[Vaginal leiomyosarcoma. Apropos of 2 cases and review of the literature]. / Léiomyosarcome du vagin. A propos de deux cas et revue de la littérature.

The leiomyosarcoma of the vagina is extremely rare. This paper reports two observations treated at the Ibn Rochd oncology center of Casablanca. The first patient was 32 years old, and presented a tumor of 15 cm to the detriment of the posterior wall of the vagina. The treatment consisted of a large exeresis of the tumor followed by postoperative radiotherapy. After 50 months, she is still alive. The second patient who was 42 years old, had a 10 cm tumor of the posterior wall of the vagina. A tumorectomy was realized and then the patient was not heard of. The evolution was marked by the appearance of pulmonary metastasis and a palliative chemotherapy was prescribed. This patient is deceased after 31 months. Seventy-five cases only are described in the literature. The surgery is the basic treatment whereas radiotherapy is still discussed. The prognosis of these tumors remains linked especially to the histological rank.

[Adenocarcinoma of the cervix uteri: a retrospective study of 83 cases]. / Adénocarcinome du col utérin: étude rétrospective de 83 cas.

UNLABELLED: The frequency of the adenocarcinoma of cervix uteri is increasing. AIM OF THE STUDY: To define the characteristics of the entity. PATIENTS AND METHODS: Between 1986 and 1992, 83 adenocarcinoma of cervix uteri, were treated at the Ibn Rochd Oncology Centre in Casablanca. It's a retrospective study with univariate analysis of the prognostic factors. This analysis was done for patients who were followed until the death or have 5 years or more follow up and the survival was calculated according the Kaplan & Meier method at 5 years. The local and regional recurrence factors were evaluated statically according the chi 2 and those for survival rate according the Logrank test. RESULTS: The frequency increased during the period with 2.1% in 1986 and 8.2% in 1992. The median of aged was 49 years. Fifty one patients have localised stage. Combined radiotherapy and surgery was performed in 66 cases and 17 received radiation alone. The loco-regional control was obtained in 83% among 73 available patients for results. The univariate analysis showed that the histological type was not a significant factor. However, age, tumor size, stage, histological grade and lymph node involvement were significant factors. These factors, the degree of differentiation and the lymph node involvement were significant for the 5-years survival. CONCLUSION: The prognosis factors of the cervix uteri adenocarcinoma are, size tumor more than 4 cm, lymph node involvement, microscopic involvement to the parameters and positives excision merges.

[Nephroblastoma in adults. Three case reports]. / Le néphroblastome de l'adulte. A propos de trois cas.

The authors report three nephroblastoma's cases occurred in adult and treated at Ibn Rochd Oncology Center at Casablanca. The average of age was 24 years (19-29 years) and the delay of diagnosis was five months (3-8 months). The most frequent clinical sign was a lumbar fossa mass. At diagnosis, radiological exams revealed that patients presented an advanced stage and metastatic disease in one case. The treatment was a total nephrectomy with ganglioma dissection when the tumor was resectable followed by chemotherapy and radiotherapy. Two patients was in progressive disease despite treatment, and one patient was lost at follow-up. The prognosis of adult's nephroblastoma remains very severe, due to the advanced stage at diagnosis and the mediocre reply to the treatment.

[Primary malignant melanoma of the cervix uteri: apropos of 1 case with review of the literature]. / Mélanome malin primitif du col utérin: à propos d'un cas avec revue de la littérature.

The authors report a case of malignant melanoma of the cervix uteri diagnosed in a young 35-year-old patient. Isolated genital bleeding was the beginning symptom. The physical exam showed a cervical dark tumor, with extension into the vagina (superior third), the parametrium was free. Cervical biopsy concluded to a malignant melanoma. No other abnormalities were observed and the tumor was classed stage IIA-FIGO. A total hysterectomy with bilateral annexectomy and pelvic lymphadenectomy was performed. In the way, the patient died after ten months by local and general recurrence. Primitive malignant melanoma of the cervix uteri is rare. Only 39 cases are reported in literature at this day. It is usually initially misdiagnosed mainly in the achromic forms, then the immuno-histochemical study is useful. Its treatment is not well codified and its histogenesis was controversial for a long time.

[Pure choriocarcinoma of the testis: report of a case and review of the literature]. / Choriocarcinome pur du testicule: à propos d'un cas avec revue de la littérature.

We report a case of a young man 31 years old treated at the Ibn Rochd Oncology Center for a pure choriocarcinoma of the right testis. The first examination note a skin metastasis without another localization. The beta HCG level was 328 mu/mL. The diagnosis was confirmed by pathological examination of the testis after orchidectomy. The adjuvant treatment consisted in chemotherapy like using in germ cell neoplasm's of the testis. During the evolution, partial remission (50%) was obtained after the third course and complete remission one month after the end of treatment. The patient still alive after 20 months.

