Adénocarcinome polymorphe de bas grade des glandes salivaires: à propos de neuf cas

Abstracts

Abstracts     

Carcinome papillaire du rein: étude rétrospective à propos de six cas

Introduction

Papillary carcinomas of the kidney are relatively rare tumors. The purpose of this study was to discuss clinicopathological and imaging features of six cases of papillary carcinoma.

Material and methods

In a retrospective study, we studied the clinicopathological and imaging features of six cases of papillary carcinoma retrieved in a 10-years period at the pathology department of F. Hached hospital (Sousse, Tunisia). These tumors were graded according to the new 2004 WHO histopathological classification of renal tumors, on which the prognosis depends.

Results

In our study, there were five men and one woman. The median age was 68 years, the tumors were asymptomatic in three cases and revealed by lumbar pain in the other three cases. Treatment consisted of radical nephrectomy in five cases and tumorectomy in one case. The tumors measured 15 to 110 mm. The tumor was multifocal in one case. Histopathological examination found type 1 in 3 cases and type 2 in three cases. Metastases were observed in one case.

Conclusion

Renal papillary carcinoma represents a specific group characterized by their less aggressive behaviour.

     

Aspects diagnostiques et résultats du traitement chirurgical des tumeurs maxillomandibulaires : à propos de 23 cas

Tumors of the maxilla and mandible are common and diverse in nature. Their treatment is based primarily on the large surgical resection. We report in this study our experience in the surgical management of these tumors at the Military Hospital Ouakam. This was a retrospective study of 23 cases diagnosed in the Military Hospital Ouakam (HMO, Dakar, Senegal) from 2004 to 2012. There were 18 cases of benign tumors (78.3%) and 5 cases of malignant tumors (21.7%). We had 7 cases of maxillary tumors (30.4%) including 5 cases of cancer (71.4%of tumors of the jaw) and 16 cases of tumors of themandible (69.6%), all benign. The circumstances of discovery in cases of malignant tumors were mainly marked by the oral ulcerative lesions (80%). Themean duration of symptoms was 5.8 months. The circumstances of discovery for benign tumors were dominated by facial swelling (100%) with a mean duration of 3.5 years. Panoramic dental radiography showed picture of osteolysis in 23 cases (100%). The ameloblastoma was the first maxillo-mandibular tumor with 14 cases, 60.9% of all tumors and 77.8% of benign tumors. Squamous cell carcinoma was the second tumor with 4 cases, 17.4% of all tumors and 80%of cancers. Surgical treatment had consistedmainly of a large resection of the tumor (69.6%). The evolution was good for benign tumors and bad for malignant tumors after a mean follow-up of 9.8 months.     

Les lymphomes osseux primitifs au Maroc. Étude rétrospective à propos de 12 cas

Primary bone lymphomas (PBL) are rare. They account for 5% of the primary bone tumors and 1% of the whole of the lymphomas. This is a retrospective study over four years PBL cases gathered at the National Institute of Oncology in Morocco between January 2003 and December 2006. The median age was 44 years; the average time of diagnosis was 11 months. The predominant localization was the lumbar spine. Treatment was based on chemotherapy and radiotherapy. A laminectomy was conducted in the menacing spine localizations. The protocol of chemotherapy used was the CHOP. The follow-up varied, with extremes ranging from 1 month to 3 years. During this follow-up, no relapse was detected. Although the PBL are aggressive tumors, the prognosis is better than other bone tumors.     

Dose de tolérance à l’irradiation des tissus sains : les glandes salivaires

Xerostomia is one of the most a common complication of radiotherapy for head and neck cancers, affecting quality of life. Parotid glands produce approximately 60% of saliva and submandibular glands 20% of saliva while the rest is secreted by sublingual and accessory salivary glands. Methods of measuring the salivary output are collection of unstimulated or stimulated saliva or 99mTc-pertechnate scintigraphy. Several studies demonstrated that late salivary dysfunction after radiotherapy has been correlated to the mean parotid gland dose, with recovery occurring with time. Severe xerostomia could be avoided if at one parotid gland is spared to a mean dose of less than approximately 25–30 Gy. Clinical benefit of submandibular gland sparing is more controversial. A mean dose less than 39 Gy could preserve submandibular gland function. This paper aims to review main studies evaluating tolerance dose of salivary glands.     

