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Abstract Introduction Transitional cell carcinoma (TCC) of the ovary is a rare, recently recognized, subtype of ovarian surface epithelial cancer. Case presentation A 69-year-old postmenopausal woman presented with a 2-year history of progressive enlargement of an abdominal mass. Abdominal computed tomography showed a pelvic mass. CA-125 was normal. A staging operation with total abdominal hysterectomy, bilateral salpingo-oophorectomy, infracolic omentectomy and pelvic lymph node dissection was performed. After surgery, the pathologic report of the right ovarian tumour was TCC, grade 3, stage IC. The patient underwent 3 cycles of chemotherapy: carboplatin and paclitaxel. She is regularly followed up and has been disease free for 10 months Conclusion Transitional cell carcinoma (TCC) of the ovary is a rare subtype of epithelial ovarian cancer. Surgical resection is the primary therapeutic approach, and patient outcomes after chemotherapy are better than for other types of ovarian cancers.

Background: Pelvic recurrences of cervical cancer after primary surgical treatment can be potentially cured with radical hysterectomy or chemoradiation therapy. Combined radio-chemotherapy is believed to improve results compared to other option. Currently, RapidArc radiotherapy is considered an excellent technological advance that shows great potential for producing highly conformal doses to treatment volumes. Case presentation: We present a case of a 67-year-old woman with history of early cervical cancer initially treated by radical laparoscopic hysterectomy. More than 5 years later, the patient presented with a central pelvic vaginal cuff recurrence that is histologically confirmed. Salvage radiotherapy using RapidArc with concurrent cisplatin-based chemotherapy was indicated. A high dose of 70 Gy was delivered to the gross recurrent disease with simultaneous integrated boost (SIB) to the subclinical disease and good sparing of organs at risk especially the rectum and sigmoid. Conclusions: This case clearly demonstrates a large benefit for salvage RapidArc radiotherapy to central pelvic recurrences of gynecological cancers with an excellent rate of local control and less rate of toxicity. [ABSTRACT FROM AUTHOR]

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Introduction: Transitional cell carcinoma (TCC) of the ovary is a rare, recently recognized, subtype of ovarian surface epithelial cancer. Case presentation: A 69-year-old postmenopausal woman presented with a 2-year history of progressive enlargement of an abdominal mass. Abdominal computed tomography showed a pelvic mass. CA-125 was normal. A staging operation with total abdominal hysterectomy, bilateral salpingo-oophorectomy, infracolic omentectomy and pelvic lymph node dissection was performed. After surgery, the pathologic report of the right ovarian tumour was TCC, grade 3, stage IC. The patient underwent 3 cycles of chemotherapy: carboplatin and paclitaxel. She is regularly followed up and has been disease free for 10 months Conclusion: Transitional cell carcinoma (TCC) of the ovary is a rare subtype of epithelial ovarian cancer. Surgical resection is the primary therapeutic approach, and patient outcomes after chemotherapy are better than for other types of ovarian cancers. [ABSTRACT FROM AUTHOR]

La maladie de HODGKIN (MDH) survient le plus souvent chez les enfants, adolescents et jeunes adultes. Elle représente une des tumeurs malignes les plus curables. Grâce aux progrès thérapeutiques actuels, plusieurs patients ont pu obtenir des réponses complètes durables, mais les tumeurs solides malignes, secondaires au traitement, demeurent la complication tardive la plus redoutable chez les longs survivants. Il s’agit d'un patient de 28 ans, sans antécédents pathologiques notables, suivi depuis L'age de 13 ans pour une MDH scléro-nodulaire stade IV (à localisation pulmonaire). Le patient a reçu initialement 06 cures de chimiothérapie, suivies d"une radiothérapie externe sus et sous-diaphragmatique. l'évolution a été marquée par la survenue de 02 rechutes, pour lesquelles, 02 autres lignes thérapeutiques ont été administrées. Puis, survenue d"une progression, pour laquelle il a été mis sous Cyclophosphamide par voie orale. Après 02 ans d"un bon contrôle clinique et radiologique sous cette dernière drogue cytotoxique, le patient a fait apparaître une hématurie macroscopique et parallèlement, un adénocarcinome (ADK) colique, survenant 15 ans après le début du traitement initial du lymphome, ayant nécessité une hémicolectomie droite élargie. Les modalités thérapeutiques de la MDH chez les adolescents et jeunes adultes ont subit des modifications remarquables ces dernières décennies. L�évaluation du risque de cancers secondaires chez les longs survivants, reflète souvent l�effet de modalités anciennes plus agressives. La plupart des études rapportant des cas de cancers secondaires, tiennent en compte la 1ère ligne thérapeutique et les traitements de rattrapage de la MDH. En effet, les jeunes patients traités par chimiothérapie et plus particulièrement par radiothérapie, sont à haut risque de développer des cancers secondaires. La radio-chimiothérapie parait par ailleurs, augmenter de façon plus significative ce risque. L�estimation du risque de cancers secondaires à long terme demeure alors essentielle, afin de minimiser les complications tardives, et ceci à travers des mesures de prévention et de dépistage chez les jeunes patients potentiellement à risque.

