Reversible posterior leukoencephalopathy syndrome following carboplatin and paclitaxel in cervical cancer: Case report.

Posterior reversible leukoencephalopathy is a rare radio-clinical entity that has gained increasing recognition over the last two decades. It is associated with various etiologies: arterial hypertension, autoimmune diseases, chemotherapy, and immunosuppressive drugs. Several cases have already been reported following cancer therapy. Posterior reversible leukoencephalopathy is characterized by capital clinical signs (headache, seizures, confusional syndrome, and visual disorders) and radiological abnormalities (cerebral edema predominantly in the posterior regions). We report the case of a 38-year-old female patient diagnosed with posterior reversible leukoencephalopathy after receiving Carboplatin and Paclitaxel chemotherapy for recurrent cervical cancer, which was revealed by a generalized seizure. Brain magnetic resonance imaging showed T2 Flair hyper signals in the parieto-occipital regions. This complication is rare but is probably underdiagnosed due to a lack of awareness and limited hindsight. Rapid diagnosis is essential to prevent acute neurological complications, which can be life-threatening or functionally crippling regardless of neoplasia.

Patterns of practice survey for cervical cancer brachytherapy in Morocco.

PURPOSE: This study surveyed radiation oncologists in Morocco to explore current practices and perspectives on brachytherapy for cervix cancer. METHODS AND MATERIALS: A 37-question survey was conducted in April 2023 among 165 Moroccan radiation oncologists using Google Forms. RESULTS: Of the 93 respondents, 39% treated over 20 patients in 2022 using 3D image-guided brachytherapy (BT) through the HDR technique; 2D techniques were not reported in the last five years. Intracavitary BT is uniformly applied with a tandem and ovoid applicator. Only 14% utilized interstitial needles for hybrid BT. Iridium-192 was the primary radioactive source (63%), followed by cobalt (37%). Ultrasound-guided 47% of applicator insertions. All used CT scans for planning, but only 6% used MRI fusion due to limited availability. Guidelines for target volume and dose prescription were mostly based on GEC-ESTRO recommendations (74%), followed by Manchester Point A (30.4%) and ABS (11%). Over 90% delineated CTV-HR and CTV-IR; 30% delineated GTV. All marked the bladder and rectum, while 52% marked the sigmoid, 5% the small bowel, and 3% the recto-vaginal point. For dosimetry, 12% used ICRU 89 points, 54% used dose-volume histograms (DVH), and 36% used both. Most reported EQD2cc for OARs for the rectum and bladder, with nine still using ICRU point doses. The most common fractionation schema was 7 Gy in four fractions (60%) and 7 Gy in three fractions (55%). CONCLUSIONS: Brachytherapy remains essential for treating cervical cancer in Morocco. Key areas for improvement include MRI fusion-guided brachytherapy, access to advanced applicators, expanding interstitial techniques, and professional training and national referential.

Metachronous ureteral metastasis of a gastric adenocarcinoma: a case report and review of literature.

BACKGROUND: Ureteral metastasis from gastric cancers are rare and can be a cause of ureteral obstruction. There have been few published case reports in the literature. In this paper, we report an additional case and a review of the literature of all the previous reported cases. CASE PRESENTATION: A 67 years old North African women who was treated four years before for a gastric adenocarcinoma, presented with abdominal pain. Imaging and endoscopy showed a mural stenosis of the left ureter, without any other abnormality. Histopathology confirmed the gastric origin of the metastasis. A palliative chemotherapy was foreseen, but due to the deterioration of the general condition of the patient, she received palliative care. We have also reviewed the literature and reported the previously published cases of ureteral metastasis from gastric cancer. CONCLUSIONS: It is worth recalling that in a context of neoplasia and with the presence of signs of ureteral obstruction, it is important to keep in mind the possibility of a ureteral metastasis.

Epidemiological, Clinicopathological and Prognosis Features of Moroccan Patients with Nasopharyngeal Carcinoma.

