Tumeurs à cellules géantes de l’os. Particularités anatomocliniques: à propos de 14 cas

Introduction

Giant cell tumors of the bone have specific morphologic features and a progressive course pattern but they lack accurate prognostic criteria.

Patients and method

We report a retrospective study of fourteen cases of giant cell tumor of the bone diagnosed in the pathology department of the Farhat-Hached hospital, Sousse city, between 1990 and 2007. The radiological and histological images were reviewed and compared with the clinical and therapeutic data from the patients’ follow-up.

Results

Our results were as follows: five patients out of seven with grade I tumour had a local recurrence; one patient out of seven with a grade II tumour had a local recurrence with synchronous pulmonary metastases; eight patients had a favourable outcome without any recurrence or metastasis.

Conclusion

The histological parameters only may not predict the propensity for a giant cell tumor to induce recurrence or metastasis; the clinical, radiological and biological features must be always taken in consideration.

     

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.     

Dépression et cancer : le mythe à l’épreuve de l’épidémiologie

Three recent meta-analyses involving well-powered prospective studies found evidence for a weak association between depression, especially chronic, and both cancer onset and cancer survival. These associations reach statistical significance but effect sizes are small, challenging their clinical significance. The underlying mechanisms of these associations are likely to involve some confounders (i.e. factors that may promote both depression and cancer onset or mortality without any direct link between the two variables), as well as both behavioral and biological mediators (i.e. correlates of depression that may in turn lead to an increased risk of cancer or to poorer outcome). Further studies are needed to explore the clinical implications of these associations.     

Tumeur à cellules géantes du péroné chez l’enfant: à propos d’un cas

Introduction

Giant cell tumours (GCT) are practically benign and are usually located at the epiphysiometaphyseal level of a young adult’s long bones. Its localisation at a child’s fibula is exceptional.We are presenting a case of a 12-year-old child’s giant cell tumour.

Observation

A 12-year-old girl with a previous history of a road accident at the age of four with an open fracture of her right leg was examined for a tumefaction at the lower extremity. The clinical examination revealed a good general state of health, and no inflammation at the latero-external side of her right leg. A standard X-ray photography showed a bee nest-like osteolysis lesion at the lower fibula metaphyse. A biopsy was performed and it confirmed the diagnosis of a GCT. The treatment consisted in a large ablation of the tumour including part of the healthy zone, followed by an autologous iliac bone graft, stabilized with a Métaizeau pin and a cruropedal plaster. The evolution was favourable after a period of two years.

Conclusion

The GCTcase we are presenting is fairly exceptional because of its location and the age of the patient. The diagnosis was suspected with the standard radiology and will be confirmed by histology, and the treatment consists of a large ablation with an autograft fill.     

Pourquoi certains cancers métastasent-ils préférentiellement à l’os ?

Bone metastases are common complications of several cancers, among which breast and prostate cancer are the most osteotropic. Different factors produced by the bone microenvironment draw cancer cells to invade the bone marrow where they seed in specific regions termed the premetastatic niche and the osteoblastic niche. Cancer cells then acquire bone-like properties to adapt and thrive in the bone microenvironment (osteomimicry). The inhibition of these mechanisms may offer new therapeutic perspectives, preventing bone metastasis formation inpatients at high risk of relapse in bone.     

Liposarcome rétropéritonéal géant récidivant: à propos d’un cas

The retroperitoneal liposarcoma is a malignant, primitive, and rare tumor. It has a long time asymptomatic evolution and a late diagnosis. It is generally single and consists of only one histological type. This tumor is characterized by the high risk of locoregional recurrence, and its prognosis is related to the possibilities of a complete exeresis and the histopronostic rank. The surgical resection extended to the surrounding organs constitutes the treatment of reference and this remains possible even in the event of recurrence. We report the observation of a retroperitoneal liposarcoma at multiple, synchronous localizations and which occurred twice, with the histological type of the liposarcoma differentiated well from the more aggressive liposarcoma myxoide. The surgical treatment was always a curative exeresis extended to the surrounding organs.     

Changer les représentations négatives à l’égard des sujets agés en oncogériatrie

With regard to the elderly cancer patient, different approaches by care providers hinder appropriate patient care and bring the matter of possible conditions for improving practices into consideration. An observation of the procedures for informing patients by the care providers allows the avoidance and truth avoidance tactics to be identified, which highlights the pessimism of care providers?? thoughts with regard to elderly cancer patients. The study of patients?? attitudes showed that, from their point of view, they ??manipulate?? the information they give to care providers, making light of their situation and thus preserving as much of their independence as possible. Finally, although from a different area, patients and care providers are driven by identical negative thoughts, that often shape the relationship without allowing attention to be given to each other??s specific needs. A return to the psychological characteristics of a cancer patient suggests another possible perspective on the elderly cancer patient, and identifies the ways in which to support the changes in practices with regard to elderly cancer patients. The implementation of a participatory approach (an approach seen in the palliative care domain and applicable to all care situations) that encompasses the concept of a team project, professional training and areas dedicated to discussions with colleagues, is suggested as an alternative way to look at the care of elderly cancer patients. In conclusion, the concept of a Geriatric Oncology project, developed within the scope of a participatory approach, is proposed for all adult Oncology and Haematology departments, to change the negative ideas of care providers and contribute to the improvement of the management of elderly cancer patients.     

