Association métachrone d’un adénocarcinome rectal et d’une GIST: à propos d’un cas

Background

Gastointestinal stromal tumors (GISTs) are rare neoplasms. They represent less than 1% of all gastrointestinal tumors. Little is known about their association with other tumors of different histogenesis. Coexistence of GISTs, especially with metachronous or synchronous colorectal cancer, is a phenomenon with increasing number of relative reports in the last five years.

Case report

We report a 64-year-old man, with no history of disease, presenting with colorectal adenocarcinoma, treated with concomitant chemoradiotherapy, anterior resection of rectum, and adjuvant chemotherapy. After 9 months, he developed a locally advanced recurrent tumor. The patient received a second-line chemotherapy. Radiology estimate after six cycles discovered incidentally an antral gastric mass, which measured 5/4 cm in tomodensitometry imaging. Histological examination of mass’s biopsy revealed a GIST, and immunohistochemistry proved positive CD117. The patient continued to receive chemotherapy because of both malignant progress of colorectal adenocarcinoma and poor prognosis. Surgery of GISTs will be considered if complete or partial responses to chemotherapy of colorectal cancer are achieved.

Discussion

The coexistence of GISTs and other primary tumors is usually discovered incidentally during GI surgery for carcinoma, or during work-up for radiological or endoscopy exploration. The known genetic pathways of tumorigenesis are different for the two neoplasms: c-kit appears to be occasionally overexpressed in colorectal cancer, and it is not clear if the protein is indeed a key player in the carcinogenetic process, as it is in GISTs. Other studies are necessary to assess if tyrosine-kinase inhibitors could be used in a multimodality regimen in colorectal cancer.     

Aspect anatomoradiologique de l’adénocarcinome duodénal: à propos d’un cas

A duodenal adenocarcinoma is a very rare type of tumour. The clinical signs are not specific, and they pose a diagnosis problem; hence the usefulness of endoscopic and radiological explorations. Cephalic duodenopancreatectomy is the first-choice treatment, especially in patients without ganglionic metastases. We report on the observation of a female patient, aged 52, showing the anatomical and radiological aspect of this location, which is rare in the literature. The follow-up period for this observation is one year.     

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.     

Dermatofibrosarcome de Darier et Ferrand : à propos d’un cas désespéré

We report this hopeless case in order to describe the bad prognosis factors may be life-threatening on short and medium term. The patient is aged 29 years, with a dermatofibrosarcoma protuberans of Darier and Ferrand of considerable size, with multiple recidivisms, and necrotic and ulcerative colitis. After transfusion and antibiotic therapy, the patient was released from the hospital without medical advice for financial reasons, before being taken over surgically. Early diagnosis and management without prepayement will improve the prognosis in hopeless cases of dermatofibrosarcoma of Darrier and Ferrand.     

Carcinome adénoïde kystique du sein: à propos d’un cas

Introduction

Adenoid cystic carcinoma (ACC) of the breast is a rare neoplasm, accounting for less than 1% of breast carcinomas. The aim of our study is to describe the epidemiological and clinicopathological characteristics, the treatment and the prognosis of this type of breast tumor.

Case report

We report a new observation occurring in a 53-year-old female patient, who consulted for a left breast nodule. The ultrasound and mammography showed that it was a well-limited mass. Diagnosis was based on a histopathological exam completed by histochimical techniques. Estrogen and progesterone receptors were positive. The patient was treated by lumpectomy with adjuvant radiotherapy and hormonal therapy.

Discussion

ACC of the breast has a favorable prognosis. The diagnosis is made by histological examination with histochemical or immunohistochemical techniques. The treatment is not well established. It consists of lumpectomy with radiation or mastectomy. Lymph node involvement or distant metastases seldom occur.     

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.     

Carcinome adénoïde kystique primitif du poumon : à propos d’un cas

Introduction

Primary adenoid cystic carcinoma of the lung is an uncommon disease, accounting for only 0.09–0.2% of all lung cancers. The speed of growth is slow and the clinical course is relatively long, so it is generally considered tobe a low-grade malignancy.

Case report

A 30-year-old man was admitted to hospital for investigation of haemoptysis. Bronchofibroscopy showed a polypoid tumour in the left lower bronchus. A CT scan of the chest showed that this tumour measured 4 cm in diameter and extended to the left lower pulmonary vessels. A complete excision was achieved by a left total pneumonectomy. The diagnosis of adenoid cystic carcinoma was made.

