The Prognosis and Predictive Value of Estrogen Negative/Progesterone Positive (ER-/PR+) Phenotype: Experience of 1159 Primary Breast Cancer from a Single Institute.

Breast cancer is a serious worldwide public health problem and is currently the most common cancer overall. Its endocrine therapy is related to the expression of the steroid hormones, estrogen receptor (ER), and progesterone receptor (PR). Breast cancers can be presented under multiple profiles of steroid hormones: ER(-)/PR(+), ER(+)/PR(-), double-positive/negative ER, and PR. 2-8% of all breast cancers express only PR (ER-/PR+) which is an abnormal phenotype, with less known about their behaviors and outcomes. Our study was performed on a large and well-characterized database of primary breast cancer from 2012 to 2019, up to 1159 cases. These cases were divided according to ER and PR expression, as we put all of our focus on ER-negative/PR-positive group, more specifically ER-/PR+/HER2+ and ER-/PR+/HER2- gene expressions, to highlight their features and find a pattern that links HR (hormone receptors) profiles and breast cancer subtypes. Out of the informative cases, 94 patients (8%) had ER-/PR+ breast cancers, while 676 (58.4%) had ER+/PR+, 88 (7.6%) had ER+/PR-, and 164 (14.2%) had ER-/PR- tumors. The ER-/PR+ group was statistically correlated with a high risk of recurrence and death in midway between the double-negative and double-positive HR. According to HER2 status, a low DFS was observed in patients ER-/PR+/HER2-, which is closer to the DFS of TNBC cases but worse than ER+/PR any. On the other side, the ER-/PR+/HER2+ showed also a poorer DFS closer to the HER2+ subgroup in between TNBC and ER+/PR any. The clinicopathological features of the ER-/PR+/HER2- and ER-/PR+ HER2+ have distinguished the patients into two groups with a difference in some clinicopathological characteristics: both groups had closer OS estimation, which was worse than ER-/PR any and better than TNBC and HER2. The ER-/PR+/HER2- seems to increase the risk of recurrence than ER-/PR+/HER2+ when compared to ER+/PR any. On the other hand, the ER-/PR+/HER2+ seems to increase the risk of death more than ER-/PR+/HER2- in comparison with ER+/PR any. Our results support that ER-/PR+ tumors really exist and are rare and clinically and biologically distinct subtypes of breast cancer. In addition, our analysis, which was based on dividing the groups according to HER2 expression, has revealed the existence of two distinct groups; this gave the ER-/PR+ subgroup a heterogeneity characterization. Moreover, this breast cancer subtype should not be treated as a luminal tumor but rather according to the HER2 expression status.

[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.

[Small cell neuroendocrine carcinoma of the vulva]. / Carcinome neuroendocrine à petites cellules de la vulve.

Neuroendocrine small cell carcinoma of the vulva is a rare and aggressive cancer with a pejorative behavior. Because it is rare, there is no consensus to date. We report the fourteenth case of a 52-year-old woman with neuroendocrine small cell carcinoma of the vulva, treated by surgery and combined chemoradiotherapy 46 Gy and cisplatinum-étoposide and adjuvant chemotherapy. Twelve months after the diagnosis, she is alive with no evidence of disease recurrence. A review of the literature on this topic is also presented.

Primary breast leiomyosarcoma.

Primary leiomyosarcoma of the breast is an extremely rare neoplasm. Only few cases have been reported in the literature. We report here a case of breast leiomyosarcoma in a 44-years-old female and we discuss the data of the existing literature.

A Case of a Metastatic Disease to the Pancreas from a Small-Cell Lung Carcinoma Documented by a CT-Scan-Guided Trucut Biopsy: The Diagnostic Role of Cytomorphology and Immunohistochemistry.

Unlike primary pancreatic carcinoma, metastatic lesions of the pancreas are uncommon and account for approximately 2% of pancreatic malignancies. Small-cell lung carcinoma (SCLC) represents a group of highly malignant tumors giving rise to early and widespread metastasis at the time of diagnosis. However, the pancreas is a relatively infrequent site of metastasis by this neoplasm, and reports on metastatic small-cell carcinoma (SCC) in the pancreas, either of pulmonary or extrapulmonary origin, to be diagnosed by CT-scan-guided trucut biopsy (CT-TCB) are very rare. A 56-year-old man presented with a laterocervical lymphadenopathy associated to a mixed-density lung mass and a mass in the pancreatic body. CT-TCB slides from the pancreatic mass contained small, round tumor cells with extensive nuclear molding. The cytomorphological and histological diagnosis was metastatic SCC. Immunocytochemical staining showed that a variable number of neoplastic cells were positive for cytokeratin 7, TTF1, chromogranin A, and synaptophysin but negative for leukocyte common antigen and cytokeratin 20 with a very high expression of KI67. The transbronchial needle biopsy confirmed the diagnosis of an SCC. This case represents a rare metastatic lesion in the pancreas from SCLC, diagnosed by CT-TCB histological and immunohistochemical studies.

