Fadila Kouhen

Solitary intraosseous schwannoma of the base and vault of the skull: a summary review of such unusual location.

Intra-osseous schwannoma is a rare mesenchymal tumor. Although, the head and neck region is one of the most common sites for schwannomas, its location at the skull bone is uncommon and accounted for less than 0.2% in the largest series of bone tumors ever reported. Furthermore, it is most often a benign tumor, malignant transformation is exceedingly rare.Clinical presentation is non-specific, most often symptoms are associated with compression and invasion of adjacent organs. Neuro-imaging features are non-specific and the diagnosis is based on histological examination with immunohistochemical study.Surgery remains the aim of treatment. However, radiation therapy could be an interesting therapeutic option in unresectable tumors.This systemic review offers new clinicopathological data useful for better defining the diagnosis and clinicopathological behavior of schwannoma. The purpose of this work is to raise awareness among clinicians adding this clinical entity as a differential diagnosis when a mass of skull bone is identified.

NEUROBLASTOMA IN AN ADULT: A CASE REPORT OF A RARE ENTITY WITH A SUMMARY REVIEW

Neuroblastoma is a very uncommon neoplasm in adulthood. It occurs almost exclusively in children younger than 10 years (More than 90% of cases). We report the case of a healthy 40-year-old male who complained of a right flank pain in 2010. Clinical examination revealed an enormous abdominal mass involving the adrenal gland as showed at abdominal CT scan. The patient underwent a surgical en-bloc excision of the right adrenal mass, after a laborious dissection of the tumor. Histological and immunohistochemical findings were suggestive of a neuroblastoma. Adjuvant treatment was not indicated since the complete gross excision of the tumor was performed, and subsequently the patient was considered stage 1 disease and because of the unavailability of MYCN status, necessary for achieving risk group stratification and a risk-adapted strategy. The patient remained in good local control, until January 2015 when he accused a locoregional and metastatic relapse consisting of two new para-renal masses and magma of celiac adenomegalies extending into the mediastinum. As the mass was considered unresectable, therapeutic decision of administrating neoadjuvant chemotherapy, followed by local treatment (surgery and / or radiotherapy) based on tumor response was taken. Given the bad tumor response to systemic treatment, a palliative radiotherapy was instaured. Currently the patient is two months after the end of radiation with mild clinical improvement. The purpose of presenting this case is not only to report an uncommon malignancy in adulthood, but also to raise awareness among clinicians adding this clinical entity as a differential diagnosis when a retroperitoneal mass is identified. We also conducted a literature review to enhance cliniciansÂ’ acknowledgment about the management of this rare entity in adults.

Prognosis of Medullary Carcinoma of the Breast: 10 years’ Experience in a Single Institution

To the Editor: Medullary carcinoma represents 3–5% of all histologic types of breast cancer (1). Its diagnosis is mainly based on histologic criteria proposed by Ridolfi et al. (2). Despite its aggressive histologic features, medullary carcinoma has a better prognosis than other invasive breast carcinoma up to 84% 10-year survival. Prognostic factors specific to medullary carcinoma are relatively unknown. Determination of these factors is important to identify patients at greatest risk for disease recurrence and death, and who might be candidates for more aggressive treatment. We performed a population-based study of 80 patients to analyze the epidemiological, clinical, and therapeutic outcomes of the medullary breast cancer over a period of 10 years at the National Institute of Oncology in Rabat. Statistical analysis was performed using SPSS software, version 10.0. A value of p < 0.05 was considered statistically significant. Our population was exclusively female. The median age at diagnosis was 45 years. Six patients had a family history of one-first-degree female relative diagnosed with breast cancer. The mean duration of symptoms prior to presentation was 5.6 months. The palpation of a breast lump was the most common manifesting symptom, on the right breast in 52.5% and on the left breast in 47.5%. No case of bilateral involvement was found. Tumor size was less than 5 cm in 90% of cases. According to 2009 American Joint Committee on Cancer, the tumor was classified T1N0M0 in 13.75%, T2N0M0 in 47% of cases, T3N0M0 in 11.25%, T2T3T4N1 in 13.75%, T4N0M0 in two patients and only two patients were metastatic at diagnosis (bone and lungs). Seventy-eight patients underwent surgery (50 cases had a lumpectomy and 28 cases a mastectomy). Axillary dissection was performed in all surgical cases. Histologic tumor size ranged between 10 and 70 mm with a median of 30 mm. The diagnosis was based on the criteria of Ridolfi. Lymph node metastasis was found in 29 patients, 24 of them had N1 nodal disease. Surgical margins of the resected specimen were negative in all patients. A total of 28.75% of tumors are hormone receptors (HR) positive. Postoperative radiotherapy was delivered to 70 patients, with a mean dose of 48 Gy and mean total treatment duration of 25 days. Chemotherapy was administered to 75 patients: adjuvant 71 patients, neoadjuvant in two patients, and palliative in two patients. Twenty-three patients received adjuvant endocrine therapy for a period of 5 years. With a median follow-up of 65 months, 71 patients (88.75%) have been regularly followed. Three patients had local recurrence, one patient developed a contralateral breast cancer 3 years after treatment and two patients developed distant metastases: the first was initially classified T4dN0M0 and the second had N2 nodal disease. The overall 3-year survival rate for our study was 90%, and the overall local control rate was 85%. A univariate and multivariate analysis was achieved to define prognostic factors associated to recurrences (Table 1). In univariate analysis, tumor size, lymph node involvement, and the stage of the disease were significantly associated with local recurrence. The involvement of these factors was confirmed in multivariate analysis. We could not demonstrate the role of age, HR status, and tumor grade as prognostic factors involved in relapse. For overall survival, in univariate and multivariate analysis, only nodal involvement was significantly associated with death. Address correspondence and reprint requests to: Fadila Kouhen, Department of Radiotherapy, National Institute of Oncology, Rabat, Morocco, or e-mail: fadila10m@hotmail.com

Quelle prise en charge nutritionnelle des patients atteints du cancer de la sphère oto-rhino-laryngée traités par la radiothérapie ? Une mise au point

Radiotherapy is an effective treatment for head and neck cancers but patients often experience side effects, which lead to malnutrition. Morbidity related to weight loss during treatment may include dehydration, hospitalization, compromised treatment efficacy, and reduced quality of life and may impact survival hence the importance of early nutritional management prior to radiotherapy. Multiple interventions have been implemented to help ameliorate the impact of treatment on weight loss and nutritional status, including the use of percutaneous endoscopic gastrostomy tubes. The goal of this overview is to search the predictive factors of malnutrition and an overview of the different types of nutritional interventions and their impact on the local control of the disease, mortality and quality of life of patients treated with radiotherapy or concomitant chemoradiotherapy.