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Clear cell sarcoma of the esophagus is very rare. The etiology of this neoplasm remains unknown. Confirmed diagnosis requires histopathology with immunochemistry and molecular study. CCS typically shows highly aggressive behavior with a high rate of local recurrence, metastases, and death from disease.

Introduction Filgrastim is a granulocyte colony-stimulating factor (GSCF) used in some chemotherapy regimen to prevent febrile neutropenia. Most common reaction of filgrastim are aches and pain including headaches, nausea and skin rash. Case report We report the case of a patient who developed unusual, non-commonly reported adverse toxidermy to filgrastim. At first the eruption was limited to the lower members and genetics organs. Then it slowly spread across the whole body presenting as a polymorphic exanthematous-pustulosis lesions. Management & Outcome A cutaneous biopsy was done, identifying a toxidermy modified by systemic treatment. A pharmacological study linked the role of filgrastim to these lesions. After switching from filgrastim to lénograstim, his lesions are completely gone and haven't flared up again. Thus, clearly imputing the use of filgrastim. Discussion The cutaneous reaction that has reported with use of GSCF are sweet syndrome, erythema nodosum, pyoderma nodosum and pyoderma gangrenosum. As far as we know, no acute generalized exanthematous pustulosis due to GSCF has been reported.

Introduction: Hidradenocarcinoma is a rare aggressive tumor arising from sweat glands that may occur from preexisting hidradenoma or most frequently appears de novo. It occurs most often in old patients and is located in the head, neck and trunk in the majority of time. this tumor is also characterized by a high potential of local recurrence, metastasis and poor outcome. This tumor is often radiotherapy and chemotherapy resistant. We report herein an observation of a good clinical response with a long disease control under capecitabine in metastatic hidradenocarcinoma. Presentation of Case: We report a case of a 77-year-old man with a metastatic hidradenocarcinoma to the bone and lymph nodes who was operated 7 years ago for an hidradenoma of the right foot. He was treated with capecitabine based chemotherapy with good tolerance and obtention of partial response during 10 months. After that, his disease progressed and he died 1 year after diagnosis. Conclusion: Hidradenocarcinoma is a cancer with a poor prognosis. Because of its low prevalence and high rate of recurrence, its treatment is still controversial. Our good result demonstrates that adjunction of chemotherapy in metastatic forms is effective for a better control and long overall survival.

COVID-19 is an exceptional public healthcare emergency that affected all countries. The corona virus pandemic has made the treatment of all cancers difficult. This international phenomenon represents an outbreak in medicine and this situation is a major issue for all patients, whether they are infected with the virus or not. Colorectal cancer is one of the most common malignant tumors of the digestive tract which needs special multidisciplinary care. Treatment modalities including chemotherapy and targeted therapies can weaken the immune system and then cause serious or lethal coronavirus infections. This document gives an idea about how we dealt to protect patients with colorectal cancer at Salah Azaiez Institute during COVID 19 pandemic.

Cancer patients are at higher risk to be infected with COVID-19 and to develop a more severe form. Breast cancer (BC) treatments, including chemotherapy (CT), targeted therapy and immunotherapy can weaken the immune system and possibly cause lung problems. For all these reasons Salah Azaiez Institute's department of Medical Oncology took drastic actions to protect patients. In this article we will discuss protocol adjustments taken during the COVID-19 pandemic for breast cancer patients.

Colorectal cancer (CRC) is at present the third most common malignancy in the world. With changes in lifestyle its incidence and mortality have increased during last decades.To explore the association between red meat, processed meat and risk of colorectal cancer.We performed a case-control study, conducted from February to March 2019 at Salah Azaiez institute. One hundred and two subjects were enrolled.The case group included 52.9% males and 47.1% females. The control group enrolled 49%males and 51% females. The median age was 56 years old in the two groups. 63% of patients were stage I-III disease and 37% have a metastatic disease. The mean Body mass index was 24,76 Kg/m2 in CRC group was 27,39Kg/m2 in controls. CRC cases were more likely than controls to have a family history of CRC and a lower education level. There was a significant difference between cases and controls for socio-economic level and geographic origin. Ninety point two percent of cases and 76.5% of controls consume red meats, no significant association was observed between moderate red meat intake and colorectal cancer risk (p 0,063). However, a high total day meat consumption (100 g) was significantly associated with a high risk of CRC compared to low consumption (50 g) ( p=0.023). In contrast no significant association was observed when comparing all cooking methods of meet. 51% of cases and 23,5% of controls intake processed meats. Processed meat was positively associated with CRC (p 0,004).Our findings suggest that higher consumptions of red meat, the consumption of industrially processed meat increased the risk of CRC.

