Search

(1) Background: Magnesium deficiency is usually associated with type 2 diabetes mellitus (T2DM). Individuals living with T2DM with hypomagnesemia show a more rapid disease progression and have an increased risk for diabetes complications. (2) Methods: This is a cross-sectional and descriptive study in the National Institute of Nutrition and Food Technology of Tunis in Tunisia, including all adult outpatients (≥18 years old) with a diagnosis of T2DM from 1 September 2018 to 31 August 2019. The aim of this study was to evaluate the prevalence of plasmatic magnesium deficiency in a Tunisian population of T2DM and to study the relationship between magnesium status and intake, glycemic control and long-term diabetes-related complications. (3) Results: Among the 101 T2DM outpatients, 13 (12.9%) presented with a plasmatic magnesium deficiency. The mean age was 56 ± 7.9 years with a female predominance (62%, n = 63). The mean of the plasmatic magnesium level was 0.79 ± 0.11 mmol/L (0.5–1.1), and the mean of 24 h urinary magnesium excretion was 87.8 ± 53.8 mg/24 h [4.8–486.2]. HbA1c was significantly higher in the plasmatic magnesium deficiency group than the normal magnesium status group (10% ± 1.3 vs. 8.3% ± 1.9, p = 0.04), with a significant difference in participants with a poor glycemic control (HbA1c &gt, 7%) (100%, n = 13/13 vs. 53%, n = 47/88, p = 0.001). A weak negative relationship was also found between plasmatic magnesium and HbA1c (r = −0.2, p = 0.03). Peripheral artery disease was more commonly described in individuals with low plasmatic magnesium levels than in individuals with normal levels (39%, n = 5 vs. 0%, n = 0, p &lt, 0.001). The mean plasmatic magnesium level in participants without diabetic nephropathy and also peripheral artery disease was significantly higher compared to individuals with each long-term diabetes-related complication (0.8 mmol/L ± 0.1 vs. 0.71 mmol/L ± 0.07, p = 0.006) and (0.8 mmol/L ± 0.1 vs. 0.6 mmol/L ± 0.08, 0.001), respectively. (4) Conclusions: Hypomagnesemia was identified in individuals with T2DM, causing poor glycemic control and contributing to the development and progression of diabetes-related microvascular and macrovascular complications.

Background: The Mediterranean diet (MedDiet) is a dietary pattern effective in terms of prevention of many diseases such as gestational diabetes mellitus (GDM). Recently, many studies have paid attention to nutritional factors during pregnancy as a modifiable contributor to GDM risk. Objective: to investigate associations of nutrients intakes and MedDiet pattern of eating with risk of GDM. Subjects/Methods: This study conducted on N = 120; Pregnant women with GDM (n = 60) and without controls (n = 60). The dietary habits were assessed by a dietary history method and a validated food frequency questionnaire. We calculated a MedDiet score which mea- sures the degree of adherence to a Med Diet. Result: A low Med Diet score was found in pregnant women with and without gestational diabetes in 46.7% and 38.8% of cases, respectively, with no significant difference. Our data showed that the higher the adherence score to the MedDiet, the lower the fasting blood glucose level and the plasma glucose 2 h post load. These findings concerned the two groups studied (P < 10−3). We also noted that controls had a significantly higher intake of legumes, vegetables and fish. Monounsaturated fatty acids and saturated fatty acids consumption was significantly higher in the control group (2.3 ± 0.8 vs 1.7 ± 0.7, P < 10−3). GDM subjects consumed significantly more dairy products and cereals (P < 10−3). After adjustment for confounders, no nutrient was associated with the risk of developing gestational diabetes except vitamin D intake (OR 0.29 [0.15−0.54], P < 10−3) which had a protective effect. Conclusion: Our study underlines the importance of adequate vitamin D intake during pregnancy and suggests that the MedDiet may reduce the incidence of gestational diabetes.

Background Growing evidence have shown promise for targeting programmed death-1 (PD-1)/programmed death-ligand 1 (PD-L1) signaling in several tumors. In female breast cancer, PD-L1 expression has been correlated with poor clinical outcome. However, whether PD-L1 has any indication for prognosis in male breast cancer (MBC) patients remains unknown. The purpose of this study was to examine the expression levels of PD-L1 in MBC and to identify the relationship between PD-L1 expression and patient survival. Methods We retrospectively identified 110 male breast cancer patients diagnosed between 2000 and 2013 at Salah Azaïz Cancer Institute. PD-L1 expression was evaluated by immunohistochemistry (IHC) using CD274 antibody. Specimens were scored as IHC low or high, when < 5% or ≥ 5% of cells were PD-L1 positive, respectively. The association between expression of PD-L1 and survival was investigated using Kaplan-Meier survival and COX proportional hazard regression analyses. Results Median follow up was 12.5 months [range 1-132 months]. High expression of PD-L1 was observed in 64.5% of MBC samples (71/110). PD-L1 expression was significantly associated with advanced clinical stage (p=0.012), higher histological grade (p=0.014), higher Ki67 expression (p=0.023) and hormone-receptor negative status (p=0.024). Patients with high PD-L1 expression had significantly shorter overall survival (OS) than patients with low expression (p=0.002, hazard ratio (HR) =5 [2.624–10.642]). Multivariate analysis identified PD-L1 as an independent prognostic factor for OS (p Conclusion Our results indicate that high PD-L1 expression may be a prognostic indicator for reduced OS. Thus, PD-L1 expression is a promising novel biomarker with prognostic significance in MBC and may suggest a potential therapeutic target of anti-PD-L1 antibody therapy in MBC patients. Citation Format: Abdeljaoued S, Bettaieb I, Adouni O, Goucha A, Chiba D, Bouzaiene H, Ben Hassouna J, Boussen H, Rahal K, Gamoudi A. Prognostic value of PD-L1 expression in male breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-23-05.

