Particularités anatomocliniques des cancers du sein chez l’homme dans le centre tunisien : à propos de 21 cas

Background

Breast cancer in men is rare. By contrast, it is the most common cancer diagnosis in women with rates that are >100-fold those of men. It accounts about 1% of all breast cancer and less than 1% of men cancer. The molecular classification of breast cancer distinguishing five subtypes, which are characterized by distinct molecular and immunohistochemical features as well as the prognosis and the treatment one. The aim of our study is to analyze the clinicopathological and the evolutive features of male breast cancer in Tunisian Patients and to define the molecular characteristics of this rare disease.

Methods

This is a retrospective review included 21 cases of male breast cancer diagnosed at the Department of Pathology, Farhat Hached hospital, Sousse, Tunisia and treated at the gynecology one along 9 years. The clinico-pathological and immunohistochemical (hormonal receptors, HER2, cytokeratine 5/6 and EGFR) features, treatment modalities as well as evolutive features patient??s outcome were recorded.

Results

The mean age of patients was 69 years; a family history of breast cancer is found in 2 cases. Nodular tumefaction was the most common presenting symptom (17 cases). The duration of symptoms ranged from 1 to 36 months. Histologically, the conventional infiltrating cancer was found in 20 cases. Lymph node metastases were seen in 10 cases. Three cases were classified as pT1, 6 cases as pT2, 1 case as pT3 and 10 cases as pT4. Immunohistochemical exams were done in 17 cases. Hormone receptors were expressed in 13/17 cases, HER-2 was expressed in 2/17 cases. CK5/6 and EGFR were negative in all cases. Follow up information revealed that 3 patients were lost sight. Visceral metastases were seen in 4 cases.

Conclusion

Male breast cancer is a rare disease. As compared to women breast cancer, it has similarities related to clinicopathological and evolutive characteristics.     

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.     

Tumeurs phyllodes du sein à propos de 53 cas

PurposePhyllode tumors of the breast are fibroepithelial tumors similar to fibroadenomas but with a predominant conjunctive tissue component. These are composed of a connective tissue stroma and epithelial elements. They are rare with an incidence of 0.3–0.9% of all breast neoplasms. The present study demonstrates the recent experiences in diagnosis, therapeutical management and clinical follow-up of this disease.Patients and methodsThis is a retrospective study of the experience of the Institut National d’Oncologie (INO, Rabat) from 1998 to 2006.ResultsWe included 53 patients. Median age was 37.2 years (15–67), tumor size was 1–30 cm (median 10.25 cm). The histological diagnosis was based on the biopsy in (7.8%) cases and extemporany in 22% cases, distant metastasis occurred in two patients; the treatment consisted of a surgery. The median follow-up was three years. Local recurrence occurred in ten patients. Distant metastasis occurred in two patients and five patients have died.ConclusionThe confrontation of our results to the data of the international literature shows that the diagnosis of the phyllodes tumours is histological. The basis of the treatment is surgery. The adjuvant radiotherapy is very important in patients at high risk for local recurrence; chemotherapy has a badly defined place. The prognostic is based on the histological characters of the tissue conjunctive component of these tumours.     

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.     

Étude histopathologique des cancers mammaires dans l’ouest algérien: à propos de 81 cas

Through its impact, breast cancer remains the most frequent in woman. This incidence is low before 35 years and increases with age. It is a heterogeneous mammary disease with variations between individuals. Our study has focused on a histopathological analysis of 81 cases of malignant mammary tumors collected in the Laboratory of anatomy pathological (Pr Bourouis Oran, Algeria). The objective of this study is to determine the frequency of each type of tumor and its histological analysis and prognosis. The results obtained revealed two cases of sarcomas and 79 cases of carcinomas. The current histological type is the infiltrating ductal carcinoma with a percentage of 76.54% of cases. According to the histopronostical classification Scarff-Bloom-Richardson (SBR), 70% of the cases belonged to grade III. An examination of lymph node indicates that the tumoral process invaded 80% of them.     

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.     

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.     

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.     

Carcinome métaplasique sein: à propos de cinq cas

Metaplastic carcinoma of the breast is a rare and heterogeneous group of malignancies that accounts for less than 1% of all breast cancers. The histogenesis remains unknown. Clinical and radiological appearances are not specific. The treatment is based on surgery associated to radiation therapy and chemotherapy. There is no place for hormone therapy. The prognosis is poor. The diagnosis is based onmorphological and immunochemical findings. We report five cases of metaplastic carcinoma of the breast originating from an anatomopapthology laboratory, with a literature review.     

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.     

Les tumeurs des glandes salivaires : étude anatomopathologique à propos de 105 cas

Introduction

Salivary gland tumours are rare and extremely varied. They represent 3% of all tumours in the body, and 6% of those of the head and neck. From a morphological point of view, they are dominated by their lesional polymorphism. This polymorphism is further increased, especially on a clinical level, by the diversity of the possible sites.

