[Bilateral gestational macromastia: case report]. / La gigantomastie gravidique bilatérale: à propos d'un cas.

PURPOSE: We report a case of bilateral gestationnal macromastia in order to discuss the pathogeny, the diagnosis and the treatment. METHODOLOGY: It was a case of a 33-year-old woman, admitted for a bilateral massive hypertrophy of the breast occurring on pregnancy and with progressive evolution. She had three pregnancies and one born-infant. Biological exams have shown a hyperprolactinemia. Pathological exam of the mammary biopsy had shown a benign hyperplasia. RESULTS: Medical treatment of our patient by bromocriptin was inefficient. She has had a bilateral mastectomy. She is waiting for mammary plastic surgery. CONCLUSION: Gravidic macromastia is a rare pathology whose etiology and treatment are much debated. Frequent recurrence after mammary reduction justify the mastectomy followed by prothesis.

So-called "historical" necrotic breast cancers: a terrifying actuality in Africa. The case of Burkina Faso.

Study the epidemiological, diagnostic, and treatment features and outcomes of necrotic breast cancer in women. This observational, longitudinal, and descriptive study covered the period from January, 2011, to the end of May, 2016 at the Surgery and Gynecology Departments of Yalgado Ouedraogo University Hospital and Schiphra Medical Center. The study included all women with necrotic breast cancers. Survival was calculated by the Kaplan Meier method and survival comparison was possible with the log-rank method. À risk of error of 0.05 was allowed. Necrotic cancer accounted for 9.1% of all breast cancers. The median age of the patients was 46 years old. The median interval before consultation was 12.4 months. The histological type was invasive ductal carcinoma in 90.8% of cases. Surgery was performed in 51 patients (52%). It was a palliative (cleaning) procedure in 92.2% of cases. Chemotherapy was performed in 28 patients. Overall survival was 61.8% at 6 months, 39.5% at 1 year, and 9.2% at 3 years. Median survival was 10 months: 13 months for women with surgery and 6 months for those without it (p<0.001). Necrotic breast cancer is still common in Ouagadougou. Surgery is the mainstay of the treatment. Survival is mediocre. It therefore seems urgent to focus on raising population awareness and organizing screening campaigns.

Strengthening human genetics research in Africa: report of the 9th meeting of the African Society of Human Genetics in Dakar in May 2016.

The 9th meeting of the African Society of Human Genetics, in partnership with the Senegalese Cancer Research and Study Group and the Human Heredity and Health in Africa (H3Africa) Consortium, was held in Dakar, Senegal. The theme was Strengthening Human Genetics Research in Africa. The 210 delegates came from 21 African countries and from France, Switzerland, UK, UAE, Canada and the USA. The goal was to highlight genetic and genomic science across the African continent with the ultimate goal of improving the health of Africans and those across the globe, and to promote the careers of young African scientists in the field. A session on the sustainability of genomic research in Africa brought to light innovative and practical approaches to supporting research in resource-limited settings and the importance of promoting genetics in academic, research funding, governmental and private sectors. This meeting led to the formation of the Senegalese Society for Human Genetics.

Le 9ème congrès de la Société Africaine de Génétique Humaine, en partenariat avec le Groupe d'Etude et de Recherche sur le Cancer (GERC) et le Consortium H3Africa, s'est tenu à Dakar, au Sénégal. Le thème était «Renforcer la recherche en Génétique Humaine en Afrique¼. Les 210 participants sont venus de 21 pays africains et de six non africains. L'objectif était de valoriser la génétique et la génomique à travers l'Afrique avec comme but ultime d'améliorer la santé des populations, et de promouvoir les carrières des jeunes chercheurs Africains. Une session sur la pérennité de la recherche génomique a révélé des approches innovantes et pratiques supportant la recherche dans des contextes de ressources limitées et l'importance de promouvoir la formation universitaire en génétique, le financement de la recherche par les gouvernements et le privé. Ce congrès conduisit à la création de la Société Sénégalaise de Génétique Humaine.

