Metastasis of Rectal Signet Ring Cell Carcinoma to Typical Lipoma: A Rare Presentation of the Tumor-to-Tumor Metastasis Phenomenon.

Rectal signet ring cell carcinoma represents a rare subtype of colorectal adenocarcinoma known for its aggressive biological nature and poor prognosis. Although the co-occurrence of colorectal carcinoma with other tumors has been reported, the uncommon phenomenon of tumor-to-tumor metastasis, first described in 1930, remains rare. The most frequent donor neoplasms are lung or breast carcinomas, whereas cerebral meningiomas have been reported to be the most frequent recipient neoplasms. Here we report a case of a typical lipomatous tumor harboring metastatic signet ring cell rectal carcinoma. It is about a 42-year-old man diagnosed with rectal signet ring cell carcinoma and treated with concurrent radiotherapy and chemotherapy followed by an anterior resection and manual coloanal anastomosis with a temporary ileostomy. During the surgery, an abdominal wall lipoma was discovered and excised. A histopathological examination revealed infiltration of the fibro adipose tissue by a mucinous adenocarcinoma with a contingent of signet ring cells. The patient died 12 months after adjuvant chemotherapy due to peritoneal progression. To the best of our understanding, this represents the initial documented instance of tumor-to-tumor metastasis from rectal signet cell carcinoma to a conventional nonvascular lipoma. Consequently, even if one of these tumors appears clinically and radiologically benign, it is prudent to entertain the prospect of tumor-to-tumor metastasis. Thus, a comprehensive pathologic study of both tumors is highly recommended.

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.

An incidental discovery of a gastric follicular dendritic cell sarcoma: A rare case report and a literature review.

Introduction: Follicular dendritic cell sarcomas (FDCS) are rare tumours, typically seen in lymph nodes. However, in about one third of the reported cases, a FDCS presents as an extranodal mass. Involvement of the gastrointestinal tract is rare, and the stomach is even rarer with only four cases described to date. The aim of this study was to review clinical characteristics, pathologic features, emphasize on differential diagnosis and discuss therapeutic modalities and prognosis of this rare entity.Case presentation: We report on a 36-year-old female patient with no past medical history, an incidentally discovered FDCS located in the stomach with the presence of lymph node metastasis at the time of diagnosis. The diagnosis of a FDCS was made on morphological and immunohistochemical findings where tumor cells expressed CD21 and CD23. The tumor was resected by gastrectomy with extended para-aortic lymphadenectomy, with uneventful postoperative course.Conclusions: Due to its rarity, FDCS is rarely included in the differential diagnosis of gastrointestinal spindle cell tumors. Complete surgical resection is the current gold standard of treatment.

Pathologically confirmed women's breast cancer: A descriptive study of Tunisian and Algerian series.

BACKGROUND: Breast cancer (BC) is the most frequent malignancy among women in Tunisia and Algeria. Clinical and pathological characteristics of this cancer among these populations are not widely reported. The aim of the study was to report clinical and pathological characteristics of women's BC in a Tunisian and Algerian series. METHODS: Pathologically confirmed 1089 BCs were gathered in the pathology departments of three Northern Tunisian hospitals: Tunis military, Charles Nicolle and Jendouba and in the pathology department of Alger Douera hospital between January 2015 and December 2020. Clinical and pathological findings of the two series: age, tumor size, histological type, grading according to Scarff-Bloom Richardson grading system, lymph node status at the time of diagnosis in axillary lymphadenectomy specimens and the immunohistochemical expression of estrogen and progesterone receptors (ER/PR), HER2 and Ki-67, were collected from the pathological reports. RESULTS: The median age at diagnosis was 50 and 48 years in Tunisian and Algerian series, respectively (p = 0.016). The diagnosis of BC was made on surgical specimens (lumpectomy or mastectomy) in 373/491 (76%) cases of the Tunisian series and in 225/598 (37.6%) cases of the Algerian one. Median tumor size was 2.8 cm and 2.5 cm in Algerian and Tunisian series, respectively (p = 0.252). Invasive BCs not otherwise specified was observed in 440/481 (91.5%) BCs in Tunisian series and in 519/586 (88.6%) BCs in Algerian series. Axillary lymph node positive tumors were observed in 64.6% and 58.8% of Tunisian and Algerian women, respectively (p = 0.926). BCs were ER positive in 311/385 (80.8%) and 486/571 (85.1%) cases and HER2 positive in 86/283 (30.4%) and 60/385 (15.6%) cases of Tunisian and Algerian series, respectively. CONCLUSIONS: In Tunisia and Algeria, BC has poor prognostic factors with large tumor sizes and high rates of lymph nodes involvement at diagnosis.

Predictive factors of axillary lymph node involvement in Tunisian women with early breast cancer.

