Disseminated ovarian Growing Teratoma Syndrome: a case -report highlighting surgical safety issues.

The ovarian Growing Teratoma Syndrome (GTS) is a rare condition among patients with primary Non-Seminomatous Germ Cell Tumours (NSGCT) presenting with enlarging masses during or after appropriate chemotherapy in the context of normalized serum markers. Several modes of dissemination are suggested, with the most frequent site of metastasis being the peritoneum. We report a case of a young patient with primary ovarian mixed NSGCT, who presented with Growing Teratoma Syndrome not only in the peritoneum but also within a trocar site after an initial surgery consisting in the laparoscopic morcellation and extraction of the ovarian neoplasm. Beside the rarity of this clinical entity, it also demonstrates the utmost importance of the safe laparoscopic management of all complex ovarian masses.

[Adverse skin reactions induced by BRAF inhibitors: a systematic review]. / Effets indésirables cutanés des inhibiteurs de BRAF: revue systématique.

Recent developments and therapeutic use of selective BRAF inhibitors (e.g. dabrafenib and vemurafenib) have significantly improved overall survival and disease-free survival of patients with BRAF V600 mutation-positive metastatic melanoma. Despite their survival benefits, small-molecule inhibitors of BRAF are associated with significant and sometimes severe treatment-related dermatological toxicity. The most common adverse skin reactions include photosensitivity, induced malignant lesions of the skin such as keratoacanthomas, squamous cell carcinoma and new primary melanomas, as well as keratinocyte proliferation and differentiation dysfunctions that can manifest as skin papillomas, hand-foot skin reaction, keratosis pilaris-like rash, acantholytic dyskeratosis and cysts of the milia type. In this article, we describe the clinical and histological features of the cutaneous manifestations induced by vemurafenib and dabrafenib on the basis of our clinical experience and a literature review. The crucial role of dermatologists in patient management is also highlighted.

[An individualized prognosis for truncal melanoma? A series of 77 cases]. / Les mélanomes du tronc ont-ils un pronostic individualisable ? A propos d'une série de 77 cas.

AIMS: Truncal melanoma is characterized by lymphatic drainage to single or multiple basins, affecting different anatomic regions. Since the introduction of sentinel lymph node biopsy (SLN) several questions have aroused in regard to this particular drainage. However, published data available on SLN anatomic distribution and on the prognostic value of multiple-nodal drainage is controversial. The aim of the present study was to provide further evidence based on our own experience. METHODS: From January 2003 through December 2006, a total of 77 melanoma of the trunk were diagnosed and treated at our institution. Systematic lymphoscintigraphy was obtained for all patients, followed by removal of SLN and in-transit lesions. When SLN metastasis was detected a complete lymphadenectomy was performed and adjuvant immunotherapy with interferon was administered. Statistical analysis was performed using Chi2 and Fisher's exact tests for categoric variables and Kaplan-Meier curves for survival. RESULTS: Lymphoscintigraphy visualized 70.1% of single and 28.6% of multiple-nodal drainage (uninterpretable data). The rate of SLN macrometastasis ranged from 7.8 to 14.3%. Micrometastasis were found in 6.5% of patients. Positive SLN were discovered in 12.9% (17/54) of single-nodal and 18.6% (2/22) of multiple-nodal drainage. Melanoma's topography significantly influenced lymphatic drainage distribution, with 28.6% of single-nodal and 71.4% of multiple-nodal drainage for central tumors, and with 79.4% of single-nodal and 19.1% of multiple-nodal drainage for lateral tumors. The group with multiple-nodal drainage was associated non-significantly with primary tumor ulceration, 39 vs 24%. The Breslow thickness did not associate to multiple-nodal drainage. There were no differences in the rate of lymph node metastasis between both groups, 18 vs 12.9%. After a median follow-up of 47 months, prognosis was similar regardless of SLN status, with 80.3% overall survival for negative SLN and 81.3% for positive SLN. Single or multiple drainage did not affect survival rates significantly, with 84% survival for single-nodal drainage and 95% for multiple-nodal drainage. CONCLUSIONS: Primary tumor location (medial location) was the principal risk factor for multi-nodal drainage: lymphoscintigraphy was the best technique for lymphatic drainage assessment. Primary tumor location with single or multi-nodal drainage did not influence the rate of positive SLN and had similar disease-free and overall survival. For us, truncal melanoma has not a different prognosis than melanoma of extremities.

Medullary carcinoma of the breast. A multicenter study of its diagnostic consistency.

Nine pathologists from different institutions reviewed in a double-blind study 16 breast tumors previously indexed as typical medullary carcinoma, atypical medullary carcinoma, or infiltrative ductal carcinoma. A set of 16 slides was circulated two times among the nine pathologists. The diagnoses of typical and atypical medullary carcinomas were based on a definition given by Ridolfi et al. The interobserver and intraobserver agreement was low, with a kappa value of less than .50. The only histological criterion that had more than 50% agreement was the presence or absence of an in situ component in the tumor, assuming that the disagreement of one pathologist is accepted. This study is a snapshot of the problems encountered in the diagnosis of typical medullary carcinoma in a routine context and it shows high levels of variations in diagnostic consistency.

65 and 47 kDa forms of estrogen receptor in human breast cancer: relation with estrogen responsiveness.

In breast cancer nearly 40% of estrogen receptor (ER) positive patients do not respond to hormone therapy. As several species of ER have been described, we examined 41 breast cancers for: (1) the presence of ER and progesterone receptor (PR); (2) the molecular weight (Mr) of ER; (3) estrogen responsiveness, appreciated by the ability of a piece of tumor transplanted in nude mice to show an estrogen-induced protein synthesis (PR synthesis). We found that there are: two species of ER with different Mr (65 and 47 kDa), and three species of tumors (36% containing the highest form of ER alone, 49% bearing the two components in variable amounts, and 15% bearing only the minor species). Eleven of these 41 tumors could be assayed for PR synthesis induction, showing that estrogen responsiveness is correlated with the major component. Due to the limited number of samples (11) the data are preliminary, but they strongly suggest that the different forms of ER could exist in the living cell with different functional abilities.

Weak direct proliferative action of estradiol on human endometrial cells in culture.

Since the recognition by Berthois et al. (1986) that phenol red, a pH indicator in culture media, has a weak estrogenic action on breast cancer cells, all previous experiments reporting a lack of mitogenic activity of estrogens in culture were thought to be artefactual, due to the presence of phenol red. With fifteen primary cultures of normal human endometrial cells realized in phenol red free medium we looked at the addition of phenol red and estradiol. Phenol red has a weak mitogenic activity inducing a 20-40% increase in cell number, showing that normal endometrial cells are less sensitive than breast cancer cells. Estradiol also exerts a mitogenic activity with 15-25% more cells, an increase slightly lower than that induced by phenol red. But such an activity can be observed only in the absence of insulin in the medium and the presence of 10% steroid depleted fetal calf serum. If any of these conditions are not respected, estradiol has no effect on cell multiplication. So it can be concluded that estradiol has a weak direct mitogenic activity on human endometrial cells in culture, but this activity is quantitatively beyond measure with the proliferation triggered in vivo by estrogens during the estrous cycle.

Cutaneous metastatic lymphangitis from squamous cell carcinoma of the cervix.

A case of cutaneous metastatic lymphangitis which appeared during the unusual evolution of a cervix carcinoma is reported. DNA sequences of No. 18 human papilloma virus (HPV) were isolated in both vaginal and cutaneous specimens. The hypothesis that a particular evolution of invasive cervix carcinomas might be related to the type of associated HPV is suggested.