An Uncommon Presentation of Adrenal Cyst with Subclinical Cushing's Syndrome: A Diagnosis Dilemma.

Adrenal cysts are a rare entity that is usually nonfunctional and asymptomatic. Their association with adrenal neoplasms was rarely described in the literature. We report a unique case of a 40 -year-old woman who was referred for evaluation of a left adrenal incidentaloma with subclinical Cushing's syndrome. The tumor was suspicious for malignancy regarding computed tomography scan (CT scan) features. Therefore, a laparoscopic left partial adrenalectomy was performed. Pathology examination showed multilocular spaces lined by endothelial cells which are compatible with endothelial adrenal cyst, associated to an adrenocortical adenoma. We further discuss the management of adrenal cyst with review of the literature.

[Complementary medicine in cancer patients under treatment in Marrakech, Morocco: a prospective study]. / Les médecines alternatives et complémentaires chez les patients cancéreux en cours de traitement à Marrakech, Maroc : étude prospective.

Use of complementary and alternative medicine (CAM) is very frequent in cancer patients. The aims of this study were to analyze the frequency, the reasons of use of CAM in patients with a cancer treated in a Moroccan oncology department. We included in this study 400 patients. An anonymous questionnaire was proposed to patients during treatment. Over 384 analyzable questionnaires, 71% of patients were using CAM. The most frequent method was religious therapy (60%). The second one was herbal medicine (36%). The main reason for using CAM was reducing psychic pain in 53%, and boosting the immune system in 32%. Adverse effects were reported in 2% of cases. Only 5% of patients discussed CAM with their doctors. The cost of CAM was less than 100 Euros in 88% of cases. To optimize the patient-physician relationship and to avoid a propensity to unproved treatments, accurate and adequate communication is necessary.

[Short and medium term cardiotoxicity of anthracyclins: a prospective study]. / Cardiotoxicité à court et à moyen terme des anthracyclines : étude prospective.

There is evidence that anthracyclins may affect the heart and ventricular function. This cardiac toxicity is frequent and serious. It is the first study in Morocco to investigate the frequency of anthracyclins cardiotoxicity. It has for objective to analyze the cardiotoxicity connected to anthracyclins, these risk factors as well as the echocardiographic parameters, which deteriorate prematurely. We led a forward-looking study between October 2008 and December 2009. With 90 patients followed in the service of oncology-radiotherapy and put under chemotherapy with anthracyclins. We conducted a study of various ultrasound parameters of cardiac function, before with anthracyclins, the third cure of chemotherapy, then in the 6th cure of treatment. Only 70 patients have been assessable. Average age was of 47 years (20-68 years); 91% were female. The cardiac function was preserved in 40% of the cases. Among our patients, 56% developed a decrease moderated in light of the cardiac function and 4% of cases developed a severe cardiotoxicity. The echocardiographic parameter most significant in our series was LVEF, followed by TEI index. We found a cardiotoxicity was strictly correlated with the cumulative dose, anthracyclins type and associated comorbidity. The anthracyclins cardiotoxicity is quite common in our series, which requires more thorough preventive measures including monitoring by echocardiography.

[Lymphoepithelial carcinoma of the conjunctiva: an unusual location]. / Carcinome lymphoépithélial de la conjonctive : une localisation exceptionnelle.

Lymphoepithelial carcinoma is an undifferentiated carcinoma associated with a lymphocytic infiltration and constitutes a rare category of malignant neoplasms that share morphologic features with undifferentiated nasopharyngeal carcinoma. Its pathogenic aspects remain unknown and it has been described at several sites, but it is rarely found in the conjunctiva. We report a case in a patient aged 66, revealed by a tumefaction of the internal angle of the left eye. The initial examination found a tumoral lesion in the medial canthus, extending to the medial half of the lower eyelid and a preauricular lymphadenopathy. Facial computed tomography scan showed that the lesion was responsible for an osteolysis of the medial wall of the left orbit. Histologic examination showed a proliferation of undifferentiated tumour cells with an intratumoral lymphocytic infiltrate. Immuno-histochemical evaluation led to a diagnosis of lymphoepithelial carcinoma (cytokeratin 7+, cytokeratin 20+, vimentin-). No Epstein-Barr viral genomic sequences were detected by in situ hybridization. Nasofibroscopy was normal. Treatment was a wide excision with enucleation, followed by 50 Gy external radiotherapy. After a follow-up period of 18 months, the patient was still in a situation of complete remission.