Étude clinicopathologique des carcinomes lobulaires du sein dans le Centre tunisien : à propos de 74 cas

Objective

To analyze the epidemiological characteristics and clinicopathologic features of breast lobular carcinomas in the Central Region of Tunisia.

Patients and methods

A retrospective study was carried out on all breast lobular carcinomas cases diagnosed in the Department of pathology, CHU Farhat Hached Sousse (Tunisia) from 1990 to 2005. The demographic, clinical, histological and treatment were analyzed. The probability of survival or recurrence was calculated using the Kaplan-Meier method. Prognostic factors were studied using the log-rank test.

Results

The mean age was 51 years old and half of the patients were postmenopausal. The average clinical tumor size at diagnosis was 49.9 mm. Seventy five percent of the patients were seen at an advanced stage of the disease (stages T3 an T4). The histological diagnosis was based in all cases on preoperative biopsies. It was in most cases the classical form (94.6%), a low histological grade (64.8%) and hormone receptor positive (65.5%). Surgical treatment was performed in 74.3% cases. Overall survival and disease-free survival at 5 years were respectively 94 and 70.9%. No local recurrence was observed after conservative treatment. Metastasis to lymph node, the clinical stage, the histological grade and non-expression of hormone receptors were significant factors influencing disease-free survival.

Conclusion

Our results were compared with data from literature and show that lobular carcinoma is rare, its diagnosis is often difficult and late, surgical treatment and its prognosis do not currently appear to differ from ductal carcinomas.     

Les tumeurs de vessie: aspects épidémiologiques et thérapeutiques à Brazzaville

Objectives

To define the epidemiological variables and to appreciate the therapeutic and evolutionary aspects of bladder tumors.

Patients and methods

The study is a retrospective survey of the files of patients hospitalized for bladder tumor in the Department of Urology and Andrology of Brazzaville University Hospital between 1990 and 2006. During this period, 82 patients had been hospitalized for bladder tumor. Only 40 complete files have been used for the survey. The epidemiological, diagnostic, therapeutic and evolutionary aspects have been analyzed.

Results

Bladder tumors are the second most prevalent urogenital tumors after the prostate tumors, with a frequency of 4.78%. The mean age of the patients was 51 (range 23–77) years. The majority of the patients came from the southern part of the country, which is a zone of endemic bilharzia. Hematuria was the main clinical sign. The diagnosis was based on ultrasound and intravenous urography. Anatomopathological examinations performed in 11 patients revealed a predominance of transitional carcinomas of epidermoids. Among the 40 patients, 17 (43%) had been treated surgically, with 4 (23%) recidivisms. Eleven (27.5%) patients died during the period of survey.

Conclusion

Bladder tumors in Congo seem more frequent in the zones of endemic bilharzia.     

Maladies trophoblastiques gestationnelles persistantes: une étude de 26 cas

Objective

This retrospective study aimed at discussing epidemioclinical criteria and therapeutic results of persistent gestational trophoblastic disease (PGTD) and choriocarcinoma throughout a series of 26 patients treated between 1990 and 2002.

Patients and methods

We reviewed the epidemioclinical records of all the patients. After aspiration, pretherapeutic work-up, and hebdomadary dosage of plasmatic HCG, patients were divided into three prognostic groups according to the Gustave-Roussy Institute (IGR) classification (hydatidiform mole, low-risk tumors, and high-risk tumors). They were treated with different chemotherapy regimens: monodrug methotrexate therapy, AE protocol (actinomycin and etoposid), and APE protocol (actinomycin, etoposid, and cisplatinum) adapted to each group.

Results

The mean age was 32 years (extremes: 20 and 49). Metrorragia and pelvic pain were themost frequent symptoms. There were 20 cases of PGTD (mole retention: three cases, invasive moles: 16 cases, and choriocarcinoma: one case) and six primary choriocarcinomas. All the evaluable patients were cured with the first-line chemotherapy or after salvage chemotherapy in patients with considerable risk for the disease who showed a resistance to monodrug methotrexate therapy. We recorded two toxic deaths with APE protocol.

