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Osteosarcomas and rhabdoid tumors are highly aggressive cancers, often described in children. Association of these two pathologies was described for the first time in Miami in 2016. Here, we report the second case of osteosarcoma associated with rhabdoid features diagnosed in Tunisia in a 16-year-old female. Our patient had metastatic mediastinal adenopathy at presentation and died after one course of chemotherapy. As this tumor is unusual, the diagnosis represents a real challenge.

International audience; HLA-G is highly expressed in cancer. Also, it is associated to its progression. Here, we explored the relationship between two HLA-G polymorphisms with breast cancer (BC) and tried to make a correlation with sHLA-G levels. We genotyped 104 patients with BC and 83 controls (CTRL) for HLA-G 14-bp insertion/deletion (Ins/Del) and HLA-G +3142 C > G polymorphisms. The mutations were identified with PCR and PCR-RFLP. The sHLA-G dosage was performed on plasma samples by a specific ELISA. A significant association with BC was found concerning the G allele in the +3142 C > G polymorphism (p = 0.0004). The G/G genotype is the protective genotype (1 % in BC patients vs. 13.1 % in CTRL, OR 0.065, 95 % CI 0.008-0.523). No statistically significant differences were observed for the 14-bp Ins/Del polymorphism between BC patients and controls frequencies. The protection by G/G genotype of +3142 C > G polymorphism is maintained in young patients (< 50 years, p = 0.0006) and in early-diagnosed BC patients (< 50 years, p = 0.0033). In addition, an association was found between the haplotypes inferred by both HLA-G polymorphisms and BC susceptibility. Indeed, the (DelG) haplotype is found as the protective haplotype against BC (OR 0.269, 95 % CI 0.081-0.895, p = 0.023). The ELISA dosage of sHLA-G revealed increased levels in BC compared to CTRL (p < 0.0001). We demonstrated also that sHLA-G is closely associated with advanced stages of BC without significance. sHLA-G is increased in TNM IV and SBR III subgroups. It is also enhanced in patients with a tumor size over 20 mm and in triple-negative patients. Taken together, our findings demonstrate, for the first time, the association of HLA-G +3142 C > G polymorphism with BC susceptibility in Tunisian population. Our results revealed also a potential implication of sHLA-G in advanced stages of BC.

We investigated the association between six common and novel interleukin-6 (IL-6) polymorphisms with the risk of cervical cancer (CC) among Tunisians. Study subjects comprised 112 CC cases and 164 control women. Genotyping of IL-6 rs2069845, rs2069840, rs1474348, rs1800795, rs1800797, rs2069827 variants was done by real-time PCR, with defined clusters. The allelic and genotypic distributions of the tested IL-6 SNPs were comparable between CC patients and control women. Stratification according to FIGO staging revealed that rs1800795 homozygous major allele genotype (P = 0.033; OR =0.49(0.25–0.95)) and major allele (P = 0.037; OR = 0.57 (0.33–0.97)) were protective of CC. Moreover, carriage of rs1474348 major allele was also protective of CC (P = 0.014; OR = 0.53(0.32–0.88)), while higher rs1474348 minor allele frequency was seen in CC patients with early FIGO stage (P = 0.044; OR = 0.39 (0.15–1.00)), thus implicating rs1474348 in CC evolution and progression of angiogenesis. Haploview analysis demonstrated high linkage disequilibrium (LD) between rs2069845, rs2069840, rs1474348 and rs1800795, and 6-locus haplotype analysis identified GACCCA haplotype to be positively associated with increased CC, while GAGGGG haplotype was negatively associated with CC, thus suggesting a protective role for this haplotype in CC. Furthermore, there was a significant association between the incidence of CC and the use hormonal contraception (P = 0.047; OR = 1.97 (0.94–4.13)) and smoking (P