Background:Ocular involvement is a common complication of human immunodeficiency virus (HIV). Knowledge about this topic in Tunisia is limited. Objective:To investigate ophthalmic manifestations in patients living with HIV in Tunisia. Method:This was an observational study, performed between January 2007 and December 2016. We included patients with ocular disorders related to HIV. The data were recorded retrospectively from chart review. Results:Amongst 98 people living with HIV (PLWH), 36 participants (55 eyes) had ocular manifestations. The mean age was 32.2 ± 5.6 years. Twenty-four patients were men and 12 were women. The mean value of CD4+ T-cell count was 156.5 ± 4.2 cells/µL. Bilateral lesions were found in 19 eyes. Best corrected visual acuity was better than 6/12 in 36 eyes. The most common ocular finding was dry eye syndrome (22%), cotton-wool spots (20%) and retinal haemorrhage (16%) followed by cytomegalovirus (CMV) retinitis (9%), anterior uveitis (7%), toxoplasmosis (4%) and tuberculosis retinochoroiditis (7%) Herpetic keratitis (5%), Herpes zoster ophthalmicus (2%) and syphilitic chorioretinitis (2%). Papilledema was found in three eyes (5%). Panuveitis was observed in four eyes (7%): three of them were associated with chorioretinal toxoplasmosis, syphilitic chorioretinitis and CMV retinitis. The fourth was attributable to immune recovery uveitis. A CD4+ T-cell count of ≤ 200 cells/µL was found to be an independent risk factor for developing posterior segment manifestations. Conclusion:Various ophthalmic manifestations were observed in PLWH. The most common lesion was retinopathy. Ocular involvement can be serious leading to poor visual prognosis, which requires close collaboration between the ophthalmologist and infectious disease physician.

The stomach is the most frequent site of extranodal lymphoma. Mucosa-associated lymphoid tissue (MALT) lymphoma is a low-grade, B-cell neoplasm strongly associated withHelicobacter pylori(HP) infection. The presenting complaints of gastric MALT lymphoma are usually nonspecific. HP eradication is regarded as the first-line therapy in early stage disease. Management of patients who failed to achieve remission following HP eradication include chemotherapy, radiotherapy and in selected cases, surgery. The aim of the present study was to examine the clinical characteristics and treatment outcome of patients with gastric MALT lymphoma.

Endometrial cancer is the most prevalent genital tract cancer in occident and the third most common cancer among women in Tunisia. It is dominated by carcinoma. The identification of prognostic factors allows a better understanding of its outcome and guides its therapeutic approach. We propose to describe the clinicopathological features and identify the histoprognostic factors of this cancer. It is a retrospective analysis of a series of 62 total hysterectomy specimens with bilateral salpingo-oophorectomy from women with primary carcinoma of the endometrium, colligated in Anatomy Laboratory and Pathology Salah Azaiz Institute of Tunis over a period of 5 years, from January 2003 to December 2007. The median age was 60 years. At the time of diagnosis, 25% of patients were nulliparous and 86% were menopaused. The endometrioid adenocarcinoma was the most common, accounting for 84% of cases (5% of them were grade 3). A myometrial invasion superior or equal to 50% was observed in 40% of cases. 42% of cases were classified as stage IA, 14% in stage IB, 16% in stage II, 18% stage III and 10% in stage IV. 22% of patients had nodal involvement. Overall survival at 5 years was 81%. In multivariate analysis, stage IV, nodal involvement and brachytherapy have influenced this rate. Event-free survival at 5 years was 71%. It was directly related to stage and nodal involvement. Stage, histological type, tumor grade, invasion of more than half of the myometrium and lymph node involvement were the most important adverse prognostic factors, dictating an appropriate management of these tumors.

