[Management of phyllodes tumors of the breast at the National institute of oncology of Rabat, Morocco]. / Prise en charge des tumeurs phyllodes du sein à l'Institut national d'oncologie de Rabat, Maroc.

OBJECTIVES: Phyllodes tumors of the breast (PTB) are rare fibro epithelial tumors. Their terminology, histological classification and their treatment are exposed to controversy. The aim of our work is to underline the epidemiological, clinical, histological, therapeutical, prognostic and evolutive features of these tumours through a retrospective study and a review of the literature. PATIENTS AND METHODS: We reviewed at the National Institute of Oncology of Rabat, Morocco, between 1985 and 1998, all the files of patients with histological certainty of PTB, doubtful PTB were excluded. We collected epidemiological, clinical, histological, therapeutical, prognostic and evolutive features of these tumours. STATISTICS: quantitative parameters were represented by mean +/- S.D. and qualitative parameters by percentage or effective. RESULTS: We studied nine cases of PTB, which represented 0.09% of all primitive tumors of the breast treated at our institution during the study period. All our patients were female. Mean age was 37.3 +/- 10.07 years. Two of our patients (22.2%) had a history of fibroadenoma and 44.4% were nulliparous. Mean delay before consulting was 60.7 +/- 17.56 months and the median tumour size was 13 +/- 7.47 cm. Pathological findings were six benign or borderline phyllodes tumours (66.7%) and three cystosarcomas phyllodes (33.3%). The treatment consisted in simple mastectomy in seven cases (77.8%) and tumorectomy in two cases (22.2%). All the surgical margins were clear. Two of the three cystosarcomas phyllodes received adjuvant external bean radiation therapy 50 Gy on the thoracic chest wall. After a median outcome of 3 +/- 2 years ranging from 3 to 74 months, we did not note any relapse or metastasis. DISCUSSION AND CONCLUSION: In our series, PTB happened exclusively in females. History of fibroadenoma within 22.2% of the patients suggests the hypothesis of a filiation between these two entities. Their distinctive features were young age in diagnosis, long delay before consulting, important tumor size, predominant benign and borderline histological types, treatment mainly surgical and good local and distant control.

[Post-radiotherapy ureterovaginal fistula. 12 case reports]. / Fistules urétérovaginales post-radiques. A propos de 12 cas.

The authors report a series of 12 cases of ureterovaginal fistulas observed over 15 years period. Our patients had a mean age of 38 years (range 27 to 44 years old). Eighty four percent of ureterovaginal fistulas were due to radiotherapy and clopohysterectomy. Sixteen percent of ureterovaginal fistulas were due to brachy and radiotherapy. The clinical features were dominated by urine leak via the vagina with persistent micturition. Intravenous urography confirmed the diagnosis and revealed ureterohydronephrosis. Various therapeutic methods were used, in 7 patients treatment consisted of end-to-end anastomosis. We have used ureterovesical reimplantation in 3 cases and double J sent in 2 cases. The course was favourable in 84%.

[Kidney cancer: report of 47 cases]. / Cancer du rein: à propos de 47 cas.

The authors report a series of 47 cases observed over a 15-years period in the department of carcinological at the national oncological institute of Rabat. Patients consisted of 16 mean and 21 women (57%), with a mean age of 49 years old (range 29 to 70 years). The clinical features were polymorph, firstly loin pain (81%), hematuria is the next (25%). A lumbar mass (10%). The diagnosis was established by ultra-sonography and CT-scan in all the patients. The mean tumour diameter was 10 cm (5-17 cm), it were located in down pole in 53%. The surgical procedure consisted of radical nephrectomy and regional or hailer lymph node dissection in 46 patients. The post operative course was marked by one death due to pulmonary metastases. The mean follow-up was (2 to 15 years). Asynchronies metastases occurred in 6 patients after a mean interval (9 to 36 months). The overall 5 year survival was 100% PT1, 78% PT2, 34% PT3.

Male breast cancer. A report of 71 cases.