PROPOSAL: A distinct epidemiology, etiology, clinical characteristics, and therapeutic outcomes characterize nasopharyngeal carcinoma (NPC) from other head and neck cancers. An actualized analysis of NPC patients' features enables a global view of NPC management. Accordingly, the current study investigated the epidemiological and clinical characteristics of Moroccan patients with NPC, as well as their 4-years survival outcomes and influencing prognostic factors. METHODS: We prospectively analyzed data of 142 histologically confirmed Moroccan patients with NPC between October 2016 and February 2019. Kaplan-Meier and Cox regression analyses were used to assess predictive prognostic factors related to NPC. All analyses were conducted using SPSS version 21 statistical software. RESULTS: In the present study, a net male predominance was found, with a mean age of 44±16.3 years old. Advanced stages of NPC were observed in 64.1% of patients, and 32.4% of patients presented with distant metastasis at diagnosis. The 4-years overall survival, locoregional relapse-free survival, distant metastasis-free survival and progression-free survival were 68.0%, 63.0%, 53.9%, and 39.9%, respectively. Age, N category and distant metastasis were identified as the most important independent prognosis factors for NPC in this cohort (p<0.05). CONCLUSION: In conclusion, NPC affects young adults and is frequently diagnosed at advanced disease stages, impacting therefore negatively patients survival; which is in line with data from endemic areas for NPC. The current study clearly highlights that a greater attention should be directed to improving the management of this aggressive malignancy.

[Which chemotherapy regimen in patients with metastatic phyllodes tumors of the breast? case report]. / Quelle chimiothérapie dans les tumeurs phyllodes métastatiques du sein? rapport de cas.

Phyllodes tumors (PT) of the breast are rare. They can be benign, borderline or malignant. Malignant forms account for 20-30% of PTs, with distant metastases in 10-26% of cases. Chemotherapy is one of the main therapeutic weapons for metastatic phyllodes tumors (MPTs). We here report four cases of MPTs of the breast managed at The Mohammed VI Center For Cancers Treatment in Casablanca from January 2015 to December 2017. The average age of patients ranged from 25 to 45 years. The mode of revelation was represented, in the majority of cases, by the occurrence of a huge breast mass and in all patients the histological diagnosis was based on the examination of mastectomy specimen. Three patients had lung metastases, two had axillary lymph-node metastases, two had bone metastases and only one had liver metastases. All patients received chemotherapy. Doxorubicin monotherapy and doxorubicin-ifosfamide (AI) were used. Only one patient had a very favorable outcome, with radiologic complete response after 3 AI regimens. MPTs of the breast have a poor prognosis. The role of systemic chemotherapy is to be defined, especially since there are no data available on optimal chemotherapy regimen.

Evaluation of cardiac toxicity of systemic treatments in Moroccan patients followed for localized breast cancer: Prospective observational study of 549 cases.

