[Cutaneous melanoma: about 200 cases]. / Mélanome cutané: A propos de 200 cas.

AIM: To analyze the clinical and pathological aspects of cutaneous melanoma and to determine the prognostic factors. METHODS: This is a retrospective study about 200 cases of cutaneous melanoma collected in Salah Azaiz Institute over a period of 36 years (1969-2005). RESULTS: The mean age was 55.4 years, with a slight female predominance. The tumour was developed on a pre-existent lesion in 31.5% of cases. The average delay of consultation was 18 months. The mean tumor size was 37 mm (10-180 mm). The ulcero exophytic appearance represented 45% of the cases. The tumor was metastatic in 19.5 % of cases. Hands and feet represented 53% of the tumour localizations. The treatment was curative in 71% of cases and palliative in 13% of cases. The lymph node dissection was performed in 59% of the patients. Histologically, nodular melanoma and Grade V of Clark represented 43.5 and 35% of the cases, respectively. The mean tumoral thickness was 14 mm. Chemotherapy, immunotherapy and radiotherapy were performed in 5.5%, 3.5% and 5.5% of cases respectively. The lymph node recurrences were noted in 43.6% of the patients treated with curative intent. The mean recurrence free survival was 76 months. Tumour size > 2 cm, the localization on the leg, Clark level invasion IV and the involvement of the tumour margin were significant prognostic factors for the recurrence free survival. The prognostic factors for the metastasis free survival were: tumour size, tumour localization, type of resection and finally the lymph node dissection. The 5-year overall survival was 28.5% and was influenced significantly by the tumour size, tumour localization, type of resection, involvement of the tumour margins, Clark grade, tumour thickness and finally the lymph node involvement. CONCLUSION: The dismal prognosis can be improved by early diagnosis and especially the prevention based on the photo protection and surveillance of patients at high risk.

Fertility-sparing surgery in advanced stage malignant ovarian germ cell tumor: a case report.

BACKGROUND: Malignant ovarian germ cell tumor is a rare type of disease, which generally has a good prognosis due to the high chemosensitivity of this type of tumor. Fertility preservation is an important issue because malignant ovarian germ cell tumor commonly affects young women. Although conservation is the standard for early stage, it becomes more debatable as the disease progresses to more advanced stages. AIM: Report the case of a patient with an International Federation of Gynecology and Obstetrics Stage IIIc malignant ovarian germ cell tumor, who had conservative surgery and chemotherapy with a good fertility outcome. CASE PRESENTATION: A 23-year-old North African woman with a left malignant ovarian germ cell tumor stage IIIc was treated by left adnexectomy and omentectomy followed by chemotherapy. A 15-year follow-up showed no signs of relapse, and she completed three full-term natural pregnancies. CONCLUSIONS: Malignant ovarian germ cell tumor is a rare ovarian tumor with a good prognosis. It is usually associated with a good fertility outcome in early stages. However, due to the rarity of the disease in advanced stages, the fertility outcome for this group of patients is not clear. This lack of data surrounding advanced stages points to the need for a meta-analysis of all published cases.

Prognostic Factors of Phyllodes Tumors of the Breast: Analysis of 170 Cases.

Background: Phyllodestumors (PT) of the breast are rare and their prognosis and treatment are still subject of discussion. The purpose of this study is to determine the prognostic factors of this rare tumor. Patients and Methods: We retrospectively reviewed the medical records of 170 patients who had histologically confirmed PT, collected over a period of 24 years in one single Institute (Salah Azaiz Institute). Results: The mean age was of 38.7 years (14-75 years). The mean tumor size was 82.6 mm (15-300). According to criteria of WHO classification, tumors were classified into three groups: benign (97 cases, 57.1%), borderline (22 cases, 12.9%) and malignant (51 cases, 30%). One hundred and twenty eight patients (75.2%) were treated conservatively (96 benign, 17 borderline and 15 malignant) and 42 (24.7%) by radical surgery (6 borderline and 36 malignant). For malignant PT treated by local excision with or without reexcision of the tumor bed, the 5-year overall and recurrence free survivals were 46.2% and 44.2% vs. 55 and 63.8% when the surgery was radical (mastectomy with or without axillary dissection) (P=not significant and P=0.01). The rate of recurrence was 15.3 % (26) after a mean follow-up of 40 months (6 benign, 6 borderline and 14 malignant). Twelve patients developed metastases (7%). The 5-year overall and recurrence free survivals were 92.8% and 91.7%, respectively. In univariate analysis, age and recurrences are not of prognostic value for survival, while tumor size, histotype, necrosis, stromal overgrowth, cytonuclearatypia, tumor margins and number of mitosis were significant prognostic factors for survival. In multivariate study, stromal overgrowth and cytonuclearatypia remained independent predictors for survival. The tumor size and margins status were independent predictors for local recurrence. Conclusion: According to our results, the most important factor for local recurrence is the tumor size and the margins status and for the overall survival is the stromal overgrowth and the cytonuclearatypia. The best treatment remains wide local excision for the benign forms while total mastectomy appears to be correlated to better recurrence free survival in large malignant PT.