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Endometrial cancer is the fourth most common malignant tumor in women in developed countries, and in Morocco it represents the third most common gynecological cancer. It primarily affects postmenopausal women. Our study is a retrospective descriptive study conducted from 01/01/2014 to 01/01/2018 at the radiation therapy department of the National Institute of Oncology in Rabat. Data were collected from medical records and included epidemiological, clinical, therapeutic and prognostic aspects of this cancer. The median age at diagnosis was 61 years. The median delay to consultation was 6 months. The histological diagnosis was made by endometrial biopsy in 52.3% of cases. Pathological examination revealed endometrioid adenocarcinoma in 91% of cases. 32 patients received adjuvant treatment consisting of external radiotherapy at a dose of 46 Gy in 23 fractions, followed by vaginal brachytherapy (37%), of which 6 of these patients also received sequential chemotherapy (7.1%). 21 patients were treated with brachytherapy alone (25%), 11 patients with external radiotherapy alone (13%), and 21 patients with concurrent radiochemotherapy (25%). The treatment interval between diagnosis and surgery was 42 days. In our series, the overall 5-year survival rate was 93.6% for all stages combined.

The announcement of the diagnosis of cancer represents a fundamentalstep in the patientshistory, it conditions the quality of the bond of trust with the doctor and requiresveryspecial attention. It is for thisreasonthat the announcement consultation must beidentified in the course of care for cancer patients. The objective of oursurvey of 80 patients followed in the radiotherapydepartment at the National Institute of Oncologyis to analyze the methods of announcing cancer and the feelings of patients in order to target possible points for improvement for a better care whileaddressingsomepsychological and communicationalcharacteristics of the announcement of bad news, ethicalconsiderations and regulatory and deontologicalframeworksthat structure thisapproach in Morocco. &nbsp

Endometrial cancer is the fourth most common malignant tumor in women in developedcountries, and in Morocco it represents the third most common gynecological cancer. It primarily affects postmenopausal women. Our study is a retrospective descriptive study conducted from 01/01/2014 to 01/01/2018 at the radiation therapy department of the National Institute of Oncology in Rabat. Data were collected from medical records and included epidemiological, clinical, therapeutic and prognostic aspects of this cancer. The median age at diagnosis was 61 years. The median delay to consultation was 6 months. The histological diagnosis was made by endometrial biopsy in 52.3% of cases. Pathological examination revealed endometrioid adenocarcinoma in 91% of cases. 32 patients received adjuvant treatment consisting of external radiotherapy at a dose of 46 Gy in 23 fractions, followed by vaginal brachytherapy (37%), of which 6 of these patients also received sequential chemotherapy (7.1%). 21 patients were treated with brachytherapy alone (25%), 11 patients with external radiotherapy alone (13%), and 21 patients with concurrent radiochemotherapy (25%).The treatment interval between diagnosis and surgery was 42 days.In our series, the overall 5-year survival rate was 93.6% for all stages combined. &nbsp

Adenoid cystic carcinoma of the nasal cavity is a rare malignancy. It is a slowly progressive disease, characterized by local recurrences and distant metastases and requires early and adequate management. We report a case of Adenoid cystic carcinoma of the nasal fossa and will discuss the diagnostic and therapeutic characteristics in the highlight of a review of the literature. &nbsp

Paratesticular Rhabdomyosarcoma (RMS) is a rare tumor. Treatment must be multimodal and based on surgery, chemotherapy and radiotherapy. We report an observation of a paratesticular RMS in a child and willdiscuss the diagnostic and therapeuticmodalities in the highlight of a review of the literature. &nbsp

Introduction: To determine the proportion and the reasons which lead to palliative treatment in patients initially a candidate for concomitant chemoradiotherapy (CCRT). Methods: A retrospective study including patients followed for locally advanced lung cancer newly diagnosed from April 1, 2016, to 12/31/2017 in the radiotherapy department of the National Oncology Institute who received palliative treatment. Results: We collected 52 patients out of a total of 225 stage III patients (23%) followed by lung cancer candidates for CCRT who had undergone palliative treatment. The mean age in our series was 61.23 years [22 - 81] with 86% male. The majority of patients (71%) had Performance Status (PS) ≤ 2. Histological confirmation was obtained by pathological examination in all our patients. It was an adenocarcinoma (ADK) in 54% of cases; squamous cell carcinoma in 46% of cases. The reasons for palliative treatment were mainly due to dosimetric constraints: large tumor volume 22/52 (42%); the tumor location close to the bone marrow in 15 of 52 (29%) patients; and general Performance Status impairment (29%) in 15 of 52 patients. Palliative treatment consisted of palliative chemotherapy in 37 of 52 patients (71%), among whom 19 (51%) were stable after 2 months of chemotherapy, in palliative dose chest radiotherapy on the pulmonary parenchyma and/or mediastinum in 10 of 52 (19%) patients, and supportive care in 5 (10 %) patients. We observed 40/52 (77%) cases of stationary course, 04/52 (8%) cases of progress to metastases, and 08/52 (15%) deaths before radiotherapy. Conclusion: A large proportion of patients followed for locally advanced non-metastatic lung cancer are not eligible for curative treatment. The reasons for the palliative treatment of patients followed for lung cancer candidates for CCRT are variable but for a large proportion of patients due to the deterioration of their state of health during their diagnostic journey. Hence, there is the need to improve the early diagnosis and early management of patients with lung cancer to avoid delayed care.

Ameloblastoma is a benign odontogenic tumor. It is locally invasive and unlimited growth capacity, with a propensity for recurrence if not entirely excised. The therapeutic challenge in this type of tumors is to have an adequate resection with a wide margin of normal tissue but also a functional and aesthetically acceptable reconstruction of the residual defect. The role of radiotherapy is currently demonstrated in inoperable cases. We are reporting a case of a 45 years-old male patient with large ameloblastoma of the mandible recurrent 10 years after surgical resection. The patient benefited from exclusive radiotherapy at a dose of 60 Gy.

