Mouna Khouchani

Métastase intramammaire d’un cancer vulvaire : à propos d’un cas avec revue de la littérature

The breast metastases resulting of vulvar carcinoma are very rare, and represent exceptionally the first manifestation of the disease. We report the case of a 42 year-old patient who underwent a treatment because of vulvar epidermoid carcinoma, right away metastatic at the level of the inguinal ganglia. The treatment consisted in a total vulvectomy with bilateral ganglial curretage, followed by external radiotherapy about the perineum and the inguinal ganglia. Three months after the end of her treatment, the patient presented with a nodula on the left outer breast with features of malignancy noticed by clinic and mammographic examination. The histologic study of the mammary biopsy showed epidermoid carcinoma of likely metastatic origin. A left Patey has been realized and confirmed the metastatic localization of epidermoid carcinoma with axillary ganglial metastasis (2N+/-7). Besides, this patient presented a right cervical ganglial parcel that the biopsy showed a metastatic localization of a vulvar carcinoma. A palliative chemotherapy type cyclophosphamid, adriblastin, cisplatine (CAP) has been admistrated during three cycles spaced out three weeks. The patient died 11 months after the supervene of the cerebral metastasis. We present this case because its rarety and to show the possibility of metastasis at the level of breast due to vulvar cancer. The clinicians must remember this possible tropism of the vulvar cancer for the breast, not only during the supervision and the complete examination as regards the disease spreading but also when the affection revealed unknown primary tumor. The diagnostic orientation is based on the mammography and the mammary biopsy. In this stage, the treatment is unfortunately palliative, the survival until a year is not more than 20%.

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.

Combination of Trastuzumab and Radiotherapy in the Adjuvant Treatment of Breast Cancer: A Single Center Experience and Focus on the Cardiac Safety

Background: The main toxicity of trastuzumab, is the alteration of cardiac function. The objective of this study is to examine the acute cardiotoxicity of the combination of Radiotherapy (RT) and trastuzumab in the adjuvant treatment of breast cancer. Materials and Methods: This is a retrospective study of 41 patients followed for localized breast cancer, treated by multimodal strategy combining chemotherapy, Radiotherapy and trastuzumab as adjuvant treatment in the medical oncology department at the Ibn Sina Military hospital of Marrakesh. Results: All patients underwent adjuvant RT on the wall, including 17 on the left side. The median value of the Left Ventricular Ejection Fraction (LVEF) before starting treatment was 64%. The median value of the absolute decrease of LVEF, after the end of RT, was of the order of 4%. All patients received treatment with trastuzumab, during irradiation at usual doses for twelve months. Trastuzumab was stopped temporarily in seven patients, because of the fall in LVEF of more than 10%. After a median followup of 13 months, one patient developed congestive heart failure, imposing the definitive cessation of trastuzumab. Conclusion: The association RT and trastuzumab, does not appear to increase the risk of acute cardiac toxicity, whatever the irradiated side.

Neurocytomes centraux: corrélations cliniques et radiopathologiques à propos de 12 observations

Les neurocytomes centraux sont définis comme étant des néoplasmes composés de cellules rondes, uniformes, ayant un profil immunophénotypique neuronal et un index de prolifération bas. Elles représentent 0,5% des tumeurs intracrâniennes. Elles sont habituellement situées à proximité du foramen de Monro et peuvent être à l’origine d’une hydrocéphalie obstructive. Nous rapportons 12 observations de neurocytomes centraux colligés au laboratoire d’anatomie pathologique du CHU Mohammed VI de Marrakech entre janvier 2006 et juin 2015. Le but de ce travail est de rapporter et décrire les aspects radio-pathologiques de ce type histologique rare. Le sex-ratio homme/femme était de 1,4. L’âge moyen au diagnostic était de 22,3 ans. La symptomatologie révélatrice était dominée par l’hypertension intracrânienne chez tous nos patients, associée à une baisse de l’acuité visuelle et une diplopie. Notre matériel d’étude a concerné une biopsie simple dans un cas, une exérèse subtotale dans sept cas et une exérèse totale dans quatre cas. L’étude histopathologique a montré une prolifération tumorale d’architecture endocrine. Les cellules tumorales sont uniformes de petite taille le plus souvent. L’index mitotique était bas. Cette prolifération tumorale s’accompagnait d’un fond fibrillaire et d’un réseau vasculaire développé de type arborescent. L’étude immunohistochimique était identique chez tout les patients. Elle a montré une positivité des cellules tumorales à l’anticorps anti synaptophysine, à chromogranine et NSE. Chez tous nos patients la corrélation radiopathologique était en faveur d’un neurocytome central (Grade II – OMS 2016). A travers cette série, nous rapportons les particularités anatomo-cliniques, radiologiques et évolutives de ces tumeurs rares.Central neurocytomas are defined as neoplasms composed of round, uniform cells, with neural immunophenotypic profile and low proliferation index. They account for 0.5% of intracranial tumors. They usually occur near the foramen of Monro and can cause obstructive hydrocephaly. We conducted a retrospective data collection from records of 12 patients with central neurocytomas in the Anatomopathological Laboratory at the Mohammed VI University Hospital, Marrakech, between January 2006 and June 2015. This study aimed to report and describe the radiopathological features of this rare histologic type. The male/female sex-ratio was 1.4. The average age at diagnosis was 22.3 years. The revealing symptomatology was dominated by intracranial hypertension associated with decreased visual acuity and diplopia in all patients. Our study concerned about simple biopsy in one case, subtotal resection in seven cases and total resection in four cases. Histopathological examination showed tumor proliferation with endocrine architecture. Tumor cells are more often small and uniform. Mitotic index was low. Tumor proliferation was associated with fibrillary fundus and vascular network with three types of trees. Immunohistochemical examination was identical in all patients. It showed tumor cells positive for anti-synaptophysin antibodies, chromogranine and NSE. In all patients the radio-pathologic correlation suggested central neurocytoma (grade II - WHO 2016). This study highlights the anatomo-clinical, radiological and evolutionary features of these rare tumors.

