Rhizlane Belbaraka

Male breast cancer: a report of 127 cases at a Moroccan institution

BackgroundMale breast cancer (MBC) is a rare disease representing less than 1% of all malignancies in men and only 1% of all incident breast cancers. Our study details clinico-pathological features, treatments and prognostic factors in a large Moroccan cohort.FindingsOne hundred and twenty-seven patients were collected from 1985 to 2007 at the National Institute of Oncology in Rabat, Morocco.Median age was 62 years and median time for consultation 28 months. The main clinical complaint was a mass beneath the areola in 93, 5% of the cases. Most patients have an advanced disease. Ninety-one percent of tumors were ductal carcinomas.Management consisted especially of radical mastectomy; followed by adjuvant radiotherapy and hormonal therapy with or without chemotherapy. The median of follow-up was 30 months. The evolution has been characterized by local recurrence; in twenty two cases (17% of all patients). Metastasis occurred in 41 cases (32% of all patients). The site of metastasis was the bone in twenty cases; lung in twelve cases; liver in seven case; liver and skin in one case and pleura and skin in one case.ConclusionMale breast cancer has many similarities to breast cancer in women, but there are distinct features that should be appreciated. Future research for better understanding of this disease at national or international level are needed to improve the management and prognosis of male patients.

Hepatoid Adenocarcinoma of the Lung: A Case Report and Literature Review.

Hepatoid adenocarcinoma of the lung is a rare form of malignancy defined as an alpha-fetoprotein (AFP)-producing primary lung carcinoma with specific morphological features resembling hepatocellular carcinoma (HCC). Hepatoid lung adenocarcinomas are extremely rare. Due to the rarity of the tumor, any new case contributes to the clarification of its complete clinico-morphological description, biological behavior, and prognosis. It occurs in a multitude of organs: most frequently in the stomach, but also rarely in other areas, including the lung, kidney, female reproductive tract, pancreas, and gallbladder. We present a case of stage IV primary lung cancer with highly elevated AFP levels and morphological and immunohistochemical characteristics for hepatoid adenocarcinoma of the lung.

Anthracycline and concurrent radiotherapy as adjuvant treatment of operable breast cancer: a retrospective cohort study in a single institution

BackgroundConcurrent chemoradiotherapy (CCRT) after breast surgery was investigated by few authors and remains controversial, because of concerns of toxicity with taxanes/anthracyclines and radiation. This treatment is not standard and is more commonly used for locally advanced breast cancer. The aim of our study was to evaluate the efficacy and safety of the concomitant use of anthracycline with radiotherapy (RT).FindingsFour hundred women having operable breast cancer, treated by adjuvant chemotherapy (CT) and RT in concomitant way between January 2001 and December 2003, were included in this retrospective cohort study. The study compares 2 adjuvant treatments using CCRT, the first with anthracycline (group A) and the second with CMF (group B). The CT treatment was repeated every 21 days for 6 courses and the total delivered dose of RT was 50 Gy, divided as 2 Gy daily fractions. Locoregional recurrence free (LRFS), event free (EFS), and overall survivals (OS) were estimated by the Kaplan-Meier method. The log-rank test was used to compare survival events. Multivariate Cox-regression was used to evaluate the relationship between patient characteristics, treatment and survival.In the 2 groups (A+B) (n = 400; 249 in group A and 151 in group B), the median follow-up period was 74.5 months. At 5 years, the isolated LRFS was significantly higher in group A compared to group B (98.7% vs 95.3%; hazard ratio [HR] = 0.258; 95% CI, 0.067 to 0.997; log-rank P = .034). In addition, the use of anthracycline regimens was associated with a higher rate of 5 years EFS (80.4% vs 75.1%; HR = 0.665; 95% CI, 0.455 to 1.016; log-rank P = .057). The 5 years OS was 83.2% and 79.2% in the anthracycline and CMF groups, respectively (HR = 0.708; 95% CI, 0.455 to 1.128; log-rank P = .143). Multivariate analysis confirmed the positive effect of anthracycline regimens on LRFS (HR = 0.347; 95% CI, 0.114 to 1.053; log-rank P = .062), EFS (HR = 0.539; 95% CI, 0.344 to 0.846; P = 0.012), and OS (HR = 0.63; 95% CI, 0.401 to 0.991; P = .046). LRFS, EFS and OS were significantly higher in the anthracycline group where the patients (n = 288) received more than 1 cycle of concurrent CT (P = .038, P = .026 and P = .038, respectively). LRFS and EFS were significantly higher in the anthracycline group within the BCT subgroup (P = .049 and P = .04, respectively). There were more hematologic, and more grade 2/3/4 skin toxicity in the anthracycline group.ConclusionsAfter mastectomy or BCT, the adjuvant treatment based on anthracycline and concurrent RT reduced breast cancer relapse rate, and significantly improved LRFS, EFS and OS in the patients receiving more than 1 cycle of concurrent CT. There were more hematologic and non hematologic toxicities in the anthracycline group.

