[Non-small lung cancer, ECCO/ESMO congres 2017]. / Cancers bronchiques non à petite cellule : congrès de l'ECCO/ESMO 2017.

During the esmo congress that took place from 08 to 12 September 2017 in Madrid, non-small cell lung cancer (NSCLC) was the subject of various communications and posters. We selected the most innovative and most likely to change our daily practice These updates presented concerned both localized and metastatic lung cancers. For completely resected localized stages minimal monitoring by annual CT scan is recommended, in stage III after radio chemotherapy durvalumab treatment provides better progression-free survival (PFS). For metastatic stages, pembroluzumab immunotherapy plus platinum-based chemotherapy in first-line is superior to chemotherapy alone in terms of response rate, second-line treatment with nivolumab provides better overall survival (OS) at 3years, the duration of 1year is characterized by a PFS lower than a continuous treatment. In EGFR mutated NSCLCs, the best choice between 3rd and 1st generation EGFR antigen has generated a lot of debate after the interesting results in terms of progression-free survival (PFS) of osamertinib in 1st metastatic line as well as for NSCLC with ALK rearrangement, alectinib was superior to crizotinib in the first metastatic line even in the presence of brain metastases.

Rare variant of metaplastic carcinoma of the breast: a case report and review of the literature.

BACKGROUND: Metaplastic carcinoma encompasses a group of neoplasms characterized by differentiation of the neoplastic epithelium into squamous cells and/or mesenchymal-looking elements. Spindle cell carcinoma is a rare variant of this special histological type. Its prognosis remains poor, with a high rate of local recurrence and distant metastasis. To date, only a small number of cases have been described. There is no clear agreement on this histological subtype. CASE PRESENTATION: We report a case of a 53-year-old Moroccan woman who consulted our institution following palpation of a nodule of the left breast. Mammography in combination with breast ultrasonography revealed a lesion classified as Breast Imaging Reporting and Data System 4 with microcalcification. The patient was diagnosed with spindle cell carcinoma of the breast. The diagnosis was based primarily on histological and immunohistochemical studies of the breast biopsy and secondarily on the surgical specimen. No local or distant metastasis was found. The treatment used was total surgical excision followed by radiotherapy. CONCLUSIONS: We describe the features (epidemiological, clinical, histological, immunohistochemical, and therapeutic outcomes) of our patient's case and compare them with literature data.

[Catheter fracture and pulmonary embolization of the distal fragment: a rare complication of the totally implantable venous access port]. / Rupture du cathéter et migration du fragment distal vers les artères pulmonaires : une complication rare des chambres à cathéter implantables.

INTRODUCTION: Totally implantable venous access port plays a crucial role in the treatment of patients in oncology. However, its use can result sporadically in catheter fracture with catheter tip embolization into pulmonary arteries. CASE REPORTS: We report this unusual but potentially serious complication in four patients. In these patients, the port had been inserted percutaneously into the subclavian vein using the infra-clavicular approach. This side effect occurred late in three patients. In all patients, the catheter fracture was asymptomatic or pauci-symptomatic and was caused by the pinch-off syndrome. The retrieval of the embolized fragments was successfully performed by transcatheter procedure in the cardiac catheterisation laboratory. CONCLUSION: We reviewed the literature and the newest guidelines and recommendations to detail the clinico-radiological features, the possible causes of this complication and discussed means to recognize, manage and prevent it.

[Complementary medicine in cancer patients under treatment in Marrakech, Morocco: a prospective study]. / Les médecines alternatives et complémentaires chez les patients cancéreux en cours de traitement à Marrakech, Maroc : étude prospective.

Use of complementary and alternative medicine (CAM) is very frequent in cancer patients. The aims of this study were to analyze the frequency, the reasons of use of CAM in patients with a cancer treated in a Moroccan oncology department. We included in this study 400 patients. An anonymous questionnaire was proposed to patients during treatment. Over 384 analyzable questionnaires, 71% of patients were using CAM. The most frequent method was religious therapy (60%). The second one was herbal medicine (36%). The main reason for using CAM was reducing psychic pain in 53%, and boosting the immune system in 32%. Adverse effects were reported in 2% of cases. Only 5% of patients discussed CAM with their doctors. The cost of CAM was less than 100 Euros in 88% of cases. To optimize the patient-physician relationship and to avoid a propensity to unproved treatments, accurate and adequate communication is necessary.

[Short and medium term cardiotoxicity of anthracyclins: a prospective study]. / Cardiotoxicité à court et à moyen terme des anthracyclines : étude prospective.