Purpose The aim of this study was to extensively describe the epidemiological, clinical and therapeutic outcomes of adolescents and young adults (AYA) population with classical Hodgkin Lymphoma (cHL). Then, a comparison between AYAs and adults and between the subgroups of AYAs treated with the same adult protocol was accomplished to further inform on optimal therapy approach of choice for adolescent patients. Material and methods In this mono-centric, retrospective study, we reviewed the medical records. We analyzed 112 consecutive North Tunisian patients, including 66 AYAs (15 to 39 years) and 46 adults (≥ 40 years) affected by cHL treated from 2000 to 2015 at Salah Azaiez Institute. Then, we performed a comparative analysis between AYA and 46 adult patients and a subgroup analysis between adolescents and young adults. All patients were treated according to the national protocol for HL, edited by the Tunisian Society of Hematology. The treatment included chemotherapy and involved-field radiotherapy (RT) at a dose of 20 or 30 Grays (Gy) for responders and 36 Gy for non-responders. Results AYA patients presented with adverse features with nodular sclerosis subtype (p = 3.88 × 10−02) and mediastinal mass involvement (p = 9.40 × 10−04). At a median follow-up of 51 and 32 months for AYAs and adults, respectively, no statistical difference in terms of 3 and 5-years overall survival (OS) and event-free survival (EFS) was shown. Using the Kaplan-Meier method, in AYAs, the ABVD regimen has an impact on 3-years EFS (p = 4.63 × 10−02). The 36 Gy RT was associated with the best 3-years EFS (p = 9.24 × 10−03). Besides, AYA patients with advanced-stage had the worst 3-years OS (76%) (p = 2.41 × 10−02). Although the adolescents and young adults shared similar clinical presentation, we noted that the adolescent group had the worst 3-years EFS (48%), but the best 3-years OS (91%). We identified 15% of primary refractory patients and a rate of toxicity of 5.3% in AYA. Conclusion The treatment approach used is well tolerated by adult patients. However, the AYA patients and particularly adolescent subgroup had more advanced disease at diagnosis and should be treated more intensively in dedicated units. RT dose

Background Male breast cancer (MBC) is a rare and neglected disease. Prognostic and predictive factors in MBC are extrapoled from trials conducted on its female counterpart. Objective Since the relationship between the transcription factor Forkhead box M1 (FOXM1) expression and the clinical response to chemotherapy and hormonotherapy in MBC remains unknown, we sought to investigate the predictive value of FOXM1 in MBC. Methods FOXM1 expression was assessed in 130 MBC cases. Clinical significance was analyzed by Kaplan Meier curves, log-rank test and multivariate Cox regression analyses. Results Patients with high FOXM1 expression had a significantly lower response rate to chemotherapy (P = 0.045) and hormonotherapy (P = 0.029) than those with low FOXM1 expression. Multivariate analyses indicated that FOXM1 was an independent prognostic factor for disease free survival in MBC patients (P Conclusions FOXM1 may have a reliable predictive significance in male breast cancer and thus may become an important target for male breast cancer therapy in the near future.

Background Several studies have demonstrated that the presence and the amount of tumor-infiltrating lymphocytes (TILs) are a potential biomarker of prognostic significance in some solid tumors. Data suggests that high levels of TILs are associated with favorable prognosis. However, whether TILs have any indication for prognosis in male breast cancer (MBC) patients remains unknown. In this study, we investigated the relationship between the expression and degree of CD8+ TILs, CD4+ TILs, and TILs and evaluated the prognostic value of these three factors in MBC. Methods We retrospectively identified 110 male breast cancer patients diagnosed between 2000 and 2013 at Salah Azaïz Cancer Institute. Stromal (str) CD8+ and CD4+ TILs were evaluated immunohistochemically. Two pathologists independently evaluated TILs levels using H&E stained slides following 2014 International TILs Working Group guidelines. Kaplan Meier and univariate and multivariate Cox regression analysis were applied to determine the association of CD8+ TILs, CD4+ TILs and TILs with clinicopathological features and overall survival (OS). Results The median for presence of str-CD8+TILs was 7% (0%-40%), str-CD4+TILs was 2% (0%-20%) and str-TILs was 10% (1%-40%). Only 12% of MBC patients had high str-CD8+TILs and 11% had high str-CD4+TILs. Fifty three percent had low str-TILs and 47% had moderate str-TILs. No lymphocyte predominant breast cancer was identified. Regarding intrinsic molecular subtypes, TNBC subtype and HER2 enriched tumors compared with Hormone receptor positive tumors had higher median levels of str-CD8+TILs, str-CD4+ TILs and str-TILs at diagnosis. However, increased level of str-CD8+ TILs, str-CD4+TILs and str-TILs weren't associated with improved OS in IHC subtypes (p=0.597, p=0.498 and p=0.456 respectively). On univariate analysis, higher levels of str-CD8+TILs, str-CD4+ TILs and str-TILs were associated with better OS (p=0.035, p=0.043 and p=0.040 respectively). Multivariate analysis identified str-CD8+ TILs and str-TILs as independent prognostic factors for OS ([HR= 0.851 (0.706-0.997), p=0.000] and [HR= 0.69 (0.43-0.96), p=0.045] respectively) but not str-CD4+ TILs (p=0.276). A high level of str-TILs was correlated with high str-CD8+ (p = 0.025). Conclusion The level of TILs in male breast cancer is low, suggesting prominent immune regulation/suppression in this disease. Str-CD8+ T cells and str-TILs represent potential prognostic markers in male breast cancer patients. Citation Format: Abdeljaoued S, Bettaieb I, Adouni O, Goucha A, Ghozzi R, Bouzaiene H, Hdiden M, Ben Hassouna J, Makhlouf R, El Benna F, Boussen H, Rahal K, Gamoudi A. Prognostic significance of CD8+ tumor-infiltrating lymphocytes (TILs), CD4+ TILs and TILs in male breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-15-01.

// Maroua Manai 1, 5, 6, 7 , Jeanne Thomassin-Piana 2, * , Amor Gamoudi 6, * , Pascal Finetti 1, * , Marc Lopez 1 , Radhia Eghozzi 6 , Sinda Ayadi 6 , Olfa Ben Lamine 6 , Mohamed Manai 5 , Khaled Rahal 6 , Emmanuelle Charafe-Jauffret 2, 3 , Jocelyne Jacquemier 2 , Patrice Viens 3, 4 , Daniel Birnbaum 1 , Hamouda Boussen 5, 7 , Max Chaffanet 1 , Francois Bertucci 1, 3, 4 1 Departement d’Oncologie Moleculaire, Centre de Recherche en Cancerologie de Marseille, Aix Marseille Universite, Marseille, France 2 Departement de Bio-Pathologie, Institut Paoli-Calmettes, Marseille, France 3 UFR de Medecine, Aix Marseille Universite, Marseille, France 4 Departement d’Oncologie Medicale, Institut Paoli-Calmettes, Marseille, France 5 Departement de Biologie, Unite de Biochimie et Biologie Moleculaire, Faculte des Sciences de Tunis, Universite de Tunis El Manar, Tunisie 6 Departement d’Oncologie Medicale, Institut Salah Azaiez, Tunis, Tunisie 7 Service d’Oncologie Medicale, Hopital l’Ariana, Tunis, Tunisie * These authors contributed equally to second authors Correspondence to: Francois Bertucci, email: bertuccif@ipc.unicancer.fr Keywords: expression, immunohistochemistry, inflammatory breast cancer, MARCKS, survival Received: July 29, 2016 Accepted: December 14, 2016 Published: December 21, 2016 ABSTRACT Background: Inflammatory breast cancer (IBC) is the most aggressive form of locally-advanced breast cancer. Identification of new therapeutic targets is crucial. We previously reported MARCKS mRNA overexpression in IBC in the largest transcriptomics study reported to date. Here, we compared MARCKS protein expression in IBC and non-IBC samples, and searched for correlations between protein expression and clinicopathological features. Results: Tumor samples showed heterogeneity with respect to MARCKS staining: 18% were scored as MARCKS-positive (stained cells ≥ 1%) and 82% as MARCKS-negative. MARCKS expression was more frequent in IBC (36%) than in non-IBC (11%; p = 1.4E−09), independently from molecular subtypes and other clinicopathological variables. We found a positive correlation between protein and mRNA expression in the 148/502 samples previously analyzed for MARCKS mRNA expression. MARCKS protein expression was associated with other poor-prognosis features in the whole series of samples such as clinical axillary lymph node or metastatic extension, high pathological grade, ER-negativity, PR-negativity, HER2-positivity, and triple-negative and HER2+ statutes. In IBC, MARCKS expression was the sole tested variable associated with poor MFS. Materials and Methods: We retrospectively analyzed MARCKS protein expression by immunohistochemistry in 502 tumors, including 133 IBC and 369 non-IBC, from Tunisian and French patients. All samples were pre-therapeutic clinical samples. We searched for correlations between MARCKS expression and clinicopathological features including the IBC versus non-IBC phenotype and metastasis-free survival (MFS). Conclusions: MARCKS overexpression might in part explain the poor prognosis of IBC. As an oncogene associated with poor MFS, MARCKS might represent a new potential therapeutic target in IBC.

