Gastrointestinal stromal tumors: real-life experience of a Moroccan center

Introduction : Les tumeurs stromales gastro-intestinales (GIST) sont des tumeurs mésenchymateuses rares qui ont connu récemment beaucoup de progrès tant sur le plan diagnostique que thérapeutique. Matériel et Méthodes : Notre expérience porte sur 23 cas de GIST colligés à l’hôpital militaire Moulay Ismail de Meknès sur une période de 6 ans (depuis janvier 2011 jusqu’à décembre 2016). Résultats : L’âge moyen de nos patients était de 54,2 ans (de 28 à 73 ans) avec une prédominance masculine plus marquée (16 hommes/7 femmes). Les épigastralgies constituaient le principal mode de révélation de la maladie (73,9 %). La localisation gastrique était la plus fréquente (69,6 %). A l’endoscopie digestive, Il s’agissait le plus souvent d’une masse sous muqueuse (21,7 %). Le type cellulaire fusiforme était prédominant (73,9 %). La tumeur était localisée dans 47,8 % des cas, localement avancée dans 8,7 % des cas et métastatique dans 43,5 % des cas. Le traitement a consisté en une résection chirurgicale carcinologique complète dans 65,2 % des cas. Le traitement médical à base d’imatinib était préconisé chez 20 cas dont 12 cas en situation adjuvante et les autres en situation métastatique. Avec un recul moyen de 3 ans, une rémission complète a été obtenue dans 52,2 % des cas. Conclusion : Les GIST sont des tumeurs rares au Maroc. Elles sont souvent localisées dans l’estomac. La chirurgie dans les GIST localisées doit être macroscopiquement complète. L’imatinib est un traitement « à la carte ». Une étude multicentrique à l’échelle nationale permettrait une analyse plus approfondie du profil des GIST au Maroc.Introduction: Gastrointestinal stromal tumors (GIST) are rare mesenchymal tumors that have recently undergone much progress both diagnostically and therapeutically. Material and methods: Our experience concerns 23 cases of GIST collected at the Moulay Ismail military hospital in Meknes over a period of 6 years (from January 2011 to December 2016). Results: The average age of our patients was 54.2 years (28 to 73 years) with a higher male predominance (16 men / 7 women). Epigastralgia were the main mode of disclosure of the disease (73.9%). Gastric localization was the most common (69.6%). Digestive endoscopy most often showed a submucosal mass (21.7%). The fusiform cell type was predominant (73.9 %). The tumor was localized in 47.8% of cases, locally advanced in 8.7 % of cases and metastatic in 43.5% of cases. Therapeutic management consisted of complete surgical resection in 65.2% of cases. Medical treatment with imatinib was recommended in 20 cases including 12 cases in adjuvant situation and the others in metastatic situation. With a mean follow-up of 3 years, complete remission was obtained in 52.2% of cases. Conclusion: GIST are rare tumors in Morocco. They are often located in the stomach. Surgery in localized GIST should be macroscopically complete. Imatinib is an “at card” treatment. A multicenter nationwide would allow further analysis of GIST profile in Morocco

A Brief Comparative Study on Removal of Toxic Dyes by Different Types of Clay

Increasing amount of organic dyes in the ecosystem particularly in wastewater has propelled the search for more efficient low-cost bio adsorbents. Different techniques have been used for the treatment of wastewater containing toxic dyes such as: biological degradation, oxidation, adsorption, reverse osmosis, and membrane filtration. Among all these processes mentioned, adsorption with low cost adsorbents has been recognized as one of the cost effective and efficient techniques for treatment of industrial wastewater from organic and inorganic pollutants. Clays as material adsorbents for the removal of various toxic dyes from aqueous solutions as potential alternatives to activated carbons has recently received widespread attention because of the environmental-friendly nature of clay materials. This chapter presents a comprehensive account of the techniques used for the removal of industrial cationic and anionic dyes from water during the last 10 years with special reference to the adsorption by using low cost materials in decontamination processes. Effects of different adsorption parameters on the performance of clays as adsorbents have been also discussed. Various challenges encountered in using clay materials are highlighted and a number of future prospects for the adsorbents are proposed

Unusual toxicity of bevacizumab (Avastin®): Hyperlipemia?

