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IntroductionIn the setting of increasing attention to representation in medicine, we aimed to assess current perspectives of racial and ethnic workforce diversity and health care disparities among gastroenterology (GI) and hepatology professionals in the United States.MethodsWe developed and administered a 33-item electronic cross-sectional survey to members of 5 national GI and hepatology societies. Survey items were organized into thematic modules and solicited perspectives on racial and ethnic workforce diversity, health care disparities in GI and hepatology, and potential interventions to enhance workforce diversity and improve health equity.ResultsOf the 1,219 survey participants, 62.3% were male, 48.7% were non-Hispanic White, and 19.9% were from backgrounds underrepresented in medicine. The most frequently reported barriers to increasing racial and ethnic diversity in GI and hepatology were insufficient representation of underrepresented racial and ethnic minority groups in the education and training pipeline (n = 431 [35.4%]), in professional leadership (n = 340 [27.9%]), and among practicing GI and hepatology professionals (n = 324 [26.6%]). Suggested interventions were to increase career mentorship opportunities (n = 545 [44.7%]), medical student opportunities (n = 520 [42.7%]), and program and professional society leadership roles for underrepresented racial and ethnic minority groups (n = 473 [38.8%]).DiscussionOur survey explored imperative and timely perspectives on racial and ethnic representation and health equity among professionals in GI and hepatology. The findings should inform future interventions to address workforce diversity and establish priorities toward improving health equity, ultimately serving as a springboard for professional societies, academic institutions, and other organizations that aim to increase diversity, equity, and inclusion in our field.

DNA hypomethylation of long interspersed repetitive DNA retrotransposon (LINE-1) and Alu repeats elements of short interspersed elements family (SINEs) is an early event in carcinogenesis that causes transcriptional activation and leads to chromosomal instability. In the current study, DNA methylation levels of LINE-1 and Alu repeats were analyzed in tumoral tissues of invasive breast cancer in a Tunisian cohort and its association with the clinicopathological features of patients was defined. DNA methylation of LINE-1 and Alu repeats were analyzed using pyrosequencing in 61 invasive breast cancers. Median values observed for DNA methylation of LINE-1 and Alu repeats were considered as the cut-off (59.81 and 18.49%, respectively). The results of the current study demonstrated a positive correlation between DNA methylation levels of LINE-1 and Alu repeats (rho=0.284; P

ObjectivesThe aim of our study is to study the impact of covid19 on patients waiting surgery.MethodsWe retrospectively reported 33 patients diagnosed breast carcinoma and underwent surgery at salah azaiez institute Tunisia between 18/3/2020 and 29/3/2020 (72 days).ResultsDuring the first pandemic of COVID-19, 33 patients underwent breast surgery, the mean age was 51 years (ranging 34–82). 28 patients had Social insurance.28 patients patient belongs to urban environment.11 patients had neoadjuvant chemotherapy.Invasive ductal carcinoma is more frequent (30 cases), tumors had a high brad nuclear in 18 cases. In 16 cases the tumor had stade IIB, axillary lymph node metastasis were found in 20 patients. 11 patients underwent radical surgery and only one patient had plastic reconstruction.ConclusionsThe COVID-19 pandemic has affected just about every aspect of life, including screening, diagnosis, treatment, and follow-up care for breast cancer. People who’ve been diagnosed with breast cancer and people who are at high risk for breast cancer have found themselves in a uniquely difficult and sometimes frightening position since the coronavirus crisis began.

Introduction/Background* Low-grade fibromyxoid sarcoma (LGFMS) is a rare and unpredictable soft-tissue fibrous tumor that classically arises in proximal extremities and the trunk. The occurrence in the female external genitalia is exceptionally described in the literature. Methodology This report presents two patients with documented LGFMS arising from the vulva who were treated in our institution between 2019 and 2020. Result(s)* The patients were aged 22 and 31 years respectively. Both women presented in another department with painless, slow-growing nodule of the vulva evolving for two years in one case and two months in the other case. Physical examination found a well-defined subcutaneous mass of the right labia majora of 3 cm in the first case and 10 cm in the second case. The tumors had a smooth surface and hard consistency. Local excision was performed under local anesthesia. The histological examination revealed a mesenchymal proliferation of spindle cells occupying the dermis and the hypodermis with positive margins. Immunochemistry confirmed the diagnosis of LGFMS. The patients were then referred to our institution. Pelvic MRI performed in one patient revealed a contrast-enhancing epidermal mass of the right posterior part of the vulva measuring 23×13 mm with no local lymphadenopathy. CT scan showed no distant metastasis in both patients. After a multidisciplinary consultation meeting, we decided to perform a tumor bed resection. The final pathologic testing revealed no residual tumor with negative final margins. No adjuvant treatment was considered necessary to complete the treatment. The current follow-up of the two patients is free of recurrence. Conclusion* LGFMS are among the least common histologic subtypes of sarcoma arising in the lower genital tract, and its benign appearance can be misdiagnosing. Surgery with immunohistological examination remain the only way to establish the diagnosis and guide the treatment.