[Clear-cell carcinoma of the larynx: review of the literature apropos of a case]. / Carcinome à cellules claires du larynx: revue de la littérature, à propos d'un cas.

Clear cell carcinoma of the larynx is exceptional. Only six cases are described in the literature. We report a new case occurring in a 58-year-old man. The treatment consisted of a total laryngectomy with lymph node dissection followed by adjuvant irradiation. Local and regional recurrence occurred after 5 months. The patient died from the tumor's evolution 12 months after the diagnosis. The prognosis of clear cell carcinoma of the larynx is similar to the clear cell carcinoma of the lung and is unfavorable.

Study of human leukocyte antigen class I phenotypes in Moroccan patients with nasopharyngeal carcinoma.

Previous reports demonstrated an association between the human leukocyte antigen (HLA) and risk for nasopharyngeal carcinoma (NPC) among the Chinese in Singapore, a population with a high incidence of this malignancy. In our study, we assess the association between HLA and NPC in Morocco, a median-prevalence area for this cancer, where NPC presents the particularity of also affecting young individuals. Using the standard microlympho-cytotoxicity test, we typed a total of 154 Moroccan NPC patients and 257 unrelated healthy controls for their HLA-A and B antigens. The results of these analyses show that the frequencies of HLA-A10, HLA-B13 and HLA-B18 were found to be higher in the NPC group than in the control group, whereas HLA-A9 was associated with a decreased risk. After correction for the number of specificities tested, these differences were statistically significant only for HLA-B18 (corrected p value [pc] < 0.023, relative risk [RR] = 4.14) and HLA-A9 (pc < 0.023, RR = 0.45). The comparison of the distribution of the HLA antigens in younger and older cohorts of patients shows that the incidence of HLA-A10 and HLA- B18 was higher in the older group, whereas the frequencies of HLA-A19 and HLA-B13 were significantly higher in younger patients compared with controls. The presence of both HLA-A19 and HLA-B13 phenotypes correlated with an increased risk of developing NPC among overall patients compared with controls. According to the sex distribution, increased frequency of HLA-B18 was found in male and female NPC patients compared with controls, whereas the frequency of HLA-A10 was higher only in male NPC patients compared with controls.

[Primitive seminoma of the mediastinum: a case report]. / Séminome primitif du médiastin: à propos d'un cas.

In this study, the case has been reported of a 36-year old male who was treated at the Ibn Rochd Oncology Center in Casablanca for a primary mediastinal seminoma revealed by a symptomatology including cough, dyspnea, laterocervical swelling, rachidial pain and gait disorder. The preliminary investigation showed significant mediastinal enlargement with a right pleuritis and vertebral metastases; tumor markers were normal. The diagnosis of seminoma was confirmed by pathological and immunohistochemical analysis of the cervical adenopathy. Disease management consisted of BEP/cisplatin type chemotherapy and lumbar, mediastinal, and supraclavicular radiotherapy. The response after four courses of combined chemo-/radiotherapy was estimated at 25%, but the patient died from respiratory failure five months after the initiation of treatment.

[Yolk sac tumor. Report of a case]. / Tumeur du sac vitellin. A propos d'un cas.

Yolk sac tumor is rare in adult. We report a case in a young man aged of 23 years treated by orchiectomy, chemotherapy and retroperitoneal lymphadenectomy. Diagnosis is based on pathology who shows other cellular contingents. Treatment is based on orchiectomy and chemotherapy is indicated for residula masses. The prognosis is bad because metastasis is frequent.

[Association of fallopian tube cancer and polymyositis. Apropos of 1 case]. / Association d'un carcinome tubaire primitif et polymyosite. A propos d'un cas.

A 51-year-old woman consulted for pelvic pain, metrorrhagia and leukorrhea. Physical examination revealed a renitent and mobile mass in the pelvis. A right lateral uterine mass with hydroxalpinx was found at ultrasonography. Pathology examination of the right annexectomy specimen provided the definitive diagnosis: fallopian tube cancer with polymyositis. No residual tumor was found at total hysterectomy with total bilateral annexectomy. The patient was lost to follow-up for three years without complementary treatment then consulted later for functional disability of the upper then lower limbs with myalgia, swallowing disorders and left supraclavian node enlargement resulting from pelvic relapse of the right fallopian tube adenocarcinoma and left supraclavian metastasis with paraneoplastic polymositis. The patient was given 6 courses of chemotherapy with radiotherapy (45 Gy) centered on the left clavian region. The patient exhibited a spectacular response, and remains in complete remission 50 months after diagnosis. The association of a fallopian tube tumor with polymyositis is exceptional, requiring rapid anticancer treatment effective against the cancer and the paraneoplastic polymyositis.

