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

Unusual case of cavitary lung metastasis from squamous cell carcinoma of the uterine cervix

Spontaneous excavation of primary lung cancer is common; however cavitation of metastatic lung lesions is rare and usually confused with benign lesions. In Moroccan context tuberculosis is the first suspected diagnosis of lung excavations. We report a rare case of cavitary lung metastasis of a uterine cervix cancer, treated initially as tuberculosis. A 40-year old non-smoking woman with a known history of squamous cell carcinoma of the uterine cervix since August 2005; presented on September 2008 with right chest pain without fever, hemoptysis or weight loss. CT scan showed a thin walled cavity. Empirical Antibiotic therapy was conducted 15 days with poor outcome. Then antibacillary treatment was started with no proof of mycobacterial infection. A month later, the patient presented with gynecological bleeding and a pneumothorax. Bronchoscopy with transbronchial biopsy of the cavitary mass was performed. Pathology demonstrated a metastatic squamous cell carcinoma. Pelvic examination and MRI showed a subsequent local cervix recurrence. Patient underwent 3 courses of systemic chemotherapy. She died on June 2009 due to progressive disease. Even cavitary lung metastases are rare and benign differential diagnosis are more common, clinician should be careful in neoplastic context and investigation should be done to eliminate a recurrence.Pan African Medical Journal 2013; 14:3

Liposarcome dédifférencie du cordon spermatique: difficultés thérapeutiques des grosses tumeurs

Le liposarcome du cordon spermatique est une entité rare : environ 100 cas ont été rapportés dans la littérature. Nous rapportons l’observation d’un homme âgé de 42 ans, chez qui a été décelée une masse tumorale développée aux dépens du cordon spermatique droit. Une orchidectomie droite avec exérèse large de la tumeur a été difficilement réalisée en raison de la taille importante de la masse. En post opératoire, le patient a présenté une progression locale et métastatique pulmonaire. Une mono chimiothérapie a été administrée à base d’anthracycline mais le patient a décédé suite à une progression rapide de la maladie. À travers cette observation, nous rapportons brièvement les données de la littérature de cette entité rare. Une exérèse large avec des marges saines, tant que possible, est indispensable pour le contrôle local de la maladie. Néanmoins, en cas de taille tumoral importante, comme le cas de notre patient, une exérèse complète est souvent difficile. Vu le taux élevé de rechute locale, une stratégie combinée associant chirurgie et radiothérapie adjuvante peut être envisagée. Le rôle de la chimiothérapie, bien qu’incertain, garde son indication dans les cas métastatiques, surtout dans les sous types dédifférenciés

Primary pleural leiomyosarcoma with rapid progression and fatal outcome: a case report

<p>Abstract</p> <p>Introduction</p> <p>Leiomyosarcomas are neoplasms of smooth muscles that most commonly arise from the uterus, gastrointestinal tract, or soft tissue