Symptomatic hypopituitarism revealing primary suprasellar lymphoma.

BackgroundThe most common cause of hypopituitarism is pituitary adenoma. However, in the case of suprasellar masses different etiologies are possible. We report an unusual case of primary suprasellar lymphoma presented with hypopituitarism.Case presentationA 26 year old woman presented with amenorrhea, galactorrhea and neurological disorders. Also, the laboratory work-up revealed partial hypopituitarism. The magnetic resonance imaging of the head showed a suprasellar mass. A presumptive diagnosis of granulomatous processes was made and the patient was given steroid therapy. Repeated brain MRI detected new lesions in the brain with regression of the suprasellar mass. Stereotactic biopsy of the paraventricular lesion revealed the diagnosis of B-cell lymphoma.ConclusionThis case presentation reports a rare cause of hypopituitarism. Primary suprasellar lymphoma is extremely rare and represented a real diagnostic challenge. Besides, suprasellar masses are varied in aetiology and can present diagnostic problems for a radiologist. Also, because of the increased incidence of PCNSL, lymphoma must be kept in mind in the differential diagnosis of lesions in the suprasellar region.

Primary renal non-Hodgkin lymphoma: An unusual diagnosis for a renal mass

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Primary lymphoma of the prostate treated with rituximab-based chemotherapy: a case report and review of the literature.

IntroductionPrimary lymphoma of the prostate is very rare. In this paper we present a case of early stage non-Hodgkin lymphoma of the prostate managed with six cycles of rituximab-based chemotherapy, and review the related literature.Case presentationAn 84-year-old man was admitted to our hospital having signs and symptoms suggestive of prostatic disease for 3 years. Histological and immunocytochemical studies of trans-urethral biopsy of the prostate showed diffuse large B-cell lymphoma. Radiological assessment of disease confirmed the diagnosis of early stage lymphoma of the prostate. The patient was managed by 6 of rituximab 375 mg/m2 on day 1, cyclophosphamide 750 mg/m2 on day 1, doxorubicin 50 mg/m2 on day 1, vincristine 1.4 mg/m2 on day 1, and prednisone 50 mg/m2 on days 1 to 5 with complete clinical and radiological response. He remained disease free, until now, 30 months after the end of chemotherapy.ConclusionAccording to the literature, the treatment and prognosis of primary lymphoma of the prostate is the same as that of other nodal lymphomas. Rituximab-based regimen should be considered in the management of prostatic diffuse large B-cell lymphoma.

Bisphosphonates and innovative drugs in the prevention of skeletal complications secondary to metastatic prostate cancer

Over than 80% of patients with locally advanced prostate cancer will develop bone metastases during the disease management. These metastases are often responsible for complications that impaired the quality of life, impaired the prognosis and increased the mortality by prostate cancer (PC). Two drugs are currently approved by the scientific community in the prevention of skeletal complications secondary to castration-resistant prostate cancer metastatic to bone (CRPCMB), zoledronic acid at a dose of 4 mg intravenously every 3-4 weeks and denosumab at a dose of 120 mg subcutaneously every 4 weeks. This aim of the preset paper was to review the current literature on the mechanism of action, efficacy, and safety profile of these two classes of molecules in the management of CRPCMB.

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.

Triple malignancy in a single patient including a squamous cell carcinoma of the cervix, a colloid adenocarcinoma of the colon and a lung adenocarcinoma: A case report and literature review

Highlights • Triple malignancy in the same patient is exceptional.• The etiology remains controversial.• The management depend on stages.• Surgery is the standard of care in localized cancers.