Background: Axillary lymph node involvement (ALNI) is associated with an increased risk of local recurrence and poor prognosis in early breast cancer. The determination of the risk of positive axillary lymph node contributes to therapeutic decisions. Objectives: The aim of this study was to identify clinicopathological predictive factors of axillary lymph node metastases in patients with early breast cancer. Methods: We included patients with clinical T0, T1 andT2 invasive breast carcinoma who underwent resection of the primary tumor and axillary staging by sentinel lymph node biopsy and/or axillar lymph node dissection between 2012 and 2018. Results: Of the 135patients included, 41.5% had ALNI. Regarding univariate analysis, clinical factors correlated with positive ALNM were clinical tumour size>30mm, clinical tumour stage, clinical number of tumours, clinical axillary nodal status and nodal status on ultrasound. Pathologic factors associated with nodal involvement were pathologic tumour stage, tumour grade SBR, number of foci, lymphovascular invasion, perineural invasion and Ki67>20%.In multivariate logistic regression, clinical axillary nodal status, pathologic tumour stage and lymphovascular invasion (LVI) remained as independent predictors of ALNI. Conclusions: Based on these results, we suggest that clinical axillary nodal status, pathologic tumour stage and LVI are predictive factors for ALNM in Tunisian women with early breast cancer.

Primary ectopic breast carcinoma: a case report.

BACKGROUND: Ectopic breast tissue is present in 2-6% of women. Ectopic mammary tissue can experience physiological changes and the same pathological processes as the eutopic breast. Ectopic breast cancer represents an uncommon condition accounting for 0.3% of all breast neoplasms, and it is most frequently located in the axilla. CASE REPORT: We report a rare case of a 57-year-old Tunisian woman who presented with a left-sided axillary mass evolving for about 1 month. The axillary ectopic breast tissue containing the mass was excised with axillary dissection. Pathology revealed a medullary multifocal carcinoma and metastasis was detected in two lymph nodes. She had local radiotherapy after six cycles of chemotherapy. She received herceptin therapy and hormonotherapy. After a 2-year follow-up, no evidence of local recurrence or distant metastases have been identified. CONCLUSION: Ectopic breast carcinoma is a rare entity that should be the first diagnosis to be considered if an axillary lump is present in ectopic breast tissue. No particular guidelines on diagnosis and treatment are available. Therefore, physicians should be aware of this condition to avoid treatment delays. Once diagnosed, careful patient follow-up is essential because of the ambiguous natural history of this rare entity.

Social Support Is Linked to Post-Traumatic Growth among Tunisian Postoperative Breast Cancer Women.

The struggle with breast cancer (BC) is often associated with positive changes after diagnosis and treatment, that are being referred to as posttraumatic growth (PTG). We aimed to examine PTG and its relationship with psychosocial (i.e., psychological distress, spiritual well-being, social support), sociodemographic and cancer-related variables in Tunisian women operated on for breast cancer. This was a cross-sectional study. Seventy-nine (79) postoperative BC women were administered the Post-Traumatic Growth Inventory, the Spiritual Well-being Scale, the Depression, Anxiety and Stress Scales, and the Multidimensional Scale of Perceived Social Support. The changes most frequently reported by participants were discovering that they were stronger than they thought they were (70.0%), having stronger religious faith (65.0%), and being better able to accept the way things work out (63.8%). Multivariate analysis showed that anxiety and social support remained significantly associated with PTG, while no significant relationship has been found for spiritual well-being. Overall, the present study adds to the existing body of research by identifying factors related to women' s experience of PTG in a previously unexplored Arab Muslim cultural context, Tunisia. We believe that our findings may help inform strategies aiming at promoting positive psychological changes after experiencing BC, at least in our context.

Chemoradiotherapy or chemotherapy as adjuvant treatment for resected gastric cancer: should we use selection criteria?

BACKGROUND: The management of gastric adenocarcinoma is essentially based on surgery followed by adjuvant treatment. Adjuvant chemotherapy (CT) as well as chemoradiotherapy (CTRT) have proven their effectiveness in survival outcomes compared to surgery alone. However, there is little data comparing the two adjuvant approaches. This study aimed to compare the prognosis and survival outcomes of patients with gastric adenocarcinoma operated and treated by adjuvant radio-chemotherapy or chemotherapy. MATERIALS AND METHODS: We retrospectively evaluated 80 patients with locally advanced gastric cancer (LGC) who received adjuvant treatment. We compared survival outcomes and patterns of recurrence of 53 patients treated by CTRT and those of 27 patients treated by CT. RESULTS: After a median follow-up of 38.48 months, CTRT resulted in a significant improvement of the 5-year PFS (60.9% vs. 36%, p = 0.03) and the 5-year OS (55.9% vs. 33%, p = 0.015) compared to adjuvant CT. The 5-year OS was significantly increased by adjuvant CTRT (p = 0.046) in patients with lymph node metastasis, and particularly those with advanced pN stage (p = 0.0078) and high lymph node ratio (LNR) exceeding 25% (p = 0.012). Also, there was a significant improvement of the PFS of patients classified pN2-N3 (p = 0.022) with a high LNR (p = 0.018). CTRT was also associated with improved OS and PFS in patients with lymphovascular and perineural invasion (LVI and PNI) compared to chemotherapy. CONCLUSION: There is a particular survival benefit of adding radiotherapy to chemotherapy in patients with selected criteria such as lymph node involvement, high LNR LVI, and PNI.