Resume Objectif Analyser les aspects epidemiologiques, cliniques et therapeutiques de la maladie de Hodgkin de l’enfant dans le Nord Tunisien et etudier les facteurs pronostiques. Patients et methodes Etude retrospective multicentrique d’une serie de patients âges de moins de 18 ans traites consecutivement entre le 1er janvier 1994 et le 31 decembre 2004. La chimiotherapie a ete administree dans differents services d’hematologie et d’oncologie du Nord de la Tunisie alors que la radiotherapie etait centralisee dans un seul service (de l’institut Salah-Azaiz). Resultats Les dossiers de 114 patients ont ete colliges. L’âge median etait de 12 ans (4–18 ans) et la sex-ratio de 2,25. Les adenopathies peripheriques etaient la circonstance de decouverte la plus frequente (82,5 %). La sclerose nodulaire etait le type histologique predominant (56 %). Le traitement a ete base sur l’association de chimiotherapie et de radiotherapie limitee aux territoires initialement envahis. Avec un recul moyen de 23,5 mois, le taux de rechute etait de 12,2 %. Les probabilites de survie globale et de survie sans evenement a cinq ans etaient respectivement de 95 % et 76 %. La probabilite de survie globale etait a cinq ans dans les formes localisees de 98,2 % et elle etait de 90,8 % dans les formes evoluees. En analyse multifactorielle, les facteurs pejoratifs significatifs de la survie sans evenement etaient le stade IV (p = 0,029) et la reponse au traitement initial (p = 0,003) alors que le stade IV etait le seul facteur qui a significativement influence la survie globale (p = 0,002). Les sequelles a long terme etaient peu importantes. Aucune tumeur secondaire n’a ete observee. Conclusion L’association de chimiotherapie et de radiotherapie des sites initialement envahis a ete efficace et bien toleree, surtout dans les formes de debut de la maladie de Hodgkin de l’enfant. Nous recommandons de centraliser la prise en charge des maladies de Hodgkin de stade IV dans une unite specialisee permettant un traitement plus intensif. Le recul est insuffisant pour juger de la toxicite a long terme.

Background: Schwannoma is a usually a benign tumor of nerve sheath origin, most frequently occurring in the neck, the head, and the extremities. Its occurrence in breast tissue is rare. There have been only 29 proven cases of breast schwannoma described in the literature. Cases: We describe the clinicopathologic presentation, imagery findings, and management of four cases of breast schwannoma treated with surgery and review those documented in the literature. All patients in this series are doing well without any evidence of recurrent disease. Conclusion: Breast schwannomas are usually well circumscribed, noninvasive, and show a benign appearance on imagery. Complete surgical excision is the best choice of treatment. (J GYNECOL SURG 28:385)

Background: The purpose of this report is to summarize the incidence, clinical features, treatment, and prognosis of central nervous system (CNS) metastases following ovarian carcinoma. CNS involvement by epithelial ovarian carcinoma is rare, but the incidence may be increasing. The prognosis is poor and a standard treatment is not well defined. Cases: Four patients with a past medical history of ovarian carcinoma presented with neurologic symptoms. Investigations revealed CNS metastases consistent with ovarian origin. The clinicopathologic presentation and the different treatments are reported here. The associated literature is also reviewed. Results: In this series, 3 patients died within a year of being diagnosed with CNS metastases, and 1 was lost to follow-up. Conclusions: Ovarian carcinoma is common, but rarely metastasizes to the CNS. Such metastases indicate poor prognosis. An aggressive multidisciplinary therapeutic approach including surgery, radiotherapy, and chemotherapy is reasonable...

Summary Background: Anorectal melanoma is a rare and aggressive disease. The mainstay of treatment is usually surgical with curative or palliative intent, since radio- and chemotherapy do not really improve the outcome. The poor prognosis is attributable to delay in diagnosis and its inherent biologic aggressiveness. Case Report: We present a case of anorectal melanoma in a 68-year-old man who underwent solely abdominoperineal amputation and was doing well 30 months after surgery, without any evidence of recurrent disease. Conclusions: Treatment of anorectal melanoma should be by the least morbid means possible. Surgical procedure that can achieve a complete local excision and respect the functional aspects and quality of life of the patient remains the best therapeutic approach. No systemic regimen for metastatic anorectal melanoma is considered standard of care.