Objective : To assess the response rate of patients with rectal adenocarcinoma to neoadjuvant therapy and to identify the predictors of histological regression after neoadjuvant radiotherapy (RT) or concurrent chemoradiotherapy (CCRT). Methods : This study recruited 64 patients. The patients had resectable cancer of the lower and the middle rectum (T3/T4 and/or N+) without distant metastasis and received neoadjuvant RT or CCRT followed by radical surgery with total mesorectal excision (TME) between January 2006 and December 2011. The patients were classified into non-response (NR), partial response (PR), and pathologic complete response (pCR) based on the Dworak tumor regression grading system.Results : The median age of patients was 57 years (ranging from 22 to 85). A total of 24 patients were treated with neoadjuvant CCRT, whereas 40 patients were treated with RT alone. Abdominoperineal resection (APR) was performed on 29 patients (45%). Anterior resection with TME was performed on 34 patients (53%). One patient had local resection. Histologically, 12 (19%), 24 (73%), and 28 (44%) patients exhibited pCR, PR, and NR, respectively. Univariate analysis revealed that the predictors of tumor regression were as follows: the absence of lymph node involvement from initial imaging (cN0) (P=0.021); normal initial carcinoembryonic antigen (CEA) level (P=0.01); hemoglobin level ≥12 g/dl (P=0.009); CCRT (P=0.021); and tumor downstaging in imaging (P=0.001). Multivariate analysis showed that the main predictors of pCR were CT combined with neoadjuvant RT, cN0 stage, and tumor regression on imaging. Conclusions : Identifying the predictors of pCR following neoadjuvant therapy aids the selection of responsive patients for non-aggressive surgical treatment and possible surveillance.

Résumé Les lymphomes pulmonaires primitifs sont des tumeurs rares représentant moins de 1% des tumeurs malignes du poumon. La forme la plus fréquente est le lymphome de type Mucosa-Associated Lymphoid Tissue (MALT). L'atteinte oculaire est aussi rare et elle est dans la plupart du temps localisée dans les glandes lacrymales. Nous rapportons l'observation d'un patient ayant présenté un lymphome pulmonaire de type MALT associé à une atteinte synchrone des glandes lacrymales. Cette observation illustre les aspects cliniques, radiologiques et évolutifs de cette entité qui sont peu spécifiques.

Resume Objectifs Evaluer les donnees recentes de la litterature concernant les indications therapeutiques dans les cancers du rein localement avances et/ou metastatiques et analyser le benefice des therapies ciblees depuis leur adjonction dans l’arsenal de traitement. Methode Nous avons effectue une revue de la litterature en utilisant les mots-cles suivants, Renal Cell Carcinoma, Target Therapy, Surgery, Metastases, RECIST sur le moteur de recherche Pubmed pour rechercher des articles indexes entre les annees 1999 et 2014. Nous avons retenu les donnees des grandes etudes cliniques des differentes therapies ciblees dont nous avons fait la synthese et rapportons les recommandations actuelles d’utilisation pratique dans les cancers du rein a cellules claires (CRCC) localement avances et/ou metastatiques (LA/M). Resultats Les essais randomises recents de grande taille ont demontre l’efficacite des differentes therapies ciblees dans la prise en charge des CRCC en termes de survie sans progression. Conclusion L’unification et pratiquement « mondialisation » des protocoles doit beaucoup aux propositions therapeutiques, issues des resultats des differentes essais prospectifs et basees sur un niveau d’evidence eleve.

Endometrial cancer is the most prevalent genital tract cancer in occident and the third most common cancer among women in Tunisia. It is dominated by carcinoma. The identification of prognostic factors allows a better understanding of its outcome and guides its therapeutic approach. We propose to describe the clinicopathological features and identify the histoprognostic factors of this cancer. It is a retrospective analysis of a series of 62 total hysterectomy specimens with bilateral salpingo-oophorectomy from women with primary carcinoma of the endometrium, colligated in Anatomy Laboratory and Pathology Salah Azaiz Institute of Tunis over a period of 5 years, from January 2003 to December 2007. The median age was 60 years. At the time of diagnosis, 25% of patients were nulliparous and 86% were menopaused. The endometrioid adenocarcinoma was the most common, accounting for 84% of cases (5% of them were grade 3). A myometrial invasion superior or equal to 50% was observed in 40% of cases. 42% of cases were classified as stage IA, 14% in stage IB, 16% in stage II, 18% stage III and 10% in stage IV. 22% of patients had nodal involvement. Overall survival at 5 years was 81%. In multivariate analysis, stage IV, nodal involvement and brachytherapy have influenced this rate. Event-free survival at 5 years was 71%. It was directly related to stage and nodal involvement. Stage, histological type, tumor grade, invasion of more than half of the myometrium and lymph node involvement were the most important adverse prognostic factors, dictating an appropriate management of these tumors.