Le bevacizumab (Avastin®) est un anticorps monoclonal exerçant une activité antiangiogénique. Son utilisation apporte un gain en survie dans plusieurs localisations tumorales en phase métastatique dont le cancer du sein, le cancer colorectal, le cancer du rein et le cancer bronchique non à petites cellules. Ce traitement est pourvoyeur de toxicités spécifiques comme l’hypertension artérielle, la protéinurie, les perforations digestives ou les évènements thromboemboliques artériels. Nous rapporterons une série de 7 cas d’hyperlipémies apparues (5 cas) ou s’étant aggravées (2 cas) lors d’un traitement par bevacizumab. Tous nos malades ont évolué favorablement par les mesures hygiéno-diététiques, associées ou non à un traitement médical par statines.Bevacizumab (Avastin®) is an antibody humanized monoclonal neutralizing anti-VEGF (anti-growth factor vascular endothelial) exerting anti-angiogenic activity. It has shown its impact on relapse-free survival of patients treated for metastatic tumors including breast cancer, colorectal cancer, kidney cancer and no small cell lung cancer. This treatment is a provider of specific toxicities such as hypertension, proteinuria, gastrointestinal perforation or arterial thromboembolic events. We report a series of seven cases who received this therapy including 5 patients who had no dyslipidemia before treatment and 2 cases who had increased their initial lipid profile. All the patients were placed under Lifestyle and diet, associated or not to medical treatment by statins. The evolution was favorable in all cases

Is there any advantage to combined trastuzumab and chemotherapy in perioperative setting her 2neu positive localized gastric adenocarcinoma?

We report here a 44-year-old Moroccan man with resectable gastric adenocarcinoma with overexpression of human epidermal growth factor receptor 2 (HER2) by immunohistochemistry who was treated with trastuzumab in combination with chemotherapy in perioperative setting. He received 3 cycles of neoadjuvant chemotherapy consisting of trastuzumab, oxaliplatin, and capecitabine. Afterwards, he received total gastrectomy with extended D2 lymphadenectomy without spleno-pancreatectomy. A pathologic complete response was obtained with a combination of trastuzumab and oxaliplatin and capecitabine. He received 3 more cycles of trastuzumab containing regimen postoperatively

Diagnostic challenge for ovarian malignant melanoma in premenopausal women: Primary or metastatic?

<p>Abstract</p> <p>Background</p> <p>In the ovary, metastatic malignant melanoma may be confused with primary malignant melanoma and presents a diagnosis challenge. Most cases are associated with disseminated diseases and poor prognosis. We present this case report of a metastatic ovarian malignant melanoma simulating primary ovarian cancer.</p> <p>Case report</p> <p>A 45-year-old premenopausal woman was incidentally found to have an abdominal mass, 3 years after removal of a cutaneous melanoma lesion. Ultrasound and CT scan revealed left two solid masses, which were found to be an ovarian tumor at laparotomy. Left oophorectomy was performed. Histopathology and immunohistochemistry showed melanoma metastasis to the ovary. Nine months later, the patient developed epilepsy and confusion. Magnetic Resonance Imaging showed unique Wright frontal lobe lesion. She underwent stereotactic radio surgery and dacarbazine monotherapy. For months later, the patient is died from disseminate disease progression.</p> <p>Conclusion</p> <p>Ovarian metastasis is an unusual presentation of cutaneous melanoma and the prognosis was dismal. As illustrated by this case report, a differential diagnosis of a metastatic malignant melanoma must be considered.</p

Gene expression profiling of monkeypox virus-infected cells reveals novel interfaces for host-virus interactions

Monkeypox virus (MPV) is a zoonotic Orthopoxvirus and a potential biothreat agent that causes human disease with varying morbidity and mortality. Members of the Orthopoxvirus genus have been shown to suppress antiviral cell defenses, exploit host cell machinery, and delay infection-induced cell death. However, a comprehensive study of all host genes and virus-targeted host networks during infection is lacking. To better understand viral strategies adopted in manipulating routine host biology on global scale, we investigated the effect of MPV infection on Macaca mulatta kidney epithelial cells (MK2) using GeneChip rhesus macaque genome microarrays. Functional analysis of genes differentially expressed at 3 and 7 hours post infection showed distinctive regulation of canonical pathways and networks. While the majority of modulated histone-encoding genes exhibited sharp copy number increases, many of its transcription regulators were substantially suppressed; suggesting involvement of unknown viral factors in host histone expression. In agreement with known viral dependence on actin in motility, egress, and infection of adjacent cells, our results showed extensive regulation of genes usually involved in controlling actin expression dynamics. Similarly, a substantial ratio of genes contributing to cell cycle checkpoints exhibited concerted regulation that favors cell cycle progression in G1, S, G2 phases, but arrest cells in G2 phase and inhibits entry into mitosis. Moreover, the data showed that large number of infection-regulated genes is involved in molecular mechanisms characteristic of cancer canonical pathways. Interestingly, ten ion channels and transporters showed progressive suppression during the course of infection. Although the outcome of this unusual channel expression on cell osmotic homeostasis remains unknown, instability of cell osmotic balance and membrane potential has been implicated in intracellular pathogens egress. Our results highlight the role of histones, actin, cell cycle regulators, and ion channels in MPV infection, and propose these host functions as attractive research focal points in identifying novel drug intervention sites