Preliminary survey of ochratoxin A in millet, maize, rice and peanuts in Côte d'Ivoire from 1998 to 2002.

In a preliminary study, samples of millet (n =33) maize (n=41), rice (n=10) and peanuts (n=10) from Côte d'Ivoire were analysed for ochratoxin A (OTA) by HPLC with fluorimetric detection, followed by confirmation by cleavage of the OTA molecule using carboxypeptidase with HPLC separation and fluorimetric quantification of the released ochratoxin alpha (OTh). With the exception of four samples of peanuts, all samples showed OTA contamination, ranging from 3 to 1738 microg/kg. All cereals were contaminated and the OTA concentrations were in the range of 17-204 microg/kg for millet, 3-1738 microg/kg for maize, 9-92 microg/kg for rice and 0.6-64 microg/kg for peanuts, depending on the year of harvest. Most of the samples would not be accepted according to the EU regulatory limits for this mycotoxin. Following this survey, research for other mycotoxins and the evaluation of the exposure of the population is underway.

[Pap smear for mass screening: Results of an African experiment]. / Dépistage de masse par frottis cervicovaginal : résultats d'une expérience africaine.

OBJECTIVES: To assess the impact of smear test in the fight against cervix uteri cancer in Senegal. METHODS: This was a descriptive cross-sectional study of 1836 Pap smears performed in patients over 15 years during several screening campaigns in Senegal conducted between June 2010 and June 2012. We analyzed epidemiological data, pathological smears, and the proposed management. RESULTS: In 69% of cases, the women were less than 45 years old. They were mostly multiparous and did not use contraceptive methods before. The smears were interpreted in 91.4% (n=1661) and were pathological in 5.2% of cases. They revealed mainly atypical squamous cells of undetermined significance, squamous intraepithelial low-grade lesions, and squamous intraepithelial high-grade lesions, respectively in 2.5% (n=46), 1.7% (n=30) and 1% (n=19) of cases. Multiparity, early marriages were the main risk factors. Patients with pathological smars had colposcopy with cryotherapy (23 cases), and colposcopy and biopsy (13 cases). A hysterectomy was performed in 4 cases. CONCLUSION: The pathological smear rate found in this study confirms the interest to continue cervical cancer screening with this practice. Strengthening of its geographical and financial access through a national prevention program will effectively help to lower cases of cervical cancer.

[Arthroscopic subacromial decompression.]. / Arthroskopische subakromiale Dekompression.

Patients suffering from impingement grade II and III by Neer have to be operated on, if conservative therapy has failed. The value of the arthroscopical subacromial decompression in these patients is not completely cleared. In our study 54 patients have been followed up (mean 12 months). Using the UCLA - Score there were 44% very good and 50% good results; only one patient had a bad result. The average improve in the UCLA scoring from pre- to postoperative status was 14 points. Another very important advantage compared to the open procedure is the very short rehabilitation time. Key words: arthroscopy, subacromial decompression, humeroscapular periarthritis, impingement.

[Cancers of the anus: 32 cases]. / Les cancers de l'anus: à propos de 32 cas.

The purpose of this retrospective study about 32 anal carcinoma was to determine the epidemoilogy, to discuss the therapeutic indications. The mean age of patients was 56.42 years and the protologic antecedent was 14%. According to the clinical staging: 1 patient was T1, 2 T2, 19 T3, 10T4; 1 No, 2 Nx, 7 N1, 10 N2, 12 N3; 25 M x, 5 MO, 2 M1. The histologic classification of OMS found: 17 epidermoid carcinoma, 12 glandular carcinoma, 1 transitional cell carcinoma, and 1 non classify cancer. 14 radical resection and 3 local resection were realised, 8 patients had an exclusive radiotherapy: 2 curative radiotherapy and 6 palliative. The morbidity was 9.37% and dominated by perineal suppuration and the mortality was 3.12%. The adjunctive radiotherapy must be the first treatment of the anal cancer in our countries.

