Malignant peritoneal mesothelioma: treatment with maximal cytoreductive surgery plus intraperitoneal chemotherapy.

OBJECTIVE: To report survival results in patients with diffuse malignant peritoneal mesothelioma (MPM) treated with maximal cytoreductive surgery followed by immediate intraperitoneal chemotherapy, and to compare them with the median survival of 12-24 months obtained with the standard treatment based on systemic chemotherapy. PATIENTS AND METHODS: Twenty-six patients underwent this new regional approach and a median follow-up of 55 months was achieved after this treatment. Complete cytoreductive surgery (residual disease < 2 mm) was performed in all but one patient. Intraperitoneal chemotherapy was performed with hyperthermia (4245 degrees C) and oxaliplatin in 22 patients. The last 12 patients additionally received irinotecan. Data were prospectively verified and retrospectively analyzed. RESULTS: One patient died postoperatively (4%), and morbidity attained 54%. The median survival exceeded 100 months and the overall 5-year survival rate was 63%. This small series lacks the statistical power required to conduct a well-grounded study on prognostic factors, particularly as the completeness of the surgery is not analyzable here. However, the low-grade histological types had a better disease-free survival rate that was of borderline significance compared to their high-grade counterparts. CONCLUSION: This new approach combining complete cytoreductive surgery considerably increases the survival of patients with MPM compared with the standard treatment based on systemic chemotherapy.

[Gastric adenocarcinoma with lymphoid stroma. About nine cases]. / L'adénocarcinome gastrique à stroma lymphoïde. A propos de neuf cas.

AIM: the purpose of this work is to study the pathological features and the outcome of lymphoid stroma gastric carcinoma and its relation with Epstein-Bar Virus (EBV) and the imortance of the EBV serology in detection of early reccurence. METHODS: between january 1990 and december 2004, 155 patients underwent gastric resection for gastric carcinoma. Nine of them had lymphoid stroma gastric carcinoma. Over all survival as well as disease free survival were determined. Detection of reccurence was based on clinical exam and on findings yielded by endoscopy, radiological exams and EBV serology. A comprison of survival rate of patients beteween current gastric carcinoma and those with lymphoid stroma gatsric carcinoma was done using the Log Rank test. RESULTS: the patients (7 men and 2 women) had a mean age of 61 years (41 to 82). The tumor was in the antrum in 4 cases, in the body of the stomach in 3 cases and in the cardia in 2 cases. The mean tumor size was 8 cm with deep invasion of the stomach wall in 5 cases and ganglionnary invasion in 6 cases out of 9. EBV was detected in all patients by in situ hybridation. Post operative morbidity and mortality were nil. Global survival and disease free survival were, respectively, 53.3% and 65.6% in lymphoid stroma gatsric carcinoma, and 43.4% and 63.5% for current gatsric carcinoma. Three patients died of a reccurent disease after 6, 30 and 33 months. The remaing 6 patients didn't have signs of reccurence. CONCLUSION: lymphoid stroma gastric carcinoma is a bulky, local disease. In our patients, it was always associated with EBV. Over all survival was better than survival of current gastric carcinoma, although there was no significance. EBV serology can be an effective screening procedure of reccurence.

[Epithelioid leiomyosarcoma of the uterine cervix: two cases]. / Lilomyosarcome épithélioïde du col utérin: a propos de deux cas.

BACKGROUND: The epithelioid leiomyosarcoma of the uterine cervix is a rare tumor. Usually, the presenting symptoms are vaginal bleeding and pelvic pain. Surgery is the standard treatment. AIM: To present the characteristic of this rare pathology by mean of two cases handled in the Institute Salah Azaiz. CASES REPORT: Two patients, aged 51 and 42 years, were referred to our institute for vaginal bleeding. Tumors were classified stage II proximal and II distal (FIGO classification modified by Gustave Roussy Institute). The patients had total hysterectomy with pelvic lymph node dissection. Histological exams confirmed the diagnosis of epithelioid leiomyosarcoma of the uterine cervix. Adjuvant external radiotherapy was performed. At 12 and 36 months, the patients are alive with no evidence disease.

[Primary carcinoid tumors of the ovary. Report of three cases]. / Les carcinoïdes primitifs de l'ovaire. A propos de trois cas.

BACKGROUND: Carcinoïdes tumours are a rare type of ovarian tumours which anatomoclinical behaviour differs a little from epithelial type. AIM: Report of three new cases. CASE REPORT: We report 3 observations of ovarian carcinoid tumours in patients aged 50, 23 and 28 years. All our patients were operated in emergency for twisting of appendix in two patients and for acute peritonitis in the third one. Treatment was a one-sided salpingo-oophorectomy. The diagnosis of carcinoid tumour was retained on to the definitive histological exam then the patients were re operated to complete the resection.

[Hydatid cyst of ovary. Report of 7 cases]. / Le kyste hydatique de l'ovaire. A propos de 7 cas.

Hydatid disease is a wide spread disease. It is endemic in Tunisia. Man is contaminated by digestif way and by living with dogs. The disease affects usually liver and lung. Other localisations are rare. Hydatid cyst of the ovary is uncommon and clinically they present like malignant tumour of ovary. We present 7 cases of hydatid cyst of the ovary and we discuss the characteristics of this site of the hydatic disease.

[Male breast cancer: about 123 cases collected at the Institute Salah-Azaiz of Tunis from 1979 to 1999]. / Le cancer du sein chez l'homme: à propos de 123 cas colligés à l'institut Salah-Azaïz de Tunis de 1979 à 1999.

Male breast cancer is rare compared to its female counterpart representing less than 1% of cancer in men. The objective of our retrospective study is to report the epidemiologic and clinical profile and to analyse the therapeutic results and prognostic factors in a Tunisian population collected during a period of 20 years at a single institution. We collected from 1979 to 1999, all the histological confirmed male breast cancers treated at our institution. We analyse the following data: age, clinical presentation and features, therapeutic protocol, results and prognostic factors. Survival was done with the Kaplan-Meier method and comparison with the log-rank test. 123 cases of male breast carcinoma were collected with a median age of 65 years. Most patients (62.2%) have an advanced T4 disease with bilateral lesions in 4 cases. Infiltrating ductal carcinoma represent 91% of all tumours. 85% of tumours expressed hormonal receptor. The treatment consisted in a radical mastectomy in 93 cases (84%) followed by radiotherapy, chemotherapy and in many cases by hormonotherapy. After a median follow up of 26 month, 22 patients presented loco regional recurrence and 41 metastases. Estimated 5-year survival rate was 62%. The presence of metastasis, nodal involvement, advanced disease, and grade affected survival. Male breast cancer represent at our institution 1 % of the male cancers treated comparable to the literature data. T4 tumours represent a higher rate, the treatment approach is the standard applicable in breast cancer; prognostic factors are the classical one like breast cancer in women.