Purpose: Small cell neuroendocrine bladder carcinoma is a rare entity, account for less than 1% of all bladder tumors. They are of particular histological entity characterized by an aggressive clinical behaviour, high potential for metastatic spread and poor prognosis. The aim of this study was to describe the epidemiological, clinical, therapeutic modalities and the evolution data of small cell neuroendocrine bladder carcinomas. Patients and methods: During a period of 10 years, four patients with neuroendocrine bladder carcinoma were treated at the National Institute of Oncology in Rabat. Results: The median age was 66 years. There were three men and a woman. Neuroendocrine carcinoma was pure in one case and associated with transitional cell carcinoma in the other three cases. Two patients were diagnosed with lymph nodes involvement and one patient at a metastatic stage. A cystectomy was performed in one case. Two patients received a concurrent chemoradiation and the fourth patient received chemotherapy alone. A single case of complete remission was observed. Median survival was 18 months (6–30 months). Only one patient is still alive 30 months after diagnosis. Conclusion: The management of neuroendocrine carcinoma of the bladder remains debated and vary from institution to author. Despite multimodality regimens, the prognosis of these tumours remains poor.

Introduction: Apocrine carcinoma of breast is a rare type of malignant tumor, the incidence of which varies between 0.3 - 0.4 % of all female breast cancers.Apocrine carcinoma is exceptional in male patients and very few cases have been described in literature. This tumor shows distinct microscopic and immunohistological features. We report an exceptional observation of apocrine carcinoma of breast in a man. Patient and observation: He’s a 54 years old man who had for 2months a painless nodule at the left axillary..The patient had family history of breast and prostate cancers. Physical examination revealed a left axilary lymphadenopathy movable relative to superficial and deep plans with no evidence mass of breasts. MRI of the breast was performed and revealed a mass that was 38 x 10 mm in size.A biopsy of the lymphadenopathy was performed. It objectified a carcinomatous proliferation. An immunohistochemical study showed that tumor cells express Her 2, but do not express estrogenic and progesterone receptors. A tumorectomy of the left breast was performed and didn’t show any malignant lesion of the breast. The axiler dissection of 13 lymphnodes showed 11 metastatics ones with 3 breaking capsular. The diagnosis of apocrine carcinoma of the breast was made in despite of the result of the tumorectomy. The CT did not indicate metastasis. The patient was administered adjuvant chemotherapy then he received radiation therapy on left susclavicular, axila and breast with a total dose of 42Gy,15 fractions of 2.8 Gy on 21 days with no late effects. 1 year of trastuzumab was administrated. There was no recurrence or metastasis approximately 2 years after radiation therapy. Then the patient presented a susclavicular lymphnode that was comfirmed on the pet-scanner with multiple mediastinal lymphnodes. A biopsy of the susclavicular lymphnode comfirmed the progression of the disease. The patient started chemotherapy in association with pertuzumab and trastuzumab. Discussion: Apocrine carcinoma of the breast is a rare malignant tumor whose incidence varies between 0.3% and 4% of all female’s breast cancer and represents 0.5 % of all invasive breast cancers. This tumor is exceptional in men. Indeed, only a dozen cases have been described in the literature . Most neoplasms are slowly progressive, small in size, and are most frequently seen in the axilla. They can be recurrent and metastasize to the lymph node, lung, and bone. Male patients have been advanced disease at presentation compared to women which may be due to lack of public awareness of breast cancer in male. Histologically, it has glandular structures with apocrine features and decapitation secretions. There is cytoplasmic PAS positivity of the tumor cells. The presence of neoplastic glands high in the dermis and immediate subepidermis favors the primary origin of tumor cells from apocrine sweat glands. Apocrine adenocarcinomas are positive for cytokeratins, carcinoembryogenic antigen (CEA) and epithelial membrane antigen (EMA) . Usually, these tumors do not express the estrogen receptor-alpha, progesterone receptors and bcl-2. Apocrine adenocarcinoma has poor prognosis and the prognostic factors include size, histological type, lymph node involvement, and distant metastasis. The 10-year disease free survival rate in the absence of metastasis to the lymph nodes is 56%. Treatment protocols of apocrine carcinoma are similar to non apocrine carcinoma of breast. However studies involving the use of anti androgens are in progress. The treatment of choice is wide local excision with clear margins, with or without regional lymph node dissection. The role of radiation therapy also remains uncertain in the absence of clinical trials. No clear correlation between treatment modality and recurrence in apocrine carcinoma was apparent, and survival rates of apocrine carcinoma were not different from other breast carcinomas. Conclusion: In conclusion, male apocrine carcinoma is a very rare, unique and morphologically-distinctive, invasive ductal carcinoma.. Although immunohistochemical staining might show differences in males, the prognosis is not different from other breast carcinomas. It has different hormonal profile, androgen receptor positivity makes patient with apocrine carcinoma eligible for targeted therapy.

Introduction Le cancer du nasopharynx constitue une entite clinique, histologique et biologique qui se singularise des autres carcinomes de la tete et du cou par sa latence clinique, son diagnostic tardif, son potentiel metastatique eleve et sa radio-sensibilite et chimiosensibilite. Objectif Illustrer l’interet de l’imagerie par resonance magnetique sur la stadification TNM dans le bilan d’extension ainsi que son interet dans le bilan d’evaluation et de surveillance. Discussion La localisation profonde du rhinopharynx et des espaces associes, la proximite de la base du crâne et des structures encephaliques sus-jacentes font de l’imagerie la pierre angulaire du bilan pre-therapeutique, l’examen clinique etant insuffisant pour apprecier l’extension en profondeur. L’IRM a demontre sa precision dans l’analyse de l’extension tumorale et la profondeur de son infiltration. Son utilisation a entraine des changements spectaculaires dans les resultats du stade T et de la stadification clinique. En termes de surveillance post-therapeutique des patients, elle est plus sensible dans la detection des modifications et complications liees aux traitements notamment les inflammations chroniques ( Fig. 1 , Fig. 2 ).

