[Intracranial ependymomas: retrospective study of 16 cases]

PURPOSE

To report the epidemiological, clinical aspects and therapeutic results of intracranial ependymomas in Morocco.

PATIENTS AND METHODS

Our retrospective study concerned 16 cases of intracranial ependymomas, treated from January 1995 to December 2002 at the radiotherapy department of Ibn Rochd Hospital of Casablanca, Morocco.

RESULTS

The average age was 15 years and complete surgery was possible in two cases. All the patients received cranial radiotherapy, combined with chemotherapy in six cases. Overall survival and progression-free survival at 5 years were respectively 50% and 31%. Eleven patients had local recurrence after an average period of 21 months. Progression-free survival at 5 years was better if complete resection: 100% vs. 28.6% in cases of incomplete resection, and depending on the histological type with 50% for classic ependymomas and 16.6% for anaplastic.

CONCLUSION

Ependymomas are rare tumors and complete resection is the standard treatment followed by postoperative radiotherapy. The place of chemotherapy remains to be defined.

Cancer du sein: l’homme est aussi concerné. Étude de 21 cas

Introduction

Le cancer du sein, première pathologie maligne chez la femme, reste une maladie rare chez l’homme. Il représente environ 1 % des cancers du sein et moins de 1 % de l’ensemble des néoplasies masculines. L’objectif de cette étude est d’analyser les caractéristiques cliniques, histologiques et thérapeutiques du cancer du sein chez l’homme.

Patients et méthodes

Les auteurs présentent une étude descriptive menée de manière rétrospective au service de radiothérapie-oncologie du CHU Ibn-Rochd de Casablanca, entre janvier 2006 et décembre 2007, concernant une série de 21 patients de sexe masculin présentant un cancer du sein.

Résultats

L’âge médian était de 70 ans (extrêmes: 39–84). Le délai médian de consultation était de huit mois (extrêmes: 2–24). Il s’agissait, dans 16 cas, d’une tumeur rétroaréolaire dont la taille médiane était de 35 mm (extrêmes: 15–80). Les tumeurs étaient classées T2 dans 12 cas et T4 dans sept cas. Le type histologique le plus représenté était le carcinome canalaire infiltrant (CCI) [18 cas]. Le grade SBR II a été retrouvé dans 13 cas. Le taux d’envahissement ganglionnaire axillaire prouvé histologiquement était de 38 % (huit patients) et dans 14 % des cas plus de trois ganglions étaient envahis. L’effraction capsulaire n’a été retrouvée que dans quatre cas. Les récepteurs hormonaux étaient positifs dans 19 cas. La prise en charge thérapeutique a consisté en une chirurgie radicale dans 14 cas avec une chimiothérapie associée à une radiothérapie dans cinq cas, 66 % des patients ont reçu une hormonothérapie. Après un suivi moyen de 23 mois, trois malades ont développé des métastases et six malades sont encore vivants sans maladie.

Conclusion

Le cancer du sein chez l’homme est rare. Son diagnostic se fait souvent à un stade tardif. Son traitement est similaire à celui de la femme avec un retard diagnostique retentissant sur le pronostic.

Identification of G2607A mutation in EGFR gene with a significative rate in Moroccan patients with nasopharyngeal carcinoma

The epidermal growth factor receptor (EGFR) is involved in the regulation of several cellular processes and in the development of many human cancers. Somatic mutations of EGFR at tyrosine kinase domain have been associated with clinical response to tyrosine kinase inhibitors (TKIs) in lung cancer patients. In this study, we evaluated the frequency of point mutations in EGFR for future use of TKI in clinical treatment of nasopharyngeal carcinoma (NPC). Sixty Moroccan patient specimens of NPC were analysed for EGFR mutations in the region delimiting exons 18 and 21 by direct sequencing. Our results showed the absence of mutations in the EGFR kinase domain in these exons in all 60 analysed specimens. Sequence analysis of the EGFR—TK domain, revealed the presence of (G2607A) polymorphism at exon 20. The genotypes AA and GA were found respectively in 39 (65%) and 16 (26.6%) cases. Statistical analysis showed no difference between the polymorphism and either gender or age of patients. Mutations in EGFR kinase domain are rare events in NPC biopsies, suggesting, that treatment of NPC patients with TKI may not be effective. However, EGFR G2607A polymorphism at exon 20 is frequent in NPC cases and could be associated to clinical response to TKI therapy.

[A rare tumor of the infratemporal fossa]

INTRODUCTION

Giant cell tumors of bone (GCT) are usually benign and relatively rare. They have an aggressive behavior and an unpredictable prognosis. They occur mainly in the young adult, with a preferential localization in long bones. We report a giant cell infratemporal fossa tumor.