[Epidemiological factors, treatment and prognosis of uterine sarcomas: 14 cases at the Cancer Institute of Dakar]. / Etude des facteurs épidémiologiques, du traitement et du prognostic des sarcomes de l'utérus: à propos de 14 cas colligés à l'Institut du Cancer de Dakar.

The study of uterus sarcoma took in interest because these tumors were unrecognized and sat nowadays many questions. The purpose of this study is to review the epidemiological factors, the problems of treatment and prognostic of uterus sarcoma. It's a retrospective study of 14 sarcomas of uterus reported from 1959 to 1997. The mean age of the patients was 54 years and they were on menopause in 78.6%. The clinical investigation found according the FIGO staging: 6 stage I (42.6%), 4 stage II (28.4%), 1 stage III (7.1%) and 3 stage IV (21.4%). The leiomyosarcoma (42.6%) appeared as the more frequent histologic lesion. Surgery was the principal treatment: it was alone on 3 cases (24.9%), associated with chemotherapy on 8 cases (66.8%) and one patient had an association surgery, chemotherapy and radiotherapy. The global survival was 21.4% at 2 years and all the patients were dead at 5 years and it seemed that it would be better when the patients were treated by radical surgery associated with chemotherapy and radiotherapy.

[Primary lymphoma of the thyroid: a case report]. / Lymphome primitif de la thyroïde: a propos d'un cas.

Primary lymphoma of the thyroid is an uncommon disease. It diagnosis is difficult without immunohistochemestry. We report a case of thyroid lymphoma diagnosed at the A. Le Dantec Hospital of Dakar. A 22-year old young man presented anterior neck mass. Clinical examination showed a thyroid mass with a susclavicular palpable lymph node. The scintigraphy demonstrated that the mass was cold. Total thyroidectomy with cervical lymphadenectomy was the first treatment. Histological examination of the surgical specimen concluded that the mass was an anaplastic lymphoma (large cells type) involving the sus clavicular lymph nodes (stage IIE). Chemotherapy was administrated after one month with C-MOPP schedule. The patient presented no recurrent sign after 30 month. Fine needle aspiration and immunocytochemestry of the thyroid cold masses will contribute in an accurate diagnosis and the management of disease in our institution.

[Breast cancer and pregnancy: about 60 cases collected at the Cancer Institut of Dakar]. / Cancer du sein et grossesse: à propos de 60 cas colligés a l'Institut du Cancer de Dakar.

The purpose of this retrospective study of 60 breast carcinoma during pregnancy collected at the Cancer Institut of Dakar from 1962 to 1998 was to determine the epidemiology, the clinical appearance and to discuss the pathogeny, the diagnosis, the prognosis and the treatment. The mean of age of patients was 34.5 years. The number of parity was 5 and the first pregnancy at 20 years. The authors arrived at diagnosis in the post partum in 28 cases (47.45%), in the first trimester in 8 cases (13.55%), in the midtrimester in 13 cases (22.03%) and in the third trimester in 11 cases (18.64%). The polychemotherapy preceded the surgery in 30 cases and succeded in 16 cases. The hormonotherapy with Tamoxifen prescribed in 17 cases after the delivery. The mastectomy and axillary lymphadenectomy was realised in 26 cases in the post partum. The adjuvant radiotherapy was done in 12 cases. The mortality was 31% and the global survival at 2 years, 34.6%.

[Vulvar cancers. Retrospective study of 23 cases at the Cancer Institute of Dakar]. / Les cancers de la vulve. Etude rétrospective à propos de 23 cas colligés à l'Institut du Cancer de Dakar.

The vulvar cancer is an uncommon disease which is beginning mostly on vulvar intraepithelial neoplasma and it keeps a very bad prognostic. The purpose of this study is to report the epidemiological, the anatomo-clinic and and to discuss the treatment. We tell about 23 vulvar cancer from 1956 to 1995 which were followed at the cancer Institut of Dakar. The mean age of patients is 47 years and they are on menopause in 78.6%. The most of the tumors are ulcerate (96%). The clinical investigation find according the staging of FIGO: 15 tumors (T2), 8 tumors (T3), 6 tumors (N1), 9 tumors (N2) and 1 tumor (M1b). The surgery is the principal treatment with 6 radical vulvectomy and 17 palliative vulvectomy. The surgery was associated with radiotherapy and chemotherapy. So the vulvar cancer is uncommon in our country and concern the young wives. The vulvectomy with lymphadenectomy is the principal treatment; the prognostic still very bad because the diagnostic is often later.

[Epidemiological and therapeutic aspects of rectal cancer in Senegal: 74 cases at the Cancer Institute of Dakar]. / Aspects épidémiologiques et thérapeutiques des cancers du rectum au Sénégal: à propos de 74 cas colligés a l'Institut du Cancer de Dakar.

Through a retrospective study of 74 cancer of rectum the autors determine the epidemiology, the anatomic appearance and discuss the treatment, the prognostic. The mean age of patients was 48 years and the Duke's staging found: 16 stages B, 46 stages C and 12 stages D. The pathological anatomy showed: 58 adenocarcinoma, 9 colloïdal adenocarcinoma, 4 epidermoïdal carcinoma, 2 lymphosarcoma, 1 anaplasic adenocarcinoma. The operability rate was 66.2%, the resectability was 40.8% and the sphincteral preserving was 8.1%. The radiotherapy preceded the surgery in 6 cases and associated the chemotherapy. The chemotherapy preceded the surgery thein 14 cases and succeeded in 2 cases. The mortality was 24.4% and the recidivation 35%. The global survival 5 years was 32%. The prognostic could better by an earlier diagnostic and a multidisciplinary treatment.

[Complications of colpohysterectomy with lymph node dissection in the cervix carcinoma at the Cancer Institute of Dakar: report of 412 cases]. / Les complications des colpohystérectomies élargies avec lymphadénectomie pour cancer du col utérin à l'Institut du Cancer de Dakar: à propos de 412 cas.

The wertheim complications are dominated by the urinary dysfonction and the lymphocele which are linked at this procedure. This study reported 412 Wertheim associated to the radiotherapy. The purpose was to evaluate the complications among patients who underwent the Wertheim and to analyse the differents factors promotions the complications. The diagnosis was always late and the disease stage was advanced. The stages II, III and IV represented more than 80%. We found 86 complications (20.87%) distributed as follow: 17 urinary (19.76%), 30 secondary infections (34.88%), 8 colonic fistula (9.30%), 7 hemorrage (8.13%), 6 lymphedema (6.97%), 3 occlusions (3.48%), 1 phlebitis (1.16%), 1 lymphocele (1.16%). among all patients, 17 died, the mortality rate was 4.12%. A very good dissection preceded by radiotherapy may reduce the complications rate.

[Cancer of the uterine cervix in pregnancy: report of 50 cases]. / Cancer du col de l'utérus et grossesse: à propos de 50 cas.

Through a retrospective study of 50 cervix carcinoma during pregnancy, the authors determine the epidemiology, discuss the therapeutic and the pronostic. The mean age of patients were 36 years and the clinical staging of FIGO found : 3 stages Ia, 3 Ib, 7 IIa, 14 IIb, 7 IIIa, 7 IIIb, 4 IVa, 5 IVb The diagnosis of carcinoma was in 6 cases(12%) at first trimester, in 6 cases(12%) at midtrimester, in 13 cases(27%) at third trimester, in 19 cases(28%) after delivery. The termination of pregnancy was an abortion in 6 cases(12%). The treatment was: 29 delivery whose 12 followed bycolpohysterectomy,1 byconisation and 16 had not a colpohysterectomy. 5 cesarean section whose 2 followed by colpohysterectomy in the same time and 3 in the second time. The radiotherapy was neoadjuvant in 3 cases and adjuvant in 3 cases. The mortality was 4 % and the global survival at 5 years was 30%. The prognostic of the cervix carcinoma during pregnancy would get better by Pap test which must be systematic at the pregnant woman.