Les tumeurs malignes de l'intestin grèle (TMPIG) sont des tumeurs rares. Elles représentent 1 à 5% de toutes les tumeurs du tube digestif. Elles sont caractérisées par une hétérogénéité anatomopathologique et une symptomatologie pauvre et non spécifique entrainant ainsi un retard diagnostic, des difficultés Thérapeutiques et donc un mauvais pronostic. Nous rapportant les caractéristiques épidémiologiques, diagnostiques et thérapeutiques ainsi que la survie des patients atteints des TMIG au sein de l’institut national d’oncologie de Rabat. Il s’agit d’une analyse rétrospective des dossiers cliniques des 27 patients ayant le diagnostic de tumeurs malignes de l’intestin grèle admis dans notre institut entre 1998 et 2002. L’âge médian était de 46 ans (15-70 ans). Le délai médian de diagnostic était de 6 mois (0-96 mois). La douleur abdominale était le symptôme le plus fréquent (77.8%). L’étude anatomopathologique a montré 63% de lymphome non Hodgkinie, 14.8% d’adénocarcinome, 7.4% de tumeur stromale, 7.4% de carcinome neuroendocrine et 7.4% de sarcome intestinal. Vingt patients (76. 9%) ont eu une résection chirurgicale et 14 patients (53. 8%) ont eu une chimiothérapie en fonction du stade de la maladie et du type histologique. Après un recul médian de 11.6 mois, la survie globale après 12 mois était de 44.4% et la médiane de survie était de 11.6 mois. Les tumeurs malignes de l’intestin grèle sont rares. Leur diagnostic est tardif limitant ainsi la prise en charge thérapeutique curative. Les cliniciens doivent ètre avertis des symptômes gastro-intestinaux non spécifiques

Abstract Introduction Periductal stromal sarcoma is an extremely rare malignant fibroepithelial tumor of the breast which is characterized by its biphasic histology with benign ductal elements and a sarcomatous stroma made of spindle cells and lacking phyllodes architecture. Its therapeutic management is based on wide surgery with free margins. Adjuvant therapies are not needed. Periductal stromal sarcoma may evolve into a phyllodes tumor with time, as well as a specific soft-tissue sarcoma. To the best of our knowledge, this tumor has never been described in a child. Case presentation A 14-year-old Arabic boy was presented to our hospital one year ago with a nodule of the right breast that was gradually increasing in size without signs of inflammation. The histological examination after lumpectomy revealed a periductal stromal sarcoma with free surgical margins. No adjuvant treatment was given. At 50 months of close follow-up, no recurrence was observed. Conclusion Periductal stromal sarcoma in a child is a very rare disease which has the same indolent behavior as it does in adults. Therefore, close follow-up is required.

