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Background Anaplastic lymphoma kinase (ALK) rearrangement is a predictive factor of response to ALK inhibitors in non small cell lung cancer (NSCLC). The prevalence of ALK rearrangements is well known in Whites and Asians. However, data identifying the frequency of this rearrangement in Moroccan and North African population are lacking. The objective of this study is to report the frequency of ALK rearrangement in a group of Moroccan patients with NSCLC. Methods A retrospective study was performed enrolling 120 Moroccan patients with NSCLC whose biopsy samples were tested for ALK rearrangement in order to identify the frequency of ALK rearrangement and its potential association with selected variables. The ALK testing was established using fluorescent in situ hybridization (FISH) or immunohistochemistry (IHC). Results The frequency of ALK rearrangement was 4.2% (5/120). All positive cases were males with advanced adenocarcinoma. ALK rearrangements prevalence was significantly higher in older patients. Conclusions The frequency of ALK rearrangements among the Moroccan population tends to correlate with the average frequency reported worldwide, with some specific features. Further prospective studies with larger patients’ numbers are needed to verify these findings.

Introduction:the benefits of physical activity have been approved in oncology care. This is why healthcare professionals must play a principle role in promoting physical activity during all cancer care pathway. The purpose of this study was to explore and compare physicians' and nurses' knowledge and views toward physical activity advice in oncology care. Methods:this cross-sectional study included Moroccan physicians and nurses specialized in oncology. Participants were asked to complete an anonymous questionnaire. The inferential statistics were performed to find a difference between physicians' and nurses' knowledge and views. Results:questionnaires were returned by 154 healthcare professionals (response rate 48. 6%). The majority was informed about the physical activity benefits in oncology. The physicians seem to be more informed than nurses about physical activity benefits in oncology (Chi-squared test, p=0.016). The majority thought that physical activity is beneficial in post-treatment (59.7%), while 24% only granted these benefits in the palliative care. The Participants expressed positive views about physical activity in oncology, especially nurses who seem to agree the most with implementation of a physical activity program in the hospital (Mann-Withney, p=0.04). The majority of participants stated that there are some clinical factors related to the patient that constitute a barrier of physical activity advising. Conclusion:the lack of knowledge, self-declared by the majority of participants, underlines the need to strengthen training actions about physical activity advice in health professionals, especially nurses for people with cancer.

Epidermal growth factor receptor (EGFR) mutations are a heterogeneous group of genetic alterations mainly identified in lung adenocarcinoma (AC). They occur in exon 18 to 20 of the EGFR gene. Common EGFR mutations are deletions in exon 19 and substitutions in exon 21, while mutations in exon 18 and exon 20 are rare. Their response to tyrosine kinase inhibitors (TKI) is different, common EGFR mutations are more sensitive to TKI with better response rate and survival, whereas rare EGFR mutations are TKI resistant with poor prognosis and clinical outcomes. The objective of the present study was to report the frequency and characteristics of rare EGFR mutations in a group of Moroccan patients with lung AC harboring a positive EGFR mutation.All cases of Moroccan patients with lung AC harboring mutated EGFR were collected from 334 EGFR test requested. Common EGFR mutations were defined as deletions in exon 19 and substitutions in exon 21 while mutation in exons 18 and 20 were qualified as rare EGFR mutations. Patients' characteristics were reported and compared between the two groups of common and rare EGFR mutations.EGFR mutations were positive in 73/334 of all requested tests. Common EGFR mutations accounted 89% (65/73). Rare EGFR mutations were present in 8 cases (11%). Rare EGFR mutations were composed of 62.5% exon 18 mutations (5/8) and 37.5% exon 20 mutation (3/8). The frequency of regular smokers in patients with tumors expressing rare EGFR mutations was significantly higher than that found in patients with tumors having common EGFR mutations (p=0.013).The frequency found in the present study was consistent with the literature data. However, we found that rare EGFR mutations occurred mostly in exon 18 rather than exon 20, findings that are discordant with the available literature. Thus, we could suggest that Moroccan patients with rare EGFR mutations would benefit more from TKI treatment.Rare EGFR mutations are a heterogeneous subset of genetic alterations in lung AC. Their study deserves a real relevant interest. Some one tenth of lung AC tumors in Moroccan patients harbor a rare EGFR mutation. Further prospective studies are needed, in larger numbers of patients, to assess their specific characteristics and outcomes.