There is evidence that anthracyclins may affect the heart and ventricular function. This cardiac toxicity is frequent and serious. It is the first study in Morocco to investigate the frequency of anthracyclins cardiotoxicity. It has for objective to analyze the cardiotoxicity connected to anthracyclins, these risk factors as well as the echocardiographic parameters, which deteriorate prematurely. We led a forward-looking study between October 2008 and December 2009. With 90 patients followed in the service of oncology-radiotherapy and put under chemotherapy with anthracyclins. We conducted a study of various ultrasound parameters of cardiac function, before with anthracyclins, the third cure of chemotherapy, then in the 6th cure of treatment. Only 70 patients have been assessable. Average age was of 47 years (20-68 years); 91% were female. The cardiac function was preserved in 40% of the cases. Among our patients, 56% developed a decrease moderated in light of the cardiac function and 4% of cases developed a severe cardiotoxicity. The echocardiographic parameter most significant in our series was LVEF, followed by TEI index. We found a cardiotoxicity was strictly correlated with the cumulative dose, anthracyclins type and associated comorbidity. The anthracyclins cardiotoxicity is quite common in our series, which requires more thorough preventive measures including monitoring by echocardiography.

[Lymphoepithelial carcinoma of the conjunctiva: an unusual location]. / Carcinome lymphoépithélial de la conjonctive : une localisation exceptionnelle.

Lymphoepithelial carcinoma is an undifferentiated carcinoma associated with a lymphocytic infiltration and constitutes a rare category of malignant neoplasms that share morphologic features with undifferentiated nasopharyngeal carcinoma. Its pathogenic aspects remain unknown and it has been described at several sites, but it is rarely found in the conjunctiva. We report a case in a patient aged 66, revealed by a tumefaction of the internal angle of the left eye. The initial examination found a tumoral lesion in the medial canthus, extending to the medial half of the lower eyelid and a preauricular lymphadenopathy. Facial computed tomography scan showed that the lesion was responsible for an osteolysis of the medial wall of the left orbit. Histologic examination showed a proliferation of undifferentiated tumour cells with an intratumoral lymphocytic infiltrate. Immuno-histochemical evaluation led to a diagnosis of lymphoepithelial carcinoma (cytokeratin 7+, cytokeratin 20+, vimentin-). No Epstein-Barr viral genomic sequences were detected by in situ hybridization. Nasofibroscopy was normal. Treatment was a wide excision with enucleation, followed by 50 Gy external radiotherapy. After a follow-up period of 18 months, the patient was still in a situation of complete remission.

[Breast metastasis from vulvar carcinoma: case report and review of literature]. / Métastase intramammaire d'un cancer vulvaire: à propos d'un cas avec revue de la littérature.

The breast metastases resulting of vulvar carcinoma are very rare, and represent exceptionally the first manifestation of the disease. We report the case of a 42 year-old patient who underwent a treatment because of vulvar epidermoid carcinoma, right away metastatic at the level of the inguinal ganglia. The treatment consisted in a total vulvectomy with bilateral ganglial curretage, followed by external radiotherapy about the perineum and the inguinal ganglia. Three months after the end of her treatment, the patient presented with a nodula on the left outer breast with features of malignancy noticed by clinic and mammographic examination. The histologic study of the mammary biopsy showed epidermoid carcinoma of likely metastatic origin. A left Patey has been realized and confirmed the metastatic localization of epidermoid carcinoma with axillary ganglial metastasis (2N+/-7). Besides, this patient presented a right cervical ganglial parcel that the biopsy showed a metastatic localization of a vulvar carcinoma. A palliative chemotherapy type cyclophosphamid, adriblastin, cisplatine (CAP) has been admistrated during three cycles spaced out three weeks. The patient died 11 months after the supervene of the cerebral metastasis. We present this case because its rarety and to show the possibility of metastasis at the level of breast due to vulvar cancer. The clinicians must remember this possible tropism of the vulvar cancer for the breast, not only during the supervision and the complete examination as regards the disease spreading but also when the affection revealed unknown primary tumor. The diagnostic orientation is based on the mammography and the mammary biopsy. In this stage, the treatment is unfortunately palliative, the survival until a year is not more than 20%.

[Curable dementia revealing late congenital syphilis]. / Démence curable révélant une syphilis congénitale tardive.

UNLABELLED: Late congenital syphilis is a rare disease and its neurological expression is exceptional. We report a case revealed by a curable dementia. CASE REPORT: This 17-year-old patient presented for one year progressive dementia, frontal syndrome and extra pyramidal syndrome. The cerebral CT scan showed a diffuse cortical and subcortical atrophy. Blood and CSF positive antibodies confirmed the diagnosis of late congenital meningoencephalitis due to syphilis. The outcome after 13 months follow-up was favourable with penicillin therapy. COMMENTS: Late congenital syphilis is a rare disease, that may be exceptionally revealed by a curable dementia. Evolution may be favourable with early penicillin therapy.