Molecular Profile of Breast Cancer in Young Women in the Marrakech Region, Morocco: Experience of the Oncology Department CHU Mohamed VI Marrakech, Morocco

Breast cancer in young women is increasing. The objective of this work was to analyze the epidemiological, clinical, therapeutic and prognostic characteristics of breast cancer in young women under 40 years. Through a retrospective study spread over five years from 1 January 2008 to 31 December 2012 and held at the Radiation Oncology Service of the University Hospital Mohammed VI Marrakech, we identified 272 cases of breast cancer in patients aged 40 years and under. The frequency of breast cancer in young women under 40 years was 24.42%. The average age was 35.6 years. The pauciparity and nulliparity were predominant (60.6%). 8 % had a family history of breast cancer. The self-examination of a nodule was predominant (93%). Tumors classified T2 were the most frequent (45%), followed by T4 tumors (29%).17% were metastatic immediately with predominant hepatic localizations (37.6%). It was Invasive breast carcinoma no special type (NST) in 82.3% of cases, with the predominance of SBR grades II and III (96%). Hormone receptors were positive in 68% of cases and HER2 overexpressed in 29 % of cases. 218 patients underwent surgery, which was radical in 68% and conservative in 21%. 149 had a locoregional irradiation. 71% received adjuvant chemotherapy with the predominance of FAC60 protocol (35%). Hormonotherapy was prescribed in 78% of cases with positive hormone receptors and trastuzumab in 73.8 % of patients over expressing HER2. After a median follow-up of 8.1 months, 41.4 % had relapses. Overall survival at three years was 70%, and the relapse free survival was 62%. Our study joins the data in the literature advocating more advanced forms and worse prognosis of breast cancer in young patients.

Synchronous Primary Renal Cell Carcinoma and Pancreatic Ductal Adenocarcinoma: Case Report and Literature Review

Synchronous primary cancers involving the pancreas and kidney are extremely rare and poorly documented. We report the first case of this association treated with chemotherapy and tyrosine kinase inhibitor. A 70-year-old woman presented with a 2-month history of epigastric pain with weight loss of 12 kg. Two weeks previously, she had presented with jaundice and pelvic pain. A computed tomography (CT) scan of the body revealed the presence of an irregular mass in the body of the pancreas, encasing the celiac trunk, with dilatation of the biliary tract. CT also revealed a heterogeneously right renal mass with bone metastasis in the left acetabular cup and the left iliac wing. A biliary metallic prosthesis was performed with a pancreatic mass biopsy. Histology revealed a moderately differentiated pancreatic ductal adenocarcinoma. Another biopsy was performed in the right iliac wing. Pathological examination with immunohistochemistry confirmed the diagnosis of bone metastasis from clear cell renal cell carcinoma. The patient was treated with a combination of gemcitabine, sunitinib, and denosumab. She had a stabilization disease and a prolonged progression-free survival of 9 months. Side effects were manageable and included grade 2 fatigue and grade 2 hypertension. The patient died at 13 months from diagnosis after disease progression. This report suggests that the appropriate treatment for this association in metastatic or unresectable disease is chemotherapy for pancreatic cancer and tyrosine kinase inhibitor for kidney cancer. We also review the appropriate literature concerning that association.

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

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: