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.

[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.

[Emphysematous pyelonephritis with favourable outcome after conservative treatment]. / Une pyélonéphrite emphysémateuse d'évolution favorable après traitement conservateur.

Emphysematous pyelonephritis is a necrotizing renal infection characterized by bacterial gas production in the renal and perirenal area. It is a rare infection diagnosed in diabetic patients in most cases. Emphysematous pyelonephritis is responsible for a high mortality rate. We report the case of a woman, unknown diabetic, who presented with emphysematous pyelonephritis. Early diagnosis performed by CT-scan allowed effective and conservative surgical treatment and final positive outcome.

[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.