Dermatofibrosarcoma (DFS) described by Darier and Ferrand represents less than 5% of soft tissue sarcomas and metastases only very rarely. We report the case of a 51-year-old patient followed for six years for a DFS of the right thigh root recurrent several times after non-optimal surgical resections. The occurrence of thoracic pain associated with a cough with dyspnea, motivated the realization of a thoracic computed tomography (CT) showing a right basal pulmonary mass with pulmonary nodules. CT biopsy of one of the pulmonary nodules confirmed the metastatic nature of these lesions. The search for translocation t (17,22) could not be performed. A treatment based on imatinib has been started. The evolution was marked by the disappearance of the respiratory symptomatology and a good radiological response. The advent of targeted therapy with imatinib transformed the prognosis for this disease, which was considered incurable at the metastatic stage.

The etiology of post-operative ileus is usually multifactorial, but increased catecholamines have been implicated as an important cause. We present a case of catecholamine-induced prolonged post-operative ileus treated successfully with Pyridostigmine. A 70-year-old male underwent a low-anterior resection and diverting loop ileostomy for rectal cancer. Immediately post-operatively he developed refractory hypertensive urgency and a small bowel ileus. Biochemical testing revealed markedly elevated 24-hour urinary metanephrines and normetanephrines. However, radiologic studies failed to identify a pheochromocytoma. The ileus persisted despite employing a multimodal regimen consisting of avoidance of narcotic pain medications, gastric decompression via a nasogastric tube, maintenance of normal levels of electrolytes, parenteral nutritional support, and early mobilization. Two weeks after the surgery the patient was treated with oral Pyridostigmine with appropriate return of bowel function. Excessive circulating catecholamines play an important role in the etiology of refractory post-operative ileus, and cholinesterase inhibitors such as Pyridostigmine could be used as an effective treatment in such cases.

Gallbladder adenocarcinoma has a poor prognostic. The leading modes of dissemination in gallbladder cancer (GBC) are lymphatic, vascular, neural, intraperitoneal, and intraductal. The most common site of dissemination is liver. Breast metastasis in GBC is an unusual site of dissemination. Only few cases have been reported in the literature. We report a rare case of solitary breast metastasis from recurrent gallbladder carcinoma in light of existing literature.

Pulmonary Blastoma is a rare malignant lung tumor. The Biphasic pulmonary blastoma is composed of a mixture of immature epithelial and mesenchymal tissue ressembling fetal lung tissue with poor prognosis . The surgery is the treatment of choice. The strategy of treatment remains unclear due to the rarity of this tumor. We report a case of 26 year old women presenting with biphasic pulmonary blastoma who was treated with surgery and 6 cycles of adjuvant chemotherapy Etoposide-Cisplatine. Before she underwent adjuvant radiotherapy due to the positive margins, she developed dyspnea and the CT scan showed a massive local recurrence tumor compressing the heart. The patient received a palliative radiotherapy in the chest at the dose of 20Gy followed by palliative chemotherapy based on Adriamycin and Ifosfamide.

Primary adenoid cystic carcinoma (ACC) of the breast is a rare subtype of invasive breast cancer. It has a particular interest because of its excellent prognosis conversely to other triple-negative breast cancers that are associated with poor prognosis. The place of chemotherapy and radiotherapy remains controversial and there is no consensus on optimal management of the ACC of the breast.A 50-year-old woman, presented with a palpable right breast lump. Core biopsy of the lump revealed an adenoid cystic carcinoma. A lumpectomy with axillary lymph node dissection was performed and completed by a mastectomy because of the positive surgical margins. The histopathological examination revealed an adenoid cystic carcinoma, with negative expression of hormone receptors and human epidermal growth factor receptor 2 HER2 and with no lymph node involvement. The patient underwent adjuvant sequential chemotherapy with anthracycline and taxane followed by radiotherapy. We discuss diagnosis, prognostic, and treatment options for ACC of the breast in light of existing literature.Adenoid cystic carcinoma of the breast is a rare variant of triple negative breast cancer with excellent prognosis. Surgical treatment is the mainstay with no clear consensus for radiotherapy and chemotherapy.

Background A multicentre cohort study was held in Morocco, designed to evaluate the quality of life of cancer patients. The aim of this paper is to report the assessment of the quality of life of early colorectal cancer patients, before and after cancer treatment, to identify other factors which are related to this quality of life. Methods We used the third version of the QLQ-C30 questionnaire of the European organization for Research and treatment of Cancer (EORTC) after a transcultural validation. The Data collection was done at inclusion and then every twelve weeks to achieve one year of follow up. Results Overall 294 patients presented with early colorectal cancer, the median age was 56 years (range: 21–88). The male–female sex ratio was 1.17. At inclusion, the global health status was the most affected functional dimension. For symptoms: financial difficulties and fatigue scores were the highest ones. Emotional and social functions were significantly worse in rectal cancer. Most symptoms were more present in rectal cancer. At inclusion, global health status score was significantly worse in stage III. Anorexia was significantly more important among colorectal female patients. For Patients over 70 years-old, the difference was statistically significant for the physical function item which was lower. Overall, Functional dimensions scores were improved after chemotherapy. The symptoms scores did not differ significantly for patients treated by radiotherapy, between inclusion and at one year. Conclusion Our EORTC QLQ C30 scores are overall comparable to the reference values. Neither chemotherapy, nor radiotherapy worsened the quality of life at one year.

