Primary thyroid lymphoma: clinicopathologic characteristics and therapeutic outcomes of six cases in morocco

Background: Primary non-Hodgkin lymphomas of the thyroid are uncommon and account for 1-5% of all thyroid malignancies and less than 2% of extranodal lymphomas. The aim of the present study was to review our experience and management of primary thyroid lymphoma and to discuss the diagnostic and therapeutic considerations

Methods: All non-Hodgkin lymphoma diagnosed at our institution between 2007 and 2011 were reviewed, six cases of primary thyroid lymphoma were identified. The clinical and pathological features of these patients were analyzed

Results: There were five females and one male and their mean age was 67.5 years. All patients presented with an enlarging anterior neck mass and two patients also have compressive symptoms. Five patients have a history of pre-existing goiter, four have 'B' symptoms and one was hypothyroid. All patients have B-cell Non Hodgkin Lymphoma. Four patients have stage II disease, while two patients have disseminated disease. All patients underwent thyroid resection. One patient died after surgery. The five others were treated postoperatively with 3-weekly cycles of combination chemotherapy. One patient in stage II received consolidation radiotherapy after chemotherapy. Complete remission was achieved in four patients and one patient had partial response to the treatment. After a median follow-up of 26 months [2-51], three patients are still alive without any relapse, one died and the last was lost to follow up

Conclusion: Primary thyroid lymphomas are rare. Treatment depends on the histological subtype and stage of the disease, including radiotherapy and chemotherapy. The prognosis usually is favorable with proper treatment

Pain and cancer: a systematic review

Pain is the most common symptoms in patients with cancer, a significant number of cases it is undiagnosed and under treated. It is important to understand the nature of the pain experienced by patients, to distinguish between nociceptive and neuropathic pain. Successful management of cancer pain requires a good knowledge of the causes of pain and various treatment available and information to manage their side effects. Pain has a significant negative impact on the patient and his family, therefore it needs to be managed urgently and appropriately

Bevacizumab in clinical practice

The development of targeted therapies and especially angiogenesis inhibitor drugs is undoubtedly a major advancement in the treatment of cancer in the 21st century. Bevacizumab is a recombinant humanized monoclonal antibody directed against vascular endothelial growth factor that was approved for the treatment of multiple solid tumors, we have reviewed the side effects cited in clinical trials of bevacizumab and the guidelines for their management and we can conclude that bevacizumab, is generally well tolerated but is associated with increase in some adverse side effects for which monitoring is required particularly vascular and renal side effects including hypertension, proteinuria, thromboembolic events and hemorrhage. The better understanding of bevacizumab toxicity profile and the guidelines for their optimal management as well as the education of patients may allow prolonged therapy and thus improved clinical outcomes

Imaging of pseudoangiomatous stromal hyperplasia of the breast

Rare benign breast lesion that commonly affects premenopausal women. It is a myofibroblastsproliferation around optically empty slots giving a false appearance of vascular network of its name [pseudoangiomatous] hyperplasia where there is absolutely no vascular injury. It appears as a single mobile breast nodule, firm, usually unilateral and as a net opacity with regular contours and without microcalcifications.]V1. We present two lesions that were classified as malignant in the initial control by mammography, wich led to a needle biopsy.But no any histological sign of malignancy was shown. The diagnosis requires ultrasound-guided percutaneousbiopsy or stereotacticbiopsy for histological study. The false appearance of vascular network can mimic on a first reading a low-grade angiosarcoma. Then, immunohistochemistryis needed to demonstratemyofibroblastic origin. The resection must be complete with a long-term surveillance because of the risk of recurrence of up to 20% of cases when resection is not total. The diagnostic alternative is currently provided by the ultrasound guided percutaneous biopsy or stereotactic biopsy, which determines the nature of the lesion and rules out malignancy, such as angiosarcoma, in order to avoid unnecessary surgical biopsies

Clinical prognostic factors in locally advanced nasopharyngeal carcinoma in Moroccan population