Objectifs Preciser l’interet de l’imagerie dans l’exploration des rhabdomyosarcomes de la fosse infra-temporale chez l’adulte, en insistant tout particulierement sur l’IRM et son utilite dans le suivi post-therapeutique. Patients et methode Nous rapportons un cas de rhabdomyosarcome embryonnaire de la fosse infra-temporale chez une patiente de 40 ans, sans antecedent particulier, qui presentait depuis 5 mois une tumefaction jugulo-carotidienne superieure droite augmentant progressivement de taille associee a des cephalees et des paresthesies faciales droites. L’imagerie TDM et IRM etait en faveur d’un rhabdomyosarcome de la fosse infra-temporale droite aux depends du muscle pterygoidien lateral. Une biopsie a ete realisee et l’examen histopathologique a confirme le diagnostic de rhabdomyosarcome embryonnaire. Du fait du stade localement avance de la tumeur, la patiente a recu une chimiotherapie d’induction, l’evolution a ete marquee par une reponse aussi bien clinique que radiologique. Un complement de radiotherapie curative a ete administre suivi d’une chimiotherapie adjuvante. La surveillance post-therapeutique a ete effectuee par TDM et IRM qui ont conclu a une reponse therapeutique, cependant, la patiente a developpe des metastases hepatiques une annee apres la fin de la radiotherapie, elle a recu une chimiotherapie palliative. Discussion Les rhabdomyosarcomes de la fosse infra-temporale sont rares et de mauvais pronostic. C’est une tumeur mesenchymateuse frequente chez l’enfant et l’adolescent, la localisation infra-temporale est exceptionnelle chez l’adulte. C’est une tumeur de haut degre de malignite qui se distingue des autres sarcomes par son agressivite locoregionale, son evolution metastatique et son pronostic defavorable quel que soit le traitement entreprit. La tomodensitometrie est tres utile pour evaluer l’atteinte osseuse, mais elle n’etait pas optimale pour determiner l’etendu tumorale. L’IRM est meilleure que la TDM dans l’examen initial et le suivi des patients atteints de rhabdomyosarcome car elle definit plus precisement la tumeur ainsi que ses extensions aux parties molles. Dans notre cas, la reduction de la masse tumorale apres le traitement par chimiotherapie et radiotherapie ont ete clairement demontre par IRM. Conclusion Le rhabdomyosarcome est une tumeur maligne tres rare chez l’adulte. C’est une tumeur a haut risque d’extension locoregionale et metastatique. L’IRM est l’examen de choix pour un bilan lesionnel precis. L’IRM donne une evaluation plus precise, des informations non seulement sur la taille mais aussi sur l’architecture interne de la tumeur peuvent etre utiles lors de l’etude de la reponse tumorale au traitement.

Introduction La radiotherapie occupe une place primordiale dans le traitement des cancers de la sphere ORL avec une efficacite dose-dependante. L’utilisation de doses elevees est malheureusement limitee par les effets indesirables sur le tissu sain, en particulier cerebral qui est souvent implique dans le champ d’irradiation. Les complications tardives de la radiotherapie sont irreversibles et atteignent la qualite de vie des patients. La detection precoce de ces complications est donc d’un interet majeur. Objectif Illustrer l’interet de l’imagerie par resonance magnetique dans la detection precoce des complications neurologiques tardives radio-induites ainsi que le suivi de ces lesions. Discussion Le systeme nerveux presente une radiosensibilite tres particuliere dont les complications sont redoutables pour la qualite de vie des patients. La radionecrose focale et les troubles cognitifs irreversibles associes a une leucoencephalopathie constituent les principales complications tardives de l’irradiation cerebrale, survenant de quelques mois a plusieurs decennies de la radiotherapie. Les manifestations cliniques de la radionecrose sont celles d’un processus expansif intracerebral non specifique, associant un syndrome epileptique inaugural, un syndrome d’hypertension intracrânienne et un syndrome deficitaire progressif. La leucoencephalopathie se distingue de la radionecrose par la presence d’une demence postradique et l’IRM cerebrale montre un hypersignal dans les sequences T2 et FLAIR touchant la substance blanche en plages, de maniere bilaterale et symetrique, sans prise de contraste. Les facteurs associes au developpement de ces complications neurologiques sont : la dose totale delivree, son fractionnement, le volume d’irradiation, l’association d’une chimiotherapie neurotoxique, l’âge et l’etat vasculaire du patient. Le traitement de ces complications demeure avant tout preventif. Conclusion Devant une symptomatologie souvent pauvre et non specifique, l’IRM est l’examen de choix, son role est double : diagnostique et de surveillance de l’evolutivite des lesions.

Introduction Devant l’amelioration des traitements en oncologie, les metastases cerebrales sont devenues de plus en plus frequentes, et l’IRM est l’examen le plus sensible pour leur detection. Objectifs (1) Decrire les differents aspects radiologiques des differentes atteintes secondaire du systeme nerveux central (SNC). (2) Connaitre la technique de leur exploration. Discussion Les metastases cerebrales sont les tumeurs les plus frequentes du SNC. L’exploration radiologique peut etre faite par TDM, mais l’IRM reste plus sensible notamment avec l’apport de la diffusion, la perfusion et de la spectroscopie. On distingue dans les metastases cerebrales : –l’atteinte intraparenchymateuse : souvent sous forme de lesions multiples a rehaussement annulaire ou nodulaire, avec œdeme en doigt de gant ; un ratio de volume sanguin cerebral augmente a la perfusion et a la spectroscopie une elevation de la choline, des lipides et des lactates, et une diminution du N-acetylaspartate (NAA) ; –l’atteinte leptomeningee : rehaussement gyriforme de la meninge d’aspect feuillete, et parfois de forme nodulaire ; –l’atteinte durale : souvent par extension d’une atteinte osseuse. Pour ce qui est des metastases medullaires on distingue : –l’atteinte intramedullaire : lesions rehaussees de facon le plus souvent annulaire complete ou incomplete, ou en flammeche, avec un œdeme extensif s’etendant sur plus de 3 vertebres ; –l’atteinte leptomeningee : prises de contraste nodulaires le long du cordon medullaire et des racines de la queue de cheval ; –l’atteinte de la dure-mere : lesion tissulaire en fuseau pouvant entrainer une compression medullaire. Conclusion Les metastases du SNC sont frequentes et peuvent se presenter sous differents aspects. Leur connaissance est primordiale pour le diagnostic et l’IRM est l’examen le plus sensible pour leur depistage. La perfusion, la diffusion, la spectroscopie permettent de differencier les metastases des tumeurs primitives et des processus non tumoraux ( Fig. 1 , Fig. 2 ).