Objectif de l’etude L’objectif de notre etude etait de decrire les caracteristiques cliniques et therapeutiques des rhabdomyosarcomes de l’orbite de l’enfant, ainsi d’identifier les facteurs de risque de rechute locale relatifs a cette tumeur. Materiel et methode Il s’agit d’une etude retrospective ayant collige les dossiers d’enfants atteints de rhabdomyosarcome orbitaire traites et suivis a l’institut Salah-Azaiez entre 1992 et 2008. Resultats Douze cas de rhabdomyosarcome orbitaire ont ete inclus dans notre etude. L’âge median etait de 4,5 ans [2–13 ans]. La taille tumorale mediane etait de 3,5 cm. Le rhabdomyosarcome embryonnaire etait le type histologique predominant (sept cas, soit 58 %). Onze patients (92 %) ont recu une chimiotherapie. Le protocole etait de type carboplatine–epirubicine–eincristine/Iifosfamide–vincristine–actinomycine D/ifosfamide–vincristine–etoposide (CEV/IVA/IVE) chez sept patients (58 %). Dix patients (83 %) ont recu un traitement locoregional, qui consistait en une radiotherapie seule dans six cas (50 %), l’association de chirurgie et de radiotherapie dans trois cas (25 %) et une chirurgie seule dans un seul cas (8 %). La dose mediane de radiotherapie delivree etait de 54 Gy [40–65 Gy]. Un complement d’irradiation a ete delivre dans trois cas (25 %). Apres un suivi median de 60,3 mois, le taux de rechute locale etait de 33 %. Le delai median de la rechute etait de 4,3 mois. En analyse unifactorielle, l’âge superieur a 10 ans (p = 0,078), la taille tumorale superieure a 5 cm (p = 0,094), l’atteinte parameningee (p = 0,51), le type histologique alveolaire (p = 0,212) et l’exerese chirurgicale (p = 0,867) n’etaient pas correles avec le risque de rechute locale. La radiotherapie (p = 0,018), la chimiotherapie (p = 0,005) et le protocole CEV/IVA/IVE (p = 0,016) influencaient significativement la probabilite de survie sans rechute a 5 ans. La difference n’etait pas statistiquement significative en analyse multifactorielle. Conclusion L’identification de groupes a risque de rechute locale chez les enfants atteints d’un rhabdomyosarcome orbitaire est necessaire pour permettre un traitement plus adapte et un meilleur taux de controle local.

It is now widely recognized that HLA-G molecule is implicated in immune tolerance and particularly in immune subversion of tumor cells. In this study, we explored levels of soluble HLA-G (sHLA-G) in plasma samples obtained from women with breast cancer (BC). Additionally, we correlated sHLA-G concentration with pregnancy and breastfeeding history. We reported in this preliminary work significant differences in sHLA-G levels between BC patients with/without breastfeeding experience (p = 0.04). Interestingly, among women with BC, only those without previous pregnancy experience present significant increase in sHLA-G (p = 0.02). Of relevance, we demonstrated that patients without both pregnancy and breastfeeding history have advanced SBR III grade, associated with significant enhancement in tumor size compared with patients who had both experiences (p = 0.028). Taken together, our results indicate the potential implication of previous pregnancy and breastfeeding experience in sHLA-G expression during BC. We theorized that having pregnancy and breastfeeding history may protect against advanced BC stages.

Perioperative chemotherapy containing 5FU, Cisplatin ± Docetaxel is one of the most active regimens in advanced gastric cancer.To report epidemiological and clinical profile and therapeutic results of perioperative chemotherapy in locally advanced gastric cancer in Tunisia.Our retrospective study concerned patients with histologically confirmed advanced gastric cancer treated at the institute Salah Azaiez of Tunis. They received 2-3 cycles / 3 weeks of neoadjuvant chemotherapy based on FP (5FU and Cisplatin) or TPF (Docetaxel-Cisplatin-5FU).From 2010 to 2012, 25 patients with a median age of 60 years and 7.3 sex-ratio received neoadjuvant chemotherapy. Protocols used were TFP in 20 and FP in 5 patients, 17 patients receiving more than 2 cycles. Side effects were represented by mucositis grade 3 in 2 patients, neutropenia grade ¾ in 3 patients and renal failure in 5 patients. After neoadjuvant chemotherapy, we observed 40% of partial response and 20% of stable disease. Six patients (24%) underwent surgery, curative in 4 (R0 in 3 cases) by total gastrectomy and D2 lymphadenectomy and palliative in 2 cases due to peritoneal carcinomatosis. With a median follow up of 16 months, median overall survival was 16 months (2-21 months).Probably due to the very bulky and advanced stages of our gastric cancer cases, neoadjuvant chemotherapy using FP±T showed no benefit in the treatment of locally advanced gastric cancer in Tunisian patients.

The purpose of this study is to assess the effect of consanguinity on breast cancer incidence in Tunisia. We conducted a case-control study to evaluate the involvement of heterozygote and homozygote haplotypes of BRCA1 gene SNPs according to consanguinity among 40 cases of familial breast cancer, 46 cases with sporadic breast cancer and 34 healthy controls. We showed significant difference in consanguinity rate between breast cancer patients versus healthy controls P = 0.001. Distribution of homozygous BRCA1 haplotypes among healthy women versus breast cancer patients was significantly different; p=0.02. Parental consanguinity seems to protect against breast cancer in the Tunisian population.