BACKGROUND: Breast cancer is the most common cancer in women in the world and in Morocco. Anthracyclines and anti-HER2 therapy are major drugs in the therapeutic management of localized breast cancer. The most serious toxicity of these drugs is cardiotoxicity. Our work aims to assess the prevalence of this toxicity in the Moroccan population. PATIENTS AND METHODS: We conducted a prospective longitudinal observational study between January 2017 and June 2018. All our patients were followed in The Cardio-Oncology Unit, 1st unit of its kind in Morocco, created thanks to the collaboration between the Mohammed VI Cancer Treatment Center and The Cardiology Departement of Ibn Rochd University Hospital in Casablanca. Eligible patients (n=549) had Stage I-III localized breast cancer, verified histologically, and a pre-treatment adequate cardiac function with a LVEF = 50%, measured with echocardiography, and received systemic cardiotoxic treatment (anthracycines, anti-her2 drugs). All patients received regular monitoring of cardiac function mainly by echocardiography. Cardiotoxicity was defined as a decrease in LVEF of 10 points and / or <50%. RESULTS: A decrease in LVEF was observed in 8.4% of our patients, with 4% symptomatic heart failure. The baseline average LVEF in the cardiotoxicity group was 63.5% (50-77) versus 60.5% (60-74) in the group without cardiotoxicity. 97.1% of these patients received anthracyclines, 98% received trastuzumab against 97% and 65% in the group without cardiotoxicity respectively. Cardiotoxicity was reversible in 6.4% of patients, permanent discontinuation of cardiotoxic treatment was observed in 2.2%. A statistically significant relationship was found between cardiotoxicity and arterial hypertension (HTA) (p = 0.002), trastuzumab (p = 0.0001) and radiotherapy for left breast cancer (p = 0.023). CONCLUSION: This is one of the first observational studies in Morocco with a large number of patients, which gives us an idea of the cardiotoxicity of systemic treatments in Moroccan localized breast cancer patients. Our results join those of the literature, but are still worrying and invite us, oncologists and cardiologists, to be more vigilant with this toxicity, which influences the oncological and cardiac prognosis of our patients, especially cancer survivors.

Primary neuroendocrine tumors of the breast: two case reports and review of the literature.

BACKGROUND: Neuroendocrine carcinomas mainly affect the bronchopulmonary and the gastrointestinal systems. Breast localizations are very rare. They represent less than 0.1% of all breast cancers. A definitive diagnosis relies on histological and immunohistochemical examinations. CASE PRESENTATION: Case 1 We report a case of primary neuroendocrine carcinoma of the breast in a 71-year-old Arabic woman who presented with a 3 cm palpable and mobile tumor of the right breast. Clinical and radiological assessment excluded any other primary tumor. Radical mastectomy and axillary lymph node resection were performed. A histopathological examination disclosed the diagnosis of primary breast neuroendocrine tumors, with negative surgical margins and lymph nodes (18 N-/18 N). The tumor cells were positive for neuroendocrine markers, a weak Ki-67 proliferation index and negative Her2/neu. Our patient received adjuvant hormonal treatment with anti-aromatase for 21 months. She is on regular follow-up, and she remains free of disease to date. Case 2 A 48-year-old Arabic woman consulted for a right breast nodule. She underwent lumpectomy with right axillary lymphadenectomy. The diagnosis was breast neuroendocrine tumor. Systemic treatment was proposed, but she was lost to follow-up. She consulted 1 year later for a mass in the same breast. A histological and immunohistochemical examination of a mammary biopsy was consistent with a recurrence of the previous neuroendocrine tumor. A radiological assessment showed a large mass in her right breast, ipsilateral axillary lymphadenopathies, and hepatic and pulmonary metastases. She received first-line metastatic chemotherapy, with good clinical and radiological improvement. She refused the mastectomy and was given hormone therapy. One year later, the tumor expanded clinically and radiologically, and she underwent second-line metastatic chemotherapy, with good clinical progress and radiological stability, and she then underwent maintenance hormonal therapy. CONCLUSION: Due to the rarity of primary breast neuroendocrine tumors, no standard therapy exists and the prognosis remains difficult to determine. Studies, including larger series, are needed in order to understand the biological behavior of these tumors.

Radiation therapy in mycosis fungoid patient.