Discussion

Diagnosis of this unusual tumour is confirmed by pathologic examination. Its optimal treatment is a complete surgical resection whenever possible. However, postoperative radiotherapymay be the treatment of choice to control residual lesions and provide long-term survival in the case of incomplete resection.

     

Chondrosarcome mandibulaire: à propos d’un cas et revue de la littérature

Chondrosarcoma is a malignant cartilaginous tumor rarely found in the jaw bone. Tumor progression is slow with strong propensity to recurrence after surgical removal. The prognosis is poor and depends on the degree of differentiation and the quality of resection. We report a case of mandibular chondrosarcoma and discuss the epidemiology, diagnosis, treatment, and follow-up of these tumors.     

Métastases choroïdiennes d’un adénocarcinome pulmonaire traité par injections intravitréennes d’anti-VEGF et irradiation externe : à propos d’un cas

Choroidal metastases of lung cancer are very uncommon. This localization should be suspected on blurred vision and confirmed with an ophthalmological examination. Its treatment is not entirely codified. We report a case of blurred vision secondary to bilateral choroidal metastasis in a patient with choroidal metastases from a lung adenocarcinoma, treated by intravitreal anti-vascular endothelial growth factor (VEGF) injection and external beam radiotherapy. According to a literature review, we analyzed the place of the targeted treatments used alone or combined with the radiotherapy.     

Le carcinome adénoïde kystique du sein: à propos d’un cas et revue de la littérature

Adenoid cystic carcinoma is a rare type of breast cancer with distinctive histology. In contrast to extra-mammary localisation, the prognosis of adenoid cystic carcinoma of the breast is excellent although recurrence and distant metastases have been described. It can be confused with other more common breast cancers such as intra-ductal or invasive cribriforme carcinoma. We report a new case and we discuss the mainly clinical and pathological features.     

Schwannome présacré: à propos d’un cas

Introduction

Presacral schwannomas are rare benign tumors, representing 1% to 5% of all schwannomas. We report a case diagnosed by imaging modalities (CT-MRI) and treated by complete surgical resection.

Case report

A 55-year-old female has had a history of abdominal pain since one year without compressive signs. A pelvic retrorectal mass has been discovered clinically. CT and MRI were very suggestive of a presacral schwannoma. Histological examination after complete surgical removal of the mass confirmed the diagnosis of a benign schwannoma.

Discussion

Giant presacral schwannomas are rare pelvic tumors. Often asymptomatic, they are diagnosed lately. CT and MRI are very useful in assessing the diagnosis and evaluating the extent of the tumor. Surgery is the therapeutic modality of first choice. Prognosis is good if the tumor is benign but recurrence is frequent.

Conclusion

Presacral schwannoma can cause pelvic pain. Imaging modalities (MRI++) often guide surgical resection.     

Tumeur primitive inhabituelle de l’ovaire : lymphome malin non hodgkinien : à propos d’un cas

Non-Hodgkin primary ovarian lymphoma is an extremely rare tumour of which the histogenesis remains debated. Some authors consider it the manifestation of a generalized lymphoma disease. The prognosis is evaluated on the basis of the clinical stage, the histological type and the phenotype.Wepresent the case of a 13-year-old girl who presented with pelvic pain. Pelvic ultrasonography and tomography confirmed the ovarian origin. The diagnosis of B diffuse large cell lymphoma was established from the anatomic specimen after exploratory laparotomy and pathologic examination. Problems related to this rare entity are discussed in terms of diagnosis and therapy.     

Association d’un carcinome papillaire thyroïdien à une tuberculose thyroïdienne : à propos d’un cas et revue de la littérature

Introduction

Thyroid tuberculosis is a rare disease even in countries in which tuberculosis is an endemic disorder. Its clinical presentation is often misleading simulating goiter or thyroid neoplasia, and its diagnosis is most often histological. The association of thyroid cancer has been rarely reported in the literature.

Case

A twenty-five-year-old woman presented a right cervical swelling, lasting for 1 year in the context of fever and weight loss. Clinical examination found a right cervical mass with firm consistency. Thyroid function tests revealed a frank hyperthyroidism. Cervical ultrasound individualized the right thyroid lobe nodular mass and compressive necrotic lymph nodes, confirmed on neck CT-scan. Chest CT-scan showed signs of pulmonary tuberculosis. After obtaining euthyroidism by antithyroid drugs, the patient had surgery. Microscopic examination revealed thyroid and lymph node tuberculosis associated with thyroid papillary carcinoma. The patient was under bacillary treatment and received a 100 mCi dose of metabolic radiation therapy, followed by opotherapy with good clinical and biological evolution. The current follow-up is 2 years without metastasis.