[Papillary carcinoma from the thyroglossal duct cyst: review of the literature and report of a case]. / Carcinome papillaire sur kyste du tractus thyréoglosse: revue de la littérature et à propos d'un cas.

Cancer of a thyroglossal duct cyst is very rare. Clinical presentation is identical that of a benign cyst, and the diagnosis is histopathological. We report the case of 36 year-old woman treated for papillary carcinoma of a thyroglossal duct cyst. The treatment was surgical excision according Sistrunk method. There was no distant spread. After 22 months follow up, the patient is alive, with no signs of recurrence.

Antibodies to the Epstein-Barr virus transactivator protein (ZEBRA) as a valuable biomarker in young patients with nasopharyngeal carcinoma.

Epstein-Barr virus (EBV)-associated nasopharyngeal carcinoma (NPC) generally occurs in adults, especially in high-prevalence populations such as the Chinese and Eskimos. In Maghrebian populations, young patients affected with this malignancy represent 25% of the total NPC cases. In adults with NPC, relatively high titers of IgA antibodies to the EBV viral capsid antigen (VCA) and early antigen (EA) represent important markers. However, nearly 50% of young NPC patients are negative for IgA-anti-VCA and -EA or exhibit very low titers of these antibodies. We report here that 92% of sera from young NPC patients negative for IgA-EA and 89% of those negative for IgA-VCA were positive for IgG antibodies to the EBV transactivator protein (ZEBRA) at very high titers. Our results show that in young patients with NPC these antibodies represent the most reliable marker for diagnosis and prognosis, particularly when compared with conventional NPC markers, i.e., IgA-VCA (58%) and anti-EA (25%). The titers of IgG-ZEBRA antibodies increased along with lymph node involvement only in the young patient group, suggesting a prognostic value of this marker in this patient group.

[Colorectal cancer in patients younger than 40 years of age]. / Cancers rectocoliques chez le sujet de moins de 40 ans.

Between 1988 and 1994, 326 patients with colorectal cancers were treated at the Ibn Rochd Oncology Centre in Casablanca; 88 patients were less than 40 years old (27%). There were 79 males and nine females. A family history of colorectal cancer was noted in 5%. The most frequent symptoms were bleeding and rectal pain. The localisation of the tumour was the rectum in 70 cases. According to the anatomopathological profile, Dukes stages C and D were the most frequent and mucosal adenocarcinoma was noted in 24 cases. Seventy patients had surgery, associated with radiation therapy in 59 cases. Adjuvant chemotherapy was given in 44 cases and palliative treatment in 17 cases. Recurrence occurred in 14 cases and metastasis in other six cases. At five years, overall survival and disease-free survival rates were 24% and 17%, respectively. Worse prognostic factors were mucosal adenocarcinoma, poor differentiated adenocarcinoma and Dukes C and D stages.

[Liposarcoma of the larynx. Review of the literature apropos of a case]. / Liposarcome du larynx. Revue de la littérature à propos d'un cas.

Liposarcoma of the larynx is an uncommon tumor. Only 27 cases have been described in literature. We report a new case occurring in a 50-year-old patient. The treatment consisted of a total laryngectomy with lymph node dissection followed by adjuvant irradiation. Prognosis for laryngeal liposarcoma is better than that of non laryngeal liposarcoma. This tumor is at high risk of local recurrence and seldom has metastatic potential.

Nasopharyngeal carcinoma in children under 15 years of age: a retrospective review of 65 patients.

BACKGROUND: Nasopharyngeal carcinoma constitutes comprises up to 5% of primary childhood cancers but literature lacks modern uniformly treated large series. PATIENTS AND METHODS: A retrospective review was performed of sixty-five previously untreated patients younger than 16 years of age diagnosed and treated at the Ibn Rochd Centre in Casablanca between 1988 and 1992. Forty-four percent of them were stage T3 to T4 and 66% stage N2 or N3. All patients were irradiated. Prior adjuvant chemotherapy was administered in 33 patients. Thirteen patients were lost to follow-up. RESULTS: Local control was obtained in 85% of the 52 evaluable patients. The five-year overall survival was 42% and disease-free survival 38%. Ten relapses occurred at local and/or regional sites. Six patients have distant metastases. All 24 patients with relapse or persistent disease died despite salvage therapy. Stage, histology and dose of radiation, were statistically significant prognostic variables. Patients treated with chemotherapy followed by irradiation had a better outcome than those treated with radiation alone. CONCLUSIONS: Nasopharyngeal carcinoma in children is a rare chemosensitive tumor. However, conclusive treatment guidelines cannot be drawn from this series and prospective co-operative studies are needed for the development of more effective and less toxic therapeutic strategies.

