[Comparative study of inflammatory and non-inflammatory locally advanced breast cancer - the experience of a Moroccan hospital]. / Étude comparative du cancer du sein localement avancé inflammatoire et non inflammatoire : expérience d'un centre hospitalier marocain.

OBJECTIVES: The locally advanced breast cancer (LABC) covers large tumor heterogeneity. It consists of non-inflammatory LABC and inflammatory breast cancer (IBC). This study aimed to compare the epidemiological, clinical and pathological, as well as the prognosis of IBC versus non-inflammatory LABC. METHODS: This is a retrospective study of 150 cases of IBC and non-inflammatory LABC collected in medical oncology department of the CHU Hassan II of Fez during a period of 4 years [January 2009-January 2013]. Overall survival (OS) and disease-free survival (DFS) were calculated using the Kaplan-Meier method. Analysis of the various prognostic factors was performed according to the Cox model. RESULTS: IBC represented 28.7% of LABC. The median age was 47 years. The median tumor size was greater in non-inflammatory LABC compared with IBC (9.5 versus 6cm; P=0.0014). Lymph node invasion was more common in the IBC (49.7% versus 45.9%; P=0.01). An SBR grade 3 was more frequently noted in the IBC (P=0.011). The two groups were well balanced with regard to HR, HER2 status and pathologic complete response. Non-inflammatory LABC had the best OS and DFS (24 vs. 22 months; P=0.03 and 18 vs. 17 months; P=0.025 respectively). CONCLUSION: IBC has a worse prognosis compared to non-inflammatory LABC. New therapeutic approaches are needed to improve the prognosis of these patients.

[Which surgery for mediastinum tumor: Experience of the Department of thoracic surgery of CHU Hassan II of Fès]. / Quelle chirurgie pour quelle tumeur du médiastin : expérience du service de chirurgie thoracique de CHU Hassan II de Fès.

INTRODUCTION: Tumors of the mediastinum are a heterogeneous group of dysembryoplatic and neoplastic diseases essentially with different prognoses and therapeutic. These tumors develop slowly and remain long asymptomatic in 40-50% of cases. The purpose of our work is to bring the result of surgical management in diagnostic and therapeutic of principal mediastinum tumors framework. PATIENTS AND METHOD: We reviewed retrospectively the records of 68 patients in our training, between January 2009 and December 2013, for tumor of the mediastinum in the diagnostic framework and or therapy. RESULTS: There were 37 men and 31 women with a mean age of 37 years with extremes ranging from 11 to 73 years and 77.94% had an age between 11 and 50. In 39 patients, surgery had a diagnostic purpose (2 benign tumors and 37 malignancies including 27 cases of lymphomas). Curative surgery was performed in 34 patients, dominated by the tumors of thymic origin in 15 cases. Conventional surgery had involved 32 patients. The surgical approach was a total vertical sternotomy in 14 patients, in 17 patients was posterolateral thoracotomy and a left anterior thoracotomy in 1 patient. Video assisted thoracic surgery had been done in 3 patients under resection of a pleuropericardique cyst. Overall mortality was 4.41 percent. It is a death at D17 of the postoperative (thymoma with myasthenia) following a myasthenic crisis requiring a tracheotomy. A patient operated on for invasive thymoma developed myopathy and died at D44 of the postoperative following a difficulty of weaning. Another patient had a thymoma B3 benefited from 6 courses of neoadjuvant chemotherapy and then a thymectomy had presented a respiratory distress with bilateral pleural effusion, death at D10 of the postoperative by septic shock following a nosocomial infection. CONCLUSION: Tumors of the mediastinum are infrequent, discovered more often by chance. The main prognostic factor is the completeness of tumor resection without taking the break. Conventional surgery always keeps a place in our context, despite the advent of minimally invasive surgery.

[Breast cancer in young patient in Morocco]. / Cancer du sein chez la femme jeune dans le Nord-Est du Maroc.