Objectifs Évaluation de la radiothérapie conformationnelle avec modulation d’intensité (RCMI) en pratique de routine pour les cancers du cavum. Patients et méthodes Entre mars 2004 et juillet 2013, 49 patients, dont 82 % atteints d’un cancer du cavum indifférencié et 88 % d’une infection par le virus d’Epstein Barr, ont reçu une RCMI pour dans notre institution. L’âge moyen était de 51 ans (21–82 ans). La majorité des cancers (45 %) était de stade III, 33 % étaient de stade II, 20 % de stade IVA et 2 % de stade IVB (selon la classification de l’American Joint Committee on Cancer, AJCC, de 2010). Une chimiothérapie néoadjuvante par taxotère, cisplatine et 5-fluoro-uracile (TPF) a été délivrée à 37 % des patients. Une chimiothérapie concomitante a été administrée à 86 % des patients, il s’agissait essentiellement de cisplatine à la dose 100 mg/m 2 les première, quatrième et septième semaines de l’irradiation (deux tiers des patients). Résultats Durant l’irradiation, il a été observé 35 % de cas de toxicité de grade II, 35 % de grade III et 8 % de grade IV. La perte de poids moyenne était de 6,5 kg. Alors que 96 % des patients avaient une alimentation orale avant radiothérapie, ils n’étaient plus que 14 % à la fin du traitement (86 % des patients supplémentés l’étaient par gastrostomie endoscopique percutanée, 7 % par sonde nasogastrique et 7 % par voie parentérale). Le suivi médian est de 37 mois. À 5 ans, la probabilité de survie globale estimée était de 91 % et celle de survie sans progression de 79 %. Sept cancers ont rechuté, trois localement et cinq à distance. Deux récidives locales ont été rattrapées par irradiation stéréotaxique. La toxicité tardive observée était de grade II dans 16 % des cas, de grade III dans 16 % et 0 % de grade IV. À distance, 94 % des patients ont repris une alimentation orale normale. Conclusion L’analyse de ces résultats a confirmé l’excellent taux de contrôle offert par la RCMI dans les cancers du cavum au prix d’un taux de toxicité tardive acceptable. Le suivi nutritionnel en cours et au décours du traitement apparaît essentiel. [ABSTRACT FROM AUTHOR]

Abstract Background Breast cancer is uncommon in young women and induces more aggressive biologic characteristics. Survival in young women has been widely studied in developed countries. Less favorable prognosis and low survival were found. In Morocco, this study is the first investigation of clinical features, treatment and prognosis associated with breast cancer in young women. Findings Four hundred and nine women aged 35 years or less were included in this study. All these women were diagnosed as having breast cancer at the National Institute of Oncology in Rabat, Morocco between 2003 and 2007. The relation between clinical and therapeutic characteristics and event-free survival (EFS) and overall survival (OS) were assessed by Cox regression analysis. The median age of the patients was 32 years. Fifty three patients (13%) have metastatic disease at diagnosis and 356 patients (87%) had localised disease. In 57.9% of the cases, the estrogen receptors status was positive. The median follow-up was 32.2 months. After 3 years the survival rate was 80.6%. In the case of localised disease, OS and EFS at 3 years were 83.2% and 62.5%, respectively. OS and EFS at 3 years was higher in patients with stage I than patients with stage II and stage III (p = 0.001). Positive estrogen receptors was significantly associated to OS and EFS at 3 years compared to negative estrogen receptors (p = 0.001). Adjuvant chemotherapy, adjuvant radiotherapy and adjuvant hormone therapy were associated with net benefit in OS and EFS at 3 years. Cox regression analysis showed that negative ER was significantly associated with poorer OS (HR = 2.42, 95% CI = 1.25 - 4.66, p < 0.009) and poorer EFS (HR = 1.73, 95%CI = 1.05 - 2.86, p = 0.03). Stage III disease were associated to poorer EFS (HR = 5.35, 95%CI = 1.60 -17.84, p = 0.006). Conclusions In Morocco, young women with breast cancer had less favorable prognosis. Multivariate analysis showed that negative hormone receptor status was associated with lower EFS and OS. Clinical trials should be launched to improve the survival of these young women with breast cancer.

Abstract Background Concurrent 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). Findings Four 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. Conclusions After 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.

Abstract Background Excavated pulmonary metastasis are rare. We present two cases of excavated pulmonary nodules proved to be metastases from osteosarcoma and gallblader lymphoma. Case presentation The first one is 39-year-old man in whom cholecystectomy made the diagnosis of primary non-Hodgkin's lymphoma of the gallbladder. He presented in chest CT scan excavated nodules that had been biopsied and confirmed the diagnosis of non hodgkin lymphoma. He underwent 8 courses of chemotherapy CHOP 21 with complete remission. The second one is an 21 years old man who presented a right leg osteoblastic osteosarcoma with only excavated pulmonary nodules in extension assessment. He had 3 courses of polychemotherapy API (doxorubicin, platinum, and ifosfamide) with partial response. Unfortunately, he died following a septic shock. Review of the literature shows that excavated pulmonary nodules as metastasis are rare but we should consider this diagnosis every time we are in front of a cancer. Chest computed tomography is the best diagnosis imaging that could make this diagnosis. Differential diagnosis between benign and malignant bullous lesions is important because surgical excision affects survival in some malignancies. Conclusions Although pulmonary nodules are the most common cancer metastasis, a differential diagnosis of a concurrent primary malignancy should always be considered every time we have excavated lesions, even in patients with known malignant disease. Thorough chest evaluation is important, as multiple primary malignancies may occur concomitantly.

