Om.breast cancer in very young women aged 25 year-old or below in the center of Tunisia and review of the literature

Breast cancer in very young women under 40 or 35 years attracted a widespread attention. Few studies have focused on women aged below 25 years. The aim of this study was to evaluate the situation of breast cancer in women ≤25 years in the center of Tunisia. Retrospective review from 1993 to 2013. Clinical, histopathological, therapeutic and outcome data were recorded. Cases were classified into different molecular subtypes based on the immunohistochemistry-based definitions. The series included 25 patients. The mean duration of symptoms was 7.5 months. The most common presenting symptom was a palpable mass. Four patients had at least one relative diagnosed with breast cancer. Mammography combined with ultrasound was suggestive of malignancy in 60 % of cases. Curative surgical treatment could be offered in 19 cases. The mean tumor size was 39 mm. Nodal metastases were detected in 9/18 cases. Twenty cases could be classified into: luminal A (5 cases), luminal B (6 cases), Her-2 (1 case), triple negative (6 cases) and unclassified (2 cases). Two women experienced locoregional recurrence and 6 had distant recurrence. Asynchronous contralateral breast cancer occurred in one case. The overall survival at 5 and 10 years was 85 and 75 % respectively. The survival was significantly lower in grade III tumors (p = 0.04) and triple negative tumors (p = 0.03). Breast cancer in women ≤25 years is uncommon. An adequate medical education of young women and physicians is necessary.

Reproductibilité des classifications OMS 1973 et OMS 2004 des tumeurs urothéliales papillaires de la vessie

Objectif : Déterminer les taux d’accord et la reproductibilité intra et inter-observateurs des classifications OMS 1973 et OMS 2004 des tumeurs urothéliales papillaires de la vessie.Matériel et méthodes : Cent deux cas de tumeurs urothéliales papillaires de stade pTa/pT1 ont été étudiés. Deux pathologistes ont revu les lames et ont établi le grade tumoral selon les deux classifications OMS 1973 et OMS 2004. En cas de désaccord, les deux évaluateurs ont procédé à une lecture commune au microscope en double tête afin d’aboutir à un grade consensuel selon les deux classifications. La variabilité intra-observateur a été étudiée chez l’un des deux évaluateurs qui a procédé à la relecture des lames un mois après sa première lecture. Les taux d’accord entre les deux pathologistes pour chaque catégorie de grade ont été déterminés et la reproductibilité des deux classifications a été évaluée à l’aide du coefficient kappa. Une valeur de 0 à 0,2 était interprétée comme un désaccord absolu, de 0,21 à 0,4, un accord faible, de 0,41 à 0,6, un accord modéré, de 0,61 à 0,8, un accord considérable, et de 0,8 à 1, un accord absolu.Résultats : Selon la classification OMS 1973, les proportions desgrades G1, G2 et G3 étaient respectivement de 40,2 %, 50 % et 9,8 %. Selon la classification OMS 2004, les proportions respectives des tumeurs de faible potentiel de malignité, des carcinomes de bas grade et des carcinomes de haut grade de malignité étaientde 23,5 %, 60,8 % et 15,7 %. La reproductibilité intra-observateur était excellente pour les deux classifications (accord absolu). Les taux d’accord entre les deux pathologistes étaient meilleurs pour la classification OMS 2004 (kappa = 0,7) que pour la classification OMS 1973 (kappa = 0,51).Conclusions : La reproductibilité entre observateurs de la classification OMS 2004 est supérieure à celle de 1973. La reproductibilité intra-observateur est excellente pour les deux classifications.

Reproductibilité des classifications OMS 1973 et OMS 2004 des tumeurs urothéliales papillaires de la vessie

RéSUMé: OBJECTIF : Déterminer les taux d'accord et la reproductibilité intra et inter-observateurs des classifications OMS 1973 et OMS 2004 des tumeurs urothéliales papillaires de la vessie. MATéRIEL ET MéTHODES : Cent deux cas de tumeurs urothéliales papillaires de stade pTa/pT1 ont été étudiés. Deux pathologistes ont revu les lames et ont établi le grade tumoral selon les deux classifications OMS 1973 et OMS 2004. En cas de désaccord, les deux évaluateurs ont procédé à une lecture commune au microscope en double tête afin d'aboutir à un grade consensuel selon les deux classifications. La variabilité intra-observateur a été étudiée chez l'un des deux évaluateurs qui a procédé à la relecture des lames un mois après sa première lecture. Les taux d'accord entre les deux pathologistes pour chaque catégorie de grade ont été déterminés et la reproductibilité des deux classifications a été évaluée à l'aide du coefficient kappa. Une valeur de 0 à 0,2 était interprétée comme un désaccord absolu, de 0,21 à 0,4, un accord faible, de 0,41 à 0,6, un accord modéré, de 0,61 à 0,8, un accord considérable, et de 0,8 à 1, un accord absolu. RéSULTATS : Selon la classification OMS 1973, les proportions des grades G1, G2 et G3 étaient respectivement de 40,2 %, 50 % et 9,8 %. Selon la classification OMS 2004, les proportions respectives des tumeurs de faible potentiel de malignité, des carcinomes de bas grade et des carcinomes de haut grade de malignité étaient de 23,5 %, 60,8 % et 15,7 %. La reproductibilité intra-observateur était excellente pour les deux classifications (accord absolu). Les taux d'accord entre les deux pathologistes étaient meilleurs pour la classification OMS 2004 (kappa = 0,7) que pour la classification OMS 1973 (kappa = 0,51).

CONCLUSIONS

La reproductibilité entre observateurs de la classification OMS 2004 est supérieure à celle de 1973. La reproductibilité intra-observateur est excellente pour les deux classifications.

Breast cancer in Tunisia: clinical and pathological findings

INTRODUCTION

The aim of this study was to survey the clinical and pathological features of breast cancer in the Center of Tunisia.

DESIGN

Characteristics of all breast cancer cases diagnosed in the Pathology Department, Farhet Hached Hospital, Sousse, Tunisia during a 15-year period (1993-2007) were analyzed.

RESULTS

A total of 2,404 new cases of breast cancer were recorded, only 48 being diagnosed in men. The age-standardized incidence rate was 0.7 and 29.2 per 100,000 in men and women, respectively, with median ages of 48.0 and 64.5 years. Invasive ductal carcinoma was the most common (2,012 cases). Stage II was the most frequent (47.7%) followed by advanced stages (Stage III and IV, 41%).

CONCLUSION

Cancer of the breast remains the most common cancer in the absence of specific screening measures among Tunisian women. Our study justifies the need to plan and develop effective programs aiming at the control and prevention of the spread of breast cancer in Tunisia.

Lung cancer in central Tunisia: epidemiology and clinicopathological features

Lung cancer is the most common cancer worldwide but data from Tunisia are limited. The aim of this research was to describe the epidemiology, pathology and clinical features of lung cancer in Central Tunisia. All lung cancer cases diagnosed during a 15-year period were analyzed based on the data of the Cancer Registry of the Center of Tunisia. Five-year age-specific rates, world age-standardized rates (ASR), and annual percent change were calculated using annual data on population size and the estimated age structure. A total of 1,882 incident cases of lung cancer were registered (1,782 males, 100 females). The median age at diagnosis was 64 years for males and 61 years for females, with ASRs of 35.2 per 100,000 among males and 1.5 among females. Over time, there were significant decreasing trends by -6.5% (95% CI: -12.9%; -0.2%) for females and a stable incidence for males at an annual rate of +0.2% (95% CI: -1.6%; +1.8%). The predominant histological type was squamous cell carcinoma in males (36.9%) and adenocarcinoma in females (52%). During 2003-2007, adenocarcinoma became the most frequent (33.7%) followed by squamous cell carcinoma (30.3%) in males. The majority of tumor cases were diagnosed at advanced stages (79.9%). In conclusion, lung cancer has remained the most common cancer diagnosed at advanced stages among Tunisian men. Our findings justify the need to plan and develop effective programs aiming at the control and prevention of the spread of lung cancer in Tunisia.

Cancer of corpus uteri in Tunisia: epidemiological and clinicopathological features

INTRODUCTION

The aim of this study was to survey for the first time the burden and characteristics of corpus uteri cancers in Central Tunisia.

DESIGN

Characteristics of all cancer cases diagnosed during a 15-year period were analyzed based on the data of the Cancer Registry of the Center of Tunisia. Five-year age-specific rates, crude incidence rates, world age-standardized rates (ASR), and annual percent change (APC) were calculated using annual data on population size and its estimated age structure.

RESULTS

A total of 218 new cases of corpus uteri cancer were recorded. The ASR was 3.1 per 100,000 with a significant increase over time (APC: +7.1%; 95% CI: 3.1%, 11.1%). The median age at diagnosis was 60 years and only 20.6% of patients were less than 50 years old. The tumor size was higher than 2 cm in 83.5% of cases. Stage I was the most frequent (59.9%) followed by advanced stages (23.2%). Endometrial adenocarcinoma was the most frequent histological type (62.8%) with grade II accounting for 48.5% of cases.