[Cancers in the scars of thermal burns (apropos of 67 cases)]. / Les cancers sur cicatrices de brulures thermiques: (àpropos de 67 cas).

Burns are very frequent. Skin cancer on burns scars are one of the known complications. The mechanisms and the risk factors of this disease are not very well known. To review the risk factors and the mechanisms of transformation of burn scars into cancer, we analyzed 67 retrospective cases of Marjolin's ulcer to describe the epidemiological features of the disease in our practice and identify the factors of relapse. Our patients are young (means age 41), mainly male (54%), with disease localized on arms and legs (88%). The initial burn was from flames (54%), charcoal or hot cooking oil (19.5%) and never from ionizing radiation. It was never a superficial burn and covered from 4 to 37% of the body surface (mean 14%). The initial treatment was medical in only 9% of cases and ended with 85% of complete healing. After 4 to 67 years of evolution, 95% of re-ulceration occurred. Abnormal lymph node and distant metastasis were diagnosed in respectively 68 and 7% of the cases. Amputation and groin dissection were respectively done in 63 and 50%. One third of patients were lost during the follow up. 25% of the cases are still alive and free of disease. We found 30% of local recurrence and 17.5% of regional recurrence. By univariate analysis we found that the factors significantly associated to loco-regional relapse are: male status (p = 0.0327), burns by cooking oil (p = 0.0118), lack of treatment during initial burn (p = 0.0001), sclerous scar (p = 0.0281), supra regional lymph nodes (p = 0.028) lack of treatment during re ulceration (p = 0.0308). Squamous cell carcinomas on burn scars are rare diseases and of bad prognosis. Mainly associated to domestic accidents they frequently occur on limbs and arms on an articulation. Metastasis is not frequent. Conservative treatment is associated with 30% of recurrence. In our practice, the relapse risk factors are male status, burns by cooking oil, lack of treatment during the initial burn, sclerous scar, supra regional lymph nodes, lack of treatment during re ulceration.

Influence of HIV-1 and/or HIV-2 infection and CD4 count on cervical HPV DNA detection in women from Senegal, West Africa.

BACKGROUND: HIV infection is associated with greater risk of precancerous lesions and cervical cancer in women. However, several factors remain unclarified regarding the association between HIV infection and HPV detection, especially among those with HIV type 2 versus type 1 infection and severely immunocompromised persons. OBJECTIVES: To evaluate HPV overall and type-specific detection among HIV-infected and uninfected women in Senegal. STUDY DESIGN: Detection of HPV DNA for 38 genotypes in cervical swabs using PCR-based methods was evaluated in HIV-positive (n=467) and HIV-negative (n=2139) women participating in studies in Senegal. Among HIV-1 and/or HIV-2 positive women, CD4 counts were assessed. Adjusted multivariable prevalence ratios (PR) were calculated. RESULTS: The prevalence of any HPV DNA and multiple HPV types was greater among HIV-infected individuals (78.2% and 62.3%, respectively) compared with HIV-negative women (27.1% and 11.6%). This trend was also seen for HPV types 16 and 18 (13.1% and 10.9%) compared to HIV-negative women (2.2% and 1.7%). HIV-infected women with CD4 cell counts less than 200 cells/µl had a higher likelihood of any HPV detection (PRa 1.30; 95% CI 1.07-1.59), multiple HPV types (PRa 1.52; 95% CI 1.14-2.01), and HPV-16 (PRa 9.00; 95% CI 1.66-48.67), but not HPV-18 (PRa 1.20, 95% CI 0.45-3.24) compared to those with CD4 counts 500 cells/µl or above. CONCLUSION: HIV-infected women, especially those most severely immunocompromised, are more likely to harbor HPV. Measures to prevent initial HPV infection and subsequent development of cervical cancer through focused screening efforts should be implemented in these high risk populations.