We investigated the association between polymorphisms in the promoter and intron regions of the interleukin-10 (IL-10) gene with the risk of cervical cancer (CC) in Tunisian patients and control women.Study subjects comprised 86 CC cases and 126 control women. Genotyping of IL-10 intron (rs3024491, rs3024490) and promoter (rs1800872, rs1800871, rs1800896) variants was done by real-time PCR, with defined clusters.The minor allele frequencies of the five tested IL-10 SNPs were not significantly different between cervical cancer cases and control women. However, significantly higher frequencies of homozygous minor allele-carriers in cases was seen for rs3024490 (P=0.023), rs1800872 (P=0.037), and rs1800871 (P=0.028). IL-10 serum levels were significantly reduced in rs3024490 T/T vs. G/G genotype carriers, and in rs1800871 T/T than C/C genotype carriers. While carriage of rs1800872 and rs3024491 minor allele was associated with reduced IL-10 secretion, this was not statistically significant. Haploview analysis demonstrated high linkage disequilibrium (LD) among the IL10 SNPs studied, and only seven haplotypes were common, capturing 98.8% of the total possible haplotypes. Reduced frequency of haplotypes GTCCA (P0.001) and TGATG (P0.001) was seen in cervical cancer cases than in control women, thus conferring disease protection nature to these haplotype. This association remained significant for GTCCA (Pc=0.006) and TGATG (P=0.045) after correcting for multiple comparisons.Specific IL-10 variants (rs3024490, rs1800872, and rs1800871) and haplotype (GTCCA and TGATG) may contribute to the development of cervical cancer among Tunisian women.

IL23/IL17 pathway plays an important role in the development of inflammatory bowel diseases (IBD). In general, the genes encoding the cytokines are genetically polymorphic and polymorphisms in genes IL23R and IL17 have been proved to be associated with its susceptibility to inflammatory diseases as well as cancer including colorectal cancer. Moreover, it has been shown that these interleukins are involved in anti-tumor or pro-tumor effects of various cancers. Previously, we showed that there is a significant association between IL17A, IL17F and IL23R polymorphisms as well as the occurrence of colorectal cancer and the clinical features of the disease. The purpose of the present work is to investigate an association between IL17A, IL17F and IL23R polymorphisms in 102 Tunisian patients with colorectal cancer treatment. The association was analyzed by statistical tools. We found that patients with mutated genotypes of IL17A G197A SNP could be a risk factor for the inefficiency of chemotherapy and radiotherapy. Unlike IL17F variant, patients with wild type genotypes require surgery and adjuvant chemotherapy. On the one hand, we found no evidence that supports a significant association between IL23R polymorphism and the combined genotypes of these three genes and the colorectal cancer treatment. On the other hand, we showed that there is an important interaction between IL17A/IL17F polymorphisms and the stage of the disease as well as its treatment. Finally, patients with IL17F wild type genotype highlighted that there is a valid longer OS without all treatments and with radiotherapy and a neoadjuvant chemotherapy. In contrast, we observed that there are no relationships between IL17A, IL23R and the survival of these patients neither with nor without the treatment. Our results suggest that polymorphisms in IL17A and IL17F genes may be a predictive source of colorectal cancer therapy type. Therefore, IL17F may serve as an independent prognostic factor for overall survival in patients with colorectal cancer.

Background: Here, we report the case of a patient with endometrial carcinoma stage IB who was diagnosed with squamous cell carcinoma of the vaginal vault 10 years after radiotherapy. Case: A 55-year-old female patient with endometrial carcinoma FIGO stage IB received pelvic irradiation and underwent surgery for her disease. After 10 years, she experienced vaginal bleeding and was subsequently diagnosed with squamous cell carcinoma of the vaginal vault. No distant metastases were identified and the patient was not a candidate for surgery. She received chemotherapy using a combination of 5-fluoruracil and cisplatin, but it was ineffective. The patient is still alive with a progressive disease. Conclusion: Long-term follow-up and aggressive investigation, which even include tissue biopsy, are mandatory whenever patients with a past medical history of pelvic irradiation experience any pelvic symptoms in order to detect early occult second malignancies. (J GYNECOL SURG 29:56)

Background: Primary lymphomas affecting the female genital tract are uncommon; however, evidence is accumulating that these tumors are underdiagnosed, both because they are unexpected in these sites and because they are misdiagnosed as others lesions or malignant tumors. Cases: Three cases of extranodal non-Hodgkin's lymphoma presenting with signs and symptoms consistent with cancer of the lower genital tract (uterine corpus, uterine cervix, or vagina) and lacking the ‘‘B’’ symptoms often associated with systemic lymphoma such as fever, weight loss, night sweats, and fatigue. The clinicopathologic presentation, staging, and different treatments are presented. The associated literature is also reviewed. Results: All three patients were given chemotherapy and have remained well as of the time this article was written. Conclusions: An accurate diagnosis leads to the appropriate therapy, and improves prognosis. Therefore, it is important to include pelvic lymphomas in the differential diagnosis of ut...

