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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.

The use of regimens with adjuvant taxanes reduces the risk of recurrence and improves survival in patients with node-positive breast cancer, but the use of taxanes in node-negative breast cancer is still to be defined. The aim of this study is to evaluate the role of taxanes in high-risk node-negative breast cancer. Two categories of studies were reviewed: studies that evaluated both node-positive and node-negative breast cancers, and studies that included only high-risk node-negative breast cancers. Three phase-III studies that evaluated both negative and positive nodes did not show any benefit of the use of taxanes according to the node-negative subgroup analyses, versus two studies (European Cooperative Trial in Operable Breast Cancer [ECTO] et Grupo Espanol de Investigacion del Cancer de Mama [GEICAM]) that showed a significant difference in disease-free survival. In view of these studies, the role of taxanes in node-negative breast cancer is still controversial and the results of the ongoing trials may respond to this subject.

Human epidermal growth factor receptor-2 (HER2) is amplified in 25-30% of breast cancers and is associated with aggressive disease and poorer survival. Multiple anti-HER2 targeted therapies have dramatically changed management and outcome of this subgroup, both in adjuvant and metastatic settings. Despite the improvement of survival thanks to trastuzumab, unclear mechanisms of resistance occur, which has led to the development of new anti-HER2 therapies such as lapatinib, pertuzumab, and trastuzumab emtansine (T-DM1). The optimal sequence of the available drugs is still not well established. All this progress raises the question of toxicity that need to be managed, especially with longer survival of patients. In this article, we review different anti-HER2 therapies used in HER2-positive m etastatic breast cancer.

Glioblastoma (GB) is the most common and lethal primary brain tumor in adults representing 25% of primary brain tumors in adults. The objective of our study was to report the epidemiologic, clinical and therapeutic features of GB in Tunisia.Our retrospective study included 41 patients with histologically confirmed GB treated between 2006 and 2012 at the medical oncology departments of Abderrahmane Mami hospital in Ariana and the military hospital in Tunis.Median age was 54 years (13 to 72 years) and sex-ratio was 2.3. Karnofsky performance status (KPS) was70% in 31.7% of cases, while Recursive partitioning analysis radiation therapy oncology group (RTOG-RPA) classification was III in 11 (26.8%), IV in 19 (46.3%), V in 10 (24.3%) and VI in 1 (2.4%) cases. Complete resection (CR) was achieved in 29 patients (70.7%), partial resection (PR) or tumor debulking in 5 patients (12.2%) and biopsy alone (BA) in 7 patients (17.1%). All patients received brain radiotherapy (RT) at a dose of 60 Gy combined with concurrent temozolomide (TMZ). Nineteen patients (46.3%) received adjuvant TMZ, 8 of them completed 6 cycles. Median overall survival (OS) was 12 months (2 to 56 months). Six, 12, 18 and 24-months OS rates were 84.6%, 57.6%, 35.4% and 20.7%, OS being correlated to age, KPS, RPA and quality of resection.Our retrospective study is the first African GB series. Despite it included predominantly poor prognosis patients with impaired neurocognitive function and adjuvant treatment discontinuation, our median OS was comparable to Stupp.

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.

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...

The use of regimens with adjuvant taxanes reduces the risk of recurrence and improves survival in patients with node-positive breast cancer, but the use of taxanes in node-negative breast cancer is still to be defined. The aim of this study is to evaluate the role of taxanes in high-risk node-negative breast cancer. Two categories of studies were reviewed: studies that evaluated both node-positive and node-negative breast cancers, and studies that included only high-risk node-negative breast cancers. Three phase-III studies that evaluated both negative and positive nodes did not show any benefit of the use of taxanes according to the node-negative subgroup analyses, versus two studies (European Cooperative Trial in Operable Breast Cancer [ECTO] et Grupo Español de Investigación del Cáncer de Mama [GEICAM]) that showed a significant difference in disease-free survival. In view of these studies, the role of taxanes in node-negative breast cancer is still controversial and the results of the ongoing trials may respond to this subject.

Small cell carcinoma of the uterine cervix is a rare tumor. It presents clinical and biological features of both cervical neoplasm such as local aggressiveness, and small cell cancer such as early spread and metastases. To date, an effective treatment protocol is not well established. Case: On March 2009, a 44-year-old pregnant woman with small cell carcinoma of the cervix misdiagnosed initially as squamous cell carcinoma, was treated with chemoradiation followed by surgery and brachytherapy. Twenty-three months later, she experienced brain metastases. A metastasectomy lead to an accurate diagnosis. Palliative whole brain radiotherapy was conducted. The patient died of evolutive disease on August 2012. Conclusion: The optimal therapeutic approach of small cell carcinoma of the cervix is still to define. Further studies regarding multimodal treatment are necessary to achieve a significant survival benefit.

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.

e13060 Background: The primary objective of this study was to determine any difference in progression free survival (PFS), overall survival (OS), clinical benefit and tolerability between elderly a...

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)

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.