Generic docetaxel chemotherapy induced skin toxicities in breast cancer patient

Female patient, 52 years old, three months after mastectomy due to breast cancer was subjected to chemotherapy with docetaxel. After the first cycle she presented erythema and dysesthesia of the burning sensation type that greatly improved in 2 weeks. After the next session there was relapse of symptoms. She was treated with a topical corticosteroid for 7 days. There was partial improvement of symptoms. At each new chemotherapy session she presented the same symptoms with greater intensity and less expressive improvement with the treatment. Docetaxel belongs to the taxane group and act by inhibiting mitotic activity due to the suppression of microtubule depolymerization. Signs of dermatological toxicity are observed in around 65% of cases and include alopecia, hypersensitivity reactions and ungual alterations. The reactions usually occur after the first treatment cycle and are dose dependent, with relief of discomfort during relapses when the amount of the drug being given is decreased. There usually is spontaneous resolution after 2 weeks, with recurrence when the drug is reintroduced. The use of topical or systemic corticosteroids and application of cold compresses is recommended for incapacitating pain. Preventive treatment with pyridoxine was reported as beneficial in one study. It is recommended to apply local hypothermia to acral regions during medication infusion to decrease local drug perfusion. A few studies suggests that some toxic effects of docetaxel may be related to the excipients used in different formulations of the drug.The Pan African Medical Journal 2016;2

Comparative whole genome sequence analysis of wild-type and cidofovir-resistant monkeypoxvirus

<p>Abstract</p> <p>We performed whole genome sequencing of a cidofovir {[(S)-1-(3-hydroxy-2-phosphonylmethoxy-propyl) cytosine] [HPMPC]}-resistant (CDV-R) strain of Monkeypoxvirus (MPV). Whole-genome comparison with the wild-type (WT) strain revealed 55 single-nucleotide polymorphisms (SNPs) and one tandem-repeat contraction. Over one-third of all identified SNPs were located within genes comprising the poxvirus replication complex, including the DNA polymerase, RNA polymerase, mRNA capping methyltransferase, DNA processivity factor, and poly-A polymerase. Four polymorphic sites were found within the DNA polymerase gene. DNA polymerase mutations observed at positions 314 and 684 in MPV were consistent with CDV-R loci previously identified in Vaccinia virus (VACV). These data suggest the mechanism of CDV resistance may be highly conserved across <it>Orthopoxvirus </it>(OPV) species. SNPs were also identified within virulence genes such as the A-type inclusion protein, serine protease inhibitor-like protein SPI-3, Schlafen ATPase and thymidylate kinase, among others. Aberrant chain extension induced by CDV may lead to diverse alterations in gene expression and viral replication that may result in both adaptive and attenuating mutations. Defining the potential contribution of substitutions in the replication complex and RNA processing machinery reported here may yield further insight into CDV resistance and may augment current therapeutic development strategies.</p

Cardiac Metastases of Renal Cell Carcinoma Revealed by Syncope: Diagnosis and Treatment

Introduction: Cardiac metastases from renal cell carcinoma are very rare. In this report, we describe a case of ventricular metastases in the absence of vena cava or right atrial involvement. Case Report: We report the case of a 60-year-old man who had a past history of heavy tobacco intake and well-controlled arterial hypertension. He experienced sudden-onset palpitations, lost consciousness and, as a result, was involved in an accident on the public highway. Cardiac arrhythmia was suspected and, therefore, transthoracic echocardiography was suggested, which revealed a large right ventricular mass. Chest and abdominal computed tomography demonstrated a mass in the right ventricle, but without contiguous vena cava involvement, and a right renal mass related to the probable neoplasm. An ultrasound-guided renal biopsy showed a clear-cell renal cell carcinoma. A bone scan revealed a metastatic bone disease. The patient was started on sunitinib treatment, which was well tolerated. However, approximately 8 months later, reevaluation showed pulmonary metastases. The patient was subsequently started on treatment with everolimus, which, however, was poorly tolerated. Two months later, the patient died due to terminal respiratory insufficiency. Discussion: Based on the literature and our observations in this case, targeted antiangiogenic therapy should be considered as a viable therapeutic alternative to metastasectomy for patients with inoperable cardiac metastatic disease as long as there is no baseline systolic or diastolic dysfunction. The case also emphasizes the importance of a thorough history review and physical examination in the workup of patients with syncope