Hanan Elkacemi

Venous thromboembolism in cancer patients: an underestimated major health problem

Venous thromboembolism (VTE) is a major health problem among patients with cancer, its incidence in this particular population is widely increasing. Although VTE is associated with high rates of mortality and morbidity in cancer patients, its severity is still underestimated by many oncologists. Thromboprophylaxis of VTE now considered as a standard of care is still not prescribed in many institutions; the appropriate treatment of an established VTE is not yet well known by many physicians and nurses in the cancer field. Patients are also not well informed about VTE and its consequences. Many studies and meta-analyses have addressed this question so have many guidelines that dedicated a whole chapter to clarify and expose different treatment strategies adapted to this particular population. There is a general belief that the prevention and treatment of VTE cannot be optimized without a complete awareness by oncologists and patients. The aim of this article is to make VTE a more clear and understood subject.

Breast cancer associated with neurofibromatosis type 1: a case series and review of the literature

IntroductionNeurofibromatosis type 1, also known as Von Recklinghausen’s disease, is a rare neuroectodermal disease that mainly affects the skin and the nervous system. Patients with neurofibromatosis type 1 have a higher risk of developing various types of cancers, especially tumors derived from the embryogenic neural crest. However, its association with breast cancer has seldom been reported.Case presentationWe report the cases of three white Arabic women diagnosed with neurofibromatosis type 1, with a median age of 40-years-old (range: 39 to 43), who sought treatment at our centre for breast cancer.ConclusionsThe association between neurofibromatosis type 1 and breast cancer is uncommon. In our case series we readdress this association through a literature review.

Oral verrucous carcinoma complicating a repetitive injury by the dental prosthesis: a case report

Verrucous carcinoma (VC) is an unusual, well differentiated, and low-grade type of squamous cell carcinoma, characterized by benign histology and cytology but markedly invasive clinical behavior. They have a predilection for squamous mucosae, particularly those of the head and neck region. Many factors have been associated with its pathogenesis, including the presence of previous skin lesions; VC arising from a prosthesis injury is rare. Here we reported a case of VC of oral cavity a particularly very aggressive, arising from prosthesis injury. Regardless of the treatment modality, given new insights into the possible aggressivity of this tumor, radiotherapy associated to chemotherapy may be a more appropriate primary treatment compared with the significant local morbidity associated with surgery.

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.

Merkel cell carcinoma occurring in a black woman: a case report

BackgroundMerkel cell carcinoma is a rare, very aggressive neuroectodermal tumor of the skin. It is typically located on sun-exposed skin and frequently found in white men aged between 70 and 80 years.Case presentationWe report a case of a 58-year-old black woman diagnosed with Merkel cell carcinoma of the posterior face of the right elbow. She had biopsy excision and was lost to follow-up. Four months later, she presented with recurrent disease on the inferior third of the right arm with three ipsilateral axillary lymph node metastases. Amputation of the right arm and ipsilateral axillary lymph node dissection were performed, followed by adjuvant radiotherapy. Six months later, the patient died as a result of respiratory failure caused by lung metastasis. To the best of our knowledge, no specific studies have been done comparing the course and the characteristics of Merkel cell carcinoma in white and black populations, and no similar case has been reported in the literature.ConclusionsThe Merkel cell carcinoma is very rare in black people. As described elsewhere in the literature, our patient had a poor outcome despite radical management. To date, to the best of our knowledge, there has been no comparison of the prognosis of this tumor in white and black populations.

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

The Impact of Radiotherapy in the Treatment of Recurrent Desmoid Tumor of Neck: A Case Report with Literature Review

Background: Extra-abdominal desmoid tumor of the head and neck in particular commonly infiltrate vital neurovascular structures. we report a case of a large and recurrent extra-abdominal desmoid tumor causing significant morbidity and who was treated successfully by radiotherapy. Case presentation: A 34-year-old male patient presented with a history of right neck mass for 15 months, which was gradually increasing in size. Cervical CT scan revealed a large mass of the posterior soft tissues of the neck extended to the soft tissues of the posterior thoracic wall. The CT density of the mass was that of fat tissue. It was measuring 12.4 × 85.9 mm and enhanced after injection of the contrast product. A biopsy was taken. The histopathological findings were suggestive of desmoid tumor. Discussion: This case was discussed in multidisciplinary oncological team and radiotherapy was planned. The surgery was proposed but not performed due to the recurring character of the tumor and the risk of a high postoperative morbidity. After 4 weeks of treatment, the clinical evaluation showed a good response. Conclusion: Alternative treatment modalities such as primary radiotherapy may be preferable to mutilating surgery.

Complete Genital Prolapse with Cervix Carcinoma: A Case Report andLiterature Review

Background: Although genital prolapse and carcinoma of the uterine cervix are not rare event, their association is very uncommon. We report a case of this association. Case presentation: A-79-year-old female presented with 11 months history of post-menopausal bleeding, pelvic pain and sensation of heaviness which was increasing in intensity over than 8 months. Physical assessment showed a large genital prolapse third degree and ulcerous and necrotic lesion at the lower part prolapse. Histopathological examination of cervical biopsies revealed well differentiated and invasive squamous cell carcinoma. She was staging according to the International Federation of Gynecology and Obstetrics staging system 2009 as FIGO IIIB. The patient was treated by palliative chemotherapy. After 3 months, the patient died. Conclusion: Genital prolapse with cervical carcinoma is a rare association. In fact, it is necessary to individualize the optimal treatment for each patient to improve life quality and the prognosis.

Place de la radiothérapie dans les séminomes testiculaires de stade I: à propos de 25 cas

We conducted a retrospective, descriptive study of 25 stage I testicular seminomas to clarify the role of radiotherapy in the management of this disease. Between January 2001 and December 2009, 25 patients with stage I testicular seminoma were treated in the Radiotherapy Department at the National Institute of Oncology in Rabat. Primary orchidectomy was performed via the inguinal route. Initial staging was based on total beta-hCG dosage, alpha-fetoprotein dosage and exploration of superior diaphragmatic and sub-diaphragmatic lymph nodes using tomodensitometry. Adjuvant radiotherapy was delivered using linear accelerator. The median age was 33 years (18-52 years). Testicular tumor involved the right side in 16 patients and the left side in 9 patients. Radiotherapy was delivered to lombo-aortic lymph nodes in 18 patients, lombo-aortic and ipsilateral iliac lymph nodes in 7 patients, using 2 anterior-posterior beams, with delivery of 20-25 Gy in 10-14 fractions. Immediate tolerance was excellent. The average monitoring period was 73 months. Twenty three patients are currently alive in complete remission. One patient developed a pulmonary relapse 22 months after the end of the radiotherapy. One patient was lost to follow-up. Long-term toxicity, especially gastrointestinal toxicity, was not observed. No tumor or secondary hematologic disease was reported. Prophylactic radiotherapy remains the standard adjuvant treatment of stage I seminomas. Immediate tolerance is satisfactory and an increased risk for secondary cancer is negligible compared to the therapeutic benefit. However, strict monitoring and one cycle of carboplatin-based adjuvant chemotherapy are also effective.