Péritonite encapsulante cas clinique et revue de la littérature.

La péritonite encapsulante est une fibrose péritonéale diffuse pouvant évoluer vers une véritable sclérose, engainant les anses intestinales et formant le cocon de diagnostic souvent lors des laparoscopies ou laparotomie. Reste une complication rare, mais son pronostic défavorable en fait une complication redoutée. A travers une observation de péritonite encapsulante avec une revue de littérature nous avons réalisé une étude clinique, paraclinique et thérapeutique en vue d’établir une meilleure prise en charge de cette affection rare. Les signes cliniques sont très variables allant du patient asymptomatique à l’occlusion. La péritonite encapsulante est souvent secondaire à la dialyse péritonéale, à une chimiothérapie intrapéritonéale ou un syndrome d’inflammation pelvienne d’origine tuberculeuse. La radiologie notamment la TDM permet d’approcher le diagnostic. La laparoscopie/tomie permet de poser le diagnostic et la réalisation d’un geste thérapeutique. L’étude anatomopathologique confirme le diagnostic en montrant un dépôt de fibrine. Le traitement médical est souvent décevant. Les indications du traitement chirurgical sont les occlusions intestinales complètes, les subocclusions répétitives et les situations urgentes (perforations, nécroses, hémorragies). Deux techniques : la résection anastomose abandonnée. L’entérolyse consistant en une excision décortication et ablation totale de la capsule avec décollement des adhérences intestinales associée à un meilleur pronostic. Les deux principales Complications sont la Perforation et les récidives. En l’absence de traitement. L’issue est fatale dans la majorité des cas. Malgré les progrès actuels dans la prise en charge thérapeutique de la péritonite encapsulante, le pronostic reste relativement médiocre

INVASIVE PULMONARY ASPERGILLOSIS FOLLOWING BEVACIZUMAB TREATMENT FOR NON-SMALL CELL LUNG CANCER

Bevacizumab is a recombinant humanized monoclonal antibody targeting the vascular endothelial growth factor; it is actually approved for the treatment of unresectable, locally advanced and metastatic non-small cell lung cancer in association with chemotherapy and as maintenance therapy. Infection risk due to use of bevacizumab is a very rare event. Several cases of aspergillosis in patients treated with monoclonal antibodies have been reported, mostly following treatment with tumor necrosis factor alpha blockers. We present a case of a 60 year-old patient treated for stage IV non-small cell lung cancer, who has been diagnosed with invasive aspergillosis following bevacizumab treatment, and, we postulate that bevacizumab may contribute to this infection

PHYLLODES TUMOR OF THE BREAST : A CLINICOPATHOLOGICAL ANALYSIS FROM A SINGLE INSTITUTION

The aim of our study is to examine the clinical and pathological features of patients with breast phyllodes tumors and to determine features that are correlated to outcome. Forty four phyllodes tumors were assessed. There were 11 benign, 11 borderline and 22 malignant tumors. 10 of 44 patients (22.72 %) relapsed at any site. Seven patients (15.9 %) had a local recurrence and 3 patients experienced local and metastatic relapse. The 5-year and 10-year survival rates are 97% and 95 % respectively. The 5 years and 10 years DFS are 81% and 77% respectively. Grade, histological size, margin involvement impacted disease free survival. Adjuvant radiation therapy improved local control in high grade tumors although it didn’t reach significance

MANAGEMENT OF EXTRAMEDULLARY PLASMOCYTOMA OF HEAD AND NECK

Extramedullary plasmocytoma is an expansion of a single clone of immunoglobulin-secreting plasma cells without evidence of multiple myeloma. It is un uncommon entity that occurs usually in head and neck area. It is radiocurable at average doses while adjuvant chemotherapy is still controversial. Progression rates to multiple myeloma are lower than bone plasmacytoma. We report three cases of extramedullary plasmacytoma and through a literature review we discuss radiation modalities as well as evolutionary aspects

Brain metastasis from uterine malignancies: treatment modalities and prognostic factors