Our study aimed to evaluate the association between IL-1α (4845 G/T), IL-1β (-511C/T) and IL-1RN (VNTR) polymorphisms and risk of cervical cancer. This case-control study investigates three polymorphisms in 130 patients and 260 controls by PCR-restriction fragment length polymorphism (RFLP). The IL-1RN (VNTR) A1/A3 genotype appear as a cervical cancer risk factor (p = 0.048; OR = 2.92; 95 % CI = 1.00-8.74), moreover, the L/2* decreased the risk (p = 0.011; OR = 0.47; 95 % CI = 0.25-0.88) and may be a protective factor against this pathology. Stratified analysis according to the FIGO stage subgroup revealed that the IL-1β-511 T/T genotype and T allele may be a protective factors against cervical cancer development for patients with early stage (p = 0.030; OR = 0.46; 95 % CI = 0.22-0.96) (p = 0.020; OR = 0.68; 95 % CI = 0.48-0.97). However, for the patients with advanced FIGO stage, IL-1RN-VNTR L/2* genotype appear as a protective factor for this pathology (p = 0.023; OR = 0.29; 95 % CI = 0.08-0.99). The (G-T-L) haplotype showed a significant decreased frequency in cervical cancer patients as compared to controls (p = 0.032; OR = 0.53; 95 % CI = 0.29-0.95). In contrast, the (T-T-2*) combination appear a risk factor for the development of cervical cancer (p = 0.018; OR = 1.57; 95 % CI = 1.07-2.30). Our study suggested that IL1 cluster polymorphisms and haplotypes may be a genetic risk factor for cervical cancer.

Host genetic factors may confer susceptibility to Cervical Cancer. TNF-α as pro-inflammatory cytokine participates in the maintenance of immune homeostasis. Allelic variation of immuno-modulatory genes is associated with alteration in immune function. This study investigated the associations between TNF-α-308G>A, -238G>A, and TNFRII - VNTR-322 and cervical cancer in Tunisian women. Genotypes of those polymorphisms were detected in 130 cases and 260 controls. The variant heterozygote -308 G/A was associated with a 41% decreased risk of cervical cancer (GG vs A/A; p = 0.002; OR = 0.41; 95% CI =0.23-0.76). Furthermore, compared with dominant variant G/G, the (G/A+A/A) genotypes was significantly associated with a decreased risk of CC (GG vs G/A+A/A; p = 0.026; OR = 0.62; 95% CI = 0.40-0.97). The FIGO stratified analysis showed that the minor variant A/A and combined G/A+A/A of TNFα-238 G>A and TNFα-308 G>A increased the risk of the tumor evolution, respectively, (P = 0.011; OR = 2.98; 95% CI = 1.16-7.72) (P = 0.008; OR = 2.76; 95% CI = 1.20-6.41), (P = 0.000; OR = 16.33; 95% CI = (5.10-55.23) (P = 0.000; OR = 7.54; 95% CI = 2.68-22.29). There was statistically significant relationship between the incidence of the TNF-α mutations and the clinical progression of cancer according to the FIGO classification. In our study, the haploview analysis revealed no LD between rs1800629 and rs361525. TNF-α and TNFRII polymorphisms might be genetic risk factors for cervical cancer in Tunisian population.

Objective. The aim of this study was to investigate the role of IL10-1082 and IFN-γ+874 polymorphisms in susceptibility to cervical cancer among Tunisian women. Study Design. The IL10-1082 and IFN-γ+874 polymorphisms were analyzed by ARMS-PCR in 160 healthy women and 122 with cervical cancer. The search for associations between those polymorphisms and cervical cancer was based on the χ2 test or Fisher's exact test. Results. The IFN-γ+874 polymorphism showed significant increased frequency of T allele in healthy controls compared with patients (OR = 0.71, 95% CI = 0.50–1.01, and P=0.0459) and individuals with homozygote IFN-γ+874 T/T genotype were at lesser risk of cervical cancer (OR = 0.53, 95% CI = 0.31–0.92, and P=0.015). However, carriers of allele have higher risk for developing cervical cancer (OR = 1.88, 95% CI = 1.09–3.24, and P=0.015). At the polymorphic nucleotide in position 1082 of the IL10 promoter, no differences were found between patients and controls subjects. Conclusion. Our study shows that the T/T genotype polymorphism of IFN-γ+874 T>A is a protective factor for cervical cancer among Tunisian women.

