An isolated vaginal metastasis from rectal cancer: a case report.

INTRODUCTION: Vaginal metastasis from colorectal cancer is a rare occurrence, typically associated with other metastatic lesions. Isolated metastasis is exceedingly uncommon, with only a few cases documented in the literature. Vaginal involvement in colorectal cancer primarily results from direct contiguous spread from the primary tumor. CASE PRESENTATION: We present the case of a 70-year-old African woman diagnosed with adenocarcinoma of the middle rectum. She underwent chemotherapy, radiotherapy, and subsequent anterior resection. After 2 months, an isolated metastasis of rectal cancer was identified in the lower third of the left vaginal wall, confirmed by biopsy. Colonoscopy ruled out colorectal recurrence. Thoraco-abdominal computed tomography scan showed no distant metastases. The patient underwent abdominoperineal resection, removing the lateral and posterior vaginal wall with free macroscopic margins and a definitive colostomy. The final histopathological analysis confirmed the diagnosis of moderately differentiated adenocarcinoma of the vagina, measuring 5 × 4.5 cm. The rectal wall was extrinsically invaded by the tumor down to the muscularis propria while respecting the rectal mucosa. Resection margins were negative. The patient was discharged 1 week postoperation with no complications. Adjuvant chemotherapy was indicated, and the patient is currently tolerating the treatment well. CONCLUSION: Vaginal metastases from colorectal cancer are extremely rare. A vigilant gynecological examination is recommended during the follow-up of colorectal cancer patients. Diagnosis can be challenging, especially if the metastatic lesion is small and asymptomatic, even after standard radiological examination. Surgical resection followed by chemotherapy is a valid option for patients with early isolated metastases.

The perception of burnout and related influencing factors in Tunisian oncology nurses.

BACKGROUND: Oncology nurses constantly provide emotional support to patients and are confronted with their suffering, which represents chronic stress leading to the development of burnout syndrome. AIM: This study aimed to evaluate the prevalence of burnout and identify associated factors in a sample of oncology nurses. METHODS: We conducted a descriptive cross-sectional study with 70 oncology nurses at the Salah Azaiez Institute of Oncology in Tunisia. Burnout was assessed using the Maslach Burnout Inventory Human Service Survey. This study follows the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) Guidelines. RESULTS: Burnout affected 60 nurses (85.7%), with a high level in 20% of cases. High scores of emotional exhaustion, depersonalisation, and low personal accomplishment were recorded in 65.7%, 50% and 25.7% respectively. Emotional exhaustion was associated with higher age, marital status, having 2 or 3 or more dependent children, number of patients under care exceeding 15, professional experience and history of psychiatric problems. Depersonalisation was correlated with age, marital status, professional grade and history of psychiatric problems. Low levels of personal accomplishment increased with the number of patients under care, history of psychiatric problems and the regret of professional choice. CONCLUSION: Burn-out is a reality in oncology hospital with an alarming rate. Interventions including rationalisation of workload, support groups, training in emotion and stress management would improve the mental health of these nurses and increase their performance. The screening for burnout should be included as a regular practice in health promotion programmes for oncology health professionals, particularly for a vulnerable subgroup that possesses the risk mentioned above factors.

Primary thyroid lymphoma: a case series.

INTRODUCTION: Primary Thyroid Lymphoma (PTL) is defined as lymphoma involving the thyroid gland alone or the thyroid gland and adjacent neck lymph nodes without contiguous spread or distant metastases at the time of diagnosis. Most thyroid lymphomas are B cell lymphomas, and 98% of all PTL cases are non-Hodgkin's lymphoma. It is a rare disease accounting for around 5% of the thyroid neoplasms and 2% of extranodal lymphomas. If properly diagnosed and treated, the prognosis is favorable. CASE PRESENTATION: Five cases (three men and two women) of PTL were diagnosed and treated in our institute between January 2005 and September 2019. These are 5 cases of Caucasian origin. The mean age was 76.2 (range: 63-95 years); one patient had associated hypothyroid. One patient had a medical history of breast cancer; one was hypothyroid, and four were euthyroid at the diagnosis. In 4 of these patients, PTL started with compressive symptoms. No patients underwent fine needle aspiration cytology (FNAC) or biopsy for the diagnostic only. In sonography, two cases showed bilateral nodules with goiter; in the three cases it showed nodules in the lobe and isthmus. Technetium-99m scintigraphy was performed on only two patients. Bone Marrow Biopsy (BMB) showed normal cellularity in 4 cases and only one case showed tumor cells. LDH levels were increased in all cases. The extension was evaluated in all patients with cervical and thoracic CT scans, Bone Marrow Biopsy (BMB), beta-2 microglobulin, and serum lactate dehydrogenase (LDH) levels. Three cases were staged as IE and two cases as IIE. Three patients underwent total thyroidectomy; two of them underwent cervical lymph node dissection. Two patients underwent lobectomy. All were diagnosed with lymphoma postoperatively and all were diffuse large B cell lymphoma (DLBCL). One patient completed treatment with R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone), and two cases received adjuvant chemo-radiotherapy (30 Gy). Two patients died immediately after surgery. CONCLUSION: PTL is a rare disease whose diagnosis should be considered in cases of rapidly growing goitres. Timely needle biopsy in suspected cases can avoid unnecessary surgery. Systemic treatment is required, depending on the stage of the tumour.

De novo male breast metastases from nasopharyngeal carcinoma: a case report.

BACKGROUND: Nasopharyngeal carcinoma is known for its high potential for regional and distant metastasis. However, breast metastasis is rarely reported. CASE PRESENTATION: A 39-year-old Caucasian male presented with bilateral neck lymph node enlargement. Radiological examination with contrast-enhanced computed tomography scan and breast imaging revealed an enhancing mass lesion in the right breast. Histopathology of the nasopharynx mass was suggestive of undifferentiated nasopharyngeal carcinoma. A breast biopsy confirmed the diagnosis of synchronous breast metastasis from the nasopharyngeal carcinoma. We present this study to illustrate that Nasopharyngeal carcinoma can metastasize to the male breast. Furthermore, the high incidence of nasopharyngeal carcinoma metastasis underscores the pressing need to identify effective and safe strategies, emphasizing the importance of utilizing computed tomography scans for metastasis detection. CONCLUSION: The present study illustrates the first case of synchronous male breast metastases from nasopharyngeal carcinoma. Thus, it is critical to distinguish between metastatic pathology and coexisting second malignancies to plan appropriate therapy.

Pseudo tumor pelvic actinomycosis revealed by colonic obstruction with hydronephrosis: Can extensive surgery be avoided? A case report.

Pelvic actinomycosis with an intrauterine device accounts for approximately 3% of all actinomycoses. It is a chronic infectious disease characterized by infiltrative, suppurative, or granulomatous inflammation, sinus fistula formation, and extensive fibrosis, and caused by filamentous, gram-positive, anaerobic bacteria called Actinomyces israelii. The slow and silent progression favors pseudo tumor pelvic extension and exposes the patient to acute life-threatening complications, namely colonic occlusion with hydronephrosis. Preoperative diagnosis is often difficult due to the absence of specific symptomatology and pathognomonic radiological signs simulating pelvic cancer. We discuss the case of a 67-year-old woman who complained of pelvic pain, constipation, and weight loss for 4 months, and who presented to the emergency department with a picture of colonic obstruction and a biological inflammatory syndrome. The computed tomography scan revealed a suspicious heterogeneous pelvic mass infiltrating the uterus with an intrauterine device, the sigmoid with extensive upstream colonic distension, and right hydronephrosis. The patient underwent emergency surgery with segmental colonic resection and temporary colostomy, followed by antibiotic therapy. The favorable clinical and radiological evolution under prolonged antibiotic therapy with the almost total disappearance of the pelvic pseudo tumor infiltration confirms the diagnosis of pelvic actinomycosis and thus makes it possible to avoid an extensive and mutilating surgery with important morbidity.

Cutaneous metastasis as a first presentation of lung carcinoma: a case series.

INTRODUCTION: Cutaneous metastases (CM) revealing lung carcinoma are extremely rare, accounting for 0.8%. The diagnosis is guided by histology and immunohistochemistry. Treatment is palliative. The prognosis is poor. CASE PRESENTATION: This is a retrospective study of the available clinical and histological records of four North African patients with CM revealing lung cancer treated at our institute between 2004 and 2010. Three men and one woman were registered. The mean age was 54.5 years (38-74 years). Two patients had primary adenocarcinoma, one patient had small cell carcinoma and one had squamous cell carcinoma. Treatment was based on chemotherapy in two cases and antalgic radiotherapy in two cases, one patient underwent surgical resection as the lesion was infected. The overall survival after diagnosis was between one and four months. CONCLUSIONS: A skin nodule can be the first symptom revealing lung cancer. A rare clinical presentation that should not be taken for a benign nodule, the biopsy and histological study with immunohistochemistry confirm the diagnosis.

Amino acids and protein profiles of defatted camel and cow milk fractions: correlation with their in vitro antioxidant and antidiabetic activities.

Introduction: This work presents proteins, amino acids profiles and antioxidant and properties of camel and cow milk fractions produced using an integrated coagulation-centrifugation process. Methods: Antioxidant activity using DPPH radical scavenging assay; and antidiabetic activity antidiabetic activity using in vitro α-amylase inhibitory activity were assessed on defatted milk fractions and their extracts using water/ethanol or HCl/ethanol solvents. Protein profiles and amino acids composition were analyzed by high-performance liquid chromatography. Results and discussions: The predominant protein found in cow and camel milk was ß-casein in sodium caseinate, ß-lactoglobulin was found in the whey of cow milk, whereas α-lactalbumin was detected in the whey fractions of camel. The primary amino acids (comprising 1% to 5.2%) in skim milk and sweet whey milk were leucine, proline, and lysine. However, acid whey, casein fractions (sodium caseinate, and ß-casein) from both camel and cow milk exhibited elevated concentrations of histidine, leucine, lysine and proline (1.12 - 6.62%). Camel milk and its different protein fractions showed an interesting in vitro α-amylase inhibitory activity varying, according to different milk fractions and extraction methods, from 19.10 ± 1.40 to 97.40 ± 1.50%. Whatever the used method, the whey fractions from camel milk, both acid and sweet, displayed ed the highest antioxidant activity. Principal components analysis showed a positive correlation between the total phenols content, antioxidant (DPPH assay) and antidiabetic (α amylase inhibition test) activities within the milk fractions. Sweet and acid cow milk fractions seem to be the most promising for deeper exploration of in vivo biological activities and are promising milk derivatives for specific nutritional diet and/or functional food formulation.

Camel α-lactalbumin at the oil-water interface: Effect of protein concentration and pH change on surface characteristics and emulsifying properties.

Camel α-lactalbumin (Ala-C), the main whey protein of camel milk, was purified by membrane filtration. Surface hydrophobicity as well as interfacial tension were examined at different levels of pH (3.0, 6.0, 9.0) and protein concentration (0.1 %, 0.2 %, 0.4 % w/w), and compared to bovine α-lactalbumin (Ala-B). The emulsifying properties (EAI and ESI) of oil-in-water emulsions (20 %/80 %) were investigated for both proteins. The stability of the processed emulsions was characterised by ζ-potential, particle size and viscosity measurements. The main findings indicate that Ala-C exhibited greater surface hydrophobicity and undergone changes in conformational structure when pH decreased from 9.0-3.0. These changes were enhanced by increasing protein concentration from 0.1 % to 0.4 % (w/w). However, high concentrations showed low emulsifying activity, especially at pH 6.0 where interfacial tension was lower. In comparison with Ala-B, maximum EAI was close, despite the lower surface hydrophobicity of Ala-C under similar conditions. Overall, emulsions were more viscous at pH 3.0 due to the greater surface coverage than at 9.0 and 6.0. Under the conditions of this study, a protein concentration of 0.2 % resulted in the finest oil droplets and highest viscosity for both types of α-lactalbumin, and Ala-C conferred the highest long-term stability to the emulsions.

A Single Liver Metastasis From Adenoid Cystic Carcinoma of the Parotid Gland: Case Report.

Adenoid cystic carcinoma is an uncommon malignant neoplasm of the salivary gland. Liver metastasis from salivary gland cancer is a rare situation. In this article, we report the case of a 29-year-old woman treated 5 years previously for adenoid cystic carcinoma of the parotid gland by surgery and radiotherapy, who presented for a large hypervascularized hepatic metastasis of 20 cm. After 3-cycle chemotherapy stability, hepatic surgery was successfully performed. The patient maintained disease-free period of 12 months after the surgical treatment. This rare case represents a therapeutic challenge for oncologists and surgeons. Through this case and a review of the literature, we try to better detail the management of this uncommon entity.

Kinetic improvement of olive leaves' bioactive compounds extraction by using power ultrasound in a wide temperature range.

In this study, the effect of temperature and ultrasonic application on extraction kinetics of polyphenols from dried olive leaf was investigated. Conventional (CVE) and ultrasonic-assisted extraction (UAE) were performed at 10, 20, 30, 50 and 70°C using water as solvent. Extracts were characterized by measuring the total phenolic content, the antioxidant capacity and the oleuropein content (HPLC-DAD/MS-MS). Moreover, Naik's model was used to mathematically describe the extraction kinetics. The experimental results showed that phenolic extraction was faster in UAE (ultrasonic-assisted extraction) than in CVE (conventional extraction), being extraction kinetics satisfactorily described using Naik model (include VAR>98%). Besides, the total phenolic content, the antioxidant capacity and the oleuropein content were significantly (p<0.05) improved by increasing the temperature in both CVE and UAE. Oleuropein content reached 6.57±0.18 being extracted approximately 88% in the first minute for UAE experiments.

Clinicopathological characteristics of synchronous bilateral breast carcinomas. Report of 30 patients.

AIM: The objective of this study is to determine the clinicopathologic characteristics; incidence and prognosis value of synchronous bilateral breast carcinoma (SBBC). METHODS: This is a retrospective study done in Salah Azaiz Institute of Tunis about 30 patients with synchronous bilateral breast carcinomas diagnosed and treated over a 21-years period going from 1977 to 1997. The definition of synchronous breast lesions is the developpement of the contralateral breast cancer within 6 months. RESULTS: Median age was 49 years. The incidence of SBBC was 0.52%. History family was noted in 3% of our population. Mean tumor size was 40 mm (15-145). Breast conserving therapy was done in 16% of cases (9 patients). Five-year overall survival was 40%. Five year survival rates were 72 and 17% for stage II and III, respectively. Main prognostic factors for survival were lymph node involvement (P=0.004) and disease stage (P=0.02). CONCLUSION: Synchronous bilateral breast carcinoma is a rare entity, with a problem of definition concerning the delay of bilaterlisation. Their prognosis is similar to that of unilateral breast carcinoma patients of equal stage. Hence, breast conserving therapy can be used s fely if indicated.