[Breast metastasis from vulvar carcinoma: case report and review of literature]. / Métastase intramammaire d'un cancer vulvaire: à propos d'un cas avec revue de la littérature.

The breast metastases resulting of vulvar carcinoma are very rare, and represent exceptionally the first manifestation of the disease. We report the case of a 42 year-old patient who underwent a treatment because of vulvar epidermoid carcinoma, right away metastatic at the level of the inguinal ganglia. The treatment consisted in a total vulvectomy with bilateral ganglial curretage, followed by external radiotherapy about the perineum and the inguinal ganglia. Three months after the end of her treatment, the patient presented with a nodula on the left outer breast with features of malignancy noticed by clinic and mammographic examination. The histologic study of the mammary biopsy showed epidermoid carcinoma of likely metastatic origin. A left Patey has been realized and confirmed the metastatic localization of epidermoid carcinoma with axillary ganglial metastasis (2N+/-7). Besides, this patient presented a right cervical ganglial parcel that the biopsy showed a metastatic localization of a vulvar carcinoma. A palliative chemotherapy type cyclophosphamid, adriblastin, cisplatine (CAP) has been admistrated during three cycles spaced out three weeks. The patient died 11 months after the supervene of the cerebral metastasis. We present this case because its rarety and to show the possibility of metastasis at the level of breast due to vulvar cancer. The clinicians must remember this possible tropism of the vulvar cancer for the breast, not only during the supervision and the complete examination as regards the disease spreading but also when the affection revealed unknown primary tumor. The diagnostic orientation is based on the mammography and the mammary biopsy. In this stage, the treatment is unfortunately palliative, the survival until a year is not more than 20%.

[Epstein-Barr virus associated central nervous system leiomyosarcoma occurring after renal transplantation: case report and review of the literature]. / Léiomyosarcome primitif du système nerveux central associé au virus d'Epstein-Barr (EBV) et survenu après transplantation rénale : à propos d'un cas et revue de la littérature.

Central nervous system leiomyosarcomas are extremely rare, however, they became more frequent among immunodeficient patients, either in a patients infected with human immunodeficiency virus (HIV), or after organ transplantation. The data of the literature indicate that the infection by Epstein-Barr virus (EBV) plays a causal role in the development of these tumours but its precise role in the oncogenesis remains unresolved. We report a new case of EBV associated leiomyosarcoma of the left cavernous sinus occurring after renal transplantation. The epidemiological, clinical, pathological and therapeutic characteristics of these tumours are discussed.

[Vaginal leiomyosarcoma. Apropos of 2 cases and review of the literature]. / Léiomyosarcome du vagin. A propos de deux cas et revue de la littérature.

The leiomyosarcoma of the vagina is extremely rare. This paper reports two observations treated at the Ibn Rochd oncology center of Casablanca. The first patient was 32 years old, and presented a tumor of 15 cm to the detriment of the posterior wall of the vagina. The treatment consisted of a large exeresis of the tumor followed by postoperative radiotherapy. After 50 months, she is still alive. The second patient who was 42 years old, had a 10 cm tumor of the posterior wall of the vagina. A tumorectomy was realized and then the patient was not heard of. The evolution was marked by the appearance of pulmonary metastasis and a palliative chemotherapy was prescribed. This patient is deceased after 31 months. Seventy-five cases only are described in the literature. The surgery is the basic treatment whereas radiotherapy is still discussed. The prognosis of these tumors remains linked especially to the histological rank.

[Nephroblastoma in adults. Three case reports]. / Le néphroblastome de l'adulte. A propos de trois cas.