Carcinoma of unknown primary (CUP) origin is defined as histologically confirmed metastatic carcinoma in the absence of a detectable primary site at the time of making therapeutic decision.To report epidemiological, clinical, histopathological, therapeutic, and prognostic features of CUP's patients collected at the Salah Azaiez institute (SAI).We reviewed retrospectively the files of 437 CUP-patients in SAI between January 1994 and December 2006. We analyzed their epidemiological, clinical, histological and therapeutic features and classify patients in favourable and unfavourable subsets. Statistical analysis was performed with R software. Survival curves were made with the method of Kaplan-Meier.We collected 437 patients with a median age of 60 years and a sex-ratio of 1.8. CUP are metastatic to lymph nodes (56.5%), bones (29.7%) and liver (28%). 33% of patients had a unique site of metastases. Adenocarcinoma represented 50.5% of cases while 10.5% are classified in the favourable subgroup. 141 out 437 patients received palliative chemotherapy, 83% of them by cisplatin-based regimens obtaining 13% (58 patients) of objective response. Median survival was 7 months. 24 out 58 patients (41%) relapsed. Poor prognostic factors for survival were: multiple metastases (p=0.00033),3 sites (p=0.03), undifferentiated carcinoma and adenocarcinoma (p0.0001), liver metastases (p=0.0137), bone (p=0.00653) and adrenal gland (p=0.0334) metastatic sites. Patients who underwent chemotherapy (p0.001) and who received cisplatbased regimen had better survival (p=0.01).Our retrospective study done in the context of a minimal and biological work-up confirmed the difficulty to find the primary in CUP.

Gallbladder cancer is the most common malignant tumor of the biliary tract. The majority of cases are adenocarcinoma (AC). Pure squamous cell carcinoma (SCC) of gallbladder accounts only 3% of the malignant neoplasm of this organ. Many patients are at advanced stage when diagnosed and have bad therapeutic efficacy. At present, radical surgery is the only chance to gain long-term survival for patients with early-stage gallbladder cancers. Recent reports have shown a benefit of adjuvant chemoradiation in this type of tumor. At present, no therapy is defined for unresectable cancer of the gallbladder, especially for SCC.

Introduction Les cytotoxiques sont des medicaments utilises en therapies anticancereuses. Leur preparation au sein des unites de soins demeure une pratique repandue et non denuee de risques a defaut d’une prevention adaptee. Objectif Evaluer les pratiques de preparation des produits anticancereuses dans cette institution, afin de relever les insuffisances et de proposer, des recommandations adaptees. Materiel et methodes Il s’agit d’une etude prospective, ayant concerne les services de chimiotherapie et la pharmacie de l’institut de Cancerologie de Tunis. Un questionnaire a ete distribue aupres du personnel manipulant ces medicaments completes par une observation directe des pratiques de preparation et d’administration des medicaments anticancereux. Resultats L’etude a concerne 50 travailleurs manipulant les produits cytotoxiques. L’âge variait de 23 a 58 ans, 84 % etaient de sexe feminin. L’anciennete professionnelle etait de 1 a 27 ans. Le suivi medical en medecine du travail etait assure dans 92 % des cas. Les moyens de protection collective (hottes aspirantes, isolateurs) etaient fonctionnels a la pharmacie. Concernant les moyens de protection individuelle, les blouses et les gants en Latex etaient portes par 100 % des cas a l’unite de preparation et au service. Les masques respiratoires, les combinaisons a usage unique et les chaussures adaptes n’etaient portes que par 26 % du personnel. Le lavage des mains avant et apres chaque soin a ete note chez 72 % du personnel, 42 % des cas negligeaient la decontamination des palliasses souilles. Conclusion Le medecin du travail a un role pilier dans la prevention des risques lies au cytostatiques depuis leur reception. Il est le conseille de ‘l’employeur en matiere de prevention. Une identification des risques est capitale pour une prevention efficace impliquant l’employeur et le travailleur.

The concept of larynx preservation in locally advanced laryngeal or hypopharyngeal squamous cell carcinoma has evolved during the last three decades, especially with the advancement of nonsurgical strategies. These nonsurgical strategies include: (1) radiotherapy alone; (2) concomitant chemoradiotherapy (CCRT); and (3) induction chemotherapy followed by radiotherapy or CCRT and concurrent anti-epidermal growth factor receptor (EGFR). To date, the best approach for larynx preservation has yet to be defined. In this article, we review and discuss important recent randomized phase II/III trials investigating larynx preservation in order to facilitate the selection of an appropriate strategy in the clinical setting. However, the decision of larynx preservation should always be a multidisciplinary approach.

