vomiting and diarrhea], headaches, rash and periorbital edema. Hemorrhage incidents are rare in patients treated with Imatinib. They are more frequently seen in CML patients. Hemorrhage incidents in CML include in many cases upper gastro-intestinal [GI] tract bleeding and central nervous system bleeding in rare ones. In GIST patients treated with Imatinib, hemorrhage incidents are exclusively made of upper GI tract bleeding consecutive to tumor perforation or necrosis. In our observation, we present the case of a subdural hematoma occurring in a patient treated with adjuvant Imatinib for a high risk localized gastric GIST. No other case of subdural hematoma in GIST treated with Imatinib has been reported in literature

[Amelanotic spitzoid melanoma of the digit: a case report]

Melanomas of digit is rare, accounting for 1% of all cutaneous melanomas. We report a new case. Our purpose is to discuss the clinicopathological characteristics and the difficulties encountred in establishing diagnosis of this rare tumor. We report the case of a 25 years old woman, who consulted for nodular and ulcerated lesion of the right index, located in the external face of the metacrapo-phalangial joint. The nodule was biopsied and histopathologic exam concluded to spitzoid melanoma. The surgical margins were involved. The patient refused surgical recovery. She consulted 3 years later with axillary lymph nodes. A wide excision of the tumor with lymph node biopsy were made. Histological study concluded to a tumoral residu incompletely excided with lymph node metastases. Amputation of the second digit with dissection of the axillary lymph nodes was made. The surgical margins were tumor free. Lung metastases appeared with a follow up of two months. The patient died early after starting chemotherapy with Deticen. In our report, clinical presentation was misleading causing a diagnosis and therapeutic delay. Pathologically, all the histological types of melanoma were described in the digit except spitzoid melanoma

Feasibility of quality of life assessment in routine clinical oncology practice: a Tunisian study

Limited research has been devoted to quality of life [QOL] of cancer patients in developing countries. To assess the feasibility of QOL assessment in a cohort of Tunisian cancer patients, the EORTC QLQ-C30 questionnaire was administered to 23 women treated with adjuvant chemotherapy for early breast cancer on an outpatient basis at baseline and during the 3rd cycle of chemotherapy. We observed a significant deterioration in physical functioning, cognitive functioning and social functioning during chemotherapy. However, a wide range of methodological and practical obstacles to routine QOL evaluation were identified through this study. Further improvement of cancer care infrastructure and public education is still needed before reliable QOL studies can be performed

[Natural history of untreated hepatocellular carcinoma in patients with post virus B cirrhosis about 34 cases]

The aim of the present study was to evaluate the natural history of untreated hepatocellular carcinoma [CHC] developing in patients with post viral-B cirrhosis. A retrospective analysis was performed in 34 cases of CRC, admitted at Gastroenterology Department in Sfax. Survival and prognostic factors were evaluated. There were 28 men and 6 women [sex-ratio=4, 6] with a mean age of 59, 5 years. The mean time from the diagnosis of cirrhosis to CHC was 8, 9 months. The circumstances of the diagnostic of the CHC were as follows: The follow up of a known cirrhosis in 8 cases [23, 5%]. the decompensation in 10 cases [29, 5] and the clinical manifestations dominated by abdominal pain in 14 cases [47]. Cirrhosis was evaluated as Child-Pugh A, B and C in respectively in 26, 5%, 47, 1%and 26, 4%of cases. The tumor was solitary in fifty per cent of cases. The overall median survival was 51 days [IC: 95=42, 7-59, 31 from the time of diagnosis of CRC. The only prognostic factor was the serum bilirubin with a median survival of 34 days when it was superior to 34micro mol [IC: 95=25, 1-48,8] [p<0.004]

Erysipele apres traitement du cancer du sein

study of the epidemiological, clinical and evolutive characteristics of the erysipelas of patients treated for breast cancer. Between February 93 and December 9920 patients among 700 [2.85%] treated for breast cancer in the radiotherapy department of sfax have presented an erysipelas. All of these patients had undergone a chirurgical treatment containing an axillary lymph node dissection with radiotherapy in 95% and adjuvant chemotherapy in 80% of cases. the medium delay between the appearance of the erysipelas and the end of treatment was 23 months. The preferential localization was the homolateral upper limb to the treated breast [95%]. The immediate evolution was favourable in 85% after antibiotherapy. Recurrence of erysipelas was seen in 20% in cases. Erysipelas after treatment of breast cancer is known but rarely reported. The secondary lymphedema of the upper limb is the major favouring factor. Appearance of erysipelas among women treated for brest cancer is frequent, his recurrent character must always lead to antibiotic prophylaxis

Tuberculose des organes hematopoietiques et SIDA

The authors report the case of a 19 year-old male patient, admitted for a general health alteration, an abdominal tumor and transit troubles. After this, an hemorragic syndrome appeared, with a pancytopenia, Medullar biopsy noticed the presence of an epitheloid follicle, without caseum necrosis. The evolution under antituberculosis therapy is firstly favorable, but secondly an oropharyngeal candidosis and a Pneumocystis carinii pneumonia developed. HIV serology then confirms the diagnosis of AIDS infection. Final evolution is fatal

Sarcome osteogenique du sein [revue de la litterature a propos d'un cas]

The authors report the case of a 57 year old French Woman. Who presented a tumor of the left breast. Histologic examination, performed after a patey mammectomy, concluded to an osteogenic sarcoma. Extension staging showed no other localization. Mammectomy is followed by chemotherapy after Rosen T[10] protocole. The evolution is favorable without metastases, nor local recidive after 3 years and 9 months of evolution

Study of nocturnal paroxysmal hemoglobinuria-about 3 cases

We report three cases of marchiafava micheli disease or paroxysmal nocturnal hemoglobinuria [P.N.H] in 19 and 20 years-old girls and 55 years-old man. All of the patients showed an intravascular and hemolytic anemia with unfavorable pronostic criteria [Hb < 9 g/dl and Pq < 150000/mm4] explaining at least partially the short mean survival duration [5 years]relatively to that known in the literature [13 years]. Our observations are characterized by the appearance of facial paralysis for the first and severe abdominal pain for the observation n 1and n 2 which strongly suggest deep venous thrombosis. The third observation is particular because of the presence of heap blastic cells of the bone marrow evocatrice of the leukemic transformation occasionally observed during the P.N.H