Etude du codon 72 du gene p53 dans la predisposition au cancer du col de l'uterus au Senegal

Introduction: En dehors de l'infection par le Virus du Papillome Humain (HPV); des facteurs genetiques ont ete impliques dans la predisposition au cancer du col de l'uterus. L'allele Arginine du codon 72 du gene suppresseur de tumeur p53 (GC; Arg/Pro); a ete associe a une predisposition au cancer du col de l'uterus chez differentes populations. Notre objectif etait d'etudier l'effet de ce polymorphisme chez une population senegalaise atteinte de cancer du col de l'uterus. Patientes et Methodes: 30 patientes atteintes de cancer du col de l'uterus ont ete recrutees et suivies a l'Institut Curie de l'Hopital Aristide Le Dantec de Dakar et 93 femmes temoins bien portantes sans cancer du col diagnostique. Pour chaque individu; l'ADN a ete extrait a partir de sang total preleve sur tube EDTA. Le genotypage du codon 72 du gene p53 a ete realise par PCR-RFLP. Resultats et Discussion: Il n'a pas ete retrouve une association significative entre l'allele Arginine du codon 72 de p53 et la predisposition au cancer du col de l'uterus (p=0;354) de meme qu'il n'a pas ete retrouve de correlation entre l'allele Arginine et les types de lesions histologiques observees au niveau du col de l'uterus. Malgre l'absence d'association du codon 72 avec la survenue du cancer du col de l'uterus; le gene p53 reste toujours d'actualite dans ce cancer de par son role suppresseur de tumeur

Etude anatomo-pathologique du curage ganglionnaire dans les cancers pelviens

L'etude microscopique des produits de curage ganglionnaire donnent des renseignements interessants sur la conduite therapeutique post-operatoire. Aussi; avons-nous entrepris; de janvier 2003 a decembre 2012 de faire l'analyse microscopique des ganglions issus du curage effectue devant des cancers pelviens. Nous ainsi rassemble; durant la periode d'etude; 470 cancers pelviens dont 184 avaient beneficie d'un curage ganglionnaire (39;1 %). Le taux d'envahissement ganglionnaire etait de 19 % (n=35). Deux inconvenients avaient ete notes : le siege du curage non indique dans 35;9 % (n=66); l'effraction capsulaire et la taille tumorale omises dans plus de la moitie des comptes rendus. Les resultats des analyses microscopiques realisees ont permis l'ajustement du stade d'extension et l'adaptation de la therapie adjuvante

Cancer du sein chez l'homme africain : 46 observations dakaroises

Il s'agit d'une etude retrospective de 46 cas de cancers du sein survenus chez l'homme et colliges a l'institut du Cancer de Dakar de 1957 a 1999. L'age moyen des malades etait de 60;7 ans et la duree moyenne des symptomes etait de 37;5 mois. La repartition des malades selon la classification TNM de l' UICC revelait : 1T1; 1T2; 4T3; 40T4; 40N1; 1N2; SN3; 10M1 PUL; 8M1 OSS et 2M1 HEP. Le carcinome canalaire invasif representait 78;2 pour cent de l'ensemble des lesions histologiques. Nous avons realise 32 mastectomies dont 23 etaient associees a un curage axillaire. La chirurgie etait associe a une chimiotherapie dans 25 cas et a une radiotherapie dans 14 cas. Le traitement hormonal au Tamoxifene fut institue dans 7 cas. Le suivi moyen des malades etait de 24 mois. Le pronostic de ces cancers pourrait etre ameliore par une meilleure education et un diagnostic plus precoce