Mycosis fungoid (MF) is a non-Hodgkin's T-cell lymphoma determined by primary cutaneous involvement. It is a slow-progressing chronic indolent disease characterized by atypical T-cells with a cerebral nucleus. Management of this disease depends on the stage and is based essentially on the systemic treatment. Radiotherapy intervenes in case of localized or extended tumor, indeed, the radiosensibility of this tumor, like any other hematological affection, makes it possible to obtain a high rate of response. Clinical case: we report the observation of a 46-year-old patient followed since 2012 for mycosis fungoid revealed by a papullo-squamous lesion located at the level of the right lumbar fossa. The diagnosis was confirmed by cutaneous biopsy, showing the presence of T lymphocytes expressing CD2, CD3, CD4, CCR4, CD45RO markers. Initial assessment included a thoraco-abdominal pelvic CT, which was normal, an accelerated sedimentation rate at the 1st hour, a high C reactive protein (CRP), the electrolytic, renal, hepatic status and the hemogram were normal. Patient received 6 courses of chemotherapy according to the COPP protocol with a decrease in the size of the lesion estimated at 40%. A norm fractionated radiation therapy was delivered at the dose of 36Gy. The evolution was marked by a complete remission, maintained after 6 months of the treatment. Mycosis fungoid is a rare disease, whose management must be discussed in a multidisciplinary team. Radiotherapy remains an interesting option for all stages, but has to be validated in largest studies.

[Gastrointestinal Stromal Tumors "GIST": status and news through our experience on 54 cases and review of literature]. / Tumeurs Stromales Gastro-Intestinales «GIST¼: état des lieux et actualités à travers notre expérience portant sur 54 cas et une Revue de littérature.

Tumors Gastrointestinal Stromal "GIST" are a very rare form of digestive tract cancers belonging to the family of sarcomas. The aim of this study is to establish the epidemiological profile, the diagnostic and therapeutic difficulties of this malignancy supported in a developing country. A retrospective study spread over 8 years from January 2002 to March 2010, was conducted at the Department of Radiotherapy and Oncology of Casablanca (Morocco) have collated 54 cases of Gastrointestinal Stromal tumors. The average age of our patients was 55 years. The average time of evolution was 11 months (0-72 months). The biopsy confirmed the diagnosis in 14 cases and surgery in 40 cases. The main histological form was fusiform (92.6%). GIST in our series had an average tumor size of 12.5 cm with a positive C-Kit in 52 cases. The risk of progression was established in 47 cases of which 39 were high risk. Surgery was the main treatment of patients in our study. After a mean fellow of 31 months, half of evaluable patients in our series (n = 19) is maintained complete remission, one third (n= 13) died while a quarter (n= 8) has a local recurrence and / or metastatic. Although the recommendations are published for the treatment of these tumors, these still present many problems both diagnostic and therapeutic in our context.

Adult-type granulosa cell tumor of the testis: report of a case and review of literature.

Granulosa cell tumors is classified into juvenile and adult types and comprise less than 5% of ovarian tumors in women and are much rarer in men which only 45 have been previously reported. We report here a 40-year young man with a left testicular adult type granulosa cell tumor. The tumor measured 5.5X5X4cm; Immunohistochemical stains showed the tumor diffusely positive for inhibin and vimentin. Post operative CT scans shows a lomboaortic lymphnodes treated by four cycles of chemotherapy type BEP (bleomycin, etoposide, cisplatin). The thoraco abdominal CT scans post chemotherapy shows the disappearance of the right testicular nodule and the lomboaortic lymphnodes. 2 years after treatment, the patient is alive and well with no signs of recurrence. Our report highlights one more case of this very rare tumor of the testis, which is quite problematic In terms of prognosis and management, and for this reason seems to have attracted the interest of many researchers recently.

[Subcutaneous myxoid liposarcoma]. / Liposarcome myxoide sous cutané.

Although myxoid liposarcomas (MLS) are the most common type of soft-tissue sarcomas in adults, their primary location in the superficial tissues is rare. So sarcomas are classified as superficial and deep-seated. They are distinct based on their location and their frequency as well as their prognosis which is relatively better in superficial sarcomas. We here report the case of a patient with subcutaneous liposarcoma in the right thigh. The diagnosis was confirmed by histology after clinical symptoms had evolved over 1 year. Treatment involved wide surgical resection followed by locoregional radiation therapy. Patient's evolution was marked by complete remission maintained after 32 months follow-up. This study highlights that superficial sarcomas are rare and this can cause a delay in diagnosis compromising their prognosis.