Conclusion

The association of tuberculosis with thyroid papillary carcinoma is a very rare entity.

     

Carcinosarcome ovarien: à propos d’un cas

Ovarian carcinosarcoma, also called malignant mixed mesodermal tumor, is a rare ovarian tumor representing less than two per cent of ovarian cancers. Carcinosarcoma is an aggressive tumor, which associates some epithelial elements (carcinoma) with a stromal component (sarcoma). This tumor can be found in the female genital tractus, mostly in the uterus. It can be found even more rarely in the ovaries. The initial stage of the disease at the time of diagnosis is considered as the only prognostic factor. There is no existing consensus concerning treatment. Nevertheless, surgical treatment is paramount for the survival of patients. Response rates to chemotherapy are about 20%.     

Léiomyosarcome de la vésicule biliaire: à propos d’un cas

Primitive sarcomas of the gall bladder are extremely uncommon. Leiomyosarcoma, an unusual disorder of the sarcomas, is more prevalent in women. Its definitive diagnosis relies on immunohistochemical examination. We report a case of this rare disorder, i.e., a malignant tumour in the gall bladder, and also discuss different epidemiological and radiological aspects, as well as therapeutic strategies.     

Ostéosarcome du maxillaire : à propos d’un cas

Osteosarcoma is a malignant bone tumor; its maxillofacial location is relatively rare. Its diagnosis is based essentially on biopsy. The treatment involves surgery and adjuvant therapy. We report a case of maxillary osteosarcoma and discuss the epidemiology, diagnosis, treatment, and follow-up of this tumor.     

Métastase pinéale d’un carcinome mammaire : à propos d’un cas et revue de la littérature

Pineal metastases of solid tumors are rare. Primary cancer is generally absent at the diagnosis, for which a cerebral MRI is important. We report a case of pineal metastasis occurring in a 76-year-old woman treated for breast carcinoma in our department.     

Liposarcome paratesticulaire géant : à propos d’un cas

Liposarcomas are malignant tumours of mesodermic embryologic origin depend on greasy fabric. They are rare. The retroperitoneal space is their second localization aftermembers. The other locations, such as perineumand scrotal seats, are rare. The fundamental treatment is a complete and wide surgery, but is often difficult because of the extension of these tumours in various anatomical processions. The quality of the resection is the only prognostic factor found in the literature. The prognosis of these tumours remains unfavourable, with a high rate of locoregional recurrence. We report an observation of a man of 75 years to whom the diagnosis of liposarcoma was carried retrospectively after the anatomopathologic study of a bulky tumour inguinoscrotal. In the light of a new observation of paratesticular liposarcoma and the literature review, we propose to analyze the various epidemiological aspects; diagnostic difficulties of this affection and to specify the average therapeutic ones and prognostic elements.     

Rhabdomyosarcome embryonnaire paratesticulaire : à propos d’un cas et revue de la littérature

Paratesticular rhabdomyosarcoma is a rare tumor. Multimodality treatment should involve surgery, radiotherapy and chemotherapy, which are indicated according to risk groups. Risk group stratification depends on pretreatment staging and definitive histology. Patients older than 10 years or those with suspected lymph nodes on imaging have higher incidence of lymph node involvement. Prognosis is excellent for localized tumors, survival rates exceed 90%. We report a case of embryonal paratesticular rhabdomyosarcoma treated in our institution.     

Toxicité de l’association radiothérapie et antiangiogéniques : à propos d’un cas

The combined administration of antiangiogenic agents (AA) and radiation is being evaluated. No AA has yet received Marketing Authorization in this indication. However, they are widely used in medical oncology and criteria for stopping their administration in case of irradiation have not been defined. We report the case of a 63-year-old man experiencing grade 2 skin toxicity while on radiation treatment and sorafenib (400 mg twice daily) for a metastatic lesion developing between the vastus medialis muscle and the cortical of the mid-diaphysis of the right femur. Toxicity occurred at 21 Gy, for a total dose of 36 Gy (12 fractions of 3 Gy). Cutaneous symptoms rapidly disappeared after treatment discontinuation. Radiotherapy alone was resumed after a few days and the total dose could be delivered, with good tolerance. At 2-month follow-up, the intramuscular lesion had regressed. Several other cases of patients with poor tolerance to the association of AA and radiotherapy have been reported. Further studies of the effectiveness and tolerance of the combination treatment are needed before indications for AA can be extended to other diseases.