Radiation induced esophageal adenocarcinoma in a woman previously treated for breast cancer and renal cell carcinoma

BACKGROUND: Secondary radiation-induced cancers are rare but well-documented as long-term side effects of radiation in large populations of breast cancer survivors. Multiple neoplasms are rare. We report a case of esophageal adenocarcinoma in a patient treated previously for breast cancer and clear cell carcinoma of the kidney. CASE PRESENTATION: A 56 year-old non smoking woman, with no alcohol intake and no familial history of cancer; followed in the National Institute of Oncology of Rabat Morocco since 1999 for breast carcinoma, presented on consultation on January 2011 with dysphagia. Breast cancer was treated with modified radical mastectomy, 6 courses of chemotherapy based on CMF regimen and radiotherapy to breast, inner mammary chain and to pelvis as castration. Less than a year later, a renal right mass was discovered incidentally. Enlarged nephrectomy realized and showed renal cell carcinoma. A local and metastatic breast cancer recurrence occurred in 2007. Patient had 2 lines of chemotherapy and 2 lines of hormonotherapy with Letrozole and Tamoxifen assuring a stable disease. On January 2011, the patient presented dysphagia. Oesogastric endoscopy showed middle esophagus stenosing mass. Biopsy revealed adenocarcinoma. No evidence of metastasis was noticed on computed tomography and breast disease was controlled. Palliative brachytherapy to esophagus was delivered. Patient presented dysphagia due to progressive disease 4 months later. Jejunostomy was proposed but the patient refused any treatment. She died on July 2011. CONCLUSION: We present here a multiple neoplasm in a patient with no known family history of cancers. Esophageal carcinoma is most likely induced by radiation. However the presence of a third malignancy suggests the presence of genetic disorders

Tumeur pseudo-papillaire et solide du pancréas : à propos de deux cas et revue de la littérature

La tumeur pseudo-papillaire et solide du pancréas (TPPSP) est une tumeur exocrine rare, maligne de bas grade, qui prédomine chez la femme jeune à la deuxième décennie. Elle a été décrite initialement par Frantz en 1959. Nous rapportons deux observations cliniques à travers lesquelles on fait une revue de la littérature, en vue de proposer une meilleure prise en charge de cette affection. L’imagerie radiologique, en particulier lorsqu'elle est combinée avec les caractéristiques cliniques, tels que l'âge et le sexe, soulève la possibilité d'une TPPSP. Mais l’examen anatomopathologique couplé à l’immunohistochimie reste l’élément clé du diagnostic, et permet aussi d’écarter les diagnostics différentiels dont le principal est la tumeur neuro-endocrine du pancréas. L’histogénèse de cette tumeur reste toujours controversée. La chirurgie est le meilleur traitement curatif pour ces tumeurs. Une résection complète devrait être l'objectif de cette chirurgie. Il faut éviter les résections trop conservatrices qui exposent au risque de récidive tumorale. Les organes adjacents envahis, les métastases à distance ainsi que les récidives tumorales doivent être réséqués dans la mesure du possible. Les thérapies adjuvantes sont peu utilisées, essentiellement au « cas par cas », ce qui ne permet pas de tirer des conclusions quant à leur efficacité. De manière générale, le pronostic des patients atteints de TPPSP est bon, même avec une récidive locale, ainsi le taux de survie globale à 5 ans est d’environ 95% et il peut atteindre 97% chez les patients qui ont subi une résection chirurgicale réglée. Bien que la résection chirurgicale est généralement curative, une surveillance post-chirurgicale prolongée, par échographie et TDM abdominales, au minimum pendant 10ans est nécessaire en raison des récidives possibles et de la lenteur d’évolution