Basal cell carcinoma is the most common skin cancer, characterised by a slow growing behavior, metastasis are extremely rare, and it occurs in less than 0, 1% of all cases.Giant basal cell carcinoma is a rare form of basal cell carcinoma, more aggressive and defined as a tumor measuring more than 5 cm at its largest diameter. Only 1% of all basal cell carcinoma develops to a giant basal cell carcinoma,resulting ofpatient's negligence. Giant basal cell carcinoma is associated with higher potential of metastasis and even death, compared to ordinary basal cell carcinoma.We report a case of giant basal cell carcinoma metastaticin lung occurringin a 79 years old male patient, with a fatal evolution after one course of systemic chemotherapy.Giant basal cell carcinoma is a very rare entity, early detection of these tumors could prevent metastasis occurrence and improve the prognosis of this malignancy.The Pan African Medical Journal 2016;24

Introduction: Mutations in human epidermal growth factor receptor 2 (HER2) gene have been reported in lung adenocarcinoma, mainly in East Asian, American and Caucasian patients. There are no data available on the frequency of HER2 mutations in North African and Arab lung cancer patients. Materials and Methods: The mutational status of the HER2 gene was evaluated in 88 Moroccan lung adenocarcinoma patients. HER2 mutations in exon 20 were analyzed using conventional DNA sequencing. Results: One HER2 mutation was found in this series of 88 patients (1.1%). This patient was male and a heavy smoker. Conclusion: This study, the first to date dedicated to HER2-mutated North African lung adenocarcinoma patients, revealed that HER2 mutations are relatively infrequent in Moroccan lung adenocarcinomas and thus a probably limited interest of HER2 inhibitors.

The Editor Current Oncology 31 August 2015 We read with great interest the article of Ma and colleagues titled “An exploratory comparative analysis of tyrosine kinase inhibitors or docetaxel in second-line treatment of EGFR wild-type non-small-cell lung cancer: a retrospective real-world practice review at a single tertiary care centre”1. The authors presented a retrospective cohort study including patients with EGFR wild-type non-small-cell lung cancer (nsclc) who received tyrosine kinase inhibitor (tki) as second- or third-line therapy, and they compared clinical outcomes for tki and single-agent docetaxel in second-line treatment. In the article, the authors concluded that second-line therapy with tki for EGFR wild-type nsclc (compared with docetaxel) was associated with statistically better progression-free survival (pfs) and event-free survival, and noninferior overall survival. That finding is quite surprising and might be related to the many limitations of the study. Indeed, in addition to the limitations reported by the authors (the relatively small size of the cohort, the selection bias, the variability in the timing of imaging, and the retrospective nature of the analysis), we can make several comments. First, considering the results of two large randomized phase iii trials (delta and tailor)2,3 and a meta-analysis4, it is now well established that chemotherapy is better than erlotinib in terms of pfs in the second-line treatment of nsclc with wild-type EGFR status. It is difficult to consider the results of a retrospective study such as that in the article from Ma and colleagues rather than those from the more methodologically strong studies. Second, Ma et al. did not specify in the article how they defined EGFR wild-type patients. That information is important, because if the authors excluded only patients with classical EGFR mutation (exon 19 deletion and L834R substitution mutations), it is possible that some patients classified as EGFR wild-type in the study might have some rare activating EGFR mutations (non-classical mutations in exons 18–21).When receiving tkis, those patients might consequently achieve a longer pfs than do those with true EGFR wild-type mutations, thus leading to a better pfs than is seen in patients receiving docetaxel. Furthermore, the detection method used for the EGFR mutation analysis (not reported in the study) might also have affected the study results, because the currently available methods have different sensitivities and specificities5. Third, the treatment-free interval after the prior line of chemotherapy is another important parameter to take into consideration. Indeed, Odabaset al.6 recently reported that the time elapsed after first-line treatment (≥3 months vs.

Background Breast metastasis is fairly uncommon and prognosis is dismal. Breast metastasis might be the first symptom or may occur during the course of other malignancies dominantly arising from the contralateral breast. Leukemia, lung cancer and conjunctival melanoma may spread to the breast. Case presentation A 43-year-old female patient was operated on for conjunctival melanoma. After two years the disease progressed quickly and cutaneous nodes appeared on the back and paraumbilical region. Physical and radiological examination showed a breast mass. No palpable lymph’s nodes were noted. She underwent an open biopsy. Histopathologic examination and immunohistochemistry confirmed breast metastases from melanoma. During post-operative staging multiple nasopharyngeal and oropharyngeal lesions were also objective. The patient was given palliative dacarbazine (250 mg/m2 per day for 4 days) for 4 cycles. She died 4 months after the diagnosis of breast metastases. Conclusion Histopathological evaluation should be mandatory in patients with medical history of malignancies in order to differentiate new primary tumors, metastases, and benign tumors.