Abstract Introduction Primary Hodgkin's disease of the nasopharynx is a rare and uncommon event. It has a relatively favorable prognosis and represents less than 1% of all documented cases of Hodgkin's disease. Case presentation A 40-year-old Arabic man presented initially with bilateral nasal obstruction, which was then followed by a significant involvement of his bilateral cervical lymph nodes. His nasopharyngeal biopsy together with immunohistochemistry analysis showed negative expressions of CD15, CD20 and CD3, but positive expressions of CD30 and epithelial membrane antigen. This confirmed the diagnosis of nasopharyngeal Hodgkin's disease of a mixed cellularity subtype. The disease was at stage IIEA. Our patient received four cycles of chemotherapy, which yielded a 75% response. This was followed by irradiation of his Waldeyer's ring and supraclavicular lymph nodes. He remains in good local control after 30 months of follow-up. Conclusion The literature review and our case report discuss the optimal management of this rare and atypical localization of Hodgkin's disease, which should be differentiated from lymphoproliferations associated with Epstein-Barr virus and non-Hodgkin's lymphoma.

Objectif de l’étude L’objectif était le calcul des marges pour le volume cible prévisionnel et l’évaluation de la corrélation entre les mouvements de la prostate et ceux du rectum et de la vessie. Matériel et méthode Quinze patients ont été irradiés pour un cancer de la prostate. Le contrôle du positionnement a été par des images de basse énergie (kV) avant chaque fraction et des tomographies coniques hebdomadaires pour vérifier la position de la prostate. Les composantes systématique Σ et aléatoire σ ont été calculées dans les trois directions (antéropostérieure, supéro-inférieure, médiolatérale). Les set-up margins et internal margins ont été calculées par la formule de van Hesk : 2,5 Σ + 0,7 σ . Le volume cible prévisionnel (PTV) a été calculé selon la formule P T V = IM 2 + SM 2 (ICRU 62). Les mouvements des parois antérieure, postérieure, droite et gauche de la vessie et rectum ont été mesurés sur les tomographies coniques sur quatre niveaux sur le plan transversal : A : 1,5 cm au-dessus de la symphyse pubienne ; B : le bord supérieur de la symphyse pubienne ; C : mi-pubis ; D : le bord inférieur de la symphyse pubienne. Des mouvements des parois supérieure et inférieure de la vessie sur le plan sagittal médian. Résultats Sur les axes supéro-inférieur et médiolatéral, 99,3 % et 96,3 % des déplacements sur imagerie de basse énergie (kV) étaient de inférieurs ou égaux à 10 mm. Sur l’axe antéropostérieur, tous les déplacements sur l’imagerie de basse énergie (kV) étaient de inférieurs ou égaux à 10 mm et 93,7 % étaient de inférieurs ou égaux à 5 mm. Sur les axes antéropostérieur, supéro-inférieur et médiolatéral, les set-up margins étaient de 5,54, 5,73 et 7,17 mm, les internal margins de 6,35, 3,06 et 2,12 mm. Les volumes cible prévisionnels étaient de 8,42, 6,49 et 7,47 mm. Il n’y avait pas de variation significative entre la scanographie de planification et les tomographies coniques en ce qui concerne le volume de la vessie ( p = 0,123) et celui du rectum ( p = 0,06). Il n’y avait pas de corrélation entre le volume de la vessie et le mouvement supéro-inférieur de la prostate ( p = 0,798). Une corrélation positive significative entre le volume du rectum et le mouvement de la prostate a été observée uniquement dans l’axe antéropostérieur ( p = 0,012). Seule la paroi antérieure du rectum à mi-pubis influençait les mouvements de la prostate dans l’axe antéropostérieur ( p = 0,033). Conclusion Avec le respect des consignes de la scanographie de planification, le volume de la vessie n’influencerait pas le mouvement de la prostate dans l’axe supéro-inférieur. En revanche, le volume du rectum, et sa paroi antérieure à mi-pubis influençait le mouvement de la prostate dans l’axe antéropostérieur. [ABSTRACT FROM AUTHOR]