OSTEOSARCOMA OF THE SPHENO-TEMPORO-ORBITAL BONE: IMAGING ASPECTS OF SUCH UNUSUAL LOCATION

Osteosarcoma of the spheno-temporo-orbital bone is a very rare tumor. Despite the fact that primary osteogenic sarcomas are the most common bone neoplasm, their location in the skull bone is uncommon representing less than 2% of all skull tumors. We report the case of a 41-year-old woman, who has experienced periorbital pain with exophthalmos and left eye vision loss. Neuroimaging analysis including both brain computed tomography (CT-scan) and Magnetic resonance imaging (MRI) were performed. Although radiographic features of skull bone osteosarcomas are not specific, the combination of several radiographic features could lead to this diagnosis in such rare location. The final diagnosis was established by a trans-temporal biopsy with immunohistochemical study. Neurosurgical resection of the primary tumor was not possible given the important extent of the tumor and the involvement of adjacent structures, so the patient underwent conformational radiotherapy. The evolution was marked by local and metastatic progression. The patient received palliative chemotherapy and died few months later. The purpose of presenting this case is not only to report an uncommon malignancy of the skull bone, but also to provide imaging aspects of this rare location and to raise awareness among radiologists in order to consider this radiological entity as a differential diagnosis when a skull bone process is identified

Metastatic giant basal cell carcinoma: a case report

Basal cell carcinoma is the most common skin cancer, characterised by a slow growing behavior, metastasis are extremely rare, and it occurs in less than 0, 1% of all cases.Giant basal cell carcinoma is a rare form of basal cell carcinoma, more aggressive and defined as a tumor measuring more than 5 cm at its largest diameter. Only 1% of all basal cell carcinoma develops to a giant basal cell carcinoma,resulting ofpatient's negligence. Giant basal cell carcinoma is associated with higher potential of metastasis and even death, compared to ordinary basal cell carcinoma.We report a case of giant basal cell carcinoma metastaticin lung occurringin a 79 years old male patient, with a fatal evolution after one course of systemic chemotherapy.Giant basal cell carcinoma is a very rare entity, early detection of these tumors could prevent metastasis occurrence and improve the prognosis of this malignancy.The Pan African Medical Journal 2016;2

Small-Cell neuroendocrine carcinoma of nasopharynx: A case report

Extra pulmonary small cell carcinomas are extremely rare, accounting for 0.1-0.4% of all malignancies and 2.5-4% of small cell carcinomas. In the head and neck region, the most common primary sites are the larynx, salivary gland, nasal cavity, paranasal sinus, tonsil, and oral cavity. Small cell carcinomas occurring in nasopharynx are extremely rare, to our best knowledge, only four cases of primary nasopharyngeal small cell carcinoma has been described in English literature. We report another case of nasopharyngeal small cell carcinoma arising in a 46-year-old woman. She accused, for five months, nasal blockage, right hypoacousia, exophthalmos and reduced visual acuity. Cerebral and facial magnetic resonance imaging showed an extensive mass of the nasopharynx with the invasion of sphenoidal body, the diagnosis of disseminated small cell carcinoma of nasopahrynx was established. The patient received three courses of systemic chemotherapy; unfortunately, she died after the third course. The prognosis of such entity is poor and is similar to that for patients with extensive small cell lung cancer

Radiation induced esophageal adenocarcinoma in a woman previously treated for breast cancer and renal cell carcinoma

Abstract Background Secondary radiation-induced cancers are rare but well-documented as long-term side effects of radiation in large populations of breast cancer survivors. Multiple neoplasms are rare. We report a case of esophageal adenocarcinoma in a patient treated previously for breast cancer and clear cell carcinoma of the kidney. Case presentation A 56 year-old non smoking woman, with no alcohol intake and no familial history of cancer; followed in the National Institute of Oncology of Rabat Morocco since 1999 for breast carcinoma, presented on consultation on January 2011 with dysphagia. Breast cancer was treated with modified radical mastectomy, 6 courses of chemotherapy based on CMF regimen and radiotherapy to breast, inner mammary chain and to pelvis as castration. Less than a year later, a renal right mass was discovered incidentally. Enlarged nephrectomy realized and showed renal cell carcinoma. A local and metastatic breast cancer recurrence occurred in 2007. Patient had 2 lines of chemotherapy and 2 lines of hormonotherapy with Letrozole and Tamoxifen assuring a stable disease. On January 2011, the patient presented dysphagia. Oesogastric endoscopy showed middle esophagus stenosing mass. Biopsy revealed adenocarcinoma. No evidence of metastasis was noticed on computed tomography and breast disease was controlled. Palliative brachytherapy to esophagus was delivered. Patient presented dysphagia due to progressive disease 4 months later. Jejunostomy was proposed but the patient refused any treatment. She died on July 2011. Conclusion We present here a multiple neoplasm in a patient with no known family history of cancers. Esophageal carcinoma is most likely induced by radiation. However the presence of a third malignancy suggests the presence of genetic disorders.</p

Role of 18F-choline and 18F-fluorodeoxyglucose positron emission tomography in combination with magnetic resonance imaging in brachytherapy planning for locally advanced cervical cancer: A pilot study

Background and purpose: This pilot study aims to describe the advantages of combining metabolic and anatomic imaging modalities in brachytherapy (BT) planning for locally advanced cervical cancer (LACC) and to evaluate the supplementary value of Fluoro(F)-Choline positron emission tomography/computed tomography (PET/CT) in comparison to 18F-fluorodeoxyglucose (FDG) in this setting. Materials and methods: A prospective cohort of six patients with LACC was included in this study. Each patient underwent BT planning CT scan, magnetic resonance imaging (MRI), and both FDG and F-Choline PET/CT scans on the same day, with BT applicators in place. Patients were treated according to the standard of care. Metabolic target volumes (TV) were generated retrospectively and compared with the anatomic volumes using Dice coefficients and absolute volume comparison. Results: The threshold at which the metabolic and anatomic volumes were the most concordant was found to be 35% maximum standardized uptake value (SUV max) for both PET/CT scans. Amongst the six patients in this cohort, three in the FDG cohort and four in the F-Choline cohort were found to have more than ten percent ratio of excess (increase) in their MRI gross tumor volumes (GTV) when incorporating the metabolic information from the PET/CT scans. However, no significant changes were needed in the high risk-clinical target volumes (CTVHR) for both PET tracers. Conclusions: FDG and F-Choline PET/CT scans can substantially modify the BT GTV on MRI, without affecting the CTVHR. F-Choline is potentially more informative than FDG in assessing residual TV, particularly in cases with significant post-radiation inflammatory changes

Reuse of treated wastewater and non-potable groundwater in the manufacture of concrete: major challenge of environmental preservation

This work concerns the reuse of treated wastewater from Er-Rachidia wastewater treatment plant (WWTP) in the mixing of ordinary C20/25 concrete, to reduce the overexploitation of non-potable groundwater, avoid its discharge into watercourses and reduce the risk of environmental pollution due to its mineral and organic matter load. In this respect, three types of mixing water were used in this study: drinking water (DW), non-potable groundwater (GW), and treated wastewater (TW). The results recorded for each type of mixing water, in the fresh and hardened state of concretes, were compared with the requirements of the standards. The obtained results show that the treated wastewater does not have any adverse effect upon the quality of the concrete; it has shown an improvement of the mechanical strength from the first stage, a similar density, setting time, and porosity and a slight decrease of the workability compared with the control concrete. A one-way analysis of variance (ANOVA) of the mechanical performance of concrete at different cure times (7, 14, 28, and 90 days) has shown that there is no significant decrease in the mechanical performance of concretes based on TW and GW compared with concretes formulated with DW. Through this study, the substitution of drinking water by treated TW and GW will help to minimize the footprint of construction materials on natural resources. From a point of view of the mechanical performance, TW and GW improve the mechanical performance of concrete. Additionally, it makes wastewater treatment plants more economically attractive and contributes to sustainable developmen

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