Introduction/Background*The COVID-19 pandemic has turned the standard of care of medicine worldwide into a “public health emergency of international concern. “Cancer patients are a unique population in that they are vulnerable to COVID-19, particularly if immunocompromised, and also, their oncologic outcome is based on the type and timing of the treatment.MethodologyA retrospective review comparing all surgical activities between the year before COVID-19 and the year after.This study was conducted in the Surgical Oncology Department in Salah Azaiez Institute of Oncology, the reference cancer care center in Tunisia.Result(s)*In our center, we created a new surgical procedures team.There was a significant reduction in the median daily breast surgery, superficial surgery, and ambulatory surgery (< 0,001). But not all operation types decreasing in frequency.Three months after COVID -19, we selected patients for laparotomy and decreased our activity by 50%.Starting from June 2020, we have increased our activity to exceed that of 2019. No increase in mortality or morbidity from treatment during COVID-19 for operated patients.The total surgically consults volume decreased by 36,17% in the post-COVID-19 period, significantly reducing the median daily consult volume (p

Introduction : Les conjoints de patientes atteintes de cancer du sein représenteraient souvent la première source de soutien de leurs femmes et seraient lourdement sollicités dans la prise en charge aux différents stades de la maladie. Nous nous proposons à travers ce travail d’étudier le niveau de fardeau chez des conjoints de femmes souffrant de cancer du sein et d’analyser l’association entre le niveau de fardeau, la détresse psychologique du conjoint, les données relatives au cancer du sein et les données sociodémographiques chez cette population. Méthode : Il s’agit d’une étude transversale réalisée auprès des patientes atteintes de cancer du sein, suivies en ambulatoire, ayant été accompagnées par leurs conjoints en consultation. Le recueil des données s’est fait au moyen d’une fiche qui comportait les données sociodémographiques et cliniques, la mesure de la détresse psychologique à l’aide de l’échelle Depression, Anxiety and Stress Scales et l’évaluation du fardeau au moyen de l’inventaire du fardeau de Zarit. Résultats : L’âge moyen des patientes incluses était de 53,64 ans. La majorité des couples vivaient en milieu urbain (74 %) et avaient un niveau socioéconomique moyen (76 %). La maladie était à un stade avancé dans 36 % des cas, et un traitement chirurgical a été réalisé dans 84 % des cas. La majorité des conjoints présentaient un niveau élevé de détresse psychologique : 46 % avaient une dépression modérée à sévère, 60 % avaient une anxiété modérée à sévère et 51 % avaient un stress modéré à sévère. Le score médian de fardeau était de 35, avec des extrêmes de 15 et 64. Un niveau de fardeau élevé était significativement associé à la profession de la patiente, au niveau scolaire et à la profession du conjoint, au stade du cancer, à la présence de douleur et de fatigue, au traitement chirurgical et aux scores de dépression, de stress et d’anxiété. Conclusion : Détecter un éventuel fardeau ressenti par le conjoint en dépistant la population à risque et le prendre en charge de manière adéquate permettraient de garantir une meilleure adhésion aux soins de leurs épouses aux différents stades de la maladie.

Introduction The sentinel lymph node (SLN) concept represents advancement in the management of the endometrial cancer (EC). We aim to assess the performance of the SLN procedure; its positive predictive value (PPV) and negative predictive value (NPV); in stage I of EC (FIGO2009). Method A prospective study is conducted in our institution. We perform a double detection of the SLN (radiolabel Tc 99 microsulfur colloid and a color method using patent blue) followed by pelvic lymphadenectomy with or without paraaortic lymphadenectomy. A pelvic MRI is performed to determine myometrial invasion and nodal status. The injection of Tc 99m colloid occurs the day prior to surgery. The injection into the stroma of the cervix at the 3 and 9 o'clock positions was performed by an oncologist surgeon with the assistance of a nuclear medicine physician. Preoperative lymphoscintigraphy was obtained after 90-120 minutes. We inject into the cervical stroma 2cc of patent blue similar to the Tc99 injection. A gamma detecting probe is used to locate radioactive lymph nodes. The SLNs identified then are labelled as radioactive and/or blue. No frozen-section analysis was performed. Results For the pathological analysis of the SLN, Haematoxylin Eosin is used. If there is no metastasis detected, an ultra staging protocol using different anti-cytokeratines is conducted. Studies have shown that this approach is possible having satisfactory results when conducted by dedicated surgical, radiology and pathology team. We look forward to our outcomes to illustrate those results. Take-home message Sentinel lymph node is a good alternative for gynecological cancer