Background: Primary giant cell tumor (GCT) of soft tissue (GCTST) is an extremely rare slow-growing entity bearing a high similarity to conventional bone TCG (GCTB). The term, malignant tumor of giant cells of soft tissues have been reserved for histologically high-grade lesions. Although the gold standard remains surgical carcinological resection, bisphosphonates are beginning to prove their benefit in the treatment of GCTST. Results and Discussion: A 37-year-old man came to the outpatient department of medical oncology with a painful swelling arising from his right elbow. Magnetic resonance imaging (MRI) of the right elbow was done and revealed a 19 cm × 7 cm, T1 and T2 hypointense lesion with significant postcontrast enhancement of calcified tissue nodules, distance extension report was negative. An echo-guided biopsy of the right elbow was performed. The anatomopathological examination showed a poorly delimited encapsulated tumor proliferation composed of sheets of histiocytic cells admixed with multinucleated giant cells dispersed uniformly among this tumor. Cells were embedded in a richly vascularized tissue. No significant nuclear pleomorphism or mitotic activity was appreciated. There were focal areas of osseous metaplasia. On the basis of these date, the diagnosis of giant cell tumor of low malignant potential was retained. Due to its intra-articular extension, the mass was judged unresecable. The case was discussed in a multidisciplinary consultation meeting indicating medical treatment with zoledronic acid given the unavailability of denosumab. After 8 monthly injections of zoledronic acid, a control imaging of the right elbow and forearm concluded to tumor stability. Conclusion: GCTST is a slow-growing tumor known as soft tissue tumor. Numerous studies show the role of bisphosphonates when complete surgical excision cannot be performed. Further studies are needed to establish a standardized treatment protocol particularly in the context of inoperable large primary GCTST.

The small-cell carcinoma of hypercalcemic type (SCOCHT) of the ovary is a rare and highly aggressive tumor. Due to the rarity of the disease, there is no consensus on its optimal therapy, and the treatment options are usually combines surgery, chemotherapy, and radiotherapy. Herein, we report the clinical presentation, management, and outcome of three cases of SCCOHT treated at Salah Azaiez Institution in Tunisia. The literature on this rare disease is also reviewed.

Hematologic toxicity is a severe complication of chemotherapy. The objective of our study is to evaluate the impact of early lymphopenia on the risk of occurrence of febrile neutropenia and hematological toxicity after aggressive chemotherapy for Hodgkin lymphoma or high grade non-Hodgkin lymphoma.This prospective study involved 42 patients who received 193 cycles of chemotherapy in 2009. We assessed the impact of lymphopenia on day 1 and 8 on the risk of occurrence of febrile neutropenia. We also investigated the relation between the occurrence of hematologic toxicity after the first cycle and the subsequent cycles.Febrile neutropenia was observed in 25% of cycles. Grade 3/4 hematologic toxicity occurred in 63% of cycles. Growth factors were used in 79% of cycles. Lymphopenia ≤ 700/mm3 on day1 and 8 was noted in 21% and 65% of cycles. If the lymphocyte count was ≤700/mm3 on day1, the risk of febrile neutropenia was significantly higher (p=0.042) and the mean duration of antibiotic therapy longer (p = 0.013). Lymphopenia ≤700/mm3 on day 8 was associated with a greater risk of febrile neutropenia in univariate analysis (OR=2.4; p=0.02). Moreover analyzes showed that this factor was significantly associated with increase in hematologic toxicity (p=0.02), duration of neutropenia (p=0.001) and duration of antibiotics (p=0.05). Hematologic toxicity during the first cycle was predictive of its occurrence in subsequent cycles of chemotherapy (p=0.028).Our results confirmed the impact of early lymphopenia on the occurrence of febrile neutropenia and hematologic toxicity after aggressive chemotherapy for Hodgkin lymphoma or high grade non Hodgkin lymphoma.

To analyze the medical literature concerning the results of the international randomized muticentric trials concerning therapeutic innovations, mainly targeted therapies in locally advanced and or metastatic renal cell cancer and to evaluate the benefit of these TT.We performed a review of publications that concerned this topic published from 2000 to 2014.They concerned the large randomized trials have showed a benefit of the targeted therapies in the treatment of clear cell carcinomas in terms of progression-free survival.Advances in molecular biology have allowed the development of these targeted therapies that have all proved their role in the treatment of metastatic renal cell carcinoma.

Gallbladder cancer is the most common malignant tumor of the biliary tract. The majority of cases are adenocarcinoma (AC). Pure squamous cell carcinoma (SCC) of gallbladder accounts only 3% of the malignant neoplasm of this organ. Many patients are at advanced stage when diagnosed and have bad therapeutic efficacy. At present, radical surgery is the only chance to gain long-term survival for patients with early-stage gallbladder cancers. Recent reports have shown a benefit of adjuvant chemoradiation in this type of tumor. At present, no therapy is defined for unresectable cancer of the gallbladder, especially for SCC.