Signet Ring Cell Carcinoma of the Vater's Ampulla: A Very Rare Malignancy.

Most tumors affecting Vater's ampulla are adenocarcinomas, and other histological variants are less frequent. Signet ring cell carcinoma is more commonly found in the stomach than at other sites of the digestive system. Signet ring cell carcinoma of the Vater's ampulla is extremely rare, and only 15 cases have previously been described in the literature. It mainly occurs in elderly patients (median age = 57 years). We report a case of advanced signet ring cell carcinoma of the ampulla of Vater, with invasion of the duodenum (D3) admitted in the Medical Oncology Unit of HASSAN II University Hospital.

[Neoadjuvant chemotherapy in non-small cell lung cancer: current state and future]. / La chimiothérapie néoadjuvante dans les cancers pulmonaires non à petites cellules : état des lieux et perspectives d'avenir.

Non-small cell lung cancer (NSCLC) continues to be the leading cause of cancer-related mortality in the world. The combination of chemotherapy and surgery is a standard of care for resectable NSCLC. If the adjuvant chemotherapy is a standard, the role of neoadjuvant chemotherapy is still debated. Most trials of neoadjuvant chemotherapy were closed when the positive studies of adjuvant chemotherapy were published. Only the Spanish trial NATCH, designed to compare the neoadjuvant chemotherapy in the adjuvant chemotherapy, was fully completed. Therefore, the trials of preoperative chemotherapy lack strength to become proof of concept. Confirmation will come from meta-analyses. Two of them are positive. Others are in progress. The current research is to select the patients according to predictive factors to chemotherapy response.

[Phyllodes tumors of the breast: analysis of 53 patients]. / Tumeurs phyllodes du sein à propos de 53 cas.

PURPOSE: Phyllode tumors of the breast are fibroepithelial tumors similar to fibroadenomas but with a predominant conjunctive tissue component. These are composed of a connective tissue stroma and epithelial elements. They are rare with an incidence of 0.3-0.9% of all breast neoplasms. The present study demonstrates the recent experiences in diagnosis, therapeutical management and clinical follow-up of this disease. PATIENTS AND METHODS: This is a retrospective study of the experience of the Institut National d'Oncologie (INO, Rabat) from 1998 to 2006. RESULTS: We included 53 patients. Median age was 37.2 years (15-67), tumor size was 1-30cm (median 10.25cm). The histological diagnosis was based on the biopsy in (7.8%) cases and extemporany in 22% cases, distant metastasis occurred in two patients; the treatment consisted of a surgery. The median follow-up was three years. Local recurrence occurred in ten patients. Distant metastasis occurred in two patients and five patients have died. CONCLUSION: The confrontation of our results to the data of the international literature shows that the diagnosis of the phyllodes tumours is histological. The basis of the treatment is surgery. The adjuvant radiotherapy is very important in patients at high risk for local recurrence; chemotherapy has a badly defined place. The prognostic is based on the histological characters of the tissue conjunctive component of these tumours.

Desflurane pharmacokinetics during cardiopulmonary bypass.

OBJECTIVE: To describe the washin and washout of desflurane when first administered during cardiopulmonary bypass (CPB) for cardiac surgery. DESIGN: A single-arm prospective study. SETTING: University-affiliated hospital operating room. PARTICIPANTS: Ten adult patients presenting for cardiac surgery. INTERVENTIONS: Consenting patients presenting for cardiac surgery received anesthesia with midazolam and fentanyl. Patients were cooled to 32 degrees C on CPB, then desflurane 6% was administered and blood samples drawn repeatedly from the arterial and venous bypass cannulae as well as from the membrane oxygenator inlet and exhaust from 2 to 32 minutes of desflurane administration. Just before rewarming, final (maximum) washin samples were taken. On rewarming, desflurane was discontinued, and blood and gas samples were taken 2 to 24 minutes thereafter. MEASUREMENTS AND MAIN RESULTS: CPB time was 116 +/- 10 minutes, and ischemic time was 81 +/- 6 minutes. Mean pump flow was 4.49 +/- 0.03 L/min, and mean arterial pressure was 70.1 +/- 1 mmHg during the study period. Arterial washin of desflurane was initially rapid; arterial concentrations reached 50% of administered concentrations within 4 minutes, but then slowed, reaching 68% of inspired concentrations at 32 minutes (desflurane concentration 4.0% +/- 0.3%). Arterial washout of desflurane was more rapid; arterial concentrations fell to 18% of the maximum concentration reached within 4 minutes, and only 8% of the maximum arterial concentration was present in blood 20 minutes later. CONCLUSION: Desflurane showed rapid initial washin and washout on CPB when administration was started at 32 degrees C and stopped at time of rewarming.