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Resume Nous utilisons la methode d’autopsie psychologique pour identifier les determinants des suicides en population generale, ainsi que d’eventuelles failles dans le processus de soin. Sur un an, on recense 146 suicides en Sarthe ; 47 ont pu etre analyses. Les deux tiers ont eu un contact en sante mentale sur la vie entiere ; la moitie lors de la derniere annee de vie. Au moment du deces, 87,2 % presentent un trouble mental. Un quart a ete place/abandonne durant l’enfance, 70 % a ete victime de carences affectives precoces. Les trois quarts des actifs disent souffrir d’une detresse psychique majeure et durable au travail. Les experts estiment que la maladie mentale est le determinant le plus important du suicide. La majorite des personnes souffrant d’ethylisme n’est pas suivie ; les personnes abandonnees durant l’enfance echappent totalement aux soins. L’expertise souligne le besoin d’une approche therapeutique de type antidepresseurs plus psychotherapie, en actant les benefices de l’ambulatoire de crise.

IF 6.029; International audience; BackgroundDiagnosis and management of poorly differentiated gastro-entero-pancreatic (GEP) neuroendocrine carcinomas (NECs) remain challenging. Recent studies suggest prognostic heterogeneity. We designed within the French Group of Endocrine Tumours a prospective cohort to gain insight in the prognostic stratification and treatment of GEP-NEC.Patients and methodsAll patients with a diagnosis of GEP-NEC between 1st January 2010 and 31st December 2013 could be included in this national cohort. Adenoneuroendocrine tumours were excluded.Results253 patients from 49 centres were included. Median age was 66 years. Main primary locations were pancreas (21%), colorectal (27%), oesophagus-stomach (18%); primary location was unknown in 20%. Tumours were metastatic at diagnosis in 78% of cases. Performance status (PS) at diagnosis was 0–1 in 79% of patients. Among the 147 (58%) cases reviewed by an expert pathological network, 39% were classified as small cell NEC and 61% as large cell NEC. Median Ki67 index was 75% (range, 20–100). Median overall survival was 15.6 (13.6–17.0) months. Significant adverse prognostic factors in univariate analysis were PS > 1 (hazard ratio [HR] = 2.5), metastatic disease (HR = 1.6), NSE > 2 upper limit of normal [ULN]; HR = 3.2), CgA > 2 ULN (HR = 1.7) and lactate dehydrogenase >2 ULN (HR = 2.1). After first-line palliative chemotherapy (CT1) with platinum-etoposide (n = 152), objective response, progression-free survival and overall survival were 50%, 6.2 and 11.6 months; they were 24%, 2.9 and 5.9, respectively, after post-CT1 FOLFIRI regimen (n = 72).ConclusionsWe report a large prospective series of GEP-NEC which show the predominance of large cell type and advanced stage at diagnosis. Prognosis was found more homogeneous than previously reported, mainly impacted by PS and tumour burden.

Groove pancreatitis is a rare form of segmental chronic pancreatitis that involves the anatomic space between the head of the pancreas, the duodenum, and the common bile duct. We report 2 cases of groove pancreatitis with pancreatic heterotopia in the minor papilla. Patients were a 44-year-old woman and a 47-year-old man. Both had a past history of alcohol consumption and presented with abdominal pain, vomiting, and weight loss caused by duodenal stenosis. Abdominal computed tomography revealed thickening of the duodenal wall and enlargement of the pancreatic head in both patients. In 1 patient, ultrasound endoscopy showed a dilated duct in the head of the pancreas. Pancreaticoduodenectomy was performed to rule out pancreatic adenocarcinoma and because of the severity of the symptoms. In both cases, gross and microscopic examinations showed fibrous scar of the groove area. The Santorini duct was dilated and contained protein plugs in both patients, with abscesses in 1 of them. In both cases, there were microscopic foci of heterotopic pancreas with mild fibrosis in the wall of the minor papilla. Groove pancreatitis is often diagnosed in middle-aged alcoholic men presenting with clinical symptoms caused by duodenal stenosis. The pathogenesis of this rare entity could be because of disturbance of the pancreatic secretion through the minor papilla. Pancreatitis in heterotopic pancreas located in the minor papilla and chronic consumption of alcohol seem to be important pathogenic factors.

Resume Un thrombus neoplasique dans la voie biliaire principale est une cause rare d'ictere dans le cadre du cancer de la vesicule biliaire. Nous rapportons ici le cas d'une patiente de 47 ans chez qui la biopsie endoluminale du thrombus biliaire a affirme le diagnostic de cancer de la vesicule biliaire. Une cœlioscopie exploratrice a mis en evidence une carcinose peritoneale localisee. Cependant, dans cette situation exceptionnelle au pronostic mal connu, un traitement chirurgical a ete realise associant hepatectomie IV–V associee a une resection de la voie biliaire principale, anastomose hepaticojejunale sur une anse en Y et exerese des nodules de carcinose. Les suites postoperatoires ont ete simples et a six mois la patiente est asymptomatique sous chimiotherapie adjuvante avec un suivi de 6 mois.