Objectifs Nous rapportons deux observations de carcinome adenoide kystique de la glande lacrymale, lesion rare dans cette localisation, et nous soulignons l’apport des differentes techniques d’imagerie dans le diagnostic et l’evaluation du volume et des extensions tumorales. Patients et methodes Il s’agit de deux patients âges de 48 ans et 45 ans, sans antecedent particulier. Le motif principal de consultation etait une exophtalmie unilaterale. Le diagnostic etait confirme par la biopsie. Une TDM et une IRM orbitaires etaient realisees dans les deux cas. Le traitement comprenait une chirurgie la plus large possible suivie d’une radiotherapie adjuvante hypofractionnee en utilisant une technique conformationnelle avec modulation d’intensite. A l’occasion de ces observations, nous rappelons les principales caracteristiques clinico-radiologiques de cette entite tumorale rare. Discussion Le carcinome adenoide kystique est une tumeur maligne d’agressivite locale et d’evolution lente. Il s’agit d’une tumeur epitheliale maligne developpee habituellement dans les glandes salivaires, sa localisation orbitaire aux depens des glandes lacrymales est tres rare. De pronostic est mediocre, le taux de survie a 5 ans est estime a 45 %, ce caractere agressif est explique par la presence precoce d’une invasion perineurale favorisant la rechute locale et metastatique. Cliniquement, l’exophtalmie unilaterale, indolore, irreductible et d’evolution lente, est le signe le plus frequent. L’imagerie a un interet dans le diagnostic positif en analysant la tumeur qui apparait a la tomodensitometrie sous forme d’un processus isodense aux depends des muscles extra-oculaires prenant le contraste significativement apres injection de conduit de contraste. A l’IRM la tumeur apparait en isosignal T1 et T2, se rehaussant apres injection de gadolinium. L’IRM est plus performante dans la precision des rapports de la tumeur et son extension intracrânienne via la fissure orbitaire superieure, ainsi que l’extension osseuse et perineurale. Dans le suivi post-therapeutique, l’imagerie permet la detection des recidives et des rechutes metastatiques qui sont tres frequents. Conclusion L’IRM, de par sa meilleure resolution spatiale et son caractere non irradiant, doit etre privilegiee dans cette entite tumorale.

Objectifs Les paragangliomes sont des tumeurs rares ; nous rapportons un cas de paragangliome jugulaire droit avec extension endocrânienne chez une patiente de 36 ans operee, il y a 5 ans, d’un paragangliome jugulaire droit. Nous attacherons une attention particuliere aux caracteristiques de la neuroimagerie TDM et IRM de cette entite rare et de l’interet notamment de l’IRM dans le suivi evolutif apres traitement. Patients et methode Patiente âgee de 36 ans, operee depuis 5 ans pour tumeur du glomus jugulaire droit, qui a consulte pour un syndrome d’HTIC avec hemiparesie droite et paralysie faciale droite d’installation rapidement progressive. L’IRM cerebrale a objective la presence d’un processus tumoral de l’angle ponto-cerebelleux droit localement avance. La chirurgie etait limitee a une biopsie avec un geste de coagulation car la tumeur etait tres hemorragique. L’examen anatomopathologique a confirme le diagnostic de paragangliome. Une radiotherapie a visee curative a ete administree. Le suivi clinique de la patiente etait effectue tous les 3 mois pour les 2 premieres annees, puis tous les 6 mois, ainsi une TDM cerebrale a ete demande 3 mois apres la fin de l’irradiation qui a montre la persistance du processus tumoral, la patiente a ete mise sous surveillance par IRM cerebrale annuelle qui a conclu a une stabilite lesionnelle. Discussion Les paragangliomes sont des tumeurs rares developpees a partir de la crete neurale. Il s’agit de tumeurs neuro-endocrines, generalement benignes. Les formes malignes sont tres rares, leur diagnostic est base sur la presence de metastases locoregionales ou a distance. La TDM montre une masse tissulaire a contours nets. La prise de contraste est rapide et intense du fait de phenomenes de lavage vasculaire. La TDM precise egalement l’extension tumorale ainsi que la presence d’autres localisations cervicales. L’IRM donne une evaluation precise de l’extension locoregionale grâce a la realisation de coupes multiplanaires. Les sequences ponderees en T1 fournissent une meilleure resolution spatiale alors que les sequences ponderees en T2 fournissent un meilleur contraste tissulaire, permettant le depistage des petites lesions passees inapercues sur les autres sequences. L’angiographie n’est plus indispensable pour confirmer le diagnostic, elle conserve neanmoins des indications en preoperatoire lorsqu’un geste de plastie vasculaire est a envisager ou quand une embolisation est indiquee. Conclusion Le diagnostic des paragangliomes malins est confirme devant des signes de recidive locale ou en cas de presence de metastases a distance. L’extension tumorale se fait par voie sanguine ou lymphatique. Le delai moyen de survenu apres la resection varie de 6 a 10 ans.

