Fadoua Rais

Radiation induced esophageal adenocarcinoma in a woman previously treated for breast cancer and renal cell carcinoma

BackgroundSecondary radiation-induced cancers are rare but well-documented as long-term side effects of radiation in large populations of breast cancer survivors. Multiple neoplasms are rare. We report a case of esophageal adenocarcinoma in a patient treated previously for breast cancer and clear cell carcinoma of the kidney.Case presentationA 56 year-old non smoking woman, with no alcohol intake and no familial history of cancer; followed in the National Institute of Oncology of Rabat Morocco since 1999 for breast carcinoma, presented on consultation on January 2011 with dysphagia. Breast cancer was treated with modified radical mastectomy, 6 courses of chemotherapy based on CMF regimen and radiotherapy to breast, inner mammary chain and to pelvis as castration. Less than a year later, a renal right mass was discovered incidentally. Enlarged nephrectomy realized and showed renal cell carcinoma. A local and metastatic breast cancer recurrence occurred in 2007. Patient had 2 lines of chemotherapy and 2 lines of hormonotherapy with Letrozole and Tamoxifen assuring a stable disease. On January 2011, the patient presented dysphagia. Oesogastric endoscopy showed middle esophagus stenosing mass. Biopsy revealed adenocarcinoma. No evidence of metastasis was noticed on computed tomography and breast disease was controlled. Palliative brachytherapy to esophagus was delivered. Patient presented dysphagia due to progressive disease 4 months later. Jejunostomy was proposed but the patient refused any treatment. She died on July 2011.ConclusionWe present here a multiple neoplasm in a patient with no known family history of cancers. Esophageal carcinoma is most likely induced by radiation. However the presence of a third malignancy suggests the presence of genetic disorders.

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.

Osteosarcoma of the spheno-temporo-orbital bone: Imaging aspects of such unusual location

Osteosarcoma of the spheno-temporo-orbital bone is a very rare tumor. Despite the fact that primary osteogenic sarcomas are the most common bone neoplasm, their location in the skull bone is uncommon representing less than 2% of all skull tumors. We report the case of a 41-year-old woman, who has experienced periorbital pain with exophthalmos and left eye vision loss. Neuroimaging analysis including both brain computed tomography (CT-scan) and Magnetic resonance imaging (MRI) were performed. Although radiographic features of skull bone osteosarcomas are not specific, the combination of several radiographic features could lead to this diagnosis in such rare location. The final diagnosis was established by a trans-temporal biopsy with immunohistochemical study. Neurosurgical resection of the primary tumor was not possible given the important extent of the tumor and the involvement of adjacent structures, so the patient underwent conformational radiotherapy. The evolution was marked by local and metastatic progression. The patient received palliative chemotherapy and died few months later. The purpose of presenting this case is not only to report an uncommon malignancy of the skull bone, but also to provide imaging aspects of this rare location and to raise awareness among radiologists in order to consider this radiological entity as a differential diagnosis when a skull bone process 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