Pseudo-Meigs' Syndrome in Tunisian H Syndrome Female Patient: First Case Reported.

H syndrome is an extremely rare autosomal recessive affection caused by biallelic mutations in the SLC29A3 gene encoding the human equilibrative nucleoside transporter hENT3. The hallmark signs are cutaneous consisting of hyperpigmentation and hypertrichosis patches. Besides, associated systemic manifestations are highly various reflecting phenotypic pleiotropism. Herein, we report a first case of pseudo-Meigs' syndrome occurring in a young Tunisian H syndrome diagnosed patient with a novel homozygous frameshift mutation in exon 2 of the SLC29A3 gene: p.S15Pfs*86 inducing a premature stop codon. The patient developed ascites associated with left ovarian mass and she underwent surgery. After tumor resection, ascites disappeared rapidly. Histological examination showed serous cystadenoma of the ovary orienting the diagnosis towards pseudo-Meigs' syndrome.

Epidemiological and anatomopathological profile of breast cancer in the region of North-West of Tunisia.

INTRODUCTION: Breast cancer is a common and serious disease. It represents the first cause of mortality and morbidity from cancer of Tunisian women and worldwide. AIM: To analyze the clinico-pathological and evolutionary characteristics of the patients followed at the carcinology's pole in the region of the North-West of Tunisia. METHODS: We conducted a retrospective descriptive study of 114 patients, who were diagnosed with non metastatic breast cancers over a 6-year period, from January 2011 to December 2016. RESULTS: Among the 289 patients treated in the medical carcinology department of the Jendouba regional hospital for invasive breast carcinoma over a period of 6 years, 114 patients had localized breast carcinoma, they were the subject of our study. The average age was 51 years. Nonspecific invasive cancer was the most frequent histological type (95.6%). The mean histological size was 29.3 mm. SBR grade II was most prevalent. Histological lymph node involvement was observed in 50.9%. Lymphovascular invasion was detected in 23.9% of cases and perineural sheaths was detected in 21.9% of cases. The most common molecular subtype was Luminal B. After discussion in a multidisciplinary concertation meeting, the patients received locoregional treatment: surgery, radiotherapy and systemic treatment: chemotherapy, endocrine hormone therapy. After a median follow-up of 45 months, OS and PFS at 5 years were 85.6% and 79.2% respectively. CONCLUSION: In the region of the North-West of Tunisia, breast cancer is characterized by its occurrence at a young age, the importance of tumor size, the importance of lymph node involvement, the frequency of inflammatory breast carcinoma and especially by the predominance of the molecular groups Luminal B and HER2 neu.

Hopelessness is associated with poor sleep quality after breast cancer surgery among Tunisian women.

BACKGROUND: Sleep disorders are a common complaint in breast cancer patients. These women suffer from fear of death, fear of suffering, treatment complications as well as social devaluation; all leading to feelings of hopelessness. The objectives of this work were to evaluate the quality of sleep in a group of breast cancer women, and to analyze the association between sleep quality, depression, and hopelessness. METHODS: A cross-sectional study was carried out over a period of 3 months, including 50 women suffering from breast cancer and having received a surgical treatment of their disease. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). The evaluation of depression was performed using the Beck Depression Inventory (BDI-II). Hopelessness was measured with the Beck hopelessness scale (BHS). All participants were screened using the Arab-language version of these scales. RESULTS: Of 66% of breast cancer patients were considered as poor sleepers (PSQI scores >5), 30% of our sample had a moderate to severe depression, and 24% had a high level of hopelessness. PQSI scores were negatively correlated with depression (P < 0.001) and hopelessness scores (P < 0.001). Multivariate analysis retained as main predictors of the sleep quality habitation and hopelessness scores. After controlling for demographic (age) and social (habitation) variables, hopelessness significantly contributed to sleep quality. CONCLUSION: Hopelessness was positively associated to sleep disorders in women suffering from breast cancer. Hopelessness requires an appropriate management in order to prevent depression and suicide and to improve the quality of life of these patients.