Conclusions

The epidemioclinical criteria did not have any particularity. We confirmed the effectiveness of chemotherapy in PTGD. However, if we consider efficacy/toxicity ratio and the recent data of the WHO classification modified by FIGO, therapeutic deescalate may be justified at least in patients with good observance.     

Les lymphomes primitifs du tube digestif (LPTD) dans le centre tunisien : étude anatomoclinique et résultats thérapeutiques à propos de 153 cas

Primary gastro-intestinal lymphoma (PGIL) is the most common type of extra-nodal non Hodgkin’s lymphoma. Their clinical and histological presentations are heterogeneous depending on the site of the lesion. There is no consensus regarding the role of surgery and chemotherapy in the therapeutic approach. In our country epidemiology of the disease is unknown with IPSID being the most frequent type. We report anatomo-clinical features and prognostic factors of PGIL and compare intestinal to gastric forms in our region. This is a retrospective study of 153 cases of PGIL in adults diagnosed and treated in the department of medical oncology in Farhat Hached Hospital between 1994 and 2006. The median age was 52 years and the sex-ratio 2.1. Tumor sites were gastric (67%), intestinal (26%) and gastrointestinal (7%). Abdominal pain (87%) followed by vomiting and diarrhoea (37 and 15%) were the most common symptoms. Performance status (PS) < 2 was seen in 80% of patients, high grade lymphoma in 70.5% of cases and B phenotype was noted in 85%. MALT lymphoma accounts for 50% of cases, and IPSID for only 5% of PGIL. About 47.5% of cases were stage IE, 138 patients had chemotherapy with an objective response rate of 77%. Only 46% of patients had surgery (14 for surgical complication, 6 for residual tumor after chemotherapy and 22 to have histological diagnosis). The five-year overall survival (OS) was 62%. In high grade lymphoma patients favorable prognostic factors for OS included young age ≤ 60 years, PS < 2, normal serum LDH, hemoglobin > 12 g/dL, B phenotype, localised stage (IE-IIE1), anthracyclin-based chemotherapy regimen, achieving complete or partial response to induction chemotherapy and no relapse. In multivariate study only relapse and PS were significant prognostic factors for OS. In low-grade lymphoma patients, none of these factors had a significant correlation with OS: age ≤ 60 years, PS < 2, stage (IE-IIE1), response to induction chemotherapy, relapse. Compared to gastric lymphomas, intestinal cases occurred at a younger age, frequently with diarrhoea, weight loss, and occlusion. They are more often high-grade, T phenotype and have locally advanced stage (IIE); surgery is more common in this group. We conclude that stomach is the main site of PGIL in our region, intestinal lymphoma is less frequent and IPSID has become rare. Recent progress in chemotherapy has allowed good therapeutic results with a conservative approach. Surgery may be performed in case of emergency or for residual lesions after medical treatment.     

Les tumeurs mésenchymateuses malignes des membres à Brazzaville

Malignant mesenchymatous tumors are uncommon diseases. From 1st January 1996 to 31st May 2008, a period of 12 years and five months, 5307 new cases of cancer were recorded; of these, 33 cases (0.86%) of malignant mesenchymatous tumors, representing 71.72% of all malignant mesenchymatous tumors, were located in the limbs: 10 cases on upper limbs (30.30%) and 23 cases on lower limbs (69.69%). The average age was 36.69 years (range: 15 to 75 years); the mean reason for consultation was the discovery of tumor masses, with an average time before consultation of 16.5 months. The average size of tumor was 13.33 cm (range: 7 to 24 cm). The histological types frequently met were undifferentiated sarcoma (30.3%) and fibrosarcoma (30.3%), rhabdomyosarcoma (18.2%), chondrosarcoma 6.0%, leiomyosarcoma 6%, hemangiopéricytoma 6%, and synovialosarcome (3%). The immunohistochemical test was evocated in the precision of the histological type and the subsequent management of the tumors. Eleven patients did not receive specific treatment. After 12 months, 19 patients had died, seven patients had been lost to follow up, and seven patients were alive.     

