Angiosarcome du sein : à propos de deux cas

Angiosarcoma is a rare type of breast cancer; it has the worst prognosis of all breast malignancies and it is difficult to diagnose. Its definition is pathological; it is a primary malignant proliferation of endothelial cells of vascular tissue of the mammary gland. We report two cases of breast angiosarcoma observed at the Maternity of Oranges and at the National Institute of Oncology. The preoperative diagnosis was raised on the clinical and pathological data. The treatment was essentially surgical. The evolution was marked by complete remission in both cases. In light of these two observations and the literature review, we tried to update on the various aspects of this disease.     

Dermatofibrosarcome de Darier-Ferrand: deux cas à localisation cervicofaciale

The authors illustrate the diagnostic and therapeutic difficulties encountered with Darier and Ferrand dermatofibrosarcoma from 2 cases report. Patients were 40 and 31 years old. In the first case, the tumour had been evolving for 4 years and occupied the submandibular region. In the second case, it had been evolving for 14 years and was localized in the parotido-submandibular region. The two patients benefitted from at least a biopsy or a partial surgical gesture before admission in our service. Surgical excision was wide. Both patients are alive after 4 and 2 years without recurrence and metastasis. Darier and Ferrand dermatofibrosarcoma is a cutaneous tumour of local malignancy, often diagnosed after several recurrences. The best treatment is surgery and consists in a wide and deep excision sacrificing healthy tissue.     

Profil histoépidémiologique des lymphomes au Togo: à propos de 755 cas observés au CHU Tokoin de Lomé

Purpose

Lymphomas are common and serious diseases. The aim of our work was to describe the epidemiology and histological features of these tumours in Togo.

Material and methods

Retrospective review of the lymphomas observed from 1984 to 2008 at the laboratory of pathology of the Tokoin Teaching Hospital in Lomé, Togo.

Results

During our study period, we observed 755 cases of lymphomas (including 92 Hodgkin diseases and 663 non-Hodgkin lymphomas) that represent 14.4% of all cancers. The average age of occurring was 26.2 years and the sex-ratio was 2 for the Hodgkin disease, and 32 years for non-Hodgkin lymphomas with a sex-ratio of 1.4. The Hodgkin disease was dominated by lymphocytic depletion (33.7%) and nodular sclerosis (28.2%) types. Non-Hodgkin lymphomas were extranodal in 256 cases (38.7%) and dominated by centroblastic type (27.1%) and Burkitt lymphoma (21.1%).

Conclusion

Lymphomas are frequents in Togo, occurring usually in young men.     

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.     

Cancers solides de l’enfant au Togo: aspects épidémiologiques et histopathologiques à propos de 365 cas observés au CHU Tokoin de Lomé

Childhood cancers are rare. The aim of our work was to describe the epidemiological and histological aspects of these tumors in Togo. We made a retrospective review of the epidemiologic and pathologic features of solid cancers in childhood (less than 15 years), observed from 1984 to 2008 at the laboratory of pathology of the Tokoin Teaching Hospital in Lomé, Togo. During our study period, we observed 365 cases of childhood solid cancers that represent 7% of all cancers. The average age of occurring was 8.1 years and the sex-ratio was 1.5. Histologically, it was non-Hodgkin lymphomas in 51.5% of cases (including 27.9% of Burkitt lymphoma), Hodgkin disease in 9.3% of cases, and retinoblastoma in 8.5% of cases. This study showed that childhood solid cancers are frequents in Togo dominated by Burkitt lymphoma.     

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.

     

Carcinome apocrine du sein: à propos d’un cas

Apocrine carcinoma is a rare feature of breast carcinoma. We report a case of a 55-year-old patient who had a mass that was 3 cm in diameter in the external upper quarter of the right breast. The patient underwent a biopsy, but a month later, she presented with a mass in the breast with axillary lymph nodes. The patient refused radical surgery but accepted tumorectomy. The mass was found to be a grey and white tumor that was 4 cm in diameter. Using a microscope, it was found to be an apocrine carcinoma. This type of carcinoma raises diagnosis problems and a good sampling is necessary to find more than 90% of apocrine features. The prognosis remains controversial.     

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.     

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.     

Schwannome mammaire bénin : à propos de deux cas

Schwannoma is a rare nervous tumor developed on schwan cells. It occurs usually in the extremities, the trunk and the head region. Its occurrence in the breast is rare with only a few cases being reported. It usually appears as a breast lump having clinical and radiological characteristics suggestive of benign lesions. Its diagnosis is histological. Its treatment is surgical. Through two observations and a literature review we would try to remind the characteristics of this tumor and its management.     

Place de la prostatectomie radicale dans le traitement curatif du cancer de la prostate: à propos de 91 cas

Objective

To study the role of radical prostatectomy in the treatment of prostate cancer.

Patients and methods

It was a retrospective multicenter study of 5 years on 91 radical prostatectomies performed at Medico-Surgical Center le Bois of Chaumont in France and at Notre-Dame-de-la-Paix in Burkina Faso.

