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Background: Gastrosplenic fistula (GSF) is a rare and potentially fatal complication of various diseases. Lymphoma is the most common cause. It can occur spontaneously or after chemotherapy. This rare entity may be misdiagnosed. Treatment modalities include surgical resection, chemotherapy or a combination of both. Actually, more and more are headed towards a chemotherapy regimen only to treat GSF.Case presentation: Here we report two cases of GSF due to diffuse large B cell lymphoma patients. First case is of a 54-year-old woman with a primary enormous spleen diffuse large B cell lymphoma (DLBCL) leading to a spontaneous fistula in the stomach. The second one is of a 48 year-old-male patient with a primary spleen DLBCL which fistula complicating chemotherapy. The evolution was fatal for both of them after undergoing surgeryConclusions: GSF complicating lymphomas is a rare disease entity, our case report and a systematic review of the literature may help physicians to diagnose and to treat it.

PurposeGastrosplenic fistula (GSF) is a rare and potentially fatal complication of various diseases, of which lymphoma is the most common cause. We aim through our work to relate two cases of GSF and to review literature. Methods We reviewed two cases treated in our department of GSF and made a research in Pubmed using the keywords “Gastrosplenic fistula” and “Splenic lymphoma”.Results GSF is a rare condition that can occur spontaneously or after initiation of chemotherapy. It arises from the rapid growth of tumour and invasion of surrounding organs. Diagnosis may be difficult to make and confused with splenic abscess. Treatment modalities include surgical resection, chemotherapy or a combination of both. Here we report two cases of GSF due to diffuse large B cell lymphoma patients. The first case is of a 54-year-old woman with a spontaneous fistula in the stomach. The second one is of a 48 year-old- male patient presenting a fistula after chemotherapy. Both patients died after surgery. ConclusionGSF is a rare but dangerous condition in which surgery is currently the preferred treatment.

Background: Osteosarcoma is the most frequent bone cancer occurring in children and adolescents aged 10–20 years. Several prognostic factors have been identified by studies done at western centers. The aim of our study was to identify the prognostic factors in Tunisian patients in order to improve their management. Methods: We reviewed the data of localized limb osteosarcoma patients treated in Salah Azaïz Institute from January 1980 to December 2018. Patient’s treatment and survival variables were assessed. Patients received a neoadjuvant chemotherapy and underwent surgery in an expert center. They received afterward an adjuvant chemotherapy depending on the tumor necrosis assessed by Huvos. Results: Eighty-five patients were enrolled. Mean duration of follow-up was 30 months (range 1–297 months). Males were 1.6 times more frequent, median age was 17 (from 1 to 62 years). Conventional osteoblastic osteosarcoma was the most frequent histological subtype (77%). Median tumor size was 10 cm. Femoral location was the most frequent (60%). The overall average history of symptoms was 103 days (4 to 423 days). The 5-year overall-survival was 38% and the event free survival 32%. Tumor site, lactate dehydrogenase levels, high methotrexate levels at 24 h, clinical evaluation of the tumor perimeter, surgery type and delay of relapse were found to affect overall survival. Tumor site, Lactate dehydrogenase levels and clinical evaluation of the tumor perimeter affected the progression free survival. Conclusion: Demographic characteristics of Tunisian patients are mainly the same than worldwide. Femoral site, normal level of lactate dehydrogenase, a clinical response during neoadjuvant treatment, an R0 surgery, a delay of relapse over 2 years and Median H24 Methotrexate level superior to 4.4 µmol/l were associated with a better prognosis in our study.

To report the conlcusions of articles and reviews assessing the benefit and harms of breast cancer screening in the world and in Tunisia.This is a review of articles searched through specialized medical data bases (Pubmud, Science Direct) using the following key-words: Dépistage / Screening,Cancer du sein/ Breast Cancer, Surdiagnostic/ Overdiagnosis,Mammographie/ Mammography,Controverse/ controversy,Tumeur in Situ/ In Situ Tumour.We reviewed 36 articles published between 2001 and 2018 assessing the benefit of breast cancer screening. The mortality reduction due to breast cancer screening is estimated between 15-30% by the randomized trials. However, overdiagnosis is estimated between 0-50%.Breast cancer screening has been useful in the fight against cancer. In the era of innovative and efficient therapies, breast cancer screening remains controversial due to the potential overdiagnosis. However, this concept still need to be defined more precisely and estimated more accuratly.