OBJECTIVE: Breast cancer occurring in young women is rare with epidemiological, diagnostic and prognostic characteristics of their own. It is more often linked to genetic predisposition and especially correlated with a lower survival and higher rates of recidivism. The aim of the study was to analyze epidemiological, clinicopathological, biological and evolutionary characteristics. PATIENTS AND METHODS: It is a retrospective study concerning 74 patients aged 35 and younger, in whom a diagnosis of invasive breast cancer was made between September 2004 and December 2009. RESULTS: Incidence of breast cancer in women aged under 35 in our series was 18.6%, mean age was 30.62years and five patients (6.75%) had a family history of breast cancer. The mean tumor size was 3.9±2.6cm; 45.4% of tumors were locally advanced. It was an infiltrating ductal carcinoma of grade III of Scarff-Bloom and Richardson (SBR) in 45.7% cases and half the time it was accompanied by an axillary lymph node involvement. Negative hormone receptor (HR-) was found in only 28.7% of cases and 13 cases overexpressed Her2. Eighteen percent of the tumors were classified as triple negative. The overall survival at 3years was 87.8%. DISCUSSION AND CONCLUSION: The incidence of breast cancer in young Moroccan patients is high. In our context, it is distinguished by a delayed diagnosis explaining the advanced stage at diagnosis. Biological characteristics are often more aggressive, including high histological grade, lack of hormone receptors and the higher rate of triple negative tumours significantly reducing treatment options.

[Bile duct dilatation associated with pancreatic heterotopia: a case report]. / Hétérotopie pancréatique associée a une dilatation kystique du cholédoque. À propos d'un cas.

Pancreatic heterotopia or aberrant pancreas is a rare congenital anomaly, usually asymptomatic. Its diagnosis is difficult. We report an original observation in an 8-month-old infant, operated in the neonatal period for esophageal atresia type III in the context of VACTERL syndrome, cystic dilatation of the bile duct, and pancreatic heterotopia.

[Intravascular papillary endothelial hyperplasia of the ankle: a case report]. / Hyperplasie endothéliale papillaire intravasculaire de la face antérieure de cheville : à propos d'un cas.

Intravascular papillary endothelial hyperplasia (IPEH) is an unusual, benign, non-neoplasic, vascular lesion characterized histologically by papillary fronds lined by proliferating endothelium. This lesion has the propensity to occur in the skin and the subcutis. Many histological features are similar to those of low-grade angiosarcoma, a common, but more serious condition. Clinical and histological differentiation is important to avoid overtreatment of this benign lesion. We report a case of cutaneous IPEH in the ankle of a 30-year-old girl, which was successfully treated by excision. The pathologic findings, differential diagnosis and a review of recent literature are discussed.

[Ischemic fasciitis. A case report]. / La fasciite ischémique. A propos d'un cas.

Ischemic fasciitis, also called atypical decubital fibroplasia, was recently described as a distinctive fibroblastic proliferation occurring predominantly in elderly, bed-ridden individuals. It is very rare. Forty cases only are reported in the literature. We report the observation of a 50-year-old patient, having an antecedent of prolonged confinement, who presents since 1 year a tumefaction compared to the higher end of the tibia of soft consistency with inflammatory signs in glance. The pathologic examination shows a pseudo tumoral lesion of ischemic fasciite type. Through this observation, we suggest to review the various problems of diagnostic differentials in particular with a sarcoma of soft tissues and to discuss the anatomoclinic features of this recent description lesion.

[Solid pseudotumoral tubo-ovarian actinomycosis. A case report in Morocco]. / Une actinomycose pseudo-tumorale tubo-ovarienne. A propos d'une observation marocaine.

Tubo-ovarian actinomycosis is a rare location for infection by actinomyces. Only around 50 cases have been described in the world literature since 1963. Diagnosis can be difficult due to the highly misleading solid pseudotumoral appearance of this infection. The purpose of this report is to describe the case of a 40-year-old patient with an intrauterine device who presented abdomino-pelvic pain associated with guarding in the right iliac fossa. Pelvic ultrasound revealed an ovarian mass. Histological examination of the surgical specimen after annexectomy demonstrated tubo-ovarian actinomycosis. Based on this case involving a rare clinical form of the actinomycosis, we review the various clinical aspects of this infection and underline the importance of histology in achieving diagnosis. We also provide a general review of the literature.