Objectif L’objectif de ce travail etait d’etablir la prevalence de la covid-19 chez des patients obeses. Methodes Il s’agit d’une etude transversale ayant inclus 200 patients obeses suivis a l’Unite d’Obesite de l’Institut National de Nutrition de Tunis. Tous les patients ont ete contactes par telephone pour leur demander s’ils ont ete infectes par la Covid-19. Les renseignements clinico-biologiques ont ete releves a partir de leur dossiers. Resultats Notre population etait âgee en moyenne de 45 ± 15,9 ans avec un sex-ratio F/H = 0,3. L’IMC moyen etait de 39,4 ± 5,7 kg/m2 avec un tour de taille de 120,5 ± 13,7 cm et un pourcentage de masse grasse de 44,5 ± 6 %. L’anciennete de l’obesite chez nos patients etait de 15,5 ± 9,9 ans. Une infection par le COVID-19 a ete rapportee dans 15,5 % des cas. Un seul patient avait une forme asymptomatique. La forme pauci-symptomatique etait observee dans 9,5 %, et la forme mineure dans 5 % des cas. Une forme compliquee de deces etait note chez un patient. L’etude analytique n’a pas montre de relation statistiquement significative entre la severite de l’infection et l’âge, la presence de comorbidites, l’IMC et l’anciennete de l’obesite. Toutefois, une relation statistiquement significative a ete retrouvee entre le pourcentage de masse grasse avec l’infection par le COVID-19 d’une part(p = 0,003), et la severite de la maladie(p = 0,006). Conclusion L’obesite est non seulement un facteur de gravite, mais aussi un facteur de risque de la maladie.

Background Pure mucinous carcinoma breast cancer (PMBC) is a relatively rare subtype cancer of breast malignancy and associated with favorable prognosis. This retrospective study aims to investigate clinical, pathological features and clinical long-term outcomes. Methods A retrospective review of 56 patients' files with pure mucinous breast cancer was performed. We evaluated the clinic-pathologic characteristics and survival status. Results The mean age was 59 years. 37 patients underwent modified radical mastectomy; 14 underwent breast-conserving surgery. The 5-years overall survival (OS) and disease free survival (DFS) rates were respectively 75,3% and 74%. According to univariate analysis for OS, age (p = 0,049), menopausal status (p = 0,024), clinical T stage (p = 0,037), N stage (p = 0,002) and pathological T stage (p = 0,033) were statistically significant factors for survival. The DFS was better in postmenopausal women (p = 0,02), histological tumor size smaller than 20 mm (p = 0,024), and negative lymph nodes (p = 0,049). Conclusion Pure mucinous breast cancer has a favorable prognosis and is characterized by lower tumor grade, higher hormone receptor expression and lower incidence of nodal involvement. Thanks to its good prognosis, this subtype of cancer should be treated less aggressively than invasive ductal carcinoma.

BACKGROUND Male breast cancer (MBC) is a rare and aggressive disease. Thus, identification of new therapeutic targets is crucial. OBJECTIVE Our objective was to evaluate the protein expression of MARCKS (Myristoylated Alanine-Rich C-Kinase Substrate) in MBC and to investigate its prognostic value. MATERIALS AND METHODS MARCKS protein expression in tumor and stromal cells was analyzed by immunohistochemistry (IHC) in a retrospective series of 96 pre-chemotherapy MBC samples and 80 normal breast samples, from Tunisian patients treated at Salah Azaiez Institute. Correlations were searched between MARCKS expression and clinicopathological features including overall survival (OS). RESULTS MARCKS was overexpressed in epithelial tumor cells in 66% of the MBC samples versus 26% of normal samples (p= 1.40 × 10-7). Such positive MARCKS expression in epithelial tumor cells was associated with positive HER2 status (p= 4.0 × 10-3). It was associated with shorter OS in uni-and multivariate analysis. By contrast, stromal IHC MARCKS expression was correlated only with tumor grade. CONCLUSION MARCKS tumor cell overexpression might in part explain the aggressiveness and the poor prognosis of MBC. MARCKS can represent a potential therapeutic target for MBC.

Background The Forkhead box M1 (FOXM1) transcription factor is known to play an important role in the development and progression of many cancer types including breast cancer. The important role of FOXM1 in cancer affirms its significance for clinical use and therapeutic intervention. Elevated expression of FOXM1 in female breast cancer correlates with undifferentiated tumor phenotype and negative clinical outcome. However, whether FOXM1 has any indication for prognosis in male breast cancer (MBC) patients is still unknown. The purpose of this study was to examine the expression levels of FOXM1 in MBC and to identify the relationship between FOXM1 expression and patient survival. Methodsl Immunohistochemical analysis for FOXM1 was performed in a total of 80 male breast cancer specimens, all with linked clinical outcome data. Kaplan-Meier method and Cox proportional hazards analysis were used to relate FOXM1 expression to clinicopathological variables and overall survival (OS). Results We observed high expression of the FOXM1 protein in 39 % of MBC samples (31/80). FOXM1 overexpression was significantly associated with higher histological grade (p=0.05), lymph node metastasis (p=0.04), tumor size (p=0.05), and estrogen receptor expression (p=0.04). Patients with FOXM1 expression had a significantly poorer overall survival than those without FOXM1 expression (p=0.02). Multivariate analyses indicated that FOXM1 positivity was an independent prognostic factor for OS (p=0.03). Conclusion These results show that FOXM1 may represent a novel MBC marker with prognostic significance that could be included into the limited marker panels for MBC. Citation Format: Rahal K, Abdeljaoued S, Bettaieb I, Bouzaiene H, Adouni O, Miladi S, Goucha A, Bouaziz H, Makhlouf R, Hechiche M, Benna F, Boussen H, El May A, Gamoudi A. Overexpression of FOXM1 is a potential prognostic marker in male breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-19-03.