We report a case of gastric myeloid metaplasia in an 89- year-old woman with agnogenic myeloid metaplasia. The lesions were fortuitously discovered on upper endoscopy. The antral mucosa was thickened and polypoid, and on histologic examination contained immature granulocytes, megakaryocytes, and a few erythroblasts without desmoplastic stromal reaction. The granulocytes were positive for CD15, CD68, and myeloperoxidase on immunohistochemistry, and the megakaryocytes showed positive reactivity for factor VIII. Gastric myeloid metaplasia is a very rare event, and to our knowledge only 6 cases have been reported in the literature to date. It usually occurs in patients with advanced myeloproliferative syndrome. Gastric myeloid metaplasia often has a pseudotumoral appearance, leading to digestive symptoms. Histologic diagnosis is straightforward when trilinear hematopoietic elements are identified in gastric biopsies. Immunohistochemistry with anti–factor VIII antibody can be useful to confirm the presence of megakaryocytes.

Summary Colonic pseudolipomatosis is a rare and benign condition. It is not well known by gastroenterologists and its pathogenesis is still unclear. Methods All cases of colonic pseudolipomatosis seen between February 2002 and June 2004 at the Amiens Universisty Hospital were identified and analyzed. Results During this period, 2099 colonoscopies were performed and 9 cases of colonic pseudolipomatosis were diagnosed (0.4%). Patients were all males aged from 41 to 67 (median age 52 years). They consulted for rectal bleeding (two patients), diarrhea (two patients) or abdominal pain (two patients). In three patients, colonic pseudolipomatosis was a fortuitous discovery during colonoscopy for polyp surveillance. The lesions presented as whitish and yellowish slightly elevated plaques ranging in size from a few millimeters to 4 cm. They extended over a two to 20 cm-long area, located in the right (two patients), transverse (four patients) or left colon (three patients). Microscopic examination showed empty spaces in the lamina propria measuring from 50 to 600 μm. They were negative for anti-CD31, CD34 and PS100 antibodies at immunohistochemistry and negative for Sudan black in three cases. The ultrastructural study showed in two cases round spaces containing small fibrillary protein-like deposits that might be lymph. Conclusion Colonic pseudolipomatosis is rare. Its pathogenesis is not well-known but could be due to gas invasion or extravasation of lymph into lamina propria, maybe induced by mucosal lesions related to barotrauma or certain colonoscope cleaning solutions.

Resume Objectifs Le traitement endoscopique est une alternative a la chirurgie dans les complications de la pancreatite chronique. Le but de cette etude a ete d’evaluer l’efficacite des traitements endoscopiques sur le syndrome douloureux, la cholestase et les pseudo kystes pancreatiques. Malades et methodes Trente-neuf malades (37 hommes, 2 femmes), d’âge moyen 44 ans ont ete inclus. Les criteres d’inclusion etaient : l’existence d’une dilatation du canal de Wirsung avec ou sans stenose (N = 13), une stenose de la voie biliaire principale avec dilatation d’amont (N = 12), un pseudokyste pancreatique symptomatique (N = 14) associe a une stenose du canal de Wirsung (N = 11) ou de la voie biliaire principale (N = 3). Les malades ont ete traites, selon le type de lesion, par sphincterotomie pancreatique ou biliaire, mise en place de prothese pancreatique ou biliaire ou kystostomie avec eventuelle mise en place d’un drain. Les effets du traitement sur la douleur ou la cholestase ont ete evalues dans les suites immediates du premier acte endoscopique,pendant la duree de l’intubation canalaire, et apres ablation du materiel prothetique. Resultats Le nombre moyen de gestes endoscopiques a ete de 3,5 par malade avec intervalle de 2,2 mois entre deux interventions. Un traitement endocanalaire pancreatique ou biliaire a ete fait chez 25 malades ayant des lesions canalaires et chez 11 malades ayant un pseudokyste. Une kystostomie a ete faite dans 6 cas. La duree moyenne d’intubation canalaire biliaire ou pancreatique a ete de six mois (extreme 3-21 mois). Le suivi moyen apres ablation du materiel prothetique a ete de 9,7 mois (extreme 2-48 mois). La morbidite liee au traitement endoscopique a ete de 7 %, la mortalite etait nulle. Le traitement endoscopique a entraine une disparition du syndrome douloureux initialement et pendant toute la duree de l’intubation canalaire chez tous les malades. Le syndrome douloureux a recidive apres ablation des protheses pancreatiques dans 5/11 cas necessitant dans 4 cas un traitement chirurgical ulterieur. La cholestase a disparu en moins d’un mois apres mise en place d’une prothese biliaire mais a recidive apres son ablation dans 4/9 cas necessitant un traitement chirurgical complementaire. Aucune recidive a distance n’a ete observee apres drainage endoscopique des pseudo-kystes pancreatiques. Conclusion Le traitement endoscopique des pseudokystes et des complications canalaires de la pancreatite chronique est efficace a court terme et pendant la duree de l’intubation canalaire dont la duree optimale reste a definir.