Objectifs Decrire les aspects TDM et IRM du melanome muqueux de la fosse nasale, lesion rare dans cette localisation, ainsi que son interet dans le bilan d’evaluation et de surveillance. Patients et methode Nous rapportons le cas d’une patiente âgee de 60 ans, qui a consulte pour une obstruction nasale droite permanente avec des episodes d’epistaxis evoluant depuis 3 mois. L’examen endoscopique a revele la presence d’une masse pigmentee de la fosse nasale droite. La biopsie etait en faveur d’un melanome muqueux malin. La TDM initiale a objective la presence d’un processus tissulaire heterogene de la fosse nasale droite avec lyse osseuse de la cloison nasale. L’IRM du massif faciale a montre la presence d’un processus tumoral comblant la totalite de la fosse nasale droite de signal heterogene sur les sequences T1 et T2, hypersignal diffusion avec un apparent diffusion coefficient (ADC) bas, se rehaussant de facon heterogene apres injection de produit de contraste iode et mesurant 48 × 21 × 33 mm. Ce processus lyse la cloison nasale et les os propres du nez droit avec lyse de la lame papyracee homolaterale sans extension intra-orbitaire. En raison du stade localement avance de la tumeur, une chimiotherapie d’induction a ete realisee en premier afin de diminuer la taille tumorale ceci a ete objective par l’IRM post-chimiotherapie qui a montre une reponse partielle de 47 %. La patiente a eu par la suite d’une resection chirurgicale. L’IRM post-chirurgicale a montre un petit comblement localise des cellules ethmoidales droites de 9 × 17 mm. Le traitement a ete complete par une radiotherapie adjuvante sur le lit operatoire ainsi qu’un boost sur la zone a haut risque de recidive. La patiente a ete suivie regulierement et il n’y avait pas de signe de recidive locoregionale ou a distance apres 2 ans de recul. Discussion Les melanomes muqueux de la tete et du cou (principalement nasosinusiens ou de la cavite buccale) representent 1 % des cancers, 4 % des melanomes et plus de 50 % des melanomes muqueux. Leur prise en charge requiert une approche multidisciplinaire dans laquelle l’imagerie en coupes (TDM et IRM) occupe une place fondamentale dans la decision therapeutique. Lors du bilan initial, la TDM et l’IRM permettent une evaluation precise de la localisation, du volume et de l’extension vers les cavites sinusiennes, le rhinopharynx, les choanes, ainsi que l’extension orbitaire et endocrânienne. En cours de traitement, l’imagerie permet d’evaluer la reponse therapeutique en objectivant une reduction de la taille tumorale ou une progression. Dans le suivi post-therapeutique, l’imagerie joue un role dans la detection des recidives sous muqueuse ou des metastases a distance. Conclusion La TDM garde une utilite dans l’analyse des structures osseuses du massif facial, mais pour l’extension aux tissus mous, l’IRM permet une etude plus fine et se revele superieure pour caracteriser la tumeur de la reaction inflammatoire.

Introduction La radiotherapie occupe une place primordiale dans le traitement anticancereux, or, elle est associee a une toxicite non negligeable responsable de multiples complications precoces et tardives. Nous discutons dans notre travail uniquement les complications neurologiques du SNC. Objectifs Definir le role de l’IRM dans la detection des complications neurologiques de la radiotherapie.Decrire et illustrer les differentes complications neurologiques du SNC de la radiotherapie. Materiels et methodes Etude retrospective portant sur 29 patients explores dans le service de radiologie de l’institut national d’oncologie de Rabat, sur une periode de 2 ans (de septembre 2017 au septembre 2019). Tous les patients ont beneficie d’une IRM cerebrale et/medullaire, sur un machine de 3 TESLA. Le protocole realise comportait des sequences ponderees en T1, T2, FLAIR, T2*, sequence de diffusion, sequence injectee en ponderation T1. Sequence de spectroscopie a ete realisee selon les cas. Resultats Les complications neurologiques etaient comme suit : radionecrose (n = 8), leuco-encephalopathie (n = 14), myelopathie (n = 2), atrophie cerebrale avec troubles cognitifs (n = 5). Discussion Le SNC presente une radiosensibilite tres particuliere dont les complications sont redoutables pour la qualite de vie des patients. Elles sont classees en fonction de leurs presentations cliniques et leur delai d’apparition apres l’irradiation. L’IRM est l’examen de choix pour l’exploration de ces complications, permet de les confirmer et d’eliminer d’autres origines, cependant elle reste non specifique. Le couplage avec l’etude dynamique est alors necessaire pour etudier la perfusion du parenchyme cerebrale ( Fig. 1 ).

Introduction Le germinome pineal est la tumeur la plus commune de la region pineale representant ∼50 % de toutes les tumeurs, et la majorite (∼80 %) des tumeurs germinales intracrâniennes. L’IRM est la modalite de choix pour leur evaluation, cependant, l’etude anatomopathologique permet de poser le diagnostic definitif. L’objectif de ce travail est de rapporter les aspects en imagerie de deux patients porteurs d’un germinome pineal avec extension lepto-meningee. Observations 1er cas : patient de 25 ans qui a presente un syndrome d’hypertension intracrânienne (HTIC). Une IRM cerebrale a montre un processus de la region pineale en iso T1 et T2 avec rehaussement intense et homogene apres injection ( Fig. 1 ), avec localisation secondaire meningee. 2e cas : patient de 13 ans qui a presente un syndrome d’HTIC. Une IRM cerebrale a montre un processus de la glande pineale, de signal tissulaire rehausse par le gadolinium avec hydrocephalie sus jacente ( Fig. 2 ). La biopsie est revenue en faveur d’un germinome pineal et un complement par IRM medullaire a montre une formation nodulaire dans la partie posterieure des racines de la queue de cheval en hypersignal T1 hyposignal T2 avec prise de contraste annulaire. Discussion Le germinome pineal est une tumeur maligne representant 60 % des tumeurs germinales. Il a une predominance masculine (M :F de 13 :1). La plupart des patients ont L’IRM permet la delimitation precise des masses pineales avant la chirurgie et permet de distinguer les vraies masses pineales des masses parapineales qui touchent la glande pineale. Les germinomes sont radiosensibles avec des taux de survie d’environ 85 % et de guerison de 80 a 90 %. Conclusion L’IRM est l’examen de choix en cas de suspicion d’une tumeur de la glande pineale.