The authors report three nephroblastoma's cases occurred in adult and treated at Ibn Rochd Oncology Center at Casablanca. The average of age was 24 years (19-29 years) and the delay of diagnosis was five months (3-8 months). The most frequent clinical sign was a lumbar fossa mass. At diagnosis, radiological exams revealed that patients presented an advanced stage and metastatic disease in one case. The treatment was a total nephrectomy with ganglioma dissection when the tumor was resectable followed by chemotherapy and radiotherapy. Two patients was in progressive disease despite treatment, and one patient was lost at follow-up. The prognosis of adult's nephroblastoma remains very severe, due to the advanced stage at diagnosis and the mediocre reply to the treatment.

[Primitive seminoma of the mediastinum: a case report]. / Séminome primitif du médiastin: à propos d'un cas.

In this study, the case has been reported of a 36-year old male who was treated at the Ibn Rochd Oncology Center in Casablanca for a primary mediastinal seminoma revealed by a symptomatology including cough, dyspnea, laterocervical swelling, rachidial pain and gait disorder. The preliminary investigation showed significant mediastinal enlargement with a right pleuritis and vertebral metastases; tumor markers were normal. The diagnosis of seminoma was confirmed by pathological and immunohistochemical analysis of the cervical adenopathy. Disease management consisted of BEP/cisplatin type chemotherapy and lumbar, mediastinal, and supraclavicular radiotherapy. The response after four courses of combined chemo-/radiotherapy was estimated at 25%, but the patient died from respiratory failure five months after the initiation of treatment.

[Association of fallopian tube cancer and polymyositis. Apropos of 1 case]. / Association d'un carcinome tubaire primitif et polymyosite. A propos d'un cas.

A 51-year-old woman consulted for pelvic pain, metrorrhagia and leukorrhea. Physical examination revealed a renitent and mobile mass in the pelvis. A right lateral uterine mass with hydroxalpinx was found at ultrasonography. Pathology examination of the right annexectomy specimen provided the definitive diagnosis: fallopian tube cancer with polymyositis. No residual tumor was found at total hysterectomy with total bilateral annexectomy. The patient was lost to follow-up for three years without complementary treatment then consulted later for functional disability of the upper then lower limbs with myalgia, swallowing disorders and left supraclavian node enlargement resulting from pelvic relapse of the right fallopian tube adenocarcinoma and left supraclavian metastasis with paraneoplastic polymositis. The patient was given 6 courses of chemotherapy with radiotherapy (45 Gy) centered on the left clavian region. The patient exhibited a spectacular response, and remains in complete remission 50 months after diagnosis. The association of a fallopian tube tumor with polymyositis is exceptional, requiring rapid anticancer treatment effective against the cancer and the paraneoplastic polymyositis.

[Urachal adenocarcinoma]. / Adénocarcinome de l'ouraque.

Cancer of the urachus is very unusual. The lesion is a mucosecretory adenocarcinoma. The diagnosis is usually established late, and has a serious prognosis because of a long clinical latency. We report a case of metastatic adenocarcinoma of the urachus revealed by hematuria. A review of the literature allows us to demonstrate the rarity of this tumour and to demonstrate its various clinical, histological, radiological and therapeutical aspects.

[Papillary carcinoma from the thyroglossal duct cyst: review of the literature and report of a case]. / Carcinome papillaire sur kyste du tractus thyréoglosse: revue de la littérature et à propos d'un cas.

Cancer of a thyroglossal duct cyst is very rare. Clinical presentation is identical that of a benign cyst, and the diagnosis is histopathological. We report the case of 36 year-old woman treated for papillary carcinoma of a thyroglossal duct cyst. The treatment was surgical excision according Sistrunk method. There was no distant spread. After 22 months follow up, the patient is alive, with no signs of recurrence.

Acute diuretic, natriuretic and hypotensive effects of a continuous perfusion of aqueous extract of Urtica dioica in the rat.