A 39 year old man with a known history of tuberous sclerosis complex (TSC) presented with haematuria due to haemorrhagic changes of a large renal angiomyolipoma. …

e15204 Background: Folfirinox is one of the gold standard in metastatic pancreatic cancer as first-line therapy for patients with PS 0-1, good haematological and renal function and a subnormal bili...

305 Background: FOLFIRINOX, one of the gold standard in metastatic pancreatic cancer as first-line therapy for patients under 76 years with PS 0-1, good haematological and renal function and a subnormal bilirubin level (Prodige 4 criteria), was analysed in Brittany (B) and Pays de la Loire (PL) in routine clinical practice. Methods: Our aim is to evaluate the use of Folfirinox between July 2010 and December 2012 in B/PL. Results: Data of 340 patients have been studied (198 men, median age 63 years [29-81]). 208 patients were metastatic at diagnosis (liver 67%). 62 primary tumors were resected and 51 patients had received previous adjuvant chemotherapy (gemcitabine, n=48). The median progression free survival PFS and overall survival OS were respectively 6.80 months IC95% [6.18-7.43] and 10.97 months IC 95% [9.56-11.83]. Patients could be divided into 4 groups : Group 1 composed of patients treated according to Prodige 4 trial (n=242), Group 2 1st line metastatic patients with at least one Prodige 4 non-eligibility criterion (n=25), Group 3 locally advanced patients (n=59) and Group 4 by Folfirinox in 2ndline (n=14). The median number of cycles was 9 [1-27] in Group 1 and 6 [1-12] in Group 2. Clinical benefit was 65% (group 1) vs 56% (group 2). During treatment, 81% of patients had a dose adjustment (Group 1) vs 72% (Group 2) and 32% vs 40% presented grade III/IV toxicity (mostly neuro- or haematotoxicity). Median PFS were respectively in Group 1 vs Group 2 : 6.54 months IC95% [5.98-7.29] vs 4.14 [1.68-6.21] (p=0.0107) and median OS :10.91 months IC 95% [8.94-12.02] vs 7.0 IC95% [4.01-11.20] (p=0.0166). For Group 3 and 4, median OS were respectively 11.24 months [10.0-15.01] vs 11.50 [4.83-14.09]. Others results will be shown at the meeting. For Group 1, stopping treatment before progression induced significatively better median PFS and OS than going on treatment until progression : PFS : 8.25 IC95[7.52-8.74] vs 3.48. IC95 [3.09-4.44] (p

248 Background: Efficacy and safety of a combination chemotherapy regimen consisting of oxaliplatin, irinotecan, fluorouracil, and leucovorin (FOLFIRINOX) is one of the gold standard in metastatic pancreatic cancer as first-line therapy for patients with PS 0-1, good haematological and renal function and a subnormal bilirubin level. Pending approval, this treatment has been allowed in Brittany (B) and Pays de la Loire (PL) respecting these criteria. Methods: Observatory of Cancer B/PL is a network of 50 private/public cancer centers focused on good practice for cancer drugs use. Our aim is to evaluate the use of FOLFIRINOX between July 2010 and June 2013 in B/PL. Sex, age, successive chemotherapeutic regimens, toxicities, response rate, progression free survival (PFS) and overall survival (OS) have been studied. Results: Data of 79 patients, treated in 2010 (37%), in 2011 (54%) or early 2012 (9%) have been studied (44 men, median age 62 years [37-74]). 64 patients were metastatic when cancer was diagnosed. Principal site of metastases was liver (73%). 17 primary tumors were resected and 15 patients received an adjuvant chemotherapy (gemcitabine (n=14)).The median number of treatment cycles was 9 [1-24]. Objective response was observed in 29 patients (37%), disease stabilization in 18 patients (23%) and progression in 18 patients (23%). During treatment, 75% of patients had a dose adjustment and 30 % had one or more dose delays. 22 patients presented grade III/IV toxicity (almost neurotoxicity or haematologic). 42 patients had a second line of treatment (mainly gemcitabine) and 7 patients a third line. The median PFS and OS were respectively 174 days IC95% [125-216] and 309 days IC 95% [229-376]. Conclusions: Our preliminary results are relatively convenient with those of Conroy et al in 2011. A higher rate of response (37% vs 32%) has been found. Concerning PFS and OS, our results are clearly worst with 174 vs 195 days and 309 vs 338 days. Our results confirm the aggressiveness of this schedule with 75% of the patients requiring a dose adjustement. Analysis of all pancreatic metastatic patients treated by FOLFIRINOX in B/PL by the Observatory of Cancer allows to assess its good use in the real life.