CONCLUSION

Corpus uteri cancer is an important female cancer with increasing trend over time. These findings justify the need to plan and develop effective programs aiming at the control of the spread of cancer in Tunisia.

Childhood cancer frequency in the center of Tunisia

OBJECTIVE

In this paper, we analyzed the frequency of childhood cancer in the Center of Tunisia during 1993-2006.

DESIGN

The different types of cancer were grouped according to the International Classification for Cancer in Children. The general and specific frequencies by age and by sex were analyzed.

RESULTS

A total of 727 new cases of childhood cancer were registered, with a male to-female sex ratio of 1.7/1. Leukemias had the highest frequency (27%) and, of these, lymphoid leukemias were the most prevalent (73.5%). Thereafter, in descending order of frequency, were lymphomas (25.7%), tumors of the central nervous system (CNS, 9.2%), neuroblastomas (7.7%), sarcomas (6.9%), carcinomas (6.3%), bone tumors (5.8%), nephroblastomas (5.5%), and germinal cell tumors (2.6%). The highest frequency of cancer was found at age 10-14 years (34.9%). Leukemias were the most frequent in age groups 1-4 and 5-9 years, whereas, neuroblastomas and lymphomas were the most frequent at age under one year and 10-14 years, respectively. Of those cases of solid tumors, 55.8% were diagnosed as having advanced stages of the disease.

CONCLUSION

Leukemias, lymphomas, and CNS tumors were the principal cancers in the Center of Tunisia. A childhood cancer registry with high-resolution data collection is advocated for in-depth analysis of pediatric malignancies.

Distribution of molecular breast cancer subtypes among Tunisian women and correlation with histopathological parameters: a study of 194 patients

According to the immunohistochemical test of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (Her-2), breast cancer can be divided into 4 molecular subtypes: luminal A, luminal B, Her-2, and basal-like. The purpose of this study is to correlate these subtypes with clinicopathological features. We have selected from the files of our Pathology Department 194 breast carcinomas which had already been studied for ER, PR, and Her-2, diagnosed between January 2008 and October 2009. The cases were classified into 4 molecular subtypes. The clinicopathological characteristics of each subtype were compared. The luminal A subtype was the most prevalent (51.5%). The basal-like and Her-2 subtypes were significantly correlated to a large tumor size, a high tumor grade, and a high-volume nodal involvement (≥4). On multivariate analysis, patients with the Her-2 and basal-like subtypes were 4.2 (95% CI, 1.3-13.5) times more likely to have developed metastases in four or more lymph nodes than those with luminal tumors. Our analysis revealed that the Her-2 and basal-like subtypes are correlated with factors associated with a poor prognosis. The luminal A subtype is the commonest subtype, showing that breast cancer in Tunisia has no aggressive phenotype.

Pure Small Cell Carcinoma of the Bladder: A Case Report

Small cell carcinoma of the urinary bladder is an uncommon tumor that has been described in case reports or small series. We report a new case in a 67-year-old male who presented with gross hematuria and irritative symptoms. Cystoscopy revealed an extensive mass of the bladder and computed tomography scan showed an important thickening of the bladder wall. Diagnosis of small cell carcinoma was established after radical cystectomy and microscopic examination. The patient received pelvic hemostatic radiotherapy and platinium-based chemotherapy. Three months after the diagnosis, he developed bone, renal and adrenal metastases.

Phyllodes Tumors of the Breast: A Review of 26 Cases

Background

Phyllodes tumors of the breast are rare and locally aggressive neoplasms. Our study aimed to report the experience of the Farhat Hached Hospital (Sousse, Tunisia) acquired during a 7-year period and to give an additional review of the available literature.

Methods

The authors analyzed retrospectively clinical, radiological, histopathological and therapeutic features as well as outcome in a series of 26 cases diagnosed as phyllodes tumors of the breast at the Pathology Department of Farhat Hached Hospital, Sousse, Tunisia, from 2003 to 2009. The slides were reviewed in order to classify the tumors into benign, borderline and malignant on the basis of the criteria proposed by the World Health Organization.