[Brain metastasis from rectal adenocarcinoma: about a case and review of the literature]. / Métastase crânienne d'un adénocarcinome rectal: à propos d'un cas avec revue de la littérature.

The most common primary sites for bone metastases in men are lung, prostate, kidney, thyroid or bladder. Colorectal origin is rare. Few studies have described this type of metastases; the axial skeleton or the pelvis are the most common metastasis locations. Craniofacial location is exceptional. We here report the case of a 38 years old man treated for metastatic rectal cancer metastasized to temporal bone. He initially had undergone surgical procedure for low anterior resection, tumor was classified as pT3N0M0; 24 months after the patient had left exophthalmos revealing a temporal tumoral process. Evolution and context favoured metastasis. In conclusion, this study reporting an exceptional case of craniofacial bone metastasis from multi-metastatic colorectal cancer will enrich the scarce data reported in the literature related to bone metastases from primary colorectal cancer.

[Breast cancer in men: about 40 cases and literature review]. / Cancer du sein chez l'homme: à propos de 40 cas et revue de la littérature.

Breast cancer in men is rare, accounting for approximately 1% of all breast cancers and less than 1% of all neoplasias in men. This study aimed to highlight the clinical histological, prognostic and therapeutic features of this rare tumor in order to contribute to improve the management of these patients. We conducted retrospective study of 40 patients whose data were collected at the Mohammed VI Center for Cancers Treatment in Casablanca from January 2000 to December 2012. The average age was 62 years, the mean consultation time was 12 months, self-exam of a peri-areolar nodul was the main reason for consultation in 90% of cases. Infiltrating ductal carcinoma was the predominant histological type in 90% of cases. Multimodal treatment was based on mastectomy followed by adjuvant therapy including chemotherapy, radiation therapy and/or hormonal therapy, depending on tumor stage and its histological features. The mean follow-up time was 38 months, patient's evolution was characterized by complete remission in 16 patients (40%), local recurrence in 3 patients (7.5%) and metastatic recurrence in 5 patients (12.5%). Metastases mainly occurred in the bones (62%), followed by the lungs and the liver. 10 patients (25%) died. Breast cancer in men is similar to breast cancer in women. However it has its own peculiarities, hence the importance of conducting broader prospective randomised studies in order to improve the treatment and the prognosis of this disease with a high psychosocial impact.

[A case of angiosarcoma of the outer ear]. / Un cas d'angiosarcome de l'oreille externe.

Angiosarcoma of the ear is a very rare and locally aggressive malignant tumor. It accounts for 4-5% of cutaneous sarcomas and less than 1% of all sarcomas. Our study aims to describe and discuss diagnostic and therapeutic modalities of this malignancy. We report the clinical case of a 31 year old patient with bulging mass of the pavilion of the left ear. CT scan was in favor of tumor of the pavilion of the ear invading ipsilateral parotid. Histological diagnosis was in favor of angiosarcoma. The treatment consisted of complete surgical resection followed by adjuvant radiotherapy. She is in complete remission with a follow-up period of 1 year.

[Small cell bronchial carcinoma and pregnancy: about a case with review of the literature]. / Cancer bronchique à petites cellules et grossesse: à propos d'un cas avec revue de la literature.

Bronchopulmonary cancer (CBP) in pregnant woman is a rare entity with a poor outcome. This situation is becoming increasingly common, due to the increase in smoking among women. Transplacental transmission of tumor associated with fetal damage is described especially among untreated women. Treatment is multidisciplinary and it is not well codified. We report the case of a 23 year old patient with small cell bronchial carcinoma diagnosed during pregnancy. She had received chemotherapy during pregnancy and it was well tolerated. Radiological evaluation objectified a stabilization of the pulmonary process. The treatment was completed with concomitant radiochemotherapy after delivery.

[Phyllodes tumor in a 12-year old teenage girl: about a case and review of the literature]. / Tumeur phyllode chez une jeune adolescente de 12 ans: à propos d'un cas et revue de la littérature.

Phyllodes tumors of the breast are very rare and are exceptional in children and adolescents; their treatment is based on surgery and radiotherapy, with a good prognosis. We report the case of a 12-year old teenage girl presenting with a mass in the left breast. The diagnosis of a phyllodes tumor was confirmed on the basis of clinical, imaging and histological examinations. Treatment consisted of a large tumorectomy without adjuvant therapy, with good evolution during a 2-year follow-up.

[Recurrence occurring ten years after the initial diagnosis of granulosa cell tumour of the ovary: about two cases and review of the literatur]. / Récidive après dix ans de tumeur de granulosa de l'ovaire: à propos de deux cas et revue de la littérature.

Granulosa Cell Tumors (GCT) of the ovary are rare tumors belonging to the group of sex cord stromal tumors. They represent 0.6 - 3% of all ovarian tumors and 5% of all malignant tumors. Two different types of GCT can be distinguished: juvenile granulosa cell tumor (JGT) which is characterized by its aggressive potential and adult granulosa cell tumor (AGT) which is the most common and the least aggressive type. GCT of the ovary usually develops recurrences within 5 years of initial diagnosis but they rarely develop local or peritoneal metastases. Although treatment options including surgery with or without chemotherapy or radiation have been reported in treating GCT relapses, there are no standardized protocols for the treatment of relapses. We here present our therapeutic strategy in the treatment of longterm relapses of GCT peritoneal carcinomatosis occurring in two patients 10 years after the initial diagnosis and a review of the literature.

[Primary large cell neuroendocrine carcinoma of the breast: a rare tumor in humans]. / Carcinome neuroendocrine à grandes cellules primitif du sein: une tumeur rare chez l'homme.

Primitive large cell neuroendocrine tumor of the breast is an extremely rare entity. Less than ten cases have been reported in the literature. We report a new case of a 61-year old male patient presenting with locally advanced tumor of the right breast, immediately metastasized to the lungs and pleura, staged cT4bN1M1. The patient received eight cycles of Docetaxel-based chemotherapy every 21 days, with a good clinical and radiological response (>50%), followed by adjuvant tamoxifen with disease stabilization for 18 months. Immunohistochemistry is still essential to determine the neuroendocrine nature of this tumor. Treatment is not well codified due to the rarity of this type of cancer.

Five years of local control of subscapularis aggressive fibromatosis managed by surgery and imatinib: a case report.

INTRODUCTION: Imatinib, a tyrosine kinase inhibitor, is a major therapeutic option for the management of unresectable aggressive fibromatosis. Unfortunately, for most patients of low or very low average income countries, surgery often is the first treatment option. This is related to unavailability of chemotherapy or targeted therapy, and to a lack of financial resources or surgeons' lack of knowledge of other therapeutic options. CASE PRESENTATION: In 2010, a 26-year-old Moroccan man was referred to our oncology and radiotherapy center by his surgeon for the management of a recurrent tumor of his right subscapularis muscle. Before his assessment in our center, two resections were performed by his surgeon after performing an incision biopsy and magnetic resonance imaging. Postoperative magnetic resonance imaging was performed and showed a right axillary nodule size 2.1cm regarding a collection with a residual tumor. We decided to administer imatinib 400mg daily by mouth. Clinical and magnetic resonance imaging evaluation were performed regularly and reported a stable tumor. We reported no adverse side effects to imatinib regarding Common Terminology Criteria for Adverse Events grading. CONCLUSIONS: Recurrences are high during aggressive fibromatosis management. Systemic treatment with imatinib for unresectable or recurrent tumors with positive c-KIT could be the best therapeutic option. In our case report, the patient was stabilized with imatinib for 30 months and he had a very good quality of life.