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Gastric cancer is the 6th most common cancer in the world. Gastric adenocarcinomas can be divided into two groups: gastroesophageal junction adenocarcinomas and distal gastric adenocarcinomas, with different risk factors and potentially different therapeutic strategies. Therapeutic strategy for esogastric adenocarcinoma is multimodal. Gastric adenocarcinomas are managed with surgery and peri-operative chemotherapy. Gastroesophageal junction adenocarcinomas can either be treated surgically after neoadjuvant chemoradiotherapy or in the same way than gastric adenocarcinomas. There is currently no evidence of superiority of either treatment strategy. Recently, nivolumab has been validated as an adjuvant therapy for patients with esophageal cancer who received preoperative chemoradiotherapy and had residual tumor on the surgical specimen. In the absence of preoperative treatment, adjuvant chemoradiotherapy or chemotherapy should be discussed on a patient-by-patient basis. Currently, there is not indication for targeted therapies, nor for adapting postoperative treatment according to the response to preoperative treatment. The only validated indication for immunotherapy is as adjuvant treatment of esophageal cancer, but many studies are ongoing and may change practices in the future. The objective of this review is to synthesize the literature concerning the management of localized esogastric adenocarcinoma.

Cet article est le fruit d'une collaboration réflexive de cinq enseignants de champs disciplinaires et de structures universitaires différents, avec l’aide de deux conseillères pédagogiques. Il s'agit d'un retour d'expérience à la suite de la participation de ces enseignants à un parcours de formation à la pédagogie universitaire intitulé CertifiENS. Notre propos est surtout de témoigner de cette expérience originale et interdisciplinaire, en décrivant les caractéristiques de notre groupe d’enseignants, le parcours CertifiENS que nous avons suivi puis les transformations pédagogiques que nous avons opérées dans nos enseignements. Nous avons sollicité a posteriori deux de nos conseillères pédagogiques (formatrices dans le cadre du parcours CertifiENS et enseignantes-chercheuses en sociologie et sciences de l’éducation) pour un entretien de groupe (focus group) visant à expliciter nos intentions et motivations initiales et mettre en lumière l'émergence d'une dynamique collective. Cet entretien de groupe nous a permis de porter une analyse réflexive individuelle puis collective sur le processus de transformation individuelle et sur la transition pédagogique effectuée et toujours en devenir. Cette analyse a montré que l’interdisciplinarité a été un atout majeur et une source de synergies, permettant de nous focaliser sur le commun : la pédagogie. Le groupe a été porteur d’une transformation durable des pratiques enseignantes, chacun sur son terrain respectif a souhaité continuer à porter ce changement de paradigme, tout en réfléchissant à la construction d’une communauté de pratiques. This article is the result of a reflective collaboration between five university teachers from different disciplines and universities, with the help of two pedagogical advisors. It consists of feedback following the participation of these teachers in a training course in university pedagogy entitled CertifiENS. Our purpose is to describe this original and interdisciplinary experience, by describing the characteristics of our group of teachers, the CertifiENS program that we followed and pedagogical transformations that we made in our teaching. We asked two of our pedagogical advisors (instructors in the CertifiENS program and teacher-researchers in sociology and education sciences) for a focus group interview to uncover our initial intentions and motivations and to highlight the emergence of a collective dynamic. This focus group interview helped us to carry out an individual and then collective reflective analysis of the individual transformation process and of the pedagogical transition that had taken place and is still in progress. This analysis showed that interdisciplinarity was a major asset and a source of synergies, allowing us to focus on the common ground: pedagogy. The group was the bearer of a sustainable transformation of teaching practices and beliefs, each one on their respective field wished to continue to carry this paradigm shift, while advancing on the construction of a community of practice.

Refractory thyroid cancers include radio-iodine-refractory cancers, metastatic or locally advanced unresectable medullary and anaplastic thyroid cancers. Their management has been based for several years on the use of multi-target kinase inhibitors, with anti-angiogenic action, with the exception of anaplastic cancers usually treated with chemo- and radiotherapy. The situation has recently evolved due to the availability of molecular genotyping techniques allowing the discovery of rare but targetable molecular abnormalities. New treatment options have become available, more effective and less toxic than the previously available multi-target kinase inhibitors. The management of refractory thyroid cancers is therefore becoming more complex both at a diagnosis level with the need to know when, how and why to look for these molecular abnormalities but also at a therapeutic level, innovative treatments being hardly accessible. The cost of molecular analyzes and the access to treatments need also to be homogenized because disparities could lead to inequality of care at a national or international level. Finally, the strategy of identifying molecular alterations and treating these rare tumors reinforces the importance of a discussion in a multidisciplinary consultation meeting.

The BRAF

We report the case of a 57-year-old man, who is hospitalized for the surgery of a gallbladder mass associated by an increase in fluorodeoxyglucose-activity on positron emission tomography/computed tomography scan. This is an incidental finding occurring during monitoring of a skin melanoma. A cholecystectomy is performed. Microscopic examination identified an infiltration of the gallbladder wall by a proliferation of atypical pigmented spindled melanocytes with numerous mitoses. The immunohistochemical analysis confirmed the melanocytic nature of this proliferation with the staining of HMB-45, S100 protein and Melan-A. A complementary immunohistochemical (p16, desmin and BRAFV600E) and molecular (BRAF sequencing) study is performed. The results are consistent with the hypothesis of a gallbladder metastasis of a cutaneous melanoma is proposed. Gallbladder metastases of melanoma are exceptional. The aim of our work is to describe a new case with immunohistochemical and molecular characterization, to review the literature on this topic and to consider the main differential diagnosis (primary malignant melanoma of the gallbladder).

Cutaneous melanoma is a multifactorial disease resulting from both environmental and genetic factors. Five susceptibility genes have been identified over the past years, comprising high-risk susceptibility genes (CDKN2A, CDK4, and BAP1 genes) and intermediate-risk susceptibility genes (MITF, and MC1R genes). The aim of this expert consensus was to define clinical contexts justifying genetic analyses, to describe the conduct of these analyses, and to propose surveillance recommendations. Given the regulatory constraints, it is recommended that dermatologists work in tandem with a geneticist. Genetic analysis may be prescribed when at least two episodes of histologically proven invasive cutaneous melanoma have been diagnosed before the age of 75 years in two 1st or 2nd degree relatives or in the same individual. The occurrence in the same individual or in a relative of invasive cutaneous melanoma with ocular melanoma, pancreatic cancer, renal cancer, mesothelioma or a central nervous system tumour are also indications for genetic testing. Management is based upon properly managed photoprotection and dermatological monitoring according to genetic status. Finally, depending on the mutated gene and the familial history, associated tumour risks require specific management (e.g. ocular melanoma, pancreatic cancer). Due to the rapid progress in genetics, these recommendations will need to be updated regularly.

We report the case of a patient with asymptomatic and fortuitously detected right ventricular colorectal cancer metastasis. These metastatic lesions are uncommon and after a description of the index case we provide a review of the most recently published cases.