Results

All the cases occurred in women. The analysis of this series showed the following characteristics: mean age at diagnosis was 40 years (19 - 66), tumor size was 1.5 - 40 cm (mean: 7.8 cm); the chief complaint was a mammary mass; the right breast was affected in 14 cases, the upper outer quadrant was the most commonly involved site (42.3%); surgical treatment was used in all cases, 21 patients (80.8%) were treated conservatively (13 benign, 6 borderline, and 2 malignant) and 5 (19.2%) by radical surgery (1 borderline and 4 malignant); seven patients underwent post-operative radiotherapy; in 14/19 cases (73.7%), a good correlation was observed between intraoperative frozen section analysis and definitive histology; the tumor was classed as benign in 13 cases (50%), borderline in 7 cases (27%) and malignant in 6 cases (23%); follow-up data was available in 22 cases; the rate of recurrence was 23% (1 benign, 3 borderline, and 2 malignant) after a mean follow-up of 13.6 months; all the recurrent tumors were initially treated by lumpectomy and were close to margin at the initial pathologic examination; the treatment of recurrences consisted of simple mastectomy in 5 cases, and local excision in one case; three patients developed metastases, one of whom after recurrence; three patients have died.

Conclusions

This is a substantial single institution experience of a rare tumor. Phyllodes tumors of the breast have an unpredictable outcome, thus a wide local excision, with an adequate margin of normal breast tissue, is the preferred initial therapy.

Lymphoepithelial Carcinoma of the Nasal Cavity With EBV Infection in a North African Man

We report the case of a 58-year-old Tunisian man who presented with a 2 months' history of left nasal obstruction and one episode of epistaxis. Nasal endoscopy revealed a polypoid mass of the left nasal septum. Magnetic resonance imaging showed a left nasal cavity tumor with erosion of the orbit. Diagnosis of nasal cavity lymphoepithelial carcinoma EBV positive was performed on biopsy. The patient was treated by chemotherapy and radiotherapy. No tumor recurrence has been reported with a follow-up of 12 months.

Mucinous carcinoma with axillary lymph node metastasis in a male breast: A case report

CONTEXT

Pure mucinous carcinoma of the male breast is an extremely rare neoplasm. It is characterized by a lower incidence of metastatic nodal involvement and a higher survival rate than invasive ductal carcinomas.

CASE REPORT

We report the case of a 75-year-old male who presented with a retroareolar mass of the right breast. The patient underwent radical mastectomy including right axillary lymph node dissection. The tumor was well demarcated and had a friable consistency with a gelatinous appearance. Histologically, the diagnostic of pure mucinous carcinoma with lymph node metastasis was performed. After surgery, the patient received chemotherapy, radiotherapy, and hormonotherapy (Tamoxifen). The patient remained free of disease for 36 months after surgery.

CONCLUSION

Pure mucinous carcinoma of the male breast is a very rare tumor; in which axillary nodal disease is exceptional.

Synchronous Bilateral Benign Phyllodes Tumor of the Breast in a 32-year-old Woman

Bilateral phyllodes tumors are distinctly uncommon. As some previous reports have described, most of them are malignant and asynchronous. We report a new case of bilateral synchronous phyllodes tumor in a 32-year-old women. Both tumors were classified as benign after large bilateral excision. No tumor recurrence was noted during the 10 months follow-up.

In Situ and Invasive Ductal Carcinoma Within a Borderline Phyllodes Tumor

A rare case of a borderline phyllodes tumor with simultaneous intraductal and infiltrating duct carcinoma is reported. The patient was a 52-year-old woman with a breast tumor detected by physical examination. A simple mastectomy was performed. The excised tumor had a macroscopic appearance of a phyllodes tumor. After histological examination, the diagnosis of ductal carcinoma within a borderline phyllodes tumor was made. Immunohistochemical staining revealed that the epithelial component was positive for Epithelial Membrane Antigen and cytokeratin. No metastasis was detected in the axillary lymph nodes and the patient didn't receive any adjuvant therapy. No recurrence or metastasis has been observed 38 months after the surgery.

Synovial Sarcoma: A Clinicopathological and Radiological Study of 12 Cases Seen Over 18 Years

Background

Synovial sarcoma is a rare malignant soft tissue tumor characterized by a poor outcome. We report herein our experience concerning synovial sarcoma and review its diagnosis, histology, treatment and prognosis.

Methods

This is a retrospective review, from 1990 to 2007, of cases of synovial sarcoma diagnosed at the Department of Pathology, Farhat Hached hospital, Sousse, Tunisia. The clinical, radiological and pathological features as well as treatment modalities and patient's outcome were recorded.