Introduction Nasopharyngeal carcinoma (NPC) is a rare malignancy with an incidence of 0.5–2 per 100,000 in Europe and the United States, it almost occur in young and middle-aged adults, the incidence is higher in the Chinese and Tunisian population Case Report A 41-year-old male presented in March 2019 with a lump in the right upper neck region, which had been growing for four months. Physical examination identified multiple circular lumps, which were palpable on the right upper third of the neck on the sternocleidomastoid (facies medialis).Examination of the head and neck by computed tomography (CT) showed thickening of the soft tissues of the right wall of the nasopharynx and bilateral cervical lymphadenopathy with a maximum node size of ~9×1.5 cm, also it identified a suspect mass in the rignt breast. The patient underwent then a Breast ultrasound that showed a two aval shaped micolobulated hypoechoic mass without spiculations measuring respectively 10 mm and 12 mm located in the upper outer quadrant and behind the nipple of the right breast, associated with right axillary lymph node. Our patient underwent an ultrasound-guided biopsy, the histological examination confirmed the diagnosis of breast metastasis. In conclusion, the present case confirmed that NPC may also metastasize to breast male. Although, there is no established guideline for the treatment, a multidisciplinary approach is always beneficial to the patient.

Introduction To retrospectively evaluate the epidemiological, clinical, imaging findings, and therapeutic features of breast lymphomas in patients who had primary lymphoma of the breast. Materials and Methods This is a retrospective study including 13 patients with primary non-Hodgkin’s lymphoma of the breast treated at the institute Salah Azaiez from 2000 to 2019. This sample includes 1 case of follicular lymphoma, 2 cases of large T-cell lymphoma, and 10 cases of large B-cell lymphoma. Results All the patients were women and aged between 17–89 years (average age: 52.6 years). The mean symptom was a breast lump, only one patient consulted for inflammatory signs in the breast. The average clinical size of the tumor was 7.2 cm, with a maximum of 15 cm. Mammography showed an oval mass with circumscribed margins in the majority of cases. Ultrasound showed in most of the cases a hypoechoic irregular mass or multilobulated mass with irregular margin and hypervascular on color Doppler. Magnetic resonance imaging (MRI) was performed in only three patients and showed a spiculated lesion with polycyclic limits. 8 patients underwent surgery. In our study lymphoma involved 10 cases of large B-cell lymphoma, one case of follicular lymphoma, and two cases of large T-cell lymphoma. 11 patients had localized stages (I + II) at diagnosis, and 2 patients had the disseminated stage (stage III) of primary breast lymphoma. Seven patients underwent chemotherapy treatment alone, and five had chemotherapy with radiotherapy. The median follow-up of our patients was 53 months, ranging from 1 to 177 months. Overall survival was 71% at 3 years and 51% at 5 years.

Introduction Postradiation cutaneous angiosarcoma of the breast (PRCA) is very rare malignancy with an incidence ranged from 0.09 to 0.16%. It usually occurs after adjuvant radiotherapy following the treatment of breast cancer. In article published in August 2019 found about 50 cases of PRCA, the first case was published in 1948. Case Report A 40-year-old woman was referred for a palpable right breast mass. She denied history of breast masses or issues. Physical examination revealed a palpable right breast mass located at upper-outer right breast quadrant. There were no other palpable breast masses, no palpable axillary, supra-clavicular, or infra-clavicular lymph nodes.The patient underwent a right breast core biopsy of the mass the pathology of the biopsy revealed invasive ductal carcinoma. She underwent a right lumpectomy with a right axillar lymph node dissection. There was no metastatic lymph node. the patient underwent standard external radiotherapy (50 gy to the whole breast and 16 gy as a boost to the tumor bed) and chemotherapy then hormonotherapy by tamoxifen. She was followed with clinical and radiological surveillance. Seven years after the surgery she was presented with erythematous plaque associate with multiple purplish nodules, the mammography and the ultrasound was normal, the patient underwent a biopsy, the histlogical examination showed a post radiation cutaneous angiosarcoma. Conclusion The PRCA is rare and aggressive disease, the diagnostic is clinically difficult and often missed on mammography, usually the biopsy confirm the diagnostic.