This study was performed on anaesthetized male Wistar rats that received a continuous intravenous perfusion during 1.25 h of an aqueous extract of aerial parts of Urtica dioica L. (Urticaceae) at a low dose of 4 mg/kg/h or at a high dose of 24 mg/kg/h, or furosemide (control diuretic) at a dose of 2 mg/kg/h. As compared with a control period in each rat, the arterial blood pressure was reduced proportionally to the dose of the perfusion of the plant extract (15 and 38%, P<0.001, respectively). These effects were accompanied by a correlative increase of diuresis (11 and 84%, P<0. 001, respectively) and natriuresis (28 and 143%, P<0.001, respectively). In the rats perfused by furosemide, the arterial blood pressure was reduced by 28% (P<0.001). The diuresis and natriuresis were also increased proportionally in this case (85 and 155%, P<0.001, respectively). Nevertheless, the hypotensive action of U. dioica was reversible during the recovery periods in about 1 h with the lower dose of the plant extract and furosemide, while the effect of the higher dose was persistent, indicating a possible toxic effect. In conclusion, the results demonstrate an acute hypotensive action of U. dioica that indicates a direct effect on the cardiovascular system. Moreover, diuretic and natriuretic effects were also observed, suggesting an action on the renal function. Finally, the plant extract seems to have a toxic effect at the higher dose.

Glucose oxidation by adipose tissue of the edible dormouse (Glis glis) during hibernation and arousal: effect of insulin.

1. The effect of insulin on U-14C-glucose oxidation by adipose tissue isolated from hibernating or arousing edible dormouse has been studied. 2. CO2 production derived from radioglucose was analysed point by point during in vitro rewarming (from 6 to 37 degrees C). 3. The rate of temperature increase was 2 degrees/5 min in order to mimic the rate of rewarming during the spontaneous arousal of the dormouse. 4. Insulin did not increase the glucose oxidation by the adipose tissue from hibernating dormouse whereas adipocytes from active animal present high insulin sensitivity. 5. These results suggest that insulin resistance occurs during hibernation.

Hibernation depth influences the edible dormouse pancreatic B cell during the spring arousal.

In order to determine the influence of hibernation depth upon the secretion and the effect of insulin, two groups of edible dormice were maintained in winter under different climatic and nutritional conditions, and their pancreatic B-cell function was tested during the spring arousal. The first group of animals was exposed to a moderate temperature and fed ad libitum. Their periods of hypothermia were short and irregular and the active periods sometimes lasted several days; their body weight increased during the winter months; in spring, the sensitivity of B cells to glucose was low, decreasing insulin secretion in vivo and in vitro, and the adipocytes were insulin resistant. The second group of fasting animals was exposed to a low and constant temperature (5 degrees). Their phases of lethargy were long and regular (about 15 days), separated by active periods (6-8 hr); their body weight decreased during the winter months; in spring the B-cell secretion was increased and the sensitivity of the tissues to insulin ensured a high peripheral glucose utilization. These data show that the winter climatic and nutritional conditions which influence the depth of hibernation modify the edible dormouse B-cell activity during the spring arousal.

Insulin secretion in the hibernating edible dormouse (Glis glis): in vivo and in vitro studies.

Plasma glucose and insulin have been studied during lethargy and spontaneous arousal of hibernating edible dormouse. During lethargy blood glucose was low while plasma insulin remained at the same level as in other seasons. Plasma glucose and insulin did not fluctuate along the phase of lethargy. During spontaneous arousal plasma insulin rose strongly from the 17 degrees C stage, reaching the higher values at 26 degrees C while blood glucose was only 85 mg/100 ml, then decreased at 37 degrees C. The effect of glucose and temperature on insulin secretion was studied using perfused pancreas preparation from hibernating edible dormice. During the rewarming of the edible dormouse pancreas the insulin release did not occur in response to the absolute extracellular glucose level but occurred in response to a B cell membrane phenomenon which was dependent on the changing rate of glucose level. The effect of glucose and temperature on insulin secretion from perfused pancreas was compared between edible dormouse and homeotherm permanent, the rat. The B cell response to glucose of the dormouse pancreas increased up to 15 degrees C whereas that of the rat only from 25 degrees C. The dormouse insulin secretion reached a peak value at the 30 degrees C of temperature, whereas that of the rat progressively increased until 37 degrees C. These results showed that some biochemical adjustment or process of acclimatization took place in the B cells of the hibernators.