Les tumeurs desmoïdes en pédiatrie : état des connaissances actuelles

Desmoid tumor (DT) or aggressive fibromatosis is a histologically benign-appearing neoplasms of the soft tissues, arising from connective tissues, the fascial sheaths and musculoaponevrotic structures of muscles. DT is a non-metastasizing tumor but has a potential for local invasion and local recurrence. DT can be seen in all age groups including young children. The overall incidence is reported as 2-4 cases per million per year. The etiology of DT is unknown. However, a genetic predisposition, familial adenomatous polyposis and Gardner's syndrome, has been implicated in 2% of the cases. The histological diagnosis has to be confirmed by biopsy in order to eliminate other sarcomas. The clinical behavior of DT seems unpredictable with a high rate of local recurrence. Treatment depends on the aggressiveness of the disease. A “wait-and-see” strategy is, at the present time, preferred in case of asymptomatic or non-progressive disease. Complete resection after surgery is rare, that is why first-line surgery should be seriously questioned and only considered when a complete resection can be feasible without functional or cosmetic damage. If not, medical treatments (cytotoxic or not) are rather discussed. Radiation therapy is rarely an option in children in this benign tumor. Authors present accurate knowledge of this disease in children.     

Mucocèles nasosinusiennes post-radiques à propos de trois cas

Nasosinusal mucoceles, although benign, are aggressive and sometimes destructive lesions. They may occur as a result of trauma, infection, sinus surgery and head and neck radiation. We describe three patients presenting mucocele, with the history of nasopharyngeal and temporal fossa cancers treated by radiotherapy.     

Adénocarcinome de bas grade des fosses nasales : à propos d’un cas

Low-grade sinonasal adenocarcinomas are uncommon and recently described entities. Its histologic diagnosis is challenging. This tumour is characterized by a tendency to local invasion, and rare distant metastases. Well treated, the prognosis is excellent. We describe a case of low-grade nasal cavity adenocarcinoma and discuss the anatomoclinical, therapeutic and evolutionary characteristics of this malignant tumour. A 54-year-old female patient presented with a 10 years history of right-sided nasal obstruction and recurrent epistaxis. On examination the patient had a large, firm mass in the right nasal cavity. Endoscopic sinonasal surgery was performed. The lesion was found to originate from the posteriolateral wall of the right nasal cavity. Histopathology analysis identified a low-grade sinonasal adenocarcinoma. Upon follow-up 4 years after surgery, the patient exhibited no clinical evidence of recurrence. Low-grade sinonasal adenocarcinomas are poorly defined neoplasms, accounting for 4 to 20% of all sinonasal malignancies. The nasal cavity is the most frequently involved site. Low-grade sinonasal adenocarcinomas pose a diagnostic challenge for the pathologist because they must be distinguished from benign tumours, especially adenomas. The primary treatment of sinonasal adenocarcinoma is complete surgical excision.     

Extravasation médiastinale de chimiothérapie cytotoxique : à propos de deux cas

The central venous catheter is a medical device commonly used in oncology for the administration of cytotoxic drugs, antibiotics, or parenteral nutrition. The usual complications are infectious, thrombotic, or mechanical in nature. An uncommon complication is catheter misplacement. Only a few cases of mediastinal infusion of cytotoxic chemotherapy have been reported. We report two cases of mediastinal catheter position. Checking the correct positioning of the catheter through chest radiography and the existence of blood reflux are necessary before utilisation of the catheter.     