Purpose To develop the results of concomitant radiochemotherapy in management of nasopharyngeal carcinoma (NPC) to the National Institute of Oncology at Rabat. Materials and methods Retrospective study of 81 patients with nasopharyngeal carcinoma and who were treated with concomitant radiochemotherapy to the National Institute of Oncology at Rabat in radiotherapy department, for a period of January to December 2012. Results Median age was 43 years old with male dominance to 78,8 %. According to TNM classification passed by AJCC 2010, 43,2% were classified stage IV, 37 % stage III and 19,8 % stage II. Neoadjuvant chemotherapy was indicated in 20 patients (24,7%) or 95% in N2-N3. The Therapeutic result after the neoadjuvant chemotherapy for lymph node was complete in 31,2 %. The concomitant radiochemotherapy treatment consisted in a conformal therapy treatment with lateral 6 MV photon beams dose of 70 Gy in conventional fractioning, and in two series by excluding spinal cord after dose of 40 Gy. We used electrons treatment in addition to treat the lymph nodes. The concomitant chemotherapy consisted of a weekly cisplatin treatment 40 mg/m2. The mean spread was 57,3 days. During the concomitant chemotherapy treatment 60 % of radiomucitis and 30 % nephrotoxicity were observed in patients receiving neoadjuvant chemotherapy. Late toxicities were dominated by hyposcialie (90,1%) and otological disorders (67,9%). After an average follow-up of 30,6 months, we were able to follow the progress of 69 patients (85,2%). Forty-nine patients (75,3%) were in good locoregional control. We observed 20 relapses (24,7 %) including 14 metastatic relapses. The main prognostic factors of metastasis were lymph node involvement in 92,2% (p = 0,04) and T3-T4 stages in 64,2% (p = 0,013). At three years, overall survival at all stages were to 81,9%, survival without recurrence to 71% and local control to 79,2%. Conclusion The nasopharyngeal carcinoma are radiosensitive and radiocurable tumors. Concomitant radiochemotherapy is the therapeutic standard for locally advanced nasopharyngeal carcinoma, and allow to obtain carcinological good results at toxicity notable disadvantage.

It’s a 24 years old female patient who presented with rhinological burning pain evolving since 1 year. She didn’t consult until a blistering lesion filled half of the oral cavity. The initial biopsy of the tumor was interpreted as a round cell tumor process. It’s a 24 years old female patient who presented with rhinological burning pain evolving since 1 year. She didn’t consult until a blistering lesion filled half of the oral cavity. The initial biopsy of the tumor was interpreted as a round cell tumor process. An immuno-histochemical complement showed a poorly differentiated neuroendocrine carcinoma (Pancytokeratine+, Ki67 at 30%, Chromogranine+, Synaptophysine-). CT scan showed a locally advanced maxillary nasal sinus tumor of 74 mm in the greatest diameter. The remainder of the staging didn’t reveal any metastases. The patient received 3 courses of chemotherapy with Etoposod-cisplatin. The clinical and radiological evaluations showed a progression of disease [Figure 1].

Background: Bladder extrophy is a rare congenital anomaly, it is now well reconized that an exstrophy of the bladder is associated with an increased risk of bladder cancer. Case presentation: We report the case of 34-year-old male with squamous cell carcinoma of an unreconstructed exstrophic bladder. Because of the locally advanced disease, he received neoadjuvant chemotherapy with favorable response. Then, he underwent a total cystectomy with uretero-intestinal anastamosis. Results: The patient progressed three months after the surgery. Chemotherapy was established and he received 2 cycles, however, he died 2 months later. Conclusion: Squamous cell carcinoma associated with bladder extrophy remains relatively high. These tumors tend to be aggressive, follow-up is mandatory in these cases.

Background Leiomyosarcoma of the rectum is a rare entity that comprises less than 0.1 % of all rectal malignancies. Given the uncommon nature of this tumor and the controversy about its treatment we report one case and review the literature in an attempt to report a particular evolution and to discuss the most appropriate treatment. Case presentation This case report describes the presentation of leiomyosarcoma of the rectum. A 30-year-old man from the north of Morocco presented with rectorrhagia and constipation. On physical examination we found a mass in his rectum approximately 6 cm from his anal margin. Pelvic magnetic resonance imaging showed a rectal mass with a parietal attachment that invaded the fascia and his perirectal tissue. Before any treatment he defecated spontaneously the tumor. On histopathological examination a diagnosis of leiomyosarcoma was made. An anterior resection of his rectum was performed with adjuvant radiotherapy at a dose of 50 Gy. After 1 year of surveillance, he has not presented any clinical symptoms and pelvic magnetic resonance imaging was normal. Unfortunately, histological analysis of a superficial biopsy of a rectal leiomyosarcoma may not be reflective of the entire tumor mass, and a diagnosis is based essentially on postoperative pathological examination. The optimal treatment modality in patients with rectal leiomyosarcomas is controversial. Prognosis is also poor; tumor size, histological grade, mitotic index, and local staging are the most known prognosis factors. Conclusion The prognosis of rectal leiomyosarcoma is poor; more investigations are necessary to understand the progression of these tumors and to define an optimal treatment modality.