Salivary gland cancers are very rare tumors. They are characterized by a histologic heterogeneity and a poor outcome. According to this rarity, few prospective data are available to date. No standard recommendations could be held for the use of systemic therapy in these tumors. Several case reports and small studies have investigated the contribution of different agents of chemotherapy. With the extension of molecular biology approach in oncology several signaling pathways have been discovered in different cancers including salivary gland cancers; thus a number of targeted therapies have been investigated. This paper reviewed exhaustively the studies investigating the role of systemic therapies (chemotherapy, targeted therapy, hormone therapy) in salivary gland cancers.

Primary small intestinal lymphoma (PSIL) is the second Non-Hodgkin lymphoma (NHL) of the digestive tract (after gastric NHL).To evaluate during the past 28 years the epidemiological, anatomoclinical and therapeutic changes of PSIL in Tunisia through an acquired experience of more than a quarter of a century.Our retrospective study included patients with histologically confirmed small intestinal lymphoma from 1981 to 2008 in Tunisia at Salah Azaiz Institute. The cohort of 210 patients was divided into two groups: A group from 1981 to 1992 (152 patients) and B group from 1993 to 2008 (58 patients). We analysed the epidemiological, anatomoclinical, histological, and therapeutic characteristics.We observed a significant decrease in the annual incidence of PSIL but also a significant transition of diffuse immunoproliferative small intestinal disease (IPSID) also known as "Mediterranean" PSIL, which were progressively replaced by "Western" lymphomas. Laparotomy with or without a debulking surgery, largely performed in group A, has disappeared at the cost of a primary chemotherapy (p0.001). Five-year actuarial global and relapse free survivals were respectively 60.5 and 57.3%.PSIL in Tunisia were subjected to a triple transition: epidemiological, histological and therapeutic.

The use of an implantable room has become indispensable in the clinical practice for the cancer patients. The increasing use of these devices was associated with a greater incidence of complications.To verify the feasibility of the cephalic vein cut-down technique for placement of venous access devices.A prospective study of 58 port placements was performed at our department of general surgery. The surveillance of devices was collectively insured by the operator and by the oncologists.The indication for implantation was the infusion of intravenous chemotherapy in patients with colorectal cancer in 55.1% cases and breast cancer in 27.5%. The specific complication rate was 7%. The cephalic vein cut-down approach was used successful in 45 (77.5%) patients. When the cephalic vein could not be used, a percutaneous technique was employed using the subclavian vein in 22.4% of the patients.Cephalic vein cut-down technique should be considered a safe and feasible approach for placement of venous access devices.

High rates of early colorectal cancers (CRC) are observed in Tunisia suggesting genetic susceptibility. Nevertheless, up to now, no molecular study has been performed in the Tunisian population. In our research, we evaluated the clinical characteristics of Tunisian families suspected of Lynch syndrome and the contribution of DNA mismatch repair (MMR) genes.Thirty-one unrelated families suspected of Lynch syndrome were studied. Probands were tested for the presence of germline mutations in the MMR genes MLH1, MSH2, MSH6 and in MUTYH. Available tumours were analysed for microsatellite instability and expression of MMR proteins. Detailed family and medical histories were collected.A total of 134 cancers were noted in the 31 families, the most frequent type of cancer corresponding to CRC (69%), followed by uterine cancer (7.5%). Germline mutations were identified in 11 (35.5%) families (six MSH2, five MLH1, including seven novel mutations), seven of which fulfilled the Amsterdam criteria (sensitivity, 63.6%; positive predictive value, 58.3%). Noteworthy, germline mutations were detected in 52.6% of male patients tested, but in only 8.3% of females (p = 0.02). Moreover, CRC were essentially left sided in families without detected mutation (p = 0.017). Ages of onset of cancers and tumour spectrum were very similar in families with or without MMR germline mutation, contrasting with previous studies performed in other populations.MMR genes contribute significantly to CRC susceptibility in the Tunisian population. However, the cause of early CRC susceptibility remains unknown in most cases, especially in women and in patients with early left colon or rectal cancer.