Background. In lung adenocarcinoma, the frequency of KRAS mutations is ethnicity dependent with a higher proportion in African Americans and white Caucasians than in Asians. The prevalence of these mutations among North Africans patients is unknown. The objective of this study was to report the frequency and spectrum of KRAS mutations in a group of Moroccan lung adenocarcinoma patients. Methods. Tumor specimens from 117 Moroccan patients with lung adenocarcinoma were selected to determine frequency and spectrum of KRAS mutations. KRAS mutations in codons 12 and 13 of exon 2 were analyzed using conventional DNA sequencing. Results. The overall frequency of the KRAS mutations was 9% (11/117). In the population with KRAS mutations, there was a trend towards more male (P=0.06) and more smokers (P=0.08) compared to patients with wild type KRAS. KRAS mutations were located at codon 12 in 10 out of 11 patients (91%). The G12C mutation was the most frequent KRAS mutation (73%). Conclusion. This is the first study to date examining the frequency and spectrum of KRAS mutations in lung adenocarcinomas in North African and Arab populations. KRAS mutation frequency in Moroccan patients was comparable with the frequency observed in East-Asian population. KRAS mutations are more likely observed in males and smokers and to be transversions. Further studies, in larger numbers of patients, are needed to confirm these findings.

We are reporting a case of multifocal reversible leucoencephalopathy syndrome induced by chemotherapy based on Folfox-Bevacizumab regimen. A 44-year-old female, with no history of hypertension, received a chemotherapy based on Folfox-Bevacizumab for her metastatic colon cancer (5 FU: 325 mg/m2 d1 by intravenous infusion, Oxaliplatin 80 mg/m2 d1, and Bevacizumab: 7.5 mg/Kg d1). During the fourth cure, she presented delirium, seizures, and visual disturbances. The computed tomography (CT) of the brain showed hypodense lesions of the white matter of frontal, parietal, and occipital lobes, which were bilateral and symmetrical. The clinical table was reversible under symptomatic treatment.

HER-2 is overexpressed in 20 to 30% of breast cancer. Generally, metastases of a breast tumor have the same HER-2 status, although some discordances were reported. We report a case of reduction in HER-2 expression assessed by immunohistochemistry, following one day of a Trastuzumab injection, of a metastatic breast cancer to lymph nodes. Initially, the breast tumor HER-2 status was positive according to the same technique. We raise a hypothesis about technical interference and discuss the case in the framework of the existing literature.

► We report a case of recurrent vulvar carcinoma with a good response to erlotinib. ► Treatment was well tolerated with no serious side effects. ► Further evaluation of this new therapeutic approach may be warranted.

Introduction Primary 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 presentation An 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. Conclusion According 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.

Introduction: Epidermal growth factor receptor (EGFR) mutations in non–small-cell lung cancer predict response to tyrosine kinase inhibitors. The frequency of EGFR mutations is ethnicity-dependent, with a higher proportion in Asian populations than in whites. The prevalence of these mutations among North African patients is unknown. The objective of this study was to report the frequency and spectrum of EGFR mutations in a group of Moroccan patients with lung adenocarcinoma (AC). Methods: Tumor specimens from 137 Moroccan patients with lung AC were selected to determine frequency and spectrum of EGFR mutations. Mutation detection techniques were polymerase chain reaction amplification and sequencing of exons 18, 19, 20, and 21. Results: The overall frequency of the EGFR mutation was 21%. Mutations were mainly detected in the exon 19 (69%), followed by exon 21 (21%) and exon 20 (7%), whereas mutations in the exon 18 were rare (3%). EGFR mutation rate was significantly higher in women and in never smokers. Conclusion: Some one fifth of lung AC tumors in Moroccan patients harbor EGFR mutations. This mutation frequency is higher than that found in whites but lower than in Asian population. Further studies, in larger numbers of patients, are needed to confirm these findings.

Choroidal metastases from renal carcinoma are rare. Most reported cases describe a clear cell carcinoma histologic subtype. Metastatic tubulopapillary renal cell carcinoma to the choroid plexus is very exceptional. We report the case of a 31-year-old man with a history of tubulopapillary renal cell carcinoma who presented two years later with metastatic disease to lungs and presternal soft tissue and three months after with choroidal metastasis revealed on ophtalmoscopic examination and magnetic resonance imaging. The case is discussed in the framework of the existing literature about the clinical features, treatment, and prognosis of this very rare condition.