Introduction: In Morocco, cervical cancer is the second most common cancer,and the third cause of death. Our department recruits more than 500 patients each year and proximally half of the cases are diagnosed at an advanced stage. Patients and methods: Between January 2011 and December 2011, all patients diagnosed with cervical cancer and treated with concurrent chemoradiotherapy were retrieved. We analyzed overall survival, local control, and defined prognostic factors influencing outcomes in this population. Results: At 3 years the overall survival rate for the cohort was 89.8% and the overall LC rate was 80.8%. The most important prognostic factors for OS and LC were the pretreatment hemoglobin, total duration of treatment, and the use of brachyteherapy. Of the included patients, 20% experienced late Grade 3 or 4 toxicity. Conclusion: The results of our study have shown that besides tumor stage, the use of brachytherapy, and lymphnode status, other factors such as pretreatment hemoglobin and treatment duration should be analyzed carefully and should be considered taking into consideration influence of all of the aforementioned factors.

Questionnaire. (DOC 32 kb)

Introduction: In Morocco, cervical cancer is the second most common cancer, and proximally half of the cases are diagnosed at an advanced stage. The standard treatment approach is concurrent chemoradiation followed by intracavitary brachytherapy (BT) boost to the cervix. Patients and methods: 293 patients diagnosed with cervical cancer and treated with concurrent chemoradiotherapy between January 2011 and December 2011 at our department was retrieved. We analyzed defined prognostic factors influencing outcomes. The aim of our study is to analyze the effect of the use of brachytherapy on treatment outcomes (overall survival and local control) and to report the toxicities for each treatment approach. Results: At 3 years, the use of brachytherapy as boost was found to be a significant factor impacting both OS (P=0.0001)), and LC (P=0.001). Also in the multivariate analysis, brachytherapy was an independent prognosis factor affecting both OS (hazard ratio [HR], 3.29; 95% CI, 1.50-7.21, P=0.03) and LC (hazard ratio [HR], 2.33; 95% CI, 1.30-7.21, P=0.005). Conclusion: At present, brachytherapy is still the standard approach to boost the cervix in patients with locally advanced cervical cancer.

Introduction: Treatment duration has always been related to treatment outcomes in cervical cancer. Our study is aiming to evaluate this parameter and its effect on treatments’ results in patients with locally advanced cervical cancer treated with concurrent chemo radiation. Patients and methods: Between January 2011 and December 2011, all patients diagnosed with cervical cancer and treated with concurrent chemo radiotherapy were retrieved. Treatment duration was calculated from the first day of EBRT to the last day of brachytherapy or EBRT, whichever was last to complete, Fifty-six days (8 weeks) was used as a limit, we analyzed the impact of treatment duration on the overall survival and local control. Results: The median time to complete pelvis RT was 37 days (34-42 days). A median of 15 days (13-26 days) between the last day of Pelvic RT and the start of the first Brachytherapy fraction (Pelvis RT-BT interval) was noted. The median time to complete EBRT in association with BT was55 days (50-69 days) while the median total treatment duration was 61 days (53-71 days). At 3 years the overall survival (OS) rate of the studied cohort was 89.8% and local control (LC) rate was 80.8%. In the univariate analysis, total treatment duration (>56 days) was found to be a significant factor impacting both OS (P=0.014)), and LC (P=0.014). Also in the multivariate analysis, total treatment duration was associated independently with prognosis, and affected both OS (hazard ratio [HR], 2.8; 95% CI, 1.07-7.54, P=0.035) and LC (hazard ratio [HR] 3.2; 95% CI, 1.57-6.64, P=0.001). Conclusion: Extended treatment duration significantly affects treatment outcomes in cervical cancer, efforts should be made to shorten it in a way to improve cancer prognosis.

Cervical cancer (CC) is one of the most widespread gynecological malignancies in women worldwide. Treatment strategies and screening modalities have largely evolved these past years resulting in an improvement of survival. However, treatment modalities are associated with long term side effects that significantly impacts quality of life (QOL) in cervical cancer survivors. The aim of this study is to evaluate QOL (General and sexual QOL) in cervical cancer survivors up to 10 years after the diagnosis. In a cross-sectional descriptive study design, 110 cervical cancer survivors (CCS) and 80 healthy controls completed questionnaires assessing QOL. Participants were Arabic White, sexually active. The mean age at diagnosis was 34 years and was 43 years at the time of the interview. In our series long term CCS have generally a good global QOL comparable with healthy controls. However, issues concerning emotional functioning were over expressed by CCS. As to the sexual impact of cervical cancer; CCS experienced less sexual functioning and enjoyment and less satisfaction with their body image when compared to healthy controls. In a multivariate analysis, spiritual well-being and social support were the predictor factors that statistically affected QOL among the studied cohort, it accounted for 81 % of the variance in QOL scores. A better understanding of the complexity of the relationship between QOL and cervical cancer sequelae in one hand and socio-demographic factors in the other hand is necessary to improve QOL among cervical cancer survivors. More efforts should make to inform disease free patients about expected side effects and symptoms to face the physical changes that would affect their QOL and sexual activity.

Objectif de l’etude Evaluer le retentissement de la radiotherapie sur la qualite de vie des patients traites pour cancer du nasopharynx. Patients et methodes Etude transversale des dossiers de 90 patients irradies pour cancer du nasopharynx a visee curative. L’âge moyen des patients etait de 47 ans (19–76), 42 % etaient analphabetes, 33 % avaient un niveau d’etude primaire, 12 % secondaire et 12 % superieur, 57 % etaient sans emploi et 42 % actifs. Trente-sept pour cent des cancers etaient de stade II, 45 % de stade III et 17 % de stade IV. Dix-huit pour cent des patients ont recu une radiotherapie bidimensionnelle et 82 %, une radiotherapie tridimensionnelle. La duree moyenne de survie etait de 67 mois (14–360). Pour l’evaluation de la qualite de vie, il a ete utilise le questionnaire de l’European Organization for Reseach and Treatment of Cancer (EORTC) QLQ-C30 et le module QLQ-H&N35. Les questionnaires pour les patients analphabetes et incapables de lire le francais ont ete remplis. Le delai minimum entre la fin de la radiotherapie et le remplissage du questionnaire etait d’un an. Pour l’analyse statistique, il a ete utilise le logiciel SPSS 10.0. Pour rechercher les facteurs influencant le score de la qualite de vie globale, il a ete utilise le test de correlation de Pearson. Un p inferieur a 0,05 an ete retenu comme significatif. Resultats Les differents facteurs qui influencent le score de la qualite de vie globale etaient : l’âge ( p = 0,03), le type de radiotherapie ( p = 0,04), le niveau d’education ( p = 0,01), le statut professionnel ( p = 0,02), la douleur ( p = 0,001), la fatigue ( p = 0,001), le trismus ( p = 0,001) et les difficultes financieres ( p = 0,01). Conclusion L’âge, le statut professionnel, le niveau d’education, le type de la radiotherapie, les difficultes financieres, la douleur, la fatigue et le trismus influencent la qualite de vie des patients suivis pour cancer du nasopharynx.

