A. Tahri

Hepatoid Adenocarcinoma of the Lung: A Case Report and Literature Review.

Hepatoid adenocarcinoma of the lung is a rare form of malignancy defined as an alpha-fetoprotein (AFP)-producing primary lung carcinoma with specific morphological features resembling hepatocellular carcinoma (HCC). Hepatoid lung adenocarcinomas are extremely rare. Due to the rarity of the tumor, any new case contributes to the clarification of its complete clinico-morphological description, biological behavior, and prognosis. It occurs in a multitude of organs: most frequently in the stomach, but also rarely in other areas, including the lung, kidney, female reproductive tract, pancreas, and gallbladder. We present a case of stage IV primary lung cancer with highly elevated AFP levels and morphological and immunohistochemical characteristics for hepatoid adenocarcinoma of the lung.

Risk factors for chronic mastitis in morocco and Egypt

Chronic mastitis is a prolonged inflammatory breast disease, and little is known about its etiology. We identified 85 cases and 112 controls from 5 hospitals in Morocco and Egypt. Cases were women with chronic mastitis (including periductal, lobular, granulomatous, lymphocytic, and duct ectasia with mastitis). Controls had benign breast disease, including fibroadenoma, benign phyllodes, and adenosis. Both groups were identified from histopathologically diagnosed patients from 2008 to 2011, frequency-matched on age. Patient interviews elicited demographic, reproductive, breastfeeding, and clinical histories. Cases had higher parity than controls (OR = 1.75, 1.62–1.90) and more reported history of contraception use (OR = 2.73, 2.07–3.61). Cases were less likely to report wearing a bra (OR = 0.56, 0.47–0.67) and less often used both breasts for breastfeeding (OR = 4.40, 3.39–5.72). Chronic mastitis cases were significantly less likely to be employed outside home (OR = 0.71, 0.60–0.84) and more likely to report mice in their households (OR = 1.63, 1.36–1.97). This is the largest case-control study reported to date on risk factors for chronic mastitis. Our study highlights distinct reproductive risk factors for the disease. Future studies should further explore these factors and the possible immunological and susceptibility predisposing conditions.

Bisphosphonates and innovative drugs in the prevention of skeletal complications secondary to metastatic prostate cancer

Over than 80% of patients with locally advanced prostate cancer will develop bone metastases during the disease management. These metastases are often responsible for complications that impaired the quality of life, impaired the prognosis and increased the mortality by prostate cancer (PC). Two drugs are currently approved by the scientific community in the prevention of skeletal complications secondary to castration-resistant prostate cancer metastatic to bone (CRPCMB), zoledronic acid at a dose of 4 mg intravenously every 3-4 weeks and denosumab at a dose of 120 mg subcutaneously every 4 weeks. This aim of the preset paper was to review the current literature on the mechanism of action, efficacy, and safety profile of these two classes of molecules in the management of CRPCMB.

Female lung cancer in Marrakech

Background: To evaluate the epidemiological aspect of lung cancer in women in Marrakech city in Morocco. Methods: This is a retrospective study conducted between 2003 and 2009 in the Department of Oncology-Radiotherapy, University Hospital Mohamed VI Marrakech. Results: Twenty nine women with lung cancer were unrolled (9% of all lung cancer). The average age was 55.7 ± 12 years. Only twenty percent of our patients were smokers while 38% reported a greater or lesser exposure to passive smoking. Ninety percent of patients were housewives and 62% were from rural areas and all reported massive exposure to smoke from cooking fuels which was mainly charcoal. Squamous cell carcinoma represents 67% of cases. Tumors were diagnosed at advanced stages II/IV in 81% of cases. Eight patients received neo-adjuvant chemotherapy followed by radio-chemotherapy combination and palliative chemotherapy has been indicated in twelve patients. Nine patients received best supportive care. Average follow-up was of twelve months. Fourteen patients were lost to follow-up. Among fifteen evaluable patients, response was noted in seven patients, stabilization in four patients and progression in four patients. Conclusion: Female lung cancer is a relatively rare condition in Marrakech, Morocco. Although the role of smoking in the pathogenesis of lung cancer is clearly established; there are other risk factors including hormones that make women more susceptible to carcinogens of tobacco. Other geographical and environmental factors could be incriminated including domestic smoke exposure especially in our context.