Male breast cancer is rare; it constitutes 0.2-1.5% of all malignant tumours in men and 1% of all breast cancers. The goal of this retrospective study is to analyse the epidemiologic, clinic, therapeutic and evolutive profiles of this disease in 71 cases collected at the National Institute of Oncology in Rabat, Morocco, between the years 1985 and 1998. The median age was 60 years. No significant risk factor was found. The average consultation's delay was 35 months. The main clinical complaint was a mass beneath the areola in 86% of the cases, associated with ulceration in 18% of the cases. For that, the disease was diagnosed at an advanced stage. Infiltrating ductal carcinoma was the most frequent pathologic type (91.5% of cases). Management consisted especially of radical mastectomy, followed by adjuvant radiotherapy and hormonal therapy with or without chemotherapy. It was possible to follow 58 of the patients. The median of follow-up was 30 months. The evolution has been characterized by local recurrence, after a median delay of 36 months, in five cases (8.5% of all patients). Metastasis occurred, after a median delay of 12 months, in 14 cases (24% of all patients). The site of metastasis was the bone in six cases, lung in five cases, liver in one case, liver and skin in one case and pleura and skin in one case. There were three cases of death. In one case, death was related to lung metastases. In the two remaining cases, death was due to comorbid disease. Progression was observed in one case.

[Association of ovarian juvenile granulosa cell tumor with Maffucci's syndrome]. / Association d'une tumeur ovarienne de la granulosa juvénile à un syndrome de Maffucci.

The authors report a rare case of the ovarian juvenile granulosa cell tumor associated with Maffucci's syndrome (enchondromathosis + hemangiomas), no heriditary mesodermal dysplasia. Sarcomatous changes of chondromas are encountered most frequently; however other various typed neoplasma have been reported: ovarian juvenile granulosa cell tumor may occur not infrequently in female patients with Maffucci's syndrome in the first or second decades. Sarcomatous changes of choromas established prognosis of the Maffucci's syndrome.

[Leiomyosarcoma of the vagina: a rare case]. / Le léiomyosarcome du vagin: une observation rare.

Vaginal leiomyosarcoma is unfrequent. We report on a case in a 50-year-old multipara patient who had presented a posterior vaginal swelling since 6 months. The tumor was discovered at the occasion of pains and non hemorragic discharge. The histological pattern of the tumor was well-differentiated spindle cell sarcoma with pleiomorphic areas. The immunohistochemistry confirmed the smooth myogenic differentiation. The treatment consisted of posterior pelvic exenteration extended to the vagina. The patient is alive and free of disease at 20 months of fellow-up.

[Spermatocytic seminoma. Apropos of a case and review of the literature]. / Le séminome spermatocytaire. A propos d'un cas et revue de la littérature.

We report a case of sperm cell seminoma caused by trauma. The data in the literature indicate the frequency is less than 5% of all seminomas. This case was exclusively located in the gonads and was a pure form. Orchidectomy with high ligature of the cord and adjuvant radiotherapy at the dose of 25 Gy centered on the para-aortic and subdiaphragmatic chains is adequate treatment. When inguinoscrotal surgery is performed, this zone must be irradiated with 25 Gy. Prognosis is satisfactory: 5-year survival is 100% with this protocol.

[Surgery of hydatid cysts of the liver: 581 patients, 952 cysts]. / Chirurgie des kystes hydatiques du foie. 581 patients. 952 kystes.

Over a period of 20 years, surgery was carried out in 581 patients for 952 hydatid cysts of the liver. Patients included 372 females and 209 males, aged from 6 to 70 years, with a mean age of 34 years. 52% of patients were aged between 20 and 40 years. The cyst was single in 324 patients, double in 102, triple in 22 and multiple in 133. Treatment most often consisted of resection of the projecting dome of the cyst (78%), and more rarely pericystectomy (5.5%), hepatic resection (3.5%) or external drainage (4.2%) via a median incision in 412 cases and a subcostal incision in 126 cases. Capitonnage of the residual cavity was combined with resection of the projecting dome, 176 cases included a cystobiliary fistula with migration occurring in 30 cases. Morbidity was 20% and included, in particular, 45 cases of subphrenic abscess. 19 patients showed signs of recurrence and 16 underwent further surgery. Overall mortality was 2.06% i.e. 12 patients. In endemic countries, resection of the projecting dome remains a method which gives good results and has a low mortality and morbidity.