We performed a population-based study to determine the significance of adenocarcinoma and to evaluate its behavior over the last 10 years among patients treated in the National cancer institute of Morocco. This is a retrospective study that was conducted in the national cancer institute of Morocco. Over a period of 10 years, we retrieved 350 cases of cervical invasive adenocarcinoma. Survival was analyzed according to the Kaplan–Meier method. A univariate analysis of prognostic factors was performed using the test of log rank. Cox regression model was used for the multivariate analysis of prognostic factors. Mean age at presentation was 46 years. Sixty seven percent of the patients had locally advanced stage. Radiotherapy was prescribed in 73.3 % of the cases. The mean follow-up time for surviving patients was 51 months. The 5-year survival rates according to clinical stages were as follows, 76 and 62 % for stages I and II, respectively, 32 and 9 % for stages III and IV, respectively. Tumor stage, tumor grade, positive lymph nodes status, lymphovascular space involvement and patient’s age were significant prognostic factors in a univariate analysis. While only stage and lymph node involvement remained significant independent predictors for survival in the multivariate analysis. Although in our country incidence of adenocarcinoma is lower than the ones reported in western countries, in general our results are consistent with those reported in the literature. Better outcomes are observed in both early stages and young patients. Also, we found that FIGO stage, grade and lymph node metastases to be significant prognostic factors for survival in cervical adenocarcinoma.

Radical cystectomy with lymphadenectomy is currently the standard of care for muscle-invasive urothelial bladder cancer; however and because of its morbidity and its impact on quality of life, there is a growing tendency for bladder-sparing strategies. Initially reserved for elderly or unfit patients unable to undergo radical cystectomy, chemoradiotherapy became a true alternative to surgery for highly selected patients. Although there are no randomized trials comparing radical cystectomy with bladder preserving approaches, surgery remains the preferred treatment for many clinicians. Furthermore, comparison is even more difficult as modalities of radiotherapy are not consensual and differ between centers with a variability of protocols, volume of irradiation and type of chemotherapy. Several ongoing trials are attempting to optimize chemoradiotherapy and limit its toxicity, especially through techniques of adaptive radiotherapy or targeted therapies.

Objectif de l’etude Evaluer l’impact du manque de soutien familial sur la survenue de la detresse psychologique chez les patientes suivies pour cancer du sein. Patientes et methodes Etude transversale utilisant le Hospital Anxiety and Depression scale (HADS) et l’echelle visuelle analogique (EVA) de la detresse psychologique. Le consentement eclaire etait obtenu de la part de toutes les patientes incluses. L’analyse des donnees socio-demographiques et cliniques a ete faite par le test de correlation de Pearson, le test de Student, le test de χ2, l’analyse de variance et les regressions logistiques simple et multiple. Nous avons utilise le logiciel SPSS version 20 pour Windows. Resultats Sur 446 patientes incluses dans cette etude, d’âge moyen de 50 ± 7,8 ans (26–66), 120 (26,9 %) etaient en destresse psychologique (score global HADS ≥ 15 et/ou score EVA ≥ 3). En analyse multifactorielle (ajustee sur le niveau d’education, la profession, le lieu de residence et la prise de medicaments analgesiques et/ou anxiolytiques), le manque de soutien familial (OR [Odds ratio] = 5,33 [2,62–10,82], p Conclusion Le soutien familial doit etre evalue tot lors de la prise en charge de nos patientes, afin de detecter les femmes a risque de developper une detresse psychologique et leur prodiguer le traitement approprie.

Introduction Cancer metastasis to the thyroid is extremely rare. The most common sites that have been reported to metastasize to the thyroid gland are breast and kidney. As to primary lung cancer metastasizing to the thyroid gland, only a few cases have been described in the literature. Case presentation We report a case of a 37-year-old white Arabian woman who had never smoked tobacco products for whom a malignant thyroid mass revealed a primary lung tumor. She had a surgical excision for both the thyroid and the pulmonary tumors, and received adjuvant chemotherapy. At 1 year, she is still in remission. Conclusions Our case is rare as it describes a case where the thyroid lesion was the revealing sign of an unknown lung carcinoma. Management of thyroid metastases should depend on the individual situation and surgical excision should be proposed whenever a patient’s condition is favorable.

Background Sebaceous carcinoma is a rare malignancy primarily with aggressive growth affecting the cutaneous tissues of the periocular region. Sebaceous carcinoma of the parotid gland is exceedingly rare, with only 32 cases reported in the literature. Our case brings this total to 33. Case presentation We present a case of a 57-year-old Moroccan woman with a firm, painless, slowly enlarging swelling at her left parotid area, with normal overlying skin and no palpable neck nodes. Parotidectomy with facial nerve preservation was performed, and microscopic examination showed sebaceous carcinoma. Then, she underwent adjuvant radiotherapy. With a follow up of 20 months, head and neck computed tomography revealed no recurrence. Conclusions The optimal treatment is unclear. With more cases reported, clinicopathological characteristics and histogenesis are increasingly understood. Therefore the treatment for this rare tumor continues to evolve.