Objectives Breast cancer is the most frequent female cancer. In some cases, a change in hormonal receptors and Her2neu status between primary tumors and relapsed tumors were reported. Our aim is to determine if it is mandatory to repeat immunohistochemistry and if there are some factors that can predict change of status. Methods A retrospective study about 46 patients with locoregional cutaneous or lymphatic relapse between 2015 to 2017. The patients were devided into 5 molecular subtypes: Lumina A, Luminal B, Luminal B Her2; Her2 and triple negative subtype. Results The median age was 47-year-old (IQR 27–79). Mean histologic size was 4.56 cm (IQR 0.5–13). 34 patients were grade II of SBR. 54,34%(25) of the patients had radical surgery associated to chemotherapy radiation therapy and hormonal therapy as initial treatment. A mean number of harvested metastatic lymph-nodes at initial surgery was 8.28 (0–36). 54,34% (25) had their status changed. The highest ratio of status changes was observed with luminal A tumors73.33% (11/15). Whereas triple negative tumors have the lowest ratio 16.66% (1/6). We studied the impact of age, time to relapse and site of relapse on status change, but no statistical significance was found. Conclusions Our results tend to prove the necessity of repeat immunochemistry. However, they failed to determine factors associated with higher risk of status change. Those results are to be taken with caution and further studies with bigger study population are mandatory.

Resume Objectif de l’etude Identifier retrospectivement les eventuels facteurs pronostiques des sarcomes mammaires primitifs et faire le point sur ses modalites therapeutiques. Materiel et methodes Il s’agit d’une etude descriptive de 30 cas de sarcome mammaire primitif. Nous avons recherche par une analyse unifactorielle et multifactorielle des correlations entre les parametres cliniques, pathologiques et therapeutiques et la survie sans recidive et a la survie globale. Resultats L’âge moyen etait de 46,8 ans. La taille tumorale moyenne etait de 10 cm. Les 30 cas etaient repartis en 18 sarcomes phyllodes, huit angiosarcomes, trois liposarcomes et un sarcome granulocytaire. Seize patientes ont recu une radiotherapie adjuvante et sept une chimiotherapie adjuvante. Le suivi moyen etait de 64 mois. Les probabilites de survie globale a 3 et 5 ans etaient de 49 % et 34 %, celles de survie sans recidive de 23 % et 15 %. L’etude analytique des parametres, taille tumorale et developpement ou non de metastases ganglionnaire ou a distance, ne montrait de correlation ni avec la survie globale, ni avec la survie sans recidive. La radiotherapie adjuvante n’a influence ni la survie sans recidive (p = 0,61 ; HR [hazard ratio] = 0,942 [0,862–1,029]), ni la survie globale (p = 0,298 ; HR = 1 [0,982–1,04]). En analyse unifactorielle, les facteurs pronostiques de la survie globale etaient les marges d’exerese de plus de 1 cm (p = 0,005 ; HR = 3,4 [1,217–9,919]) et la necrose tumorale (p = 0,028 ; HR = 0,099 [0,014–0,682]). Aucun facteur pronostique independant de la survie globale n’a ete retenu en analyse multifactorielle. Conclusion Il ressort de cette etude que le pronostic des sarcomes mammaires primitifs dependrait essentiellement d’une exerese chirurgicale satisfaisante (marges de plus de 1 cm). Le seul parametre histologique qui pourrait etre correle avec le pronostic est la presence de necrose tumorale. Le sous-type histologique n’aurait pas d’influence sur le pronostic.

We investigated human leukocyte antigen (HLA) profiles for Tunisians with nasopharyngeal carcinoma (NPC), their families, and a sample of unrelated healthy Tunisians in order to identify HLA specificities associated with familial NPC. HLA-A, -B, and -DRB1 typing was successful for 36 NPC patients, 72 unaffected family members, and 130 community controls, and the chi square or Fisher exact test was used to compare allele frequencies between cases and controls. We observed a consistent protective effect of HLA-DRB1*10 on NPC development. However, none of the NPC patients or their family members had a positive result for this HLA marker (0% vs 9.2% in controls, P = 0.047). In addition, HLA-A*26 was probably an induction marker, as its allelic frequency was significantly higher among NPC patients than among controls (P = 0.003) and among NPC patients than among at-risk family members (P = 0.067). Logistic regression analysis of the joint effect of selected HLA specificities showed that HLA-A*26 and HLA-A*30 were co-associated and have an important effect on NPC risk. Despite the small size of our cohort, we showed that HLA-A*26-A*30 and HLA-DRB1*10 might be predictive markers for NPC screening of Tunisian families with a high risk of NPC.

Background: Several studies have outlined biological differences between female and male breast cancer (MBC) and concluded that MBC should be considered as an entirely separate disease. Whether FOXM1 has any indication for prognosis in MBC patients remains unknown. We sought to examine the expression levels of FOXM1 in MBC and to identify the relationship between FOXM1 expression and patient survival. Patients and Methods: FOXM1 expression was evaluated in a total of 130 MBC specimens. Results: FOXM1 was overexpressed in 37% of the MBC samples. FOXM1 overexpression was significantly associated with tumor size (p = 0.045), histological grade (p = 0.048), lymph node metastasis (p = 0.012), Ki-67 proliferation index (p = 0.016), and molecular subtypes (p < 0.001). Multivariate analyses indicated that FOXM1 was an independent prognostic factor for overall survival in MBC patients (p < 0.001, hazard ratio = 0.69 (0.43-0.96)). Conclusions: Overexpression of FOXM1 was associated with well-established markers of poor prognosis; thus FOXM1 may represent a potential novel prognostic marker for MBC.

The role of IGF-1 in promoting cancer has been investigated for many years. The aim of this study is to explore the relationship between rates of IGF-1 and NPC and to evaluate association of IGF-1 with clinical parameters.IGF-1 levels was measured by Elisa test among 82 NPC patients and 60 healthy controlsOur results showed, for the first time, a significant increased levels of IGF-I in NPC by in comparison with healthy controls (p0.01). According to the age, sex and tumor size of NPC patients, we demonstrated that IGF-1 concentrations are significantly higher in NPC aged over 30 years compared to patients aged less than 30 years (p0.01). The IGF-1 levels are, also, higher among women compared to men (p0.01). The concentrations of IGF-1 were positively correlated with tumor size of NPC patients (p0.01).IGF-I could be a good nasopharyngeal cancer diagnostic marker.