Tumeur à cellules granuleuses : à propos d’une localisation vulvaire compliquée de métastases pulmonaires

Granular cell tumour, or Abrikossoff's tumour, is a rare, ubiquitous tumour, with mostly benign evolution. The malignant forms represent 1–3% of the cases. The vulvar localization is exceptional. We report the case of a 28-year-old patient who presented a vulvar Abrikossoff's tumour. Initially considered benign, the tumour was treated by exclusive local surgery. Five months later, the tumour showed a malignant transformation. The tumour size was 14 cm in its major axis with the presence of not systematized scattered mitoses, PS 100 was positive at 100% and Ki 67 to 20%. Because of malignant and economic excision of the neoplasm, the patient received adjuvant radiotherapy. After 20 months, the patient had a local recurrence and lung metastasis, supporting the diagnosis of malignancy. She received two chemotherapy regimens of 5-fluoro-uracil/cisplatin and pacliatxel/carboplatin without any response. Following the failure of chemotherapy, the patient received symptomatic medical treatment. This observation leads to advocate an aggressive surgical treatment and strict supervision of all granular cell tumours.     

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.     

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.     

Glutamate et gliomes malins,de l’épilepsie à l’agressivité biologique : implications thérapeutiques

In this review article, we describe the unrecognized roles of glutamate and glutamate receptors in malignant glioma biology. The neurotransmitter glutamate released from malignant glioma cells in the extracellular matrix is responsible for seizure induction and at higher concentration neuronal cell death. This neuronal cell death will create vacated place for tumor growth. Glutamate also stimulates the growth and the migration of glial tumor cells by means of the activation of glutamate receptors on glioma cells in a paracrine and autocrine manner. The multitude of effects of glutamate in glioma biology supports the rationale for pharmacological targeting of glutamate receptors and transporters in the adjuvant treatment of malignant gliomas in neurology and neuro-oncology. Using the website www.clinicaltrials.gov/ as a reference – a service developed by the National Library of Medicine for the National Health Institute in USA – we have evoked the few clinical trials completed and currently ongoing with therapies targeting the glutamate receptors.     

Standards, Options et Recommandations pour le traitement périopératoire des patients atteints d’un cancer bronchique non à petites cellules résécable d’emblée, opérables (mise à jour), rapport abrégé

Introduction

An update of the Sor Clinical Practice Guidelines (CPG) for the perioperative treatment of operable patients with resecable non-small cell lung cancer, operable has been initiated by the French National Federation of Cancer Centres (FNCLCC). This work was performed in collaboration with the French Intergroup for Thoracic Oncology (IFCT), the French-speaking Language Society of Pneumology (SPLF), specialists from university or general hospitals and private clinics, and with the French National Cancer Institute. It is based on the methodology developed and used in the “Standards, Options and Recommendations” programme. This article presents a short version of the updated 2007 recommendations.

Methods

The guideline development process is based on literature review and critical appraisal by amultidisciplinary group of experts. The methodological approach combines systematic review with expert judgement. Recommendations take into account the effectiveness and toxicity of the different therapeutic alternatives and the levels of evidence. Following their development and prior to publication, independent practitioners in cancer care delivery reviewed SOR-guidelines.

Results

Therapeutic standards and options concerning adjuvant or neoadjuvant chemotherapy as well as adjuvant radiotherapy have been defined per stage (IA, IB, II and IIIA). Specific chemotherapy regimens have also been recommended.

Conclusions

After critical appraisal, the literature data appeared sufficient to update the recommendations validated in 2000. The literature will be searched and reexamined in 2008 within SOR’s systematic monitoring.     

Acétate d’abiratérone (AA) : comment prescrire l’abiratérone et à qui en 2014 ?

Abiraterone acetate (AA) is a selective inhibitor of cytochrom p450 (CYP)17 which is required for androgen biosynthesis, and can block the androgens synthesis by testicles, surrenals and intratumoral secretion. In phase I and II studies in patients with prostate cancer, therapy with AA 250-2000 mg once daily demonstrated reductions in prostate specific antigen (PSA), and/or circulating tumor cells (CTCs). In two large phase III trials in patients with metastatic castration resistant prostate cancer (CRPC) in post-docetaxel and pre-docetaxel setting, AA plus prednisone compared with placebo plus prednisone demonstrated a significant superior overall survival in post-docetaxel setting, and a superior radiological PFS in pre-docetaxel setting. Based of these results, AA is approved in metastatic CRPC patients in post-docetaxel setting or pre-docetaxel setting in 2013.