Chronic Mastitis in Egypt and Morocco: Differentiating between Idiopathic Granulomatous Mastitis and IgG4-Related Disease

Idiopathic granulomatous mastitis (IGM) is a benign, frequently severe chronic inflammatory lesion of the breast. Its etiology remains unknown and reported cases vary in their presentation and histologic findings with an optimal treatment algorithm yet to be described owing mainly to the diseases heterogeneity. IgG4‐related disease (IgG4‐RD) is a newly recognized systemic fibroinflammatory condition characterized by a dense lymphoplasmacytic infiltrate with many IgG4‐positive plasma cells, storiform fibrosis, and obliterative phlebitis. Immunosuppressive therapy is considered to be an effective first‐line therapy for IgG4‐RD. We sought to clarify and classify chronic mastitis according to the histologic findings of IgG4‐RD mastitis with respect to IGM and to develop a robust diagnostic framework to help select patients for optimal treatment strategies. Using the largest collection to date (43 cases from Egypt and Morocco), we show that despite sharing many features, IGM and IgG4‐RD mastitis are separate diseases. To diagnostically separate the diseases, we created a classification schema—termed the Michigan Classification—based upon our large series of cases, the consensus statement on IgG4‐RD, and the histologic description of IGM in the literature. Using our classification, we discerned 17 cases of IgG4‐RD and 8 cases of IGM among the 43 chronic mastitis cases, with 18 indeterminate cases. Thus, our Michigan Classification can form the basis of rational stratification of chronic mastitis patients between these two clinically and histopathologically heterogeneous diseases.

Incidence of Gastric Cancer in Marrakech and Casablanca, Morocco.

Gastric cancer is the fifth most common cancer globally with over 70% of new cases occurring in developing countries. In Morocco, oncologists in Marrakech suspected higher frequency of gastric cancer compared to Casablanca, a city 150 kilometers away. This study calculated age-specific, sex-specific, and total incidence rates of gastric cancer in Marrakech and was compared to the Casablanca population-based cancer registry. Using medical records from Center Hospital University Mohammad VI and reports from 4 main private pathology laboratories in Marrakech, we identified 774 patients for the period 2008–2012. Comparison of rates showed higher age-specific incidence in Marrakech in nearly all age groups for both genders. A higher total incidence in Marrakech than in Casablanca was found with rates of 5.50 and 3.23 per 100,000, respectively. Incidence was significantly higher among males in Marrakech than males in Casablanca (7.19 and 3.91 per 100,000, resp.) and females in Marrakech compared to females in Casablanca (3.87 and 2.58 per 100,000, resp.). Future studies should address possible underestimation of gastric cancer in Marrakech, estimate incidence in other regions of Morocco, and investigate possible risk factors to explain the difference in rates.

Abstract 3705: Variable incidence of gastric cancer in Morocco

The purpose of this study was to evaluate and confirm clinical impressions of higher rates of gastric cancer in Marrakech, Morocco compared to Casablanca, Morocco, a city 150 kilometers away. This study collected demographic information about gastric cancer patients diagnosed or treated in Marrakech. It also calculated age-specific, sex-specific and total incidence rates of gastric cancer in Marrakech and compared them to rates from the population-based cancer registry of Casablanca. Using medical records of gastric cancer patients diagnosed/and or treated at the Center Hospital University_Mohamed VI (CHU) and reports from 4 main, private pathology laboratories in Marrakech, we identified a total of 774 patients for the period 2008-2012. The national census of Morocco was used to identify the population statistics by region and city. Incidence rates were obtained from the available published registries in Casablanca, which included years 2004-2007. Comparison of the results in Marrakech with rates from Casablanca showed higher age-specific incidence in Marrakech in nearly all age groups for males and females. A higher total incidence in Marrakech than in Casablanca was found with rates of 5.50 per 100,000 and 3.23 per 100,000, respectively. Incidence of gastric cancer was significantly higher among males in Marrakech than males in Casablanca (7.19 and 3.91 per 100,000, respectively) while the difference among females was not as pronounced, but still significantly different (3.87 and 2.58 per 100,000, respectively). By collecting demographic information from CHU gastric cancer patients, the study further revealed that most patients were from Marrakech, but many traveled from 2 administrative regions (as defined by the Kingdom of Morocco) adjacent to the region in which Marrakech is situated. In conclusion a significantly higher rate of gastric cancer was found in Marrakech when compared to the rates of Casablanca. Age-specific incidence rates of gastric cancer were higher in Marrakech in nearly all age groups for both males and females compared to respective rates in Casablanca. Comparisons of total sex-specific incidence rates found that both males and females in Marrakech had higher rates compared to their respected group in Casablanca. However, the difference in males was much more evident than the difference in females. Finally, the residence of patients found in the medical records was concentrated in the 2 regions surrounding Marrakech and the region Marrakech is in. Future studies should further evaluate the possible under-estimation of gastric cancer in Marrakech and explore the variable rates in other regions of Morocco. Citation Format: Brittney Smith, Mouna Khouchani, Mehdi Karkouri, Audrey Lazenby, Katherine Watkins, Ali Tahri, Abdel-Latif Benider, Shireen Rajaram, Amr Soliman. Variable incidence of gastric cancer in Morocco. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3705. doi:10.1158/1538-7445.AM2015-3705