Material and methods

Our retrospective study investigated 105 cases of salivary gland cancer, diagnosed in the pathology department at the Mohammed V Military Teaching Hospital in Rabat, over a period of nine years, from 2000 to 2008. The main aim of our work was to report on the experience of the anatomical pathology department of the Mohammed V Military Teaching Hospital in Rabat, to highlight the epidemiological criteria and the different anatomopathological aspects and compare them with data found in the literature.

Results

There is a peak in frequency found between 30 and 40 years old, with patients being predominantly male (58%). The average age is 42, with extremes at 13 and 82 years old. This average is greater for malignant tumours (53 years old), than for benign tumours, which is 43 years of age. Benign tumours (77%) are far more common than malignant tumours (23%). The most common malignant tumour is adenoid cystic carcinoma (10%). Tumours are commonly found in the parotid gland (60%), and here benign tumours (90%) are a lot more frequent than malignant tumours (10%), with the most common benign tumour being pleomorphic adenoma (66%). The submandibular glands represent the second most common site (22%), and here benign tumours (88%) are also a lot more common than malignant tumours (12%). The minor salivary glands represent the third most frequent location (18%), and here, unlike other sites, it is malignant tumours (57%) that are more common than benign tumours (43%). The most common malignant tumour is adenoid cystic carcinoma.

Conclusion

On the whole, the results obtained are comparable with those found in the literature. The predominant histological type in our series was pleomorphic adenoma, followed byWarthin??s tumour. The most common malignant tumour was adenoid cystic carcinoma (10%), and in disagreement with data found in the literature, mucoepidermoid carcinoma was rarely observed. Adenoid cystic carcinoma is far more common in the minor salivary glands. Finally, it should be noted that the sublingual glands are rarely affected.     

Mucocèle appendiculaire: à propos de dix cas

The appendicular mucocele or mucosecretant tumor is a rare affection defined as a cystic dilatation of the lumen of the appendix following the intraluminal accumulation of mucinous, translucent, gelatinous secretion which may reach either the entire organ or a segment more often distal. Its pathogeny is under discussion, and the diagnosis is more often preoperative. The therapy depends on the histological nature of the mucocele, which goes from a simple appendicectomy when the mucocele is benign to a right hemicolectomy in the case of a malignant mucocele.We report ten cases from the service, and through the medical record notes, we try to identify the different ways of diagnosis and the anatomopathologic aspects which arise from the therapy.     

Chondrosarcome myxoïde extrasquelettique du genou : analyse clinicopathologique et immunohistochimique à propos d’un cas

The extraskeletal myxoid chondrosarcoma (CME) is a rare malignant soft tissue tumour described as a distinct clinical, histological, immunohistochemical, genetical and evolutive entity. It represents only 2.5% of soft tissue sarcomas, and is considered by WHO as a low grade sarcoma. Its individualization is important because it has a long and indolent clinical course, and tumour-related death often occurs after a long survival period. The diagnostic key is morphological supported by immunohistochemistry and genetics t(9;22) that allow to differentiate it from other tumours with myxoid stroma and from chordoma. A new case of soft tissue myxoid chondrosarcoma (chordoid sarcoma) of the knee is reported.     

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 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.     

Dermatofibrosarcome protuberans récidivant du sein: à propos d’un cas

The dermatofibrosarcoma protuberans (DFSP) is a sarcoma of low rank developing slowly from the fibroblasts of the dermis. The main characteristic of this tumour is its big potential for local recurrence. We report the case of a patient aged 44 presenting a DFSP of the breast that relapsed on two occasions. The remaining extension was negative. She benefited from a large timorous excision. The mammary localization of a DFSP is rare. The diagnosis is difficult. The therapeutic objective of DFSP is to reach a possible most complete surgical resection; the conventional surgical excision must let healthy margins (of 3 to 5 cm) with the inconvenience of the substance loss. The technique of Moh, verifying the limits of excision in preoperative, can palliate this inconvenience. The risk of recurrence is low when the resection margins are healthy. Radiotherapy as adjuvant treatment is very useful when the margins are not sufficient. The surveillance must be prolonged.     

Les chordomes: à propos de sept cas

Chordoma is a rare bone tumor, believed to develop from notochordal rests, which generally arises at the two extremities of axial skeleton. We report seven cases of chordoma collected at the Laboratory of Anatomopathology of the Specialties Hospital of Rabat in Morocco during a period of four and half years (2003–2007). There were four men and three women, median age was 44.7. Pathology confirmed the diagnosis revealing a lobulated mass, the presence of physaliphorous cells, and intracellularmucoid substance.We present the characteristics of chordomas with a literature review. Diagnosis has been greatly improved by MRI and immunohistochemistry. Radical surgery with free surgical margins is the most accurate curative treatment. Progress in radiotherapy techniques should offer new therapeutic perspectives in the future.