Introduction Breast cancer is the most frequent primary tumor of ocular metastasis in women. The diagnosis must be regarded with uncertainty. Unless there is a histological exam. Otherwise, the diagnosis can be raised on clinical exam and MRI findings. Methods A retrospective review of five patients diagnosed with orbital metastasis of breast carcinoma from 2017 to 2020 in Salah Azaiz Oncology Institute in Tunisia. Results All the patients were female and the average age of diagnosis was 59 (range from 51 to 78). All the patients have a history of ductal adenocarcinoma of the breast. The molecular subtype was Luminal A in four cases and was triple negative in one case. The most common signs were proptosis and ptosis. The MRI was performed in four cases and revealed a mass of the extraocular muscle and the retro-orbital space in three cases, an infiltration of extra-orbital muscle in one case. In one case, a contralateral breast carcinoma and pulmonary metastases were found. The other cases were free of metastasis. A navigation-assisted intraorbital biopsy from the orbital roof, performed in one patient, revealed metastasis of breast cancer. All the patients underwent palliative systemic chemotherapy by taxotere. One patient died three months after the diagnosis and four patients are under regular follow-up. Conclusion Orbital metastasis may occur years after the diagnosis. The diagnosis is not evident to establish since the surgical biopsy is not technically possible. The treatment is based on chemotherapy, local radiotherapy, and surgery in some cases.

Introduction Breast cancer is the most common type of cancers in women. Invasive ductual carcinoma remains the most frequent histological type but invasive papillary carcinoma (IPC) is an uncommon histopathological variant. It accounts for approximately 3 to 6% of all invasive breast cancers. Morphologically, It is characterised by pseudopapillary. IPC is associated with a high incidence of axillary lymphnode metastasis and lymphovascular invasion. Local recurrence is more frequent. Patients and Methods The data of 70 patients were reviewed retrospectively. Thirty of them were included in our study between 2004 and 2019. Results All patients were women and the mean age was 62 years old. Right breast was the most site involved and tumor was located mostly in the outer upper quadrant. Clinical presentation was predominantely a breast lump and axillary lympnode was detected in 76% of cases of which 20% were metastatic. Tumoral stage was T2 N1M0 in 50%. Ultrasound examination revealed a cystic or solidocystic appearence in most cases. The mean histological tumor size was 26 mm. Immunohistochemical studies revealed the positivity of hormonal receptor in 73% and the negativity of HER in all cases. Age, Lymphovascular invasion and tumor necrosis were significantly associated to recurrence free and overall survival. Local recurrence was noted in 6%. Five- year Recurrence free survival and overall survival were respectively 87% and 88%. Conclusion Invasive micropapillary carcinoma has a poor clinical behaviour but in our study it has a good prognosis with a high rate of survival and less rate of recurrence.

Introduction Endometrial stromal sarcoma (ESS) is an uncommon malignant mesenchymal tumor. Uterine localization is frequently seen but low grade ESS arising in extrauterine sites is so rare. Clinical presentation of this entity is no specific. So that, the diagnosis is based on histological analysis. Methods We report two cases of low garde extrauterine endometrial stromal sarcoma treated at Salah Azaiez Institute. Results The first case was a premenopausal female presented with abdominal pain. MRI examination showed an abominopelvic mass. She had right salpingooophorectomy. Microscopic analysis showed a low graden endometrial stromal sarcoma probably arising from endometriosis. Six months after, CT scan revealed pelvic recurrence depending on the ovary. She had hysterectomy with left salpingooophorectomy, omentectomy and appendicectomy. Histological report concluded on low graden ESS of ovary arising from endometriosis. The second case was a postmenopausal women with the history of hysterectomy with bilateral salpingoophorectomie for benign fibroma presented with pelvic pain. CT scan showed two abdominal mass. Peroperatory, there were three mass depending on the mesorectum, the mesentery and the epiplon. Dissection was difficult. Epiploic biospy was taken. After histological and immunohistochemical study, the diagnosis of low grade extrauterine endometrial stromal sarcoma was retained. Hormonal therapy with regular follow up were indicated. Conclusion Extrauterine localisation is reported only is isolated cases in the litterature. In the absence of uterine primary tumor, the differential diagnosis considerations depend upon the site of involvement. Surgical resection or debulking are the mainstay of treatment.