Abstract 4977: Chronic mastitis in North Africa: Geographic overlap and a potential precursor comorbidity of inflammatory breast cancer

Proceedings: AACR Annual Meeting 2014; April 5-9, 2014; San Diego, CA North African countries, such as Egypt and Morocco, have a high prevalence of non-infectious, chronic mastitis (up to 10% of patients presenting with breast problems) compared to less than 1% worldwide. This same geographic region also suffers from an unusually high prevalence of inflammatory breast cancer (IBC) - 10-15% of breast cancer cases - versus just 1-2% of cases in the U.S. IBC is a serious public health issue as it is the most lethal form of breast cancer because of the propensity for rapid onset of disseminated metastases, which are present in one-third of cases at diagnosis. It is our hypothesis that this geographic overlap is not coincidental, but that the high level of background chronic breast inflammation changes the mammary microenvironment making it more auspicious for the development of IBC. Here we report our work aimed at determining molecular and histologic criteria to classify mastitis into pathogenic groups in order to rationally guide treatment for this serious inflammatory illness, as well as study its possible role in the development of IBC. We identified 44 cases of chronic mastitis of unknown etiology. Cases were defined as any female patient with histopathological diagnosis of chronic mastitis seen at the 5 study hospitals in Egypt and Morocco from 2008-2011. Exclusion criterion was previous diagnosis of malignancy. Biopsy slides were analyzed by a pathologist and stained for IgG4 and IgG. Out of the 44 cases of chronic mastitis using consensus guidelines and our molecular IgG4 profiling, we identified 10 as idiopathic granulomatous mastitis (IGM) and 17 as breast manifestations of IgG4-related disease. IGM is a rare non-neoplastic, chronic, often severe inflammatory lesion of the breast that mimics carcinoma clinically and radiologically. Treatment strategies include watchful waiting, immunosuppressive therapy, wide local or other excisions, or combinations of the above. IgG4-related disease is a newly recognized fibro-inflammatory condition. It is characterized by the formation of tumefactive lesions, a dense lymphoplasmacytic infiltrate with many IgG4-positive plasma cells, storiform fibrosis, obliterative phlebitis and, frequently, elevated serum IgG4 concentrations. While no randomized clinical trials have been conducted, glucocorticoid treatment is the standard first line therapy and appears to be quite effective in the majority of patients. This series is the largest reported and is the first step toward changing the chronic breast inflammatory landscape in North Africa by classifying the chronic mastitis into pathogenic groups that can guide personalized treatment protocols. Further studies are needed to discern whether effective and timely treatment of these chronic inflammatory conditions may lower the incidence of IBC. Citation Format: Steven G. Allen, Hanna Oltean, Kathy Toy, Omar S. Omar, Tamer Youssef, Mehdi Karkouri, Azza Abdel-Aziz, Ahmad Hablas, Ali Tahri, Celina Kleer, Amr Soliman, Sofia D. Merajver. Chronic mastitis in North Africa: Geographic overlap and a potential precursor comorbidity of inflammatory breast cancer. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4977. doi:10.1158/1538-7445.AM2014-4977

Cancer du sein chez la femme âgée

Introduction : Le cancer du sein est une affection fréquente et grave, représente la 1ere cause de mortalité et de morbidité par cancer chez la femme dans toutes les tranches d’âge[1]. La quasi-totalité des études cliniques ont montré une augmentation linéaire de l’incidence de ce cancer avec l’âge. Ainsi et devant l’augmentation de l’espérance de vie de la femme Algérienne et l’amélioration de la qualité de vie des sujets âgés le cancer du sein chez la femme âgée devient un problème de santé publique. Objectif : L’objectif est de déterminer les caractéristiques épidémiologiques cliniques et immuno-histochimiques du cancer du sein chez femme âgée. Matériels et méthode: