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Paratesticular Rhabdomyosarcoma is a rare mesenchymal tumor. The Alveolar variant is the one with the worse prognosis. It comprehend 20% of cases. The treatment is multimodal combining surgery, chemotherapy and radiotherapy. Depending on the extent of disease and the staging group, the approach of treatment is different. Here we report the case of an alveolar Paratesticular rhabdomyosarcoma and review the literature regarding this unusual clinical entity.

Soft-tissue sarcomas are malignant tumors that require good management within specialized centers. Our study aims to assess the benefit of handling these kinds of tumors using the Multidisciplinary Meeting (MDM) approach. The current paper details this approach through a prospective study that has lasted for 42 months in the HASSAN II University Hospital Center, Fez, Morocco. During this research work, 116 cases were selected with an average age of 53 years. In 95.7% of the cases, it was found that the lower limb was the most frequent tumor type (78.4%). Also, ninety-two (92) patients (79.3%) have had a prior biopsy. Ninety-nine (99) patients (85.3%) have received a magnetic resonance imaging scan (MRI) before surgery. Sixty-three (63) patients were operated on, including R0 resection used for 37 patients, R1 used for 21 patients, and R2 used for five patients. As a result, liposarcomas were the most frequent type (30.1%), followed by synovial sarcomas (14.6%), leiomyosarcomas (9.5%), ewing sarcoma (8.6), and undifferentiated pleomorphic sarcomas (7.7%). In addition, neoadjuvant chemotherapy was used for 36 patients. The other 22 patients received adjuvant chemotherapy and/or radiotherapy. The overall survival rate was 60.56 months, which proves a significant improvement, thanks to the multidisciplinary meeting approach. Conclusion. The conducted investigation has shown that using MDM for managing soft-tissue sarcomas of extremities improves the patients’ survival rate. Moreover, results have proven MDM might allow optimal treatment regarding less local recurrence and metastasis.

Paragangliomas are rare tumors arising from undifferentiated cells of the primitive neural crest. We report a case of a 33-year-old female patient who presented a large firm retroperitoneal tumor situated on the left flank above the left kidney. Levels of the serum epinephrine and norepinephrine were high. We performed a scanned biopsy; the histopathological examination and the immunohistochemical analyses concluded the diagnosis of a retroperitoneal paraganglioma. The tumor was judged secreting and inoperable; therefore it was decided to be treated with radiotherapy., Paragangliomalar, ilkel nöral krest'in farklılaşmamış hücrelerinden kaynaklanan nadir tümörlerdir. Sol böbreğin sol böbrek üzerinde yer alan geniş retroperitonal tümör hastası olan 33 yaşında bir kadın hastayı sunduk. Serum epinefrin ve norepinefrin düzeyleri yüksek bulundu. Taranmış bir biyopsi yaptık; Histopatolojik inceleme ve immunohistokimyasal analizler retroperitoneal paraganglioma tanısını koydu. Tümör salgılanıp inoperabl olarak değerlendirildi; Bu nedenle radyoterapi ile tedavi edilmeye karar verildi.

We report the case of a patient with recurrent pterygo-palatal angiofibroma and its treatment. A 21-year-old male patient had a long history of recurrent epistaxis with progressive nasal obstruction. He was diagnosed with an angiofibroma centered in the right pterygo-palatine fossa. Initially, he underwent surgical excision with removal of the entire tumor. The evolution was clinically good with no signs of recurrence on the cervico-facial scan of control (CT). Nine months after, he presented a reappearance of epistaxis. A cervico-facial MRI was performed and showed a recurrence of the tumor process, which this time was considered inextirpable, hence the decision to opt for radiotherapy with intensity modulated radiation therapy (IMRT). He has improved clinically with a clear reduction in tumor mass on CT scan. This technique represents an interesting alternative to overcome anatomical complexity of the region, cover the tumor and preserve the organs at risk.

We report here the case of a patient admitted for management of posterior fossa cerebral hemangioblastoma. A 16-year-old male patient with a history of intracranial hypertension syndrome consisting of progressively worsening headache, vomiting, especially morning and jet vomiting, and decreased visual acuity. The patient's symptomatology worsened a few days later with the appearance of a disturbance of balance with enlargement of the sustentation polygon. The patient initially benefited from a brain computed tomography (CT) scan that objectified a solidocystic process of the posterior brain fossa. The patient then underwent a surgical excision that was considered partial and the diagnosis of hemangioblastoma was made on the surgical specimen. Since the surgical removal was partial the patient was referred to our training where he received external radiotherapy on his hemangioblastoma of the posterior brain fossa. The patient was examined one month after the end of irradiation; he presented a spectacular improvement in his neurological symptomatology with a clear regression of balance disorders. The standard treatment for cerebellar hemangioblastoma is complete microsurgical removal, but our results show a high level of efficacy for fractional photon radiotherapy after partial surgery of this benign tumour.

Prognosis for patients with locally advanced rectal cancer remains controversial. The purpose of this study was to elucidate possible association between therapeutic effect on lymph nodes (LNs) and patient prognosis. Overall, 149 patients with rectal cancer received preoperative radiotherapy in concomitance with chemotherapy or exclusive radiotherapy before rectal excision. Microscopic examination of formalin-fixed lymph nodes was assessed for therapeutic effect. The establishment of groups combined reaction tissue types of fibrosis, colloid, and necrosis after neoadjuvant treatment was assigned. The average age was 56.38 years, ranged between 22 and 88 years, 53% were female, and 47% were men, with a sex ratio of 1 : 12. In the present study, we noticed that after a median follow-up time of 40.67 months (0–83; SD: 21.1), overall survival was statistically significant depending on age groups. Kaplan–Meier analysis showed significant differences in the rate of patients with an age under 65 years (70.64%) versus those with an age over 85 years (36.5%) (p<0.001). Also, the OS was statistically significant depending on therapeutic effect groups composed of 0TE (No Therapeutic effect), C+ (presence of only colloidal effect), F+ (presence of only fibrosis tissue), and ME+ (mixture of 2 or 3 types of therapeutic effect) group. Indeed, we observed a significantly higher OS rate in the ME + group (86%) compared with the OS rate of LNs group with no therapeutic effect (57%) (p=0.028). Additionally, there was a significant association between the presence of fibrosis on LNs and an extended delay of more than 8 weeks to neoadjuvant treatment completion and surgery. Our study indicates that the best patient prognosis could be predicted based on tumor presenting a best pathologic effect on lymph nodes, and that delaying surgery for more than 8 weeks to neoadjuvant treatment completion improves therapeutic response on LNs.

Pathologic features depending on tumor response to preoperative chemoradiotherapy are important to determine the outcomes in patients with rectal cancer. Evaluating the potential predictive roles of biomarker expression and their prognostic impact is a promising challenge. We reported here the immunohistochemical staining of a panel marker of mismatch repair protein (MMR), Ki67, HER-2, and p53. Additionally, identification of somatic mutations of KRAS, NRAS, and BRAF genes were performed by direct sequencing and pyrosequencing in pretreated biopsy tissues from 57 patients diagnosed for rectal cancer. Clinical features and pathological criteria for postneoadjuvant treatment surgical resection specimen’s data were collected. Immunohistochemical expression and mutational status were correlated with therapeutic response, overall survival, and disease progression. The mean age of patients was 56 years. Seven (12.3%) out of 57 patients had a complete therapeutic response. Our analysis showed that when using complete therapeutic response (Dworak 4) and incomplete therapeutic response (Dworak 3, 2, and 1) as grouping factor, high p53 expression at the pretreatment biopsy was significantly associated to an incomplete response (p=0.002). For 20 and 2 out of 57, KRAS and NRAS mutations were detected, respectively. The majority of these mutations affected codon 12. KRAS mutations detected at codon 146 (A146T, A146V) was associated with the appearance of recurrence and distant metastasis (p=0.019). A high expression of HER-2 corresponding to score 3+ was observed in 3 pretreatment biopsy specimens. This class was significantly associated with a short relapse-free survival (p=0.002). Furthermore, the high expression of Ki67 was moderately correlated with an older age (p=0.016, r=0.319). In addition, this shows that high p53 expression in the pretreatment biopsy was associated with an incomplete response in surgical resection specimens after neoadjuvant treatment, and a HER-2 score 3+ can be a predictive factor of distant metastasis and local recurrence. Larger, prospective, and more studies are needed.

Kidney Clear Cell Sarcoma (SRCC) is a rare malignant tumor of the child, recognized for its aggressiveness, its high bone metastatic potential and its tendency to recur. We report a case diagnosed SRCC in a 22-month-old infant with a large right lumbar mass. An observation of Kidney tumor type clear-cell sarcoma, whose diagnosis was placed on a piece of anatomo-pathology, insofar as the imaging remained uncertain as to the Kidney origin of this mass. Apart from the histological aspect, there is currently no criterion for its diagnosis. Its prognosis has been markedly improved by the introduction of new treatment regimens.

Patient satisfaction is an important quality outcome indicator of health care in the hospital setting. Patients are nowadays care-partners with caregivers. This relation is practically important for patients presenting chronic diseases, especially cancer. The aim of this study is to evaluate cancer patient satisfaction, treated at the Department of Radiotherapy in Hassan II University Hospital, and to study the different components of this satisfaction. A prospective transversal study was conducted between December 2016 and January 2017. Data was collected by three investigators based on structured interviews, a validated, anonymous and a standardized questionnaire. During this period, we have included 230 patients: 159 women (69.1%), 71 men (30.9%) and the sex ratio (women/men) was 2.23. Half of the investigated patients have never been schooled (52.61%). The majority had urban origin (71.3%) and 90% of patients declared being satisfied with the care at Radiotherapy department. 93.48% of cases recommended Radiotherapy department to other patients and 95.65% will want to continue their treatment at this department. Reception conditions were judged as favorable in 92.14%. Satisfaction rates regarding the availability of medical and paramedics, health-care workers were 86.52% and 83.9%, respectively. The quality of medical and paramedical care was judged as excellent or good in 78% cases. However, 44.34% of patients complained about the complexity of administrative formalities. 60.87% of cases judged that the waiting time was too long, whereas 31.4% of patients claimed that care-quality of their pain was insufficient or bad. The majority of patients declared being very satisfied or at least satisfied with different care services. For items that were judged as less satisfactory, some recommendations will be taken especially at the level of pain’s and palliative care as well as the organization of patients’ circuit inside the department. The satisfaction’s variations can be attributed to personally patients factors as well as systemic ones at the level of the hospital. Assessing and understanding these factors are essential in developing appropriate measures to improve patient satisfaction.

Aim: Endometrial cancer is the most common gynecological cancer in the West. It is the third cancer of women after that of the breast and intestine. It mainly concerns menopausal women. Our aim is to highlight, through a retrospective study and in light of literature data, the role of radiotherapy in the management of this cancer.Methods: This is a retrospective cohort study concerning patients' records for endometrial in the radiotherapy department at university hospital center of FEZ for a period of 5 years from January 2012 to December 2016.Results: We collected 158 patients of mean age 64 years (36 to 92 years), all patients had a total hysterectomy with (76% of cases) or without (24% of cases) ganglion dissection. Type 1 was the most common histological type (96% of cases). The myometrial invasion was greater than 50% in 51% of cases, histological grade III in 36% of cases, and cervical invasion was observed in 16% of cases. Therapeutically, 18% of patients received exclusive external radiotherapy at a dose of 50 Gy in conventional fractionation and spreading, a TEN at a dose of 46 Gy followed by a brachytherapy dam in 58% of cases, and 24% of patients received brachytherapy alone.After an average follow-up of 25 months, 91% of the patients are in good locoregional control, 9% of the patients had distant metastases.Conclusion: Radiotherapy retains an important place in the therapeutic strategy of high endometrial cancers, or with unfavorable histological characters, and thus allows the reduction of locoregional recurrence rates.

Le lymphome T/NK est une affection grave et rare en Afrique et en Europe. Le traitement repose sur la radiothérapie et la chimiothérapie. Les auteurs rapportent deux observations de patients âgés respectivement de 55 et 52 ans, qui présentent une obstruction nasale bilatérale avec une rhinorrhée purulente, chez eux l'examen clinique a mis en évidence la présence d'une fente palatine. Le diagnostic n'a pu être posé qu'après une étude immuno-histochimique des biopsies. Les 2 patients ont bénéficié d'une chimiothérapie type CHOEP suivi d'une cure de radiothérapie. Le lymphome T/NK nasal est une forme agressive de lymphome non hodgkinien comportant des caractéristiques clinicopathologiques qui lui sont spécifiques. L'association de la chimiothérapie pour les stades avancés ne semble pas améliorer la survie par rapport à la radiothérapie seule qui reste le traitement de choix surtout pour les stades localisés. La localisation nasal du lymphome T /NK est rare. Le diagnostic repose sur l'étude immunohistochimique. Le traitement comprend chimiothérapie et radiothérapie. Ce type lymphome est de mauvais pronostic globalement, y compris sous traitement.

Primary cerebral lymphoma is a form of non-Hodgkin lymphoma with a solitary localization in the brain, excepting other localizations involving the central nervous system. This is a rare cancer but with increasing incidence, it was predominantly observed in immunodepressed HIV-positive patients but since the advent of effective antiretroviral treatments, it has essentially been observed in immunocompetent patients. We report two cases of primary cerebral lymphoma observed in immunocompetent patients.

Angiomatous meningioma (AM) is a rare subtype of meningioma characterized by highly vascular tumor tissue comprising predominantly variable sized hyalinized blood vessels. This manuscript describes a case of intracranial Angiomatous meningioma and reports briefly its clinical, radiological, histopathological and therapeutic characteristics through a literature review.

Mediastinal chondrosarcoma is exceedingly rare. Moreover, it is particularly unusual in the posterior mediastinum. Actually, very few cases of chondrosarcoma of the posterior mediastinum are gleaned from the literature. On the other hand, neurogenic tumors make even more than 75% of all tumors in the posterior mediastinum and they are most often schwannomas that account for about 90% of all dumbbell-shaped tumors. Exceptionally, a dumbbell-shaped mass may corresponds to a chondrosarcoma. We report a case of 48 year-old Moroccan woman who presented with complaint of intermittent electric shock type pain in the right side of chest radiating to the ipsilateral arm over six months period. No apparent distress or mass were found during physical examination. Chest X-ray showed well-circumscribed opacity located in the upper right part of the posterior mediastinum. Neck and chest computed tomography (CT) scans followed by magnetic resonance imaging (MRI) were carried out and revealed a dumbbell-shaped mass of the posterior mediastinum. Such radiologic findings have oriented towards the diagnosis of cystic schwannoma. As pathologic results were inconclusive after CT-guided fine needle biopsy, the patient underwent tumor resection via right posterolateral thoracotomy. Histopathological examination of surgical resection specimen revealed a grade II chondrosarcoma with invasion of peripheral margins. Therefore, the patient received adjuvant radiation therapy to the tumor bed. Our case suggests that in case of a dumbbell-shaped or thoracic paravertebral tumor a diagnosis other than nerve sheath tumor should be considered, including chondrosarcoma.

Dermatomyositis (DM) is an uncommon inflammatory disease with characteristic cutaneous findings associated to muscle weakness. Although the majority of cases of DM is idiopathic, an increased incidence of underlying malignancy in patients with dermatomyositis has been reported. An underlying breast cancer is found in nearly 10% of cases of malignancy-associated DM. We report a case of 50 year old nulliparous woman who was diagnosed with dermatomyositis according to Bohan & Peter criteria. After performing a cancer screening which was negative,the patient was treated with topical and oral corticosteroids, then she was put under immunosuppressors with minimal improvement. One year later, a right breast mass was detected at systemic clinical examination prompting diagnostic work up of breast cancer. After mammogram which showed suspicious mass, the patient underwent stereotactic breast biopsy which reveald an invasive ductal carcinoma. Computed Tomography (CT) scan of the chest, abdomen and pelvis and bone scan reveald no distant metastases. The patient underwent mastectomy and axillary desection followed by adjuvant chemotherapy, radiotherapy and adjuvant tamoxifen. Simultaneously, she continued the treatment for her Dermatomyositis. Her cutaneous and musculoskeletal symptoms improved dramatically following the treatment of her breast cancer. After four years of uneventful follow up, the patient reported the reccurence of symptoms suggestive of dermatomyositis. A thoracic-abdominal-pelvic CT scan has been performed and revealed distant metastases. Therefore, our case demonstrates the parallel evolution between dermatomyositis and breast cancer after surgery, local radiotherapy and systemic therapy.

Malignant peripheral nerve sheath tumors of the scalp are rare lesions of the nervous system. Only 16 cases have been reported to date. In this report, we present a case of a malignant peripheral nerve sheath tumor (MPNST) of the scalp and retrospectively analyze the clinical features, imaging findings, pathological features, and prognoses of these tumors.

Primary salivary gland-type carcinoma of the nasopharynx is a rare malignancy with aggressive clinical behavior and poor prognosis. Few cases have been reported in the literature. We report the case of a salivary gland-type carcinoma of the nasopharynx diagnosed in a 70-year-old woman managed in department of radiotherapy at Hassan II University Hospital in Morocco. The patient received a total of 70 Gy of radiations, which were divided into 2 Gy per session during 7 weeks. Follow-up was performed regularly, including nasal endoscopic examination and nasopharyngeal CT. Evolution was marked by disease control after 12 months of follow-up. The aim of this work is to show the rarity of this entity, describe clinical, radiological and histological features and finally discuss the treatment management.

Le gliosarcome est une tumeur primitive mixte du systeme nerveux central, caracterisee par une proliferation biphasique associant un contingent glial de type glioblastome et un contingent sarcomateux. L'âge moyen de survenue de cette tumeur varie de 40 a 60 ans, avec un sex-ratio homme/femme de 1,8/1. Nous rapportons ici deux cas de gliosarcome traites dans notre service Le traitement standard consiste en une resection chirurgicale de la tumeur suivie d'une radiotherapie externe et parfois d'une chimiotherapie. Pan African Medical Journal 2015; 22

Resume Objectif de l’etude Les tumeurs phyllodes du sein sont des tumeurs fibroepitheliales similaires aux adenofibromes, mais avec une composante predominante de tissu conjonctif. Ce sont des tumeurs rares qui representent 0,3 a 0,9 % des tumeurs du sein chez la femme. L’objectif de ce travail etait de revoir les strategies diagnostiques et therapeutiques actuelles des tumeurs phyllodes tout en presentant notre experience a l’Institut national d’oncologie de 1998 a 2006. Patientes et methodes Il s’agit d’une etude retrospective des cas de tumeurs phyllodes colliges a l’Institut national d’oncologie de 1998 a 2006. Resultats Cinquante-trois patientes ont ete incluses dans notre etude, l’âge moyen au moment du diagnostic etait de 37,2 ans (15–67), le delai moyen entre le premier signe et le diagnostic de 35 mois, la taille tumorale moyenne de 10,25 cm (1–30). Le diagnostic histologique etait fonde dans la majorite des cas (78 %) sur une biopsie preoperatoire et dans 22 % des cas sur l’examen extemporane peroperatoire. Deux tumeurs etaient d’emblee metastatiques. Le traitement a consiste en une chirurgie suivie ou non d’une radiotherapie en fonction du grade des tumeurs. Dix tumeurs ont recidive localement. Cinq patientes sont decedees. Conclusion Les tumeurs phyllodes sont de diagnostic essentiellement histologique, leur traitement est surtout chirurgical, 13,6 a 20 % recidivent localement, la radiotherapie occupe une place primordiale comme traitement adjuvant, elle permet de diminuer le taux de recidive locale, mais non celui de survie. La chimiotherapie semble avoir une place mal definie. Le pronostic est base sur les caracteres histologiques de la composante conjonctive tissulaire de ces tumeurs.

The aim of the present study was to evaluate the characteristics and outcome of adolescent patients with nasopharyngeal carcinoma (NPC) disease. The study concerned 46 pediatric NPC patients treated during the period 1999-2002 at the National Institute of Oncology, Rabat. The median age of the patients was 16 years. The male/female ratio was 2.8/1. Histologically, all patients had undifferentiated carcinoma. A total of 93% presented nodal metastasis. Four (9%) had distant metastasis. All patients received neoadjuvant multiagent chemotherapy containing cisplatin, followed by radiotherapy. Kaplan-Meier curves were used to evaluate prognostic factors. The log-rank test was used to evaluate the differences between the groups. While none of the patients had locoregional failure, nine patients (29%) developed distant metastasis. The disease-free survival and overall survival (OS) rate for the entire group were 73 and 41%, respectively. Responders to chemotherapy had superior OS (P < 0.001). We suggest that combined modality management using multi-agent chemotherapy and RT as an effective treatment of NPC disease which will achieve satisfactory locoregional control and OS of NPC pediatric patients. Response to chemotherapy was an important prognostic factor.

Les lymphomes malins non-hodgkiniens (LMNH) primitifs du sein sont des tumeurs rares. Leur symptomatologie clinique est polymorphe. L'imagerie médicale est non-spécifique. Le diagnostic peut être évoqué à l'examen cytologique, sa confirmation est toujours histologique. Il s'agit essentiellement de lymphomes de type B, ceux de type NK/T restant rares. Les plus fréquents sont les lymphomes diffus à grandes cellules présentant la particularité de donner des rechutes sous forme d'extension au système nerveux central. Nous rapportons un cas de LMNH primitif bilatéral du sein chez une patiente âgée de 33 ans, révélé par deux nodules mammaires bilatéraux. La mammographie et l'examen extemporané ont évoqué une tumeur phyllode. Le diagnostic du LMNH n'a été fait qu'après examen histologique définitif. Sous chimiothérapie, l'évolution était favorable avec un recul de 15 mois.

The extraskeletal myxoid chondrosarcoma (CME) is a rare malignant soft tissue tumour described as a distinct clinical, histological, immunohistochemical, genetical and evolutive entity. It represents only 2.5% of soft tissue sarcomas. Its individualization is important because it has a long and indolent clinical course, and tumour-related death often occurs after a long survival period. The diagnostic key is morphological supported by immunohistochemistry and genetics t (9; 22) that allow differentiating it from other tumours with myxoid stroma and from chordoma. This report describes a patient with paravertebral extraskeletal myxoid chondrosrcoma with a high locoregional extension.

The finding on imaging (computed tomography scan or magnetic resonance imaging) of synchronous malignant renal mass in patient with an active nonrenal malignancy without renal specific symptoms is not frequent and diagnostic evaluation can be challenging. We describe a 54-yearold Moroccan male former chronic smoker who presented to our hospital with dry cough and impairment of the performance status. The imaging found a tumor mass in the left upper lobe of the lung associated to mediastinal lymph node and a scanno-guided biopsy of this tumor showed a non small cell lung cancer. The radiological staging revealed a solitary renal mass in the right kidney. The patient received firstly two cycles of a lung cancer chemotherapy with a partial response in the lung and a stability of the renal mass. Consequently, he underwent a scanno-guided biopsy of this mass which confirmed a synchronous clear cell renal carcinoma. The patient got chemo radiotherapy for the lung cancer and then after that he got a partial nephrectomy. He is still under a good control with more than 2 years after the initial diagnosis.

La compression médullaire d’origine métastatique est une complication neurologique fréquente du cancer. C’est une urgence diagnostique et thérapeutique qui nécessite une prise en charge rapide et efficace. L’imagerie par résonnance magnétique (IRM) constitue l’examen de choix pour l’exploration de l’ensemble de la moelle. La prise en charge thérapeutique doit être multidisciplinaire incluant la corticothérapie, la radiothérapie et la chirurgie.Key words: Compression médullaire, métastase, traitement corticothérapie, chirurgie, radiothérapie