Brahim Khalil El Gueddari

Antibodies to the Epstein-Barr virus transactivator protein (ZEBRA) as a valuable biomarker in young patients with nasopharyngeal carcinoma.

Epstein‐Barr virus (EBV)–associated nasopharyngeal carcinoma (NPC) generally occurs in adults, especially in high‐prevalence populations such as the Chinese and Eskimos. In Maghrebian populations, young patients affected with this malignancy represent 25% of the total NPC cases. In adults with NPC, relatively high titers of IgA antibodies to the EBV viral capsid antigen (VCA) and early antigen (EA) represent important markers. However, nearly 50% of young NPC patients are negative for IgA‐anti‐VCA and ‐EA or exhibit very low titers of these antibodies. We report here that 92% of sera from young NPC patients negative for IgA‐EA and 89% of those negative for IgA‐VCA were positive for IgG antibodies to the EBV transactivator protein (ZEBRA) at very high titers. Our results show that in young patients with NPC these antibodies represent the most reliable marker for diagnosis and prognosis, particularly when compared with conventional NPC markers, i.e., IgA‐VCA (58%) and anti‐EA (25%). The titers of IgG‐ZEBRA antibodies increased along with lymph node involvement only in the young patient group, suggesting a prognostic value of this marker in this patient group. Int. J. Cancer 86:71–75, 2000.

Study of human leukocyte antigen class I phenotypes in Moroccan patients with nasopharyngeal carcinoma.

Previous reports demonstrated an association between the human leukocyte antigen (HLA) and risk for nasopharyngeal carcinoma (NPC) among the Chinese in Singapore, a population with a high incidence of this malignancy. In our study, we assess the association between HLA and NPC in Morocco, a median‐prevalence area for this cancer, where NPC presents the particularity of also affecting young individuals. Using the standard microlympho‐cytotoxicity test, we typed a total of 154 Moroccan NPC patients and 257 unrelated healthy controls for their HLA‐A and B antigens. The results of these analyses show that the frequencies of HLA‐A10, HLA‐B13 and HLA‐B18 were found to be higher in the NPC group than in the control group, whereas HLA‐A9 was associated with a decreased risk. After correction for the number of specificities tested, these differences were statistically significant only for HLA‐B18 (corrected p value [pc] < 0.023, relative risk [RR] = 4.14) and HLA‐A9 (pc < 0.023, RR = 0.45). The comparison of the distribution of the HLA antigens in younger and older cohorts of patients shows that the incidence of HLA‐A10 and HLA‐ B18 was higher in the older group, whereas the frequencies of HLA‐A19 and HLA‐B13 were significantly higher in younger patients compared with controls. The presence of both HLA‐A19 and HLA‐B13 phenotypes correlated with an increased risk of developing NPC among overall patients compared with controls. According to the sex distribution, increased frequency of HLA‐B18 was found in male and female NPC patients compared with controls, whereas the frequency of HLA‐A10 was higher only in male NPC patients compared with controls.

Type-specific seroprevalence of herpes simplex virus type 2 and associated risk factors in middle-aged women from 6 countries : The IARC multicentric study

Goal: To determine type-specific seroprevalence of herpes simplex viruses (HSV-1 and HSV-2) and HSV-2 risk factors. Study Design: Six-hundred fifty eight middle-aged control women (hospital-based in 4 of 6 countries) from a multicenter cervical cancer case–control study participated from 1985 to 1997. Type-specific serum IgG antibodies against HSV-1 and HSV-2 were detected with Western Blot. Results: HSV-1 seroprevalence was 89% to 100% everywhere except Thailand (51%). HSV-2 seroprevalence ranged from 9% (Spain) to 57% (Colombia), and was independently associated with having ≥2 lifetime sexual partners overall [Odds ratio (OR), 2.1; 95% confidence interval (CI) 2.5–3.1], and in Morocco (OR, 2.7; 95% CI, 1.2–6.1) and Thailand (OR, 4.4; 95% CI, 1.3–15.4), and with being unmarried in Colombia, Peru, Spain, but not significantly in Mali. Women whose male partner’s sexual debut was ≤17 years had a higher HSV-2 risk (OR, 4.3 95% CI, 1.3–13.7). Conclusions: HSV-2 seroprevalence in middle-aged women varied over 4-fold and was associated with riskier sexual behaviors in women and their male partners.

Leiomyosarcoma of the thyroid gland.

The existence of primary thyroid sarcomas represents a contentious issue. Some authors believe that thyroid sarcomas are, in fact, anaplastic carcinomas with sarcomatous (spindle cell) features. From the standpoint of treatment and prognosis, the histogenesis of thyroid ‘sarcomas’ is academic, because these tumors, irrespective of the therapeutic intervention, are lethal 1. Primary thyroid leiomyosarcomas are extremely rare. Only nine isolated cases have been reported in the literature and such tumors carry a very poor prognosis 1, 2, 3, 4, 5, 6, 7.

Concurrent chemoradiotherapy in adjuvant treatment of breast cancer

BackgroundThe optimal sequencing of chemotherapy and radiotherapy after breast surgery was largely studied but remains controversial. Concurrent chemo-radiotherapy is a valuable method for adjuvant treatment of breast cancer which is under ongoing research program in our hospital. We are evaluating the feasibility of the concomitant use of chemotherapy retrospectively.MethodsTwo hundred forty four women having breast cancer were investigated in a retrospective study. All patients were either treated by radical surgery or breast conservative surgery. The study compares two adjuvant treatments associating concomitant chemotherapy and radiotherapy. In the first group (group A) the patients were treated by chemotherapy and radiotherapy in concomitant way using anthracycline (n = 110). In the second group (group B) the patients were treated by chemotherapy and radiotherapy in concomitant way using CMF treatment (n = 134). Chemotherapy was administered in six cycles, one each 3 weeks. Radiotherapy delivered a radiation dose of 50 Gy on the whole breast (or on the external wall) and/or on the lymphatic region. The Kaplan-Meier method was used to estimate the rates of disease free survival, loco-regional recurrence-free survival and overall survival. The Pearson Khi2 test was used to analyse the homogeneity between the two groups. The log-rank test was used to evaluate the differences between the two groups A and B.ResultsAfter 76.4 months median follow-up (65.3 months mean follow up), only one patient relapsed to loco-regional breast cancer when the treatment was based on anthracycline. However, 8 patients relapsed to loco-regional breast cancer when the treatment was based on CMF. In the anthracycline group, the disease free survival after 5 years, was 80.4% compared to 76.4% in the CMF group (Log-rank test: p = 0.136). The overall survival after 5 years was 82.5% and 81.1% in the anthracycline and CMF groups respectively (Log-rank test: p = 0.428). The loco-regional free survival at 5 years was equal to 98.6% in group A and 94% in group B (Log-rank test: p = 0,033). The rate of grade II and grade III anaemia was 13.9% and 6.7% in anthracycline group and CMF group respectively (Khi2-test: p = 0.009). The rate of grade II and grade III skin dermatitis toxicity was 4.5% in the group A and 0% in the group B (Khi2-test: p = 0.013).ConclusionFrom the 5 years retrospective investigation we showed similar disease free survival and overall survival in the two concurrent chemo-radiotherapy treatments based on anthracycline and CMF. However in the loco-regional breast cancer the treatment based on anthracycline was significantly better than that of the treatment based on CMF. There was more haematological and skin dermatitis toxicity in the anthracycline group.

Pediatric rhabdomyosarcoma in Morocco.

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in the first two decades of life. There is, however, a paucity of reports on the pattern of its occurrence in Africa. This study analyses the epidemiological pattern, clinical features, histology, and outcome in Moroccan children presenting with RMS.

Primary nasopharyngeal Hodgkin's disease: case report and literature review

IntroductionPrimary Hodgkins disease of the nasopharynx is a rare and uncommon event. It has a relatively favorable prognosis and represents less than 1% of all documented cases of Hodgkins disease.Case presentationA 40-year-old Arabic man presented initially with bilateral nasal obstruction, which was then followed by a significant involvement of his bilateral cervical lymph nodes. His nasopharyngeal biopsy together with immunohistochemistry analysis showed negative expressions of CD15, CD20 and CD3, but positive expressions of CD30 and epithelial membrane antigen. This confirmed the diagnosis of nasopharyngeal Hodgkins disease of a mixed cellularity subtype. The disease was at stage IIEA. Our patient received four cycles of chemotherapy, which yielded a 75% response. This was followed by irradiation of his Waldeyers ring and supraclavicular lymph nodes. He remains in good local control after 30 months of follow-up.ConclusionThe literature review and our case report discuss the optimal management of this rare and atypical localization of Hodgkins disease, which should be differentiated from lymphoproliferations associated with Epstein-Barr virus and non-Hodgkins lymphoma.