[Combination of endoscopic resection and external radiotherapy in carcinoma of the bladder]. / Association de résection endoscopique et de radiothérapie externe dans les carcinomes de la vessie.

The authors present results that were obtained by combining endoscopic resection and external beam radiation therapy in a population of 55 patients presenting with bladder cancer. They also explain the difficulties they encountered in the management of bladder cancer at the Ibn Rochd Cancer Center (Casablanca, Morocco).

[Cancer of the uterine cervix in young women. A retrospective study of 337 cases]. / Cancer du col utérin chez la femme jeune. Etude rétrospective de 337 cas.

A retrospective study of 337 cases of cervix cancers in women aged 35 years and under, treated between 1980-1990 at the Ibn Rochd Oncology Center in Casablanca, was analyzed in order to determine the main characteristics of this disease and the influence of age on prognosis. The incidence of these cases was stable throughout the 11 years study period with a mean of 7.4% of all cervix cancers. The rate of early sexual activity in age under 18 years was particularly high, with 80%, of which 45.4% before the puberty. The advanced cases were predominating (58.2%). Earlier cases were treated with combined radiotherapy and surgery and advanced cases with radiotherapy alone. Overall survival rate was 41% at 5 years. It was 45.2% for the 31-35 years of age group and 32% for women aged 30 years and less. The prognosis of these younger women was especially poor in tumoral volume more than 3 cm, in advanced cases, in undifferentiated carcinoma and in cases of lymph node involvement. The comparative analysis of all prognostic factors in function of the age had permitted to show that women aged 31-35 years old have been a good prognosis, concerning survival at 5 years, in regard to women less 30 years.

[Malignant non-Hodgkin lymphoma in choroid and nasopharyngeal sites]. / Lymphome malin non hodgkinien à localisation nasopharyngée et choroïdienne.

We report the case of a 55 year-old man admitted in May 1993 for squamous cell carcinoma of the nasopharynx (T2N2M0). Initial polychemotherapy and radiotherapy were performed in nasopharynx and cervical nodes. After 8 months of complete remission, a choroidian tumoral process appeared. Due to the rarety of this localization of nasopharynx carcinoma, we reviewed the diagnosis with immunohistochemistry that showed T-cell extensive immunoblastic non Hodgkin lymphoma.

[Leiomyosarcoma of the larynx. Review of the literature apropos of a case]. / Léiomyosarcome du larynx. Revue de la littérature, à propos d'un cas.

Leiomyosarcoma of the larynx is extremely rare, only 21 cases were reported in the literature. The authors report a personal case in a 26 years old patient treated by a total laryngectomy and analyse all cases of the literature. It comes in relative young man (42 years old) in regard to the others ORL localisations. There is not tobacco relation. The lymph node extension is rare however the distant metastasis are frequent specially in lung. The treatment is based on surgery, the neck lymphadenectomy is possible in patients with cervical lymph nodes. The Leiomyosarcoma is a resistant tumor to the irradiation and chemotherapy however the postoperative irradiation is justified. The prognosis of this tumor is reserved on account of local recurrences and distant metastasis.

[Induction polychemotherapy before radiotherapy in carcinoma of the cavum. The experience of the Ibn Rochd-Casablanca Oncology Centre]. / Polychimiothérapie préradiothérapique dans les carcinomes du cavum. Expérience du centre d'oncologie Ibn Rochd-Casablanca.

This study is an analysis of the induction chemotherapy contribution in non metastatic nasopharyngeal carcinoma. Three chemotherapy cycles ("modified BEC" or not BEC, BEC: bleomycin-épirubicin-cisplatinum,) were delivered before irradiation in 90 patients. The rate of objective response was 57%. The chemotherapy response was better in patients no more than 35 year age, presenting with UCNT and not T4 or N3. Meanwhile, the chemotherapy protocol did not influence the response. The irradiation allowed the sterilization of 51 tumours and 49 of which were in satisfying response after chemotherapy. The sterilization by radiotherapy was influenced by the same factors as chemotherapy. The evolution showed 7 locoregional recurrences, 7 metastatic recurrences, and 2 patients presented with locoregional and metastatic recurrences. According to the Kaplan and Meier method, survival at 36 months was 61%. It was influenced by the same factors as chemotherapy and radiotherapy responses. The determining factor was indeed the chemotherapy response.