Results

In 5 years, 91 patients underwent radical prostatectomy with curative intent, 85 at Medico-Surgical Center le Bois in France and 6 at Notre-Dame-de-la-Paix in Burkina Faso. Their average age was 66.52 years. Clinically, the patients were classified as stage A (2.2%) or B (98.8%) of Whitemore-Jewett. The average PSA (prostatic specific antigen) was 9.25 ng/ml. Endorectal ultrasound, CTabdominopelvic bone scan, magnetic resonance imaging, and histology of biopsy pieces were able to classify all patients as T1a to T2b N0M0. It was adenocarcinoma, and the average Gleason score was 6. Surgical treatment was radical prostatectomy. After pathologic study of surgical specimens, 2.2% were classified as pT1, 76.92% pT2, 21.92% pT3, and 1.10% pT4. The rate of PSA, six months after radical prostatectomy, was undetectable in 81.32%. In addition to radical prostatectomy, patients received hormone therapy (4 cases), radiation therapy (9 cases), and radiotherapy-hormone therapy (2 cases). The operative mortality was zero. The average length of hospital stay was 8 days. Complications such as seromas (6.60% patients), erectile dysfunction (47.25%), urinary incontinence (32.97%), and acute retention (2.2%) were noted. The 3-year survival rate was 78.33% after radical prostatectomy alone and 100% after radical prostatectomy associated with radiotherapy and/or hormone therapy.

Conclusion

Radical prostatectomy allowed to control prostate cancer, and it requires early diagnosis. The addition of radiotherapy and/or hormone therapy optimizes the prognosis.     

Tumeur neuroendocrine à grandes cellules du nasopharynx : à propos d’un cas

Neuroendocrine carcinoma of the head and neck is a rare entity. The parotid gland is the most commonly affected site. A nasopharyngeal site has not been previously described. We report a 35-year-old patient who consulted for tinnitus and nasal obstruction. The assessment found a nasopharyngeal tumour T4N0M0. The patient underwent 6 cycles of chemotherapy based on VP16 and cisplatin, followed by radiotherapy at a dose of 70 Gy to the nasopharynx and 50 Gy to the neck. The evolution was marked by clinical improvement and radiological stability. Six months after the end of treatment, the patient had a local and meningeal relapse. He received palliative care. He died 19 months after the end of treatment.     

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.

     

Lymphome de MALT du rectum : à propos d’un cas traité par irradiation

The mucosa-associated lymphoid tissue (MALT) lymphoma is a distinct clinical pathologic entity that develops in diverse anatomic locations such as the stomach, salivary gland, thyroid, lung, skin and breast. However, colorectal involvement is extremely rare. To our knowledge, only ten cases of primary rectal MALT lymphoma have been reported in the literature. We report a 46-year-old woman with rectal MALT lymphoma, which regressed after radiotherapy. The patient had rectal bleeding. Colonoscopy showed a pseudonodular and ulcerated big fold in the rectum. Microscopic and immunohistologic studies of the biopsy specimen showed typical features of low grade MALT lymphoma. Upper endoscopy showed chronic gastritis with lymphoid follicles but without any infiltration of lymphoma cells. Helicobacter pylori infection was confirmed by histology. No extra-intestinal involvement was found on the staging evaluation, which included computed tomography (CT) of the abdomen, chest, pelvis and a bone marrow biopsy. We attempted to eradicate H. pylori with a 7-day course of omeprazole, amoxycillin, and metronidazole. Eradication was proved successful by endoscopy. Repeated colonoscopy 4 months after the end of treatment showed that the rectal tumor had not regressed. Biopsy specimens confirmed the persistent infiltration of lymphoma cells. The patient was considered to be a non-responder to eradication therapy and was indicated for radiotherapy. He underwent a total of 34 Gy. Complete regression was confirmed by colonoscopic and histologic examination at 2 months after the end of treatment. He was followed up closely with colonoscopy, but no relapse of these lesions was detected after 12 months.     

Place de la radiothérapie dans le traitement du rétinoblastome : à propos de 40 cas

PurposeThe aim of this study is to analyze the results and the complications of radiotherapy in the treatment of retinoblastoma.Patients and methodsBetween 1994 and 2004, 40 children received radiotherapy for a retinoblastoma in Salah Azaiz Institute. The average age of the patients was 36 months (four to 132 months). There were 16 girls and 24 boys. Sixteen children presented a bilateral disease and 24 children a unilateral disease. Twenty eyes and thirty-six orbital cavities in 40 children with retinoblastoma were treated by radiotherapy. One child with a unilateral anterior retinoblastoma was treated with 106 ruthenium brachytherapy. External radiotherapy has been used to treat the 39 patients. In 20 cases the irradiation was conservative and in 36 cases postoperatively. The latter (n = 36) presented at least one risk factor of relapses noted in the histological examination. The average dose was 44 Gy (1.8 to 2 Gy per fraction, five fractions weekly). This radiotherapy was associated with chemotherapy in 24 cases.ResultsThirty-five children were followed with an average follow-up of 53 months (3–108 months). The average delay of relapses was of 10 months (two to 26 months). We found four orbital relapses and seven metastasis in nine children. The conservation of the eye with a useful visual field was noted in 18 cases among the 20 conservative irradiated eyes. The major therapeutic complication was the growth defect of the bones face. A femoral bone sarcoma was noted five years after the end of the irradiation and chemotherapy in one case.ConclusionIf the radiotherapy offers the advantage of the functional conservation and the improvement of the local control, its indications are more and more restricted in favor of the other therapeutic methods (chemotherapy, thermochemotherapy) and this considering the iatrogene risk. The development of new techniques of brachytherapy and the progresses of the conformational radiotherapy appear to reduce considerably this risk.