Nasopharyngeal carcinoma is a distinct cancer of head and neck by its pathology, etiology, epidemiology and clinical behavior. Morocco is considered an endemic region with intermediate incidence. The aim of our report is to underline some clinical determinants of survival in locally advanced disease. We conducted a retrospective study from January 2003 to December 2005. All patients with undifferentiated nasopharyngeal carcinoma treated in the National Institute of Oncology of Rabat, Morocco were recorded. Classified stage II to IVB disease according to TNM classification adopted by the AJCC [American Joint Committee of Cancer] 6th edition. The study included 339 patients, 122 women and 217 men [sex-ratio: 1.7]. Mean age was 43 years old [range: 6-91years]. Median duration to diagnosis was 6 months [range: 1-72] presenting symptoms at diagnosis were predominantly cervical lymph node in 79%. Forty- two patients have T1 tumors, 159 = T2 tumors, 64 = T3 tumors and 69 = T4 tumors. Sixty-five patients do not have lymph-node involvement, 49 have N1, 128 have N2 and 95 have N3. Three patients were at stage IIA, 57 patients were at stage IIB, 40 patients were at stage III, and 57 patients were at stage IVA and the remaining 96 patients were at stage IVB. Eighty-seven percent of patients underwent sequential chemoradiation and 17% underwent concurrent chemo-radiation [CTR]. Response to induction chemotherapy was assessed in 235 patients. There were 31 patients with complete response and 59 patients have partial response. Complete response to radiotherapy was reached in 235 patients. Mean overall survival [OS] was 66.2%. Gender was a prognostic factor of OS [p=0.045] and DFS favoring women. Age wasn't a prognostic factors determining the outcome with no difference between patients aged more than 40 years old and patients younger. Tumor size was not a determinant of survival with a non-significant p in OS and DFS [0.27 and 0.46 respectively] but T4 stage patients appear to have a worse prognosis. Lymph node involvement was significantly determining the outcome either in OS and DFS [p=0.001 and 0.009 respectively]. TNM stage was also a significant prognostic factor in OS but not in DFS favoring those with early stage [p= 0, 004 and p= 0, 13 respectively]. The treatment strategy was not a significant prognostic factor with no difference between patients who underwent sequential or concurrent chemoradiation [OS p= 0, 48 and DFS p= 0, 9]. In multivariate analysis, lymph-node involvement is the most significant factor. Our findings were mostly concordant with the literature data in endemic areas for TNM staging; however we are limited by the bias of retrospective studies. Prospective studies would be more accurate to define those prognostic factors in our population

Leiomyosarma of the urinary bladder

It is a rare malignancy that represents less than 1% of the bladder malignant tumors. It affects children and adults with a maximal incidence beyond 60 years. The predominance of male was marked with a sex ratio 3/1. The treatment consists on a surgical exeresemonoblocsometimes preceded by chemotherapy when complete surgery is impossible. 80 years old patient with the history of lithotomy, presented a total hematuria with stones since 3 years in a context of general state deterioration. The etiologic investigation reveals a bladder mass. The complete transurethral resection was in favour of a pseudo-sarcoma. A year and a half later, the patient was admitted with a palpable pelvic mass and hematuria. Biopsy was this time in favour of a leiomyosarcoma. The scan showed a very locally advanced tumor for which the patient was treated by anterior pelvic exenteration and cutaneous ureterostomy. The anatomopathological exam confirmed the diagnosis of urinary bladder leiomyosarcoma grade1. It is a chemo-responsive tumor. Neoadjuvant chemotherapy is recommended to shrink the tumor when it is locally advanced not easily completely removed or to avoid mutilating surgery. The quality of resection is the most important prognostic factor for local recurrence. Histological grade correlates with metastatic potential. New drugs of chemotherapy such as gemcitabine have recently demonstrated efficacy inleiomyosarcoma. This is a rare entity whose treatment must be integrated into a multidisciplinary approach in an expert center. We aim, through this observation to analyze mainly the clinical, molecular and therapeutic characteristics