OBSERVATION

A 55-year-old female patient consulted for swelling in the right cheek. Surgical excision was incomplete because of the subtemporal tumor localization. Histological assessment proved a GCT. Forty-five grays postoperative external radiotherapy was applied to the surgical site. The patient had local control at the 12-month follow-up.

DISCUSSION

GCTs are seldom observed in the facial skeleton (2%). The recommended treatment is surgery. Radiotherapy can be indicated in case of incomplete or impossible surgical excision, or when surgery would be responsible for a major functional deficit.

[Ocular metastasis heralding gastric adenocarcinoma]

Ocular metastasis is a rare presenting feature of gastric adenocarcinoma. We report a 48-year-old woman who presented with a decrease in visual acuity of the right eye leading to the discovery of an ocular metastasis. Diagnostic work-up identified a gastric adenocarcinoma with pulmonary metastases. She received four cycles of chemotherapy combining epirubicin, cisplatin and fluorouracil. The patient died 6 months after the diagnosis of respiratory failure.

[Neuroendocrine carcinoma with large cells of the breast: case report and review of the literature]

Neuroendocrine carcinoma with large cells is a slightly different tumor from the high rank of malignity. We report a case of breast localization in a 28-year-old patient. It is a locally advanced classified T4dN1M0 tumor that required neoadjuvant chemotherapy. The clinical answer was 75% of the level of the tumor. A standard surgery mastectomy with axillary lymph node dissection was realized, followed by external radiotherapy. The anatomopathologic and the immuno-histochemical study of the operational part confirmed the diagnosis of neuroendocrine carcinoma with large cells expressing the progesterone receptor. The patient is subjected to adjuvant hormonal treatment. After a 12 months retreat, a complete remission is maintained. Considering the scarcity of neuroendocrine carcinoma with large cells of the breast, the therapeutic standard is not yet available and the forecast remains difficult to determine.

[Giant-cell bone tumors of the spine: report of two cases and literature review]

Giant cell tumours (GCT) are relatively rare neoplasms, most often benign. They are characterized by their local aggression. We report two observations of GCT, the spine in a 51-year-old woman and a 14-year-old boy. They were revealed by spinal pain and cord compression for the second observation. Computed tomography and magnetic resonance imaging showed osteolysis of the body and vertebral arch of L5 for the first and a process affecting the vertebral body and medullary canal of T6-T7 with spinal cord compression for the second case. The diagnosis was confirmed by histological examination in two cases. An external radiation at a dose of 45 Gy on L4, L5 and the sacrum was made in the first case and the dose of 40 Gy on the vertebrae of T4 to T9 and an additional 6 Gy on T5-T8 in the second case. The patients are alive without progress with five years and 18 months follow-up, respectively. Radiation could be proposed as a standard treatment for patients with incomplete excision or where surgery would induces functional deficits.

[Osteosarcoma of the skull base: a case report]

Osteosarcoma, usually observed in long bones, is the second most frequent primitive malignant bone tumor after myeloma. The skull base is an exceptional localization. We report a case of skull base osteosarcoma managed in our department. A 23-year-old female was admitted for bilateral epistaxis, headache, decreasing visual acuity then blindness. Physical examination revealed bilateral blindness and exophthalmia. Cranial magnetic resonance imaging showed a voluminous mass in the skull base extending to the nasosinusal area. A rhinoseptal surgical approach was used but the tumor was so huge that excision was impossible. The biopsy identified at an osteoblastic osteosarcoma. Search for extension (chest computed tomography and abdominal ultrasonography) was negative. Chemotherapy was to be delivered before combination chemoradiotherapy but the patient died before any treatment could be started. Osteosarcoma of the skull base is very rare. The treatment is based on surgery which should be as complete as possible followed by chemoradiotherapy. Prognosis is poor. Median survival is around six months.

[Small-cell carcinoma of the vulva]

Small-cell carcinoma is a rare and aggressive malignancy; this tumor is lethal due to the propensity to metastasize early in the course of the disease. It occurs most frequently in the lung. Small-cell cancer also rarely may occur in the female genital tract, usually in the cervix. This article concerns the fifth reported case of small-cell carcinoma of the vulva in a 34-year-old women who had developed a vulvar mass3 months earlier. The physical examination revealed bilateral inguinal lymph nodes. The mass was excised and the histological finding was a small-cell carcinoma. Postoperative search for metastasis included computed tomography scan of the abdomen, pelvis, chest and brain that showed right iliac lymph nodes. The osteo medullar biopsy was positive. The patient was treated with 6 cycles of chemotherapy including cisplatinum (80mg/m2 d1) and etoposide (100mg/m2 d1 d2 d3). Adjuvant radiotherapy (50Gy) was administered but the disease progressed and the patient died after 7 months. Small-cell carcinoma of the vulva is a very rare tumor. Similarly to small-cell cancers arising in other sites, it appears that regional therapy is not a sufficient treatment for this tumor. Chemotherapy should be used to improve outcome.