Epidemiological, Diagnostic and Therapeutic Aspects of Hepatocellular Carcinoma in Morocco: A Case Series and Review of Literature.

INTRODUCTION: Hepatocellular carcinoma (HCC) is the most common primary liver tumor. It is considered a global public health problem given its incidence and high mortality rate. Epidemiological studies on hepatocellular carcinoma in our Moroccan and North African contexts are rare. Hence, our study aims to determine the epidemiological, clinical, paraclinical, etiological and therapeutic aspects of this pathology in our context. MATERIALS AND METHODS: We conducted a descriptive retrospective study on patients with HCC treated by the Hepato-gastroenterology department of the university hospital of Mohammed VI in Marrakech over a period of 7 years spread between 01/01/2015 and 31/12/2021. The epidemiological characteristics, diagnostic methods and therapeutic management of HCC in these patients have been described and analyzed. RESULTS: 100 patients with HCC were identified and included in our study. The average age was 63.3 ± 12.63 years with a male predominance. The predominant etiology was cirrhosis (87% of cases) then viral hepatitis C (35%) and B (27%) and of unknown origin in 29% of cases. HCC revealed cirrhosis in 41% and was diagnosed during cirrhosis surveillance in 36% of cases. The functional signs were dominated by abdominal pain (68%), deterioration of general condition (58%) and abdominal distension (43%). Alfa-fetoprotein was elevated in 73% of cases and was above 400ng/ml in 41% of cases. The diagnosis was mainly radiological in 92% and histological in 8% of cases. The radiological aspects of HCC were dominated by mononodular form (58%), a right lobar location (80%), a diameter greater than 5 cm (58%), a typical vascular aspect (86%) with portal thrombosis in 24% and metastases in 36% of cases, especially in lymph nodes. The majority of cirrhosis in our series was classified as Child-Pugh stage B (46%) at the time of diagnosis and most patients had an advanced stage of HCC with 31% at BCLC C and 28% at BCLC D. 72% of patients received palliative treatment, and only 6% received curative treatment. At the end of the study, 48% of patients had died with an overall survival of 6.5 months. CONCLUSION: Our study achieved its main objective by providing a snapshot of HCC in our context and confirmed that HCC remains with poor prognosis since its diagnosis is often late, limiting the therapeutic choices with a very short median survival. It also noted that the viral etiology remains the main cause of HCC in our population. Therefore, prevention remains the best therapeutic approach against HCC and the need for a national or at least a regional HCC registry in our country is essential in order to develop targeted preventive measures adapted to our context and to improve the diagnostic and therapeutic approaches for our patients.

[Primary liver melanoma: about a case]. / Mélanome hépatique primitif: à propos d'un cas.

Malignant melanoma is a disease with high metastatic potential which starts in melanocytes. The liver is the organ most often targeted for metastatic spread. Nonetheless, primary liver melanoma is very rare. Few cases have been described. We here report the case of a female patient with primary liver melanoma diagnosed based on liver biopsy results and confirmed by histological and immunohistochemical analyses as well as by providing a comprehensive assessment excluding other localizations.

Small bowel metastases from a testicular choriocarcinoma revealed by gastrointestinal bleeding: a case report.

Testicular germ cell tumors are the most common cancers in young men. In most cases, patients may present a painless testicular swelling. However, in 10% the presentation is variable and related to site of metastasis and complications. Clinically apparent gastrointestinal involvement was seen in 5% of cases and dominates by gastrointestinal bleeding. We report a case of testicular choriocarcinoma involving the small intestine revealed by melena and complicated by acute intussusception.

[Multinodular splenomegaly revealing multifocal, splenic and spinal tuberculosis: a case report]. / Splénomégalie multi-nodulaire révélatrice d'une tuberculose multifocale à localisation splénique et vertébrale: à propos d'un cas.

Splenic tuberculosis and Pott´s disease are two rare entities, in particular in immunocompetent people. We here report the case of a 57-year-old immunocompetent woman presenting with atypical pain in the left hypochondriac region evolving over the last 3 months, associated with lower limb paraparesis with progressive onset. Laboratory data did not provide any specific information regarding diagnosis, except for positive response to the QuantiFERON Test. Abdominal and pelvic computed tomography (CT) scan showed splenomegaly with multiple nodular, hypodense lesions in the spleen. Spinal cord magnetic resonance imaging (MRI) showed spondyldiscitis at the D10/D11 level with epidural and paravertebral collections responsible for medullary compression. GeneXpert assay on bone biopsy was positive and histological examination objectified granuloma characterized by the presence of central caseous necrosis. The diagnosis of multifocal tuberculosis was retained.

The global impact of COVID-19 on gastrointestinal endoscopy units: An international survey of endoscopists.

BACKGROUND & STUDY AIMS: Corona virus disease-19 (COVID-19) pandemic has markedly impacted routine medical services including gastrointestinal (GI) endoscopy. We aim to report the real-life performance in high volume GI endoscopy units during the pandemic. PATIENTS AND METHODS: A web-based survey covering all aspects of daily performance in GI endoscopy units was sent to endoscopy units worldwide. Responses were collected and data were analyzed to reveal the effect of COVID-19 pandemic on endoscopy practice. RESULTS: Participants from 48 countries (n = 163) responded to the survey with response rate of 67.35%. The majority (85%) decreased procedure volume by over 50%, and four endoscopy units (2.45%) completely stopped. The top three indications for procedures included upper GI bleeding (89.6%), lower GI bleeding (65.6%) and cholangitis (62.6%). The majority (93.9%) triaged patients for COVID-19 prior to procedure. N95 masks were used in (57.1%), isolation gowns in (74.2%) and head covers in (78.5%). Most centers (65%) did not extend use of N95 masks, however 50.9% of centers reused N95 masks. Almost all (91.4%) centers used standard endoscopic decontamination and most (69%) had no negative pressure rooms. Forty-two centers (25.8%) reported positive cases of SARS-CoV-2 infection among patients and 50 (30.7%) centers reported positive cases of SARS-CoV-2 infection among their healthcare workers. CONCLUSIONS: Most GI endoscopy centers had a significant reduction in their volume and most procedures performed were urgent. Most centers used the recommended personal protective equipment (PPE) by GI societies however there is still a possibility of transmission of SARS-CoV-2 infection in GI endoscopy units.

[Relationship between coeliac disease and multifocal tuberculosis: about a case and literature review]. / Association maladie cœliaque et tuberculose multifocale: à propos d'un cas avec revue de la littérature.

Coeliac disease is an autoimmune enteropathy related to gluten intolerance which occurs in subjects genetically disposed. The diagnosis is based on the combination of clinical biological and histological arguments. It is associated with many complications, including lymphoma. The risk of tuberculosis in patients with coeliac disease is increased. Several hypotheses explaining this association have been discussed. We report a case of coeliac disease associated with multifocal tuberculosis in a 17-year old patient.

Primary anal mucinous adenocarcinoma: a case series.

Primary mucinous adenocarcinoma is a rare malignancy of the anus (3% of anal cancers), the pathogenesis of which is better understood by immunohistochemistry. We reviewed cases of primary mucinous adenocarcinoma of the anus from 2000 to 2009 in the Hepatogastroenterology Department of the University Hospital Centre of Marrakech. Three cases were identified who were males with the mean age of 68years, and presented with a chronic anal fistula. Two cases had anal pain. Clinical examination revealed multiple fistulae in two cases with a secretion simulating 'cooked grains of tapioca'. Diagnosis was confirmed by histopathology and immunohistochemical profile (CK7 positive/CK20 negative). Imaging revealed a retro-rectal collection with thickening of the anal wall without metastasis (two cases). One patient underwent abdominoperinal resection without recurrence.