Endometrial stromal sarcoma: prognostic factors and impact of adjuvant therapy in early stages

BACKGROUND AND OBJECTIVES Endometrial stromal sarcomas (ESS) are rare uterine neoplasms. surgery remains the cornerstone of treatment for early stages and consists of an abdominal hysterectomy with bilateral salpingo-oopherectomy. Despite appropriate surgical treatment, relapse rates are high (18% to 45%) and the value of adjuvant therapies is not clear. We evaluated prognostic factors and the impact of adjuvant treatment on localized ESS (stages I and II). DESIGN AND SETTING Retrospective, case-control study conducted at the National Institute Of Oncology in Rabat, Morocco over 10 years from 2000 to 2009. PATIENTS AND METHODS twenty-one cases of localized ESS were included in the analysis. RESULTS standard surgery was performed in 71.4% of our patients. Myometrial invasion was noted in 57.1% of cases. Mitotic activity was considered high in five patients. Adjuvant treatment was given to 52.3% of patients: endocrine therapy in five patients and radiotherapy in six. Survival was significantly longer in the group of patients who underwent standard surgical treatment (P=.0007), in the absence of deep myometrial invasion (P=.0248) in cases with a low mitotic index (P<.0001) and in patients who received adjuvant therapy (hormone or radiotherapy) (P=.0048). In a multivariate analysis independent risk factors for monitoring were inadequate surgical treatment and absence of adjuvant treatment. CONCLUSIONS Myometrial invasion and mitotic index appear to be important prognostic factors. the reference surgery is hysterectomy with bilateral salpingo-oopherectomy. Lymph node dissection does not appear to provide a benefit. finally adjuvant treatment may carry a significant survival benefit.

Fibrosarcoma of the maxillary sinus

Fibrosarcoma arising in the sinonasal cavities are very rare. By the time of clinical diagnosis, they are usually advanced. Lack of adequate surgical margins predisposes these patients to tumor recurrences. Most common sites are the extremities, with only one percent of fibrosarcoma arising in the head and neck area. The imaging features of these tumors reflect their aggressive behavior. We report the case of a maxillary sinus fibrosarcoma in a 16 year-old male patient. Neoadjuvant chemotherapy, medial maxillectomy, adjuvant chemotherapy and subsequent external irradiation was perfomed.

Role of gamma knife radiosurgery in the management of pituitary adenomas and craniopharyngiomas.

INTRODUCTION Radical microsurgical removal of pituitary adenomas (PAs) and craniopharyngiomas (CPHs) is often difficult. In such cases radiosurgery can be used as a second-line treatment option. MATERIALS AND METHODS Our series included 436 PAs and 164 CPHs. The majority of patients had large or giant tumors and were treated with microsurgery. Additionally, between June 2008 and August 2011, a total of 29 PAs and 10 CPHs underwent radiosurgery using Leksell Gamma Knife PerfeXion. At the time of treatment the volume of the PAs varied from 0.6 to 26.0 cm3 (mean 5.9 cm3) and that of the CPHs from 0.19 to 17.0 cm3 (mean 6.6 cm3). The marginal doses ranged from 12 to 15 Gy (mean 14.5 Gy) for nonsecreting PAs, from 22 to 25 Gy (mean 24 Gy) for hormone-secreting PAs, and from 8 to 14 Gy (mean 11 Gy) for CPHs. RESULTS The postoperative mortality rates after surgical removal of PAs via the transspenoidal approach and craniotomy were 2.4 % and 8.0 %, respectively, whereas after surgery for CPH it was 5.9 %. No major complications were noted in our limited number of patients after radiosurgical treatment. Taking into consideration only cases with radiological follow-up of at least 12 months, shrinkage of the tumor was demonstrated in 5 of 11 patients with a PA and in 4 out of 6 patients with a CPH. CONCLUSION Radiosurgery is safe and effective second-line management option in cases of recurrent or residual PA or CPH. Occasionally, it can be applied even as a primary treatment in selected patients.