International audience; Purpose: Inflammatory breast cancers (IBC) have specific immunophenotypic profiles as compared to non-inflammatory (non-IBC): combined differential expression of estrogen receptor, Ki67, E-cadherin, MUC1, and ERBB2 can be used as an IBC signature. It is thought that IBC occurs with a high frequency in Tunisia. The aim of this study is to evaluate this signature on a Tunisian series. Methods: The expression of five proteins (E-cadherin, ERBB2, estrogen receptor, Ki67, MUC1) was studied by immunohistochemistry on a consecutive series of 91 cases of IBC (T4D) treated at Tunisian Salah Azaiz Institute (ISA) and deposited in a tissue microarray (TMA). Results were compared to the same study on a series of 85 cases treated in France. Results: The ISA cases were characterized by a significantly younger age of patients (median: 42 years old in ISA for 53.5 in IPC, p = 0.00042) and a higher frequency of invasive micropapillary pattern. None of the five parameters was expressed differentially in the two series. In non-metastatic patients, high level of proliferation (Ki67) and overexpression of ERBB2 were associated with poor outcome. Conclusion: The IBC from Tunisia were not different from those observed in France on the basis of IHC profiles. However, the younger age of the patients suggest a specific epidemiological context that should be investigated. (C) 2007 Elsevier Ltd. All rights reserved.

Background: Non-Hodgkin's lymphomas (NHLs) comprise a group of malignancies that are heterogeneous in terms of presentation, natural history, and prognosis. Primary NHL of the vagina is rare in immunocompetent females. Because of the low incidence of these lymphomas, standard treatment has not been defined. Case: A 34-year-old female patient with a primary vaginal NHL stage IE, with diffuse large-cell B lineage, had an excellent response to cytotoxic chemotherapy (rituximab, doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone) without surgery or radiotherapy. Results: After 2 years of follow-up, she did not have any recurrence. Conclusions: Conservative management, based on chemotherapy in primary genital lymphoma stages I-II may be the treatment of choice in patients who wish to preserve their fertility. (J GYNECOL SURG 28:1)

Background: Common sites of breast carcinoma metastasis are bone, lung, central nervous system, and the liver. Metastasis involving the gastrointestinal (GI) tract is less common and less often recognized, especially rectal metastasis. Cases: Two patients with past medical history of breast carcinoma presented with digestive symptoms. Investigations revealed a rectal metastasis of breast cancer. The clinicopathologic presentation and the different treatments. are presented. The associated literature is also reviewed. Results: One patient died within 1 year of the diagnosis of rectal metastasis, and the other patient was doing well at her last follow-up in November 2011. Conclusions: Breast carcinoma cells do metastasize to the rectum. Such metastasis must be suspected whenever a patient with a past history of breast cancer presents with GI symptoms. (J GYNECOL SURG 28:48)

– There are substantial parts in the article that were previously published in the article: “Involvement of Toll-like receptors in cervical cancer susceptibility among Tunisian women” by Sabrina Zidi, Hasibe Verdi, Yaprak YilmazYalcin, A.C. Yazici, Ezzedine Gazouani, Amel Mezlini, Fatma-Belgin Atac, Besma Yacoubi-Loueslati, Bulletin du Cancer, 2014; 101: E31-E35, DOI: 10.1684/bdc.2014. 2037. Although the article published in Pathology and Oncology Research uses a larger control group the two papers have very similar content, addressing the same problem with the same methodology and the differences in the articles were considered too minor. – In addition, this article was submitted to Pathology and Oncology Research without the knowledge or consent of all the authors.

Introduction: Oral cavity is a rare target for metastases. Such lesions are often misdiagnosed and the prognosis is usually poor. Case Report: We report a case of 46­year­old man who had been diagnosed with rectal tumor, and who presented one year later with a gingival lesion. Initially, primary gingival tumor was evoked, but pathologic examination revealed a gingival metastasis from the rectal cancer diagnosed previously. Conclusion: The importance of this case is to consider the possibility of such metastases and to initiate an appropriate therapy to improve quality of life.

Introduction: To present a case of chemotherapeutic regression of metastasis of breast carcinoma to the choroid in a male patient. Case Report: A 63-year-old male, with a past medical history of breast cancer, presented with blurred vision and progressive loss of visual acuity. Fundoscopy of the right eye revealed a choroidal mass in the upper temporal arcade associated with pigment epithelium impairment. Optic disc was normal and macular edema was not present. The patient was treated with systemic chemotherapy (epirubicin, cyclophosphamide, 5-fluorouracil), every three weeks, for six cycles. Five months into treatment, the patient reported a partial improvement in visual symptoms. A complete regression of the choroidal mass was noted with both magnetic resonance imaging and fundoscopy. Conclusion: In male as in female patients, breast carcinoma may metastasize to the choroid. Such metastasis must be suspected whenever a patient with a past history of breast cancer suffers from impaired vision. An In male as in female patients, breast carcinoma may metastasize to the choroid. Such metastasis must be suspected whenever a patient with a past history of breast cancer suffers from impaired vision. An appropriate ophthalmologic examination including fundoscopy should be performed. Treatment strategy is still based essentially on radiotherapy and should be modified individually depending on size, localization and presence of metastases to other organs and general condition of the patient.