[Desmoplastic small round cell tumor]

Desmoplastic small round cell tumor is a recently recognized and rare clinicopathologic entity with distinctive morphologic and immuno histochemical features .Moreover, specific cytogenetics abnormalities and molecular characteristics have been described and confirmed its identity. It is often located at the abdominal cavity, but can exceptionally be located at the cerebral level or some soft tissue and the bones of the members. We report a case of Desmoplastic small round cell involving gluteal muscle and iliac bone at a 25-year-old girl. Our patient had been treated by chemotherapy based on ifosfamide, doxorubicine, etoposide and cis platine. The evolution was marked by the tumoral progress and the death of the patient 18 months after the discovery of the disease. The second case is a 27-year old man .He had a retro peritoneal desmoplastic small round cell tumor treated by surgery alone. The evolution was marked by metastasis and the patient died 10 months after diagnosis. The prognosis of these tumors remains unclear in spite of the mulitidisciplinary treatment. Hence the necessity of new lines of therapeutic research

[Hepatoid carcinoma of the ovary]

Hepatoid carcinoma is a primary malignant extrahepatic tumor that arises outside the liver and resembles hepatocellular carcinoma both histologically and immunohistochemically in its staining for alphafoetoprotein. It's a very rare tumor described in the ovary, the lung, the stomach, the kidney and the bladder. It is seen especially at the sixth decade. We report a case of a 73-years-old woman followed since 2008 for a poorly differentiated carcinoma of the left ovary treated surgically. In the absence of adjuvant therapy, she presented one year later, with a necrotic lomb-aortic mass and an increased level of CA125 [188 u/mm]. After three [3] courses of chemotherapy, the disease progressed rapidly with resumption of tumoral syndrome and bone metastases. The case was reviewed at our institution and implemented by an immunohistochemistry analysis. The diagnosis of hepatoid carcinoma of the ovary was therefore retained. This entity was first described by Ishikura and Scull in 1987. hepatoid carcinoma was reported 18 times in the ovary. The clinical and radiological signs are not specific. Biology can guide diagnosis with elevated serum AFP. The diagnosis is pathological. The differential diagnosis include ovarian metastasis of hepatocellular carcinoma and hepatoid yolk sac tumor. Differentiating the tumor is primordial and critical, because treatment modalities depend on the exact nature of the hepatoid cancer

Paratesticular rhabdomyosarcoma

Paratesticular rhabdomyosarcoma occurs predominantly in children and adolescents. is a rare tumor and It's developped proximal to the tesicle. Clinical signs are like any intrascrotal tumor. Scrotal ultrasound, CT scan and tumor markers are necessary for the diagnostic and stadification of this cancer. Orchidectomy followed by chemotherapy and radiotherapy is the usual treatment. We report 3 cases of paratesticular rhabdomyosarcoma. We discuss the diagnosis and therapeutic attitudes, evolutionary aspects and prognostic factors of these tumors re also discussed

News drugs of chemotherapy in advanced colon cancer

Almost 40 years after it's development Fluouracil [5FU] remains the chemotherapeutic mainstay of management for patients with advanced colon cancer. Recently alternative treatment strategies have been developed which offer the promise of greater convenience and enhanced efficacy. Several forms of oral Fluropyrimidines have been introduced and are promising as an alternative to parenteral 5FU based treatment. More importantly, irinotecan and oxaliplatine, cytotoxic drugs that act through mechanisms other than inhibition of thymidylate synthetase have shown to be effective in the treatment of this disease

chimiotherapie et la chimio-radiotherapie dans le cancer de l'oesophage

The cancer of esophagus is chemosensitive. The combination of CDDP plus 5FU remains the standard treatment.The concomitant radiotherapy and systemic chemotherapy has demonstrated high response rates with 20% of tumoral eradication this result is remarkable. The randomized studies. Have shown the superiority of the radio chemotherapy association in the in operables patients.However,trials are not sufficiently mature to precise its place in the treatment for the operable patients