Results

From 1990 to 2007, 12 cases of synovial sarcoma have been diagnosed in our department. Patients' mean age at the time of diagnosis was 21 years. There was no sex predominance and the lower extremity was the most commonly involved. A painful tumefaction was the most common presenting symptom. The duration of symptoms ranged from 6 months to 6 years. Malignancy was suspected on radiological findings in only 2 cases. Ten patients underwent surgery, in association with adjuvant chemotherapy in 4 cases, one of whom underwent post-operative radiotherapy. Histological subtypes included monophasic synovial sarcoma in 8 cases, biphasic synovial sarcoma in 3 cases and poorly differentiated synovial sarcoma in one case. At the time of analysis, 6 patients were dead with an average follow-up of 18 months.

Conclusions

Synovial sarcoma is a rare malignancy with a propensity for young adults and a poor prognosis. Its symptomatology is non-specific and it is characterized by histopathological diversity. Diagnosis can be suggested by radiology and definitive diagnosis is achieved after pathological analysis.

Lymphoepithelioma - like carcinoma of the bladder in a North African man: A case report

CONTEXT

Lymphoepithelioma - like carcinoma of the bladder is an extremely rare tumour. We discuss through a new case and a review of the literature the pathological pattern and the management of this uncommon entity.

CASE REPORT

We report the case of a 58 year-old man who presented with a macroscopic hematuria. Transurethral bladder resection was consistent with the diagnostic of a poorly differentiated carcinoma infiltrating the bladder's muscle. A radical cysto-prostatectomy was performed. The pathological examination revealed an EBV negative lymphoepithelioma-like carcinoma of the bladder.

CONCLUSION

Lymphoepithelioma-like carcinoma of the bladder is a rare bladder cancer that is important to recognize since it has a favourable prognosis.

Clear cell adenocarcinoma of a female urethra: A case report and review of the literature

CONTEXT

Clear cell adenocarcinoma of the urethra is an extremely rare tumour. Its histogenetic derivation remains controversial.

CASE REPORT

We report a new case of clear cell adenocarcinoma of the proximal urethra in a 56-year-old woman who presented with grossly hematuria. Urethral cystoscopy revealed a tumour protruding from the posterior urethral wall at the bladder neck. Treatment consisted of urethrocystectomy with pelvic lymph node dissection. Histologically, the neoplasm consisted of clear cell adenocarcinoma of the urethra.

CONCLUSION

It appears that female urethral adenocarcinoma has more than one tissue of origin.

Gastrointestinal stromal tumor of the pancreas: A case report and review of the literature

CONTEXT

Primary stromal tumors of the pancreas are extremely rare. Only four cases have been reported in the literature. We describe a new case and analyze, through a review of the literature, the clinical and pathological data, and the outcome of the previously reported cases.

CASE REPORT

We report the case of a 52-year-old-woman who presented with epigastric pain. Preoperatively, abdominal pelvic computed tomography revealed a pancreatic head mass. The surgery confirmed the presence of a large tumor of the pancreatic head. Pathologic results revealed a malignant gastrointestinal stromal tumor of the pancreatic head, completely removed. There is no recurrence or metastases 10 months after surgery.

CONCLUSION

The current case consolidates the possibility that this rare tumor can involve the pancreas as a primary site and that GIST of primary pancreatic localization are usually of high risk of malignancy.

Solitary fibrous tumor with giant multinucleated cells in the retroperitoneum - a case report

CONTEXT

Solitary fibrous tumor is a distinct neoplasm, rarely recognized in extrathoracic sites.

CASE REPORT

The article reports a new case in the retroperitoneum in a 55 year-old man, who presented with urinary symptoms. Tumor was completely excised, and the solitary fibrous tumor was diagnosed after pathologic examination and immunohistochemistry. The patient has remained free of disease for five years since surgery.

CONCLUSION

An uncommon variant of retroperitoneal solitary fibrous tumor with giant multinucleated cells was documented in the study.

Primary lymphoepithelial carcinoma of the parotid gland in a North African woman

Lymphoepithelial carcinoma of the salivary glands is a rare neoplasm that is characterized by a non-neoplastic lymphocytic infiltration associated with an epithelial proliferation. It involves mainly the parotid gland. Racial and geographical factors contribute to the pathogenesis of this tumor. We report a case of a 70-year old woman from a non-endemic area who presented with several months history of swelling in the parotid region. Magnetic resonance imaging showed a parotid mass suggestive of a pleomorphic adenoma. The diagnosis of lymphoepithelial carcinoma of the parotid gland was performed on the surgical specimen. A primitive nasopharyngeal carcinoma was ruled out by random biopsies of the nasopharynx mucosa. The Epstein-Barr virus (EBV) was absent in neoplastic cells. We insist that, even in non-endemic areas and when clinical and radiological characteristics are not suggestive of malignancy, intra-operative frozen section analysis should be used in order to ensure the appropriate treatment.