Carcinome colloïde pur du sein : étude anatomoclinique de sept cas

PurposeBreast mucinous carcinoma is a particular histological form characterized by the extracellular production of mucus. The pure form is rarely reported and its prognostic is better than the other types of the breast cancer. The aim of the present study was to discuss the various anatomoclinical, therapeutic aspects and the prognostic factors of the pure mucinous carcinoma of the breast.Patients and methodsWe report seven cases diagnosed over a period of 11 years (1993-2003) in the laboratory of anatomy and pathological cytology of the university hospital of Sfax. A review of the clinical files with immunohistochemistry study (hormonal receptor, synaptophysine, chromogranine, Bcl2, Ki67, P53 and Her-2/neu (C-erbB-2)) were carried out for all the cases.Resultspure colloid carcinoma of the breast accounted for 0,5% of the whole of the breast cancers. The average age of patients was 69 years. At the time of the diagnosis, four tumours were classified T4, one T3, two T2, two N1 and one N3; no patient had presented metastasis (M0) according to pTNM classification. The echomammography showed regular contours mass in four cases. The anatomopathological study showed that the neuroendocrine differentiation was found in two cases, all the tumours had presented positivity for the hormonal receptors (oestrogen and progesterone) and negativity for the other antibodies, two cases exhibited the Bcl2 positivity and negativity for the other antibodies. An adjuvant radiotherapy was carried out for all the patients. The average duration of follow-up was of 33 months; the evolution was marked by the occurrence of metastases in two cases.ConclusionThe pure colloid carcinoma of the breast constitutes a particular morphological entity which deserves to be individualized; neuroendocrine differentiation of these tumours must be required. Their forecast is relatively favourable.     

Lymphomes non-hodgkiniens des tissus mous maxillofaciaux : à propos de deux cas et revue de la littérature

The extranodal non-Hodgkin lymphomas of maxillofacial soft tissues are rare. We report two cases of maxillofacial soft tissue non-Hodgkin lymphoma treated with chemotherapy followed by localized radiotherapy with complete remission after 3 and 6 months. We study the clinical, radiological and histopathological features as well as the treatment and the prognosis of extranodal non-Hodgkin lymphomas maxillofacial muscles.     

Adénocarcinome gastrique du jeune tunisien: à propos de 18 cas

Abstract

Gastric adenocarcinoma in young patients is considered as a cancer among the old. Its occurrence among the youth is rather rare and reputed to be of a bad prognosis.

Objective

To study the epidemiological, clinical, anatomopathological, therapeutic and prognosis characteristics of gastric adenocarcinoma among the youth.

Material and methods

A retrospective study was carried out between January 1990 to December 2004, during which 157 patients were researched for gastric adenocarcinoma. The young patients were defined according to an age inferior or equal to 40. In order to be able to highlight this study, we compared the group of young patients (group I = GI) to the rest of the patients of the series (group II = GII).We used the TNM-classification as well as the OMS-classification. We regrouped the stage T1 with T2 and the stage T3 with T4, and the tumors that were averagely differentiated with the ones that were the least differentiated. Likewise, the treatment was considered as curative as the quality of the removal was of the type R0 and the tumors of the cardia and the pan-gastric ones were regrouped with the lesions of the body as proximal cancer. The variables were analyzed with the software SPSS 8.0.

Results

We have retained 18 cases studies consisting of 12 women and six men. The average deadline of the diagnosis was eight months within GI vs nine months within GII. The tumor was located at the level of the antrum in seven cases (38%). The average size was 4.8 cm within GI vs 5.7 cm within GII. Treatment carried out was a subtotal gastrectomy in six cases (33 vs 52.9%) and a total gastrectomy in 12 cases (66.6 vs 47.1%). The treatment was judged to be curative within 17 patients (94.4 vs 71.9%). The adenocarcinoma was little or averagely differentiated in 88.9% of the cases. The component with the bezel-like cells was found among ten patients (55.5 vs 35%). A nervous sheathing was found in three cases (16.7 vs 19.5%) and some vascular embolisms were found in four cases (22.2 vs 22.3%). Five patients represented a recurrence (29.4 vs 23.7%). The survival rate after five years was 49.5 vs 38.3%.

Conclusion

Gastric adenocarcinoma among the youth is significantly much more common among women. It is characterized by its histological type which is little or averagely differentiated as well as by the frequency of the component of independent cells. Despite these pejorative features, the quality of the removal is not affected at all and the global follow up to five years is similar in the two groups of patients.