Introduction Diffuse large B-cell lymphoma (DLBCL) of the ovary is a very rare condition. Surgery is often mandatory to establish the diagnosis which is based on the histologic examination and immunohistochemistry testes. Treatment is based on chemotherapy. Methods We report a series of four cases treated in Salah Azaiz Institute of Oncology, Tunis, Tunisia, from 2001 to 2019. Results The average age was 49 (from 34 to 67 years old). The abdominal symptoms consisted of pelvic pain and swollen abdomen. CA-125 was high in one case. The average radiological size of the ovarian mass measured with CT scan was 141 mm (from 50 to 200 mm). Pleural effusion, mediastinal, axillary and supraclavicular lymphadenopathies was found in one case. Per-operative findings showed ascites in one case and unilateral ovarian mass in three cases. One case showed an invasion of the uterus requiring a hysterectomy. For another patient, the tumor invaded the small intestine therefore she underwent an additional small bowel resection. The average histological size of the tumor was 92,5 mm. CD 20 and Bcl-2 were expressed in all cases and the Ki67 was higher than 50% in all cases. Two patients had R-CHOP chemotherapy and are in total remission; the two others are lost to follow-up. Conclusion Ovarian DLBCL mimics usually both clinically and radiologically an ovarian epithelial tumor. Surgery remains the only way to establish the diagnosis and guide the treatment.

Introduction Pancreatic metastasis from other malignant tumor is a rare event and represent less than 5% of all pancreatic malignancies Most common metastases arise from epithelial carcinoma such as melanoma, renal, pulmonary then lobular breast carcinoma We report a unique case of pancreatic metastasis of myxoid breast carcinoma that occurred in a patient treated for lobular breast carcinoma 27 years ago Case Report We report a case of 70-year-old women with a history of lobular carcinoma of the left breast with positive hormone receptors treated in 1997 She developed distant cutaneous metastasis in the thigh and lomboaortic lymph node after 21 years of total remission She receiver chemotherapy and hormonotherapy She presented to our department in June 2020 for obstructive jaundice evolving for 3 months The delay was explained by the pandemic situation of COVID 19 The clinical exam founded a severely icteric patient with hitching lesions The breast exam was normal with the stability of the thigh cutaneous lesion Ca15-3 was 30UI/L and CA19 9 was 57 UI/L MRI with cholangiography demonstrated common bile duct dilatation upstreaming of suspect mass in the head of the pancreas A needle biopsy of the pancreatic lesion revealed a metastatic ER/RP +, negative HER2Neu myxoid breast carcinoma She underwent endoscopic biliary stent and a multidisciplinary decision was to pursue chemotherapy and hormonotherapy Conclusion Pancreatic metastasis is a rare event that should be considered in patients with a history of breast carcinoma and obstructive jaundice Treatment is controversial with some authors suggesting dudenopancreatectomy in patients with controled distant disease

Introduction Pure tubular breast carcinoma (PTC) is a rare and well-differentiated tumor with good outcomes and a low local recurrence rate. Our study aims to determine the clinical, radiological, and appropriate management and the prognosis of this rare entity. Materials and Methods A review of Salah Azaiez institute registry from 2004–2019 was performed including seven cases of PTC of the breast. Results Seven patients were included in this study. The average age was 54 years old (from 36 to 70 years) and all patients were female. Physical exam revealed a breast lump in 6 patients. Six cancers were clinically detected on physical examination. In one patient the diagnosis was made by mammography. The radiologic findings were variable (BIRADS 3 in 6 cases and BIRADS 5 in one case). In our study, we found that. 5 patients presented with T1 and N0 according to the TNM classification. The radiological assessment did not show any metastasis. The conservative surgery was more frequently performed (5 cases). All patients had hormone-receptor positivity and HER-2 negativity. Six patients were luminal A, and one patient was luminal B. In one case we found axillary lymph node metastasis. The adjuvant radiotherapy was indicated in all cases of breast conservation and only in one case of radical surgery. Only one patient received chemotherapy. Conclusion The PTC shows an excellent prognosis with a low SBR grade and a molecular profile luminal A and a low incidence of recurrence.

Introduction Malignant melanoma is the most rapidly increasing cancer in the world. Metastatic disease occurs in 20% of patients. Metastases to the breast are rare. Melanoma is, however, among the most commonly reported primary tumors to metastasize to the breast. Methods A retrospective case review of our melanoma registry to find all patients with melanoma metastatic to the breast in salah azaiez institute tunisia. Results Seven patients were found to have breast metastases from melnoma. Five were premenopausal females with a mean age of 51 years. Three patients had a primary lesions were in the heel, two in the axillary area, one in the vagina and one in the head. One patient had bilateral breast involvement, and all had other sites of metastases. The median survival after diagnosis of breast metastases was 4 months. Conclusions Metastases to the breast from melanoma are uncommon but should be suspected in patients with a breast mass and a prior history of melanoma even years after a primary has been removed.