Isolated brain metastases from gynecologic malignancies are unusual. Advances in therapeutic modalities including surgery, whole brain radiotherapy stereotactic radiosurgery and chemotherapy improved survival and quality of life in this population. Therapeutic decision is based on patients’ specific prognostic factors. We report three cases of isolated brain metastases from gynecologic cancers and discuss treatment modalities in the light of a literature review

Neuroblastoma in an adult: a case report of a rare entity with a summary review

Neuroblastoma is a very uncommon neoplasm in adulthood. It occurs almost exclusively in children younger than 10 years (More than 90% of cases). We report the case of a healthy 40-year-old male who complained of a right flank pain in 2010. Clinical examination revealed an enormous abdominal mass involving the adrenal gland as showed at abdominal CT scan. The patient underwent a surgical en-bloc excision of the right adrenal mass, after a laborious dissection of the tumor. Histological and immunohistochemical findings were suggestive of a neuroblastoma. Adjuvant treatment was not indicated since the complete gross excision of the tumor was performed, and subsequently the patient was considered stage 1 disease and because of the unavailability of MYCN status, necessary for achieving risk group stratification and a risk-adapted strategy. The patient remained in good local control, until January 2015 when he accused a locoregional and metastatic relapse consisting of two new para-renal masses and magma of celiac adenomegalies extending into the mediastinum. As the mass was considered unresectable, therapeutic decision of administrating neoadjuvant chemotherapy, followed by local treatment (surgery and / or radiotherapy) based on tumor response was taken. Given the bad tumor response to systemic treatment, a palliative radiotherapy was instaured. Currently the patient is two months after the end of radiation with mild clinical improvement. The purpose of presenting this case is not only to report an uncommon malignancy in adulthood, but also to raise awareness among clinicians adding this clinical entity as a differential diagnosis when a retroperitoneal mass is identified. We also conducted a literature review to enhance clinicians’ acknowledgment about the management of this rare entity in adults

Wilms tumor in childhood: Single centre retrospective study from the National Institute of Oncology of Rabat and literature review

Background: Wilms tumor is a very common renal malignancy in children. Prognosis has been improved dramatically during the last few decades because of multimodal treatment and successful sequential studies. Through a retrospective study conducted in the National Institute of Oncology of Rabat, concerning children with Wilms tumor treated following the International Society of Pediatric Oncology protocol (93-01) between 2005 and 2010, we report the experience of our institute in treatment of this malignancy. We analyze also the clinicopathologic and therapeutic aspects impacting the outcome results and compared to literature data. Results: Fifty-two patients with Wilms tumor treated in the department of radiotherapy after receiving chemotherapy and surgery at the department of hemato-oncology in children hospital of Rabat were enrolled. The main characteristic was the high prevalence of locally advanced and metastatic stages (32.6% of stage IV). With a median follow up of 54.8 months [20–79], we observed a complete response in 32 cases (61.5%), local recurrence in only one case (1.9%), metastatic relapse in 3 cases (5.8%), both local and metastatic recurrence in 3 cases (5.8%) and disease progression in 8 cases (15.4%). The mean duration of overall survival was 91.2 months. The estimated 2-year and 5-year overall survival were 78.7% and 70.1% and for metastatic patients 68.8% and 62.5% respectively. At univariate analysis several parameters were tested for survival, but only age, anaplasia, lymph node involvement, type of metastasis and response to treatment were found to significantly impact the overall survival. Outcome was better for localized tumors (stage I, II and III) compared with disseminated tumors (stage IV and V) combined. Also a better survival rate was found in the low and intermediate risk group compared to high risk, but not statistically significant. Conclusion: The relatively low outcome found in this series compared to literature can be mainly explained by the higher prevalence of metastatic disease compared to other series, but also by diagnosis and therapeutic delay, more likely because of bad socioeconomic conditions and lack of coordination between different operators. However, our results are nevertheless comparable to maghrebian series. Our department has established many procedures for improving the outcome and further studies are necessary to evaluate their efficiency