Lipoblastoma is a rare, benign tumor usually occurring in childhood. It is essentially localized in the extremities and trunk, with few cases reported in the neck. We report the case of a 2-year-old girl with a rapidly enlarging, painless neck mass. Magnetic resonance imaging (MRI) revealed a 3-cm mass in the right submandibular region. Review of literature, diagnostic methods, and genetics of lipomatous tumors are discussed. Complete surgical excision via a lateral cervical approach demonstrated a white soft tissue with an adherent ganglion. Histology and immunohistochemistry confirmed the diagnosis of lipoblastoma. Cervical lipoblastoma is rare, and typically asymptomatic, rarely causing nerve compression or airway obstruction. MRI can help identifying the lipomatous nature of the mass, but the findings can be inconsistent due to variable maturity of fat cells and the mesenchymal content of the tumor. Diagnosis is always based on pathological examination. Further chromosomal analysis is useful in differentiating lipoblastoma from liposarcoma. Complete surgical excision is the recommended treatment.

Dirofilariasis is an endemic animal parasitic disease in the Mediterranean basin. Its occurrence in humans is rare; when it occurs, it is most often in cutaneous locations. We report two new cases of dirofilariasis of the breast in two Tunisian women, aged 32 and 45 years old. Both came from northern Tunisia and consulted for breast lumps. Clinical examination and imaging findings suggested benign tumors. After surgical excision, the pathology examination confirmed the diagnosis, based on the presence of Dirofilaria repens in the specimen. Dirofilariasis prevalence is probably underestimated because of its non-specific clinical presentation. Breast locations are rare and frequently consist of tumors with benign features. Surgical resection confirms the diagnosis and is the only treatment.

In AP syndrome (APS) with severe thrombocytopenia, rituximab represents a unique drug which can balance the effect of bleeding and thrombosis. By reducing the production of autoantibodies, rituximab can simultaneously raise the platelets and reduce the chance of thrombosis by suppressing APL antibodies. Rituximab can supersede splenectomy as second-line therapy in similar patients., peer-reviewed

Eccrine hidradenoma (EH) is a rare benign cutaneous neoplasm, believed to arise from the distal excretory duct of the eccrine sweat glands. We report an exceptional lesion of eccrine hidradenoma localized to the breast and clinically mimicking a carcinoma of the breast. Aim: We aim to describe the pathological characteristics of this lesion. We report the case of a 59 year old woman. She presented with a right-sided breast nodule. Physical examination, found a mobile firm nodule retracting the skin. By ultrasound examination, the tumor was heterogeneous and measured 11 mm in great diameter. A local surgical excision of the nodule was performed. By histological exam, the diagnosis of EH was retained. The complement of immunohistochemistry was not requested. This tumor is usually confined to the dermis or subcutaneous layer without. EH of the breast is an uncommon site. Histopathological confirmation is necessary and wide excision of these tumors is the treatment of choice.

Depression is a multifactorial disease and nutrition is an important environmental factor in its development and progression. Methods: This is a retrospective study of 50 depressed patients recruited from the outpatient department of psychiatry in Tunisia, as well as 50 controls. Both groups were matched for age and sexResults: A pathological waist circumference was found in 84% of cases against 78% of controls p=0.02. Our patients had a significantly higher intake of carbohydrates and sucrose compared to controls p=0.0001, p=0.02, and significantly lower protein intake (p=0.0001), lipids (p=0.0001), SFA (p=0.01), MUFA (p=0.003), EPA (p=0.02), fibers (p=0.05 ), iron (p=0.0001), zinc (p=0.02), vitamin B9 (p=0.0001), vitamin B1 (p=0.02) vitamin C (p=0.02), calcium (P=0.004). In addition, controls consumed significantly more blue fish, hard cheeses and Olive oil than the patients respectively. Plus the depression was severe, according to the PHQ9 score, plus the intakes were significantly lower in: proteins, carbohydrates, alpha linoleic acid Calcium, consumption of butter and cheese spread, and when depression was certain, according to the HAD, intakes of protein, w3, alpha linoleic acid, corn oil and soybean were low.Conclusions: Our study revealed a very frequent deficit in micro and macronutrients in depressed patients. Some of these deficits, in particular Omega 3, were significantly associated with the severity of depression.

International audience; To report epidemiological and anatomo-clinical features within a retrospective series of inflammatory breast cancer and to evaluate prognostic factors. This retrospective study included 210 Tunisian patients presenting a clinically diagnosed IBC, treated at the Institute Salah Azaiez (ISA) of Tunis, Tunisia, from 2008 to 2013. We collected data on epidemiology, anatomo-clinical and biological features and histologic response to neoadjuvant therapy. Overall and disease-free survivals were calculated by Kaplan-Meier method and compared by log-rank tests and Cox's models were used to identify prognostic factors impacting survival. The 210 IBC patients had a median age of 42 years (24-62) and 15% of them were aged less than 35 years. Mean age at menarche was 13 years and 45% had their 1st childbirth before 23 years. On histology, grades III represented 42% of cases, hormone receptors were negative in 59%, HER2 over-expressed in 32, 25% of our IBC cases had a triple negative profile and Ki-67 was >20% in 53% of cases. High pathological grade III was significantly correlated to TN subtype (58%) (Fisher's exact test, P=7.5×10-3). Further, high Ki-67 expression (>20%) was evident in the TN subtype (84%) (Fisher's exact test, P=3.7×10-4). After neoadjuvant therapy (and trastuzumab in 88 and 69% of HER2+ patients, respectively), we observed 49% of objective clinical responses and 35% of pathological complete response (pCR) and >3 axillary lymph nodes were invaded on a resected tumor in 55% of cases. Overall survival (OS) was associated with age at menarche (Wald-test, P=2.2×10-2) and metastases at diagnosis (Wald-test, P=2.4×10-2). Reaching a pCR was correlated with a better metastasis-free survival (MFS), (Fisher's exact test, P=3.6×10-2).

Neurosyphilis refers to the infection of the central nervous system (CNS) with the Spirochete bacterium Treponema Pallidum (T.Pallidum). Due to the heterogeneity of clinical manifestations of neurosyphilis diagnosis can often be difficult. Here we describe the case of 37 year old heterosexual male, presenting with a 6 month history of recurrent episodes of expressive dysphasia, right upper limb paraesthesia and weakness, photopsia and headaches. Magnetic resonance imaging demonstrated bilateral temporal lobe signal abnormalities consistent with a viral or limbic encephalitis. Serum Treponema screening and CSF VDRL were both positive, consistent with a diagnosis of neurosyphilis. He was successfully treated with antibiotics, but has been left with left hippocampal sclerosis. The transient neurological symptoms were felt to be epileptic phenomena and his symptoms improved significantly with Lamotrigine. This case highlights the importance of early consideration of neurosyphilis in the differential for limbic or viral encephalitis.

Aim: To identify which risk factors affect short term outcome in adult patients hospitalised with radiologically confirmed community-acquired pneumonia (CAP) in the main tertiary care hospital in Malta. Method: All adult patients who were admitted with a radiologically diagnosed CAP for 3 consecutive years were included in this retrospective observational study. Aspiration or health-care associated pneumonia were excluded. Data collected included demographic data, comorbidities, baseline parameters and radiological zones involved on CXR. In-hospital stay was monitored to record duration, complications, level of care required and outcome in terms of morbidity and 30 day mortality. Results: Our cohort included 211 patients(mean age 77±12,59% males) and their CURB-65 score was 0:10.4%,1:24.1%,2: 41.7%,3:16.5%,4:6.6%,5:0.005% of patients. An increase in 30-day mortality was significantly associated with increasing age (p=0.01), a CURB-65 score of 4 (p=0.05) and radiological extent of pneumonia (p=0.01). Logistic regression identified significant association between increased mortality and CURB-65 (OR 15, 95%CI:5.1-44.2 for CURB-65 score of 3 and OR13.2, 95%CI:3.07-56.6 for CURB-65 score of 4), radiological severity of pneumonia (OR 2.76, 95%CI:1.3-5.8), and increasing age (OR1.03, 95%CI:1.002-1.06). The presence of co-morbidities including diabetes, chronic lung,kidney and liver disease, congestive heart failure, immunosuppression as well as gender and smoking history did not show statistical significance on univariate analysis. Conclusion: Early identification and treatment of local CAP patients at risk of increased morbidity and mortality can help decrease complications and improve outcomes.

The contribution of BRCA1/BRCA2 mutations to hereditary breast cancer in the Tunisian population has not been accurately estimated. The purpose of our study was to estimate the incidence and spectrum of pathogenic mutations in BRCA1/2 genes in early onset and familial breast/ovarian cancer among Tunisian women. To identify predictive factors for BRCA1/2 mutations, we screened the entire coding sequences and intron/exon boundaries of BRCA1/BRCA2 genes in 48 patients by direct sequencing. Twelve pathogenic mutations were detected (25%); three in BRCA1 (c.211dupA in four families, c.5266dupC in three families and c.1504_1508delTTAAA in one family) and two novel mutations in BRCA2 (c.1313dupT in two families and c.7654dupT in two families). We also identified 23 different polymorphisms and unclassified variants. These results indicate that our population has a spectrum of recurrent BRCA mutations.

Background: Pregnancy in diabetic women is at high-risk of maternal and fetal complications. Insulin which remains the main treatment during pregnancy is not devoid of adverse effects mainly hypoglycemia and weight gain. The objective of our study was to evaluate the efficiency and safety of insulin analogs compared to conventional insulin in a group of pregnant women with diabetes. Methods: A prospective longitudinal study comparing two groups of diabetic pregnant women (including type 1(T1DM) and type 2 diabetes mellitus (T2DM)): group 1 (G1) made of 43 patients on conventional insulin and group 2 (G2) made of 30 patients on analogues. Patients were enrolled at a gestational age before 12 weeks and were followed until childbirth. Results: At baseline, age, types of diabetes, duration of diabetes and average HbA1c at the first trimester were similar between treatment groups. Upon study of glycemic profiles, in the third trimester, the mean group 2 fasting plasma glucose (FPG) was lower compared to group 1(G1: 1.19 ± 0.32 g/l vs. G2: 1.05 ± 0.26 g/l; p=0.06). Mean evening pre-prandial glucose was although significantly higher in group 2 in the 1st and 2nd trimesters became comparable to that in group 1 in the 3rd quarter, indeed a significant improvement with insulin analogues was shown (p=0.042). The rest of the glycemic profile was comparable in both groups as well as HbA1c levels throughout pregnancy (HbA1c T3: G1: 6.7 ± 1.2 % vs. G2: 7.18 ± 1.1%; p=0.16). The episodes of nocturnal and severe hypoglycemia were similar in both groups. Weight gain was lower in G2 than in G1 but the difference was not significant (G1: 10.27 ± 5.46 kg versus G2: 7.69 ± 5.34 kg; p=0.082). Conclusion: Our study showed that insulin analogs were not inferior to conventional insulin to achieve glycemic control during pregnancy.

Introduction: Granular cell tumors are uncommon benign neoplasms. The head and neck is the most common site, usually localized to the anterior tongue. The larynx is rarely involved, representing 1.6% to 3.7%. Case report: We present the case of a 31-year-old, non-smoking female, with a history of recurrent cysts in the pyriform sinus. She consulted for dyspnea. By physical exam, there were no specific findings in head and neck area. Cervical computed tomography demonstrated a tissular mass in the laryngeal area. Laryngoscopy showed a submucosal tumor of the aryepiglottic fold. A biopsy was performed. Histopathological examination revealed round or oval-shaped tumor cells with abundant eosinophilic granular cytoplasm. The nuclei are sometimes small and regular and sometimes hyperchromatic and pleomorphic. The tumor cells showed immunoreactivity for S100 protein and vimentin. The tumor was diagnosed as an atypical granular cell tumor. Conclusion: Pathologists should be aware of this exceptional lesion. So, that the patient could have appropriate treatment.

The estrogen receptors (ERs) ERα and ERβ are important factors in breast cancer progression. Nevertheless, the molecular interplay between ERα and ERβ and its clinical significance in breast cancer is controversial. The establishment of a clear association is required; therefore, the current study analyzed the expression patterns of ERα and ERβ in 32 breast tumor tissues using reverse transcription-quantitative polymerase chain reaction. Furthermore, human epidermal growth factor receptor 2 (HER2) and the Ki-67 status were detected by immunohistochemistry. The results revealed that the ERα and ERβ expression rates recorded were 68 and 65%, respectively. The ERα:ERβ ratio exhibited a decline along with disease progression. ERα and ERβ were found to be negatively correlated with HER2 status but positively correlated with Ki-67. Co-expression of ERα and ERβ was associated with breast cancer aggressiveness, including higher histological grade and positive nodal status, which commonly occur following the menopause. In addition, in cases where ERβ was coexpressed with ERα, HER2 expression was frequently found to be negative, whereas the Ki-67 index was upregulated. These data suggest that ERα and ERβ co-expression may be an indicator of tumor aggressiveness and the sensitivity of hormonal therapy via the downregulation of HER2.

Summary Aims The objective of this study was to compare the protein expression profile between well-differentiated (papillary) and undifferentiated (anaplastic) thyroid carcinoma in Tunisian patients. Methods This first Tunisian retrospective study concerned data of 38 thyroid cancer cases (19 papillary carcinoma PTC and 19 anaplastic carcinoma ATC) collected at Salah Azaiez Institute of Tunisia. Immunohistochemistry was used to evaluate tumor expression of different molecular markers (p53, Ki67, E-cadherin, cyclin D1, bcl2, S100 and Her-2). The molecular expression was correlated with the clinicopathological characteristics of the tumors. Results There were 6 differentially expressed markers when comparing anaplastic thyroid carcinoma ATC with papillary thyroid carcinoma PTC. Expression of p53 and Ki67 were significantly increased in 16 and 18 ATC cases respectively, the Ki67 expression was lost in PTC. Cyclin D1, E-cadherin, bcl2 and S100 were overexpressed in PTC tumors; however, they were significantly decreased in ATC. The last marker, Her-2 was expressed in one case of PTC only. Conclusion Our results, similar with findings of other ethnic groups, showed alteration in expression of molecular markers associated with tumor dedifferentiation, indicating loss of cell cycle control with increased proliferative activity in ATC carcinoma. These data support the hypothesis that ATC may derive from dedifferentiation of preexisting PTC tumor.

Aim The objective is to report the correlation between pathology and molecular subtype classifications of breast cancer in Tunisian women. Methods This retrospective study concerned data of 966 breast cancer cases collected from 2007 to 2009 at Salah Azaiz Institute of Tunis. These cases were classified by an immunohistochemistry test for estrogen and progesterone receptors and human epidermal growth factor receptor 2 (HER2) status in the four molecular subtypes, namely luminal A, luminal B, HER2+ and triple negative. The molecular classifications were correlated with the clinicopathological characteristics of the tumors. Results Luminal A (50.7% of cases) was the most common subtype, with triple negative subtype 22.5%, luminal B 13.4% and HER2+ 13.4%. Triple negative and HER2+ subtypes were significantly associated with large tumor size (>5 cm, P

Because nasopharyngeal carcinoma (NPC) has a close association with Epstein-Barr virus (EBV), measuring serum EBV DNA and anti-EBV serum marker concentrations could be a feasible method for NPC diagnosis, monitoring and probably screening especially in a community at risk. The aim of this study was to determine the EBV pattern in sporadic NPC and in high risk NPC Tunisian families in order to evaluate their risk factors and help for NPC screening. The rates of anti-EBV antibodies and EBV DNA were determined in the serum of 47 healthy members randomly selected from 23 NPC multiplex families with two or more affected members, 93 healthy Tunisian community controls chosen with the same age, sex and geographic origin as unaffected individuals and 66 EBV positive sporadic NPC patients whose serum was available before and after treatment. Unexpectedly, significant lower concentrations of anti-EA (Early Antigen) IgG and anti-VCA (Viral Capsid Antigen) IgG were found in unaffected members from NPC families than in healthy controls while viral loads were negative in all the tested sera. For sporadic NPC patients, anti-EA IgG and anti-VCA IgA concentrations were significantly higher than in healthy controls and these rates decreased after treatment. The level of EBV DNA load varied according to the condition of the tumour. This study suggests that in the Tunisian NPC families, screening for malignancy is based on serum concentrations but not on EBV DNA load while in the sporadic NPC group, serologic markers and EBV DNA load are complementary for diagnosis and follow-up.

e13609Background: Breast cancer, the first malignant disease in women, remains a rare disease in men. Given the rarity of this disease, the only way to study its characteristics is the retrospectiv...

Resume Introduction Le depistage du cancer du sein a permis la decouverte de plus en plus frequente de cancers de petite taille. Ces tumeurs ont un potentiel metastatique ganglionnaire faible d’ou l’introduction de la technique du ganglion sentinelle (GS) pour connaitre l’atteinte ganglionnaire axillaire. Objectifs Rapporter les resultats preliminaires de la technique du GS dans le cancer du sein a l’institut Salah-Azaiz. Materiels et methodes Il s’agit d’une etude prospective entre janvier 2004 et decembre 2005 au cours de laquelle 115 patientes ont ete incluses, porteuses d’un cancer du sein de moins de 3 cm justiciable d’un traitement conservateur sans antecedents de chirurgie mammaire. Toutes ces femmes onteu une recherche de GS par une methode colorimetrique, et 30 % ont eu une methode combinee. Resultats Le taux de detection etait de 97,3 % ( n = 112). Un examen extemporane a ete realise chez 91 patientes. Le taux de faux-negatifs (FN) de l’examen extemporane etait de 4,3 % et la sensibilite de 95,7 %. Aucun faux-positif n’a ete trouve a l’examen extemporane. Le GGS etait le seul ganglion envahi du creux axillaire chez 15 patientes (44 %). Chez trois patientes, le GGS etait sain alors que le reste du curage comportait des ganglions atteints, soitun taux de FN de 2,6 %. Conclusion La technique du GS est une technique fiable et faisable. Elle necessite cependant un apprentissage du chirurgien, de l’anatomopathologiste et du medecin nucleaire. Elle permet de reduire la morbidite du traitement du cancer du sein en evitant des curages « inutiles » chez des patientes sans envahissement ganglionnaire. L’augmentation du nombre des petits cancers decouverts au cours du depistage permet d’augmenter le nombre de patientes qui peuvent beneficier de cette technique.

A 75-year-old Caucasian lady known case of Hodgkin’s lymphoma presented to A&E Department complaining of acute onset right sided pleuritic chest pain, sweating, dyspnoea and shivering four hours following discharge from hospital after an elective PCI for coronary artery stenosis. The patient denied night sweats, recent weight loss or anorexia. On examination, the patient was found to have a blood pressure of 112/55 mmHg, heart rate of 70 bpm, respiratory rate of 15/min and temperature of 37.5 8C. Heart sounds were slightly muffled and chest auscultation revealed right basal fibrotic crackles. JVP was noted to be raised with a steep Y descent wave form (positive Friedreich’s sign) which increased on inspiration (positive Kussmaul’s sign) and pulsus paradoxus was noted on measurement of the blood pressure on inspiration (drop of >10 mmHg systolic BP on inspiration). This shows that clinically there were signs of impaired diastolic filling of the right ventricle, i.e. a degree of cardiac tamponade. This implies that the accumulation of pericardial fluid had a rapid acute onset (if it were a long-standing pericardial effusion which had accumulated slowly accommodation would not cause any significant haemodynamic change). ECG showed diffuse, concave upwards (saddle-shaped) ST elevations (2 mm). CXR revealed an enlarged cardiac shadow and mild bilateral pleural effusions. A CT pulmonary angiography was done that excluded pulmonary embolism but revealed a concentric pericardial effusion of 17 mm and bilateral mild pleural effusions. Serological tests revealed a mild rise of troponin (0.07 ng/mL) and a CRP of 205 mg/l. The WBC was elevated at 14.6 g/dl. Serial troponin levels were not significantly elevated and the ST elevations remained concave upwards and diffuse in almost all leads.

PURPOSE To analyse the management and clinical outcome of patients treated for retroperitonal soft tissue sarcoma and to identify prognosis factors. PATIENTS AND METHODS This is a retrospective study of 20 adults ; 11 women and nine men treated between 1980 and 2000 in our institution. RESULTS There were seven liposarcomas and 13 leiomyosarcomas. The mean tumor size was 26 cm. Three patients underwent a complete resection (R0), 14 patients an incomplete resection (R1/R2) with microscopic or macroscopic tumour remained after surgery. Only three patients had a surgical biopsy. Median follow-up was 18 months. Overall survival rates was 45%, 10% at two and five years, respectively. Among the following factors, sex, age, symptom duration, tumor size, histologic type, histologic grade, resection type, mitotic index, necrosis extension, histologic differentiation, and AJCC stage, only mitotic index factor (scale 1,2 versus scale 3) significantly influenced patient survival (p = 0.02). CONCLUSIONS This study re-emphasizes the poor outcome of patients with retroperitoneal sarcoma. Survival rates appeared low when compared with other studies. These results incite for a more aggressive approach.

Introduction: Non-Hodgkin’s primary lymphoma of the breast is a rare entity. These tumors represent 0.04% to 0.52% of malignant breast pathology, 2.2% of extranodal lymphoma and 0.4% of all non-Hodgkin lymphoma. Clinical and radiological aspects show no special characteristics. The diagnosis is based on the presence of a lymphomatous proliferation strongly associated to the breast tissue and the diagnosis of an extra-mammary lymphoma must be removed except the presence of ipsilateral axillary lymphadenopathy. Patients and methods: This is a retrospective study of 9 patients treated for non-Hodgkin’s primary lymphoma of the breast. They were collected over a period of 14 years (2000-2013). They interested 1 case of follicular lymphoma, 1 case of large T-cell lymphoma and 7 cases of large B-cell lymphoma. The average age was 50 years, ranging from 30 to 76 years. The sex ratio was 0.11 (1 man/8 women). The median follow-up was 43 months (4-192). Six patients were older than 60 years. All the tumors were architecturally diffuse. The overall survival was 100% at one year 60% at 3 years. Seven patients achieved a complete remission after initial treatment; one had relapsed after 2 months. Among the 7 cases of large B cell lymphoma, two cases result from follicular lymphoma’s transformation. The average processing time was 17 months. Conclusion: The primary breast lymphoma is often diagnosed late. Treatment should be rapidly implemented. Indeed, the 5-year survival of stage I of the Ann Arbor classification is better than for stage II.

Objective: Breast carcinoma in men represents 1% of all breast cancers. The micropapillary carcinoma (MPC) of the breast is a morphologically distinctive form accounting for 2.7% of ductual carcinoma in which the tumor cells are arranged in morule-like clusters. A pure MPC of the breast is very rare. This report describes a pure micro papillary carcinoma in a 36-year old man, with clinical, pathological and immunohistochemical features. Methods: We present a case of this rare type of breast cancer diagnosed in a male patient and summarize the current literature to date. The patient presented with a painless mass measuring 1 cm in great diameter adhering to superficial and deep planes. A microbiopsy was performed and the final histopathology revealed a pure MPC of the male breast in more than 50% of tumor’s volume. On immunohistochemical investigations of the specimen, tumor’s cells stained for GCDFP15 and showed high expression of estrogen, progesterone antibodies. We had completed by lumpectomy with axillary dissection which found 14 lymph nodes including 2 metastatic lymph nodes. Results: The MPC differs histologically from conventional papillary carcinoma of the breast, which typically exhibits a complex arborescent growth pattern within cystically dilated duct-line space. A secondary MPC of the breast must be researched as a differential diagnosis of primary MPC, especially micropapillary variant of transitional carcinoma of the bladder and MPC of the lung. Immunohistochemically, the positivity of GCDFP-15 in breast cancers and the positivity of TTF-1 in lung cancers are useful in distinguishing them. Conclusion: MPC is a special subtype of invasive ductal carcinoma with an aggressive nature. Despite the small number of studies, MPC of the breast is undoubtedly not rare. Recognition of this relatively rare entity is important in predicting metastasis to lymph nodes and distant sites regardless of tumor size. Axillary and distant metastasis should be evaluated to determine the therapeutic strategy.

Background: Calcifying fibrous tumor (CFT) is a rare benign mesenchymal tumor; with a predilection for children and young adults that usually arises in the subcutaneous and deep soft tissues, pleura, or peritoneum. CFT of the gastrointestinal tract is exceedingly rare. Discussion: We describe here a patient with an unusual presentation-intestinal calcifying fibrous tumor. This 26-year-old man came to our emergency department with abdominal distension and intermittent epigastric cramping pain. The physical examination was negative. Colonoscopy showed an intestinal polyp, measuring 3 cm in greatest axe. The macroscopic examination showed a segmental resection of jejunum with pedunculated polyp. The polyp had a smooth, shiny and gray surface, it measured 3 cm. Histologically, it was consisting of hyalinized, hypocellular lamellar collagen, bland spindle cells, chronic inflammatory cell infiltrates, and psammomatous or dystrophic calcifications. Conclusion: CFT of the gastrointestinal tract is exceedingly rare. We describe a case arising in the small intestine, and discuss the differential diagnosis with other common and uncommon spindle cell lesions.

Resume Objectif Le carcinome medullaire typique du sein est une forme clinique particuliere par sa rarete — moins de 5 % de l’ensemble des cancers du sein — ses aspects cliniques, histologiques, radiologiques particuliers et son evolution favorable. Notre objectif, a partir d’une serie rare est de souligner egalement ces particularites. Patientes et methodes Etude retrospective portant sur 33 patientes traitees a l’institut Salah-Azaiz (ISA) durant une periode de six ans, allant de 1994 a 1999 pour carcinome medullaire typique du sein, confirme histologiquement selon les criteres de Ridolfi. Resultats L’âge moyen des patientes etait de 47,5 ans avec une atteinte predominante du sein gauche (55 %) et des quadrants superieurs (66 %). La taille tumorale moyenne est de 46 mm. Dans notre etude, 61 % des patientes ont eu une chirurgie radicale, 73 % une radiotherapie, 57 % une chimiotherapie et 42 % une hormonotherapie. Le taux de survie a cinq ans sans rechute etait de 85 %. Discussion et conclusion Le carcinome medullaire typique du sein est une forme rare des tumeurs malignes mammaires. Son traitement est calque sur celui des autres cancers du sein. Nos resultats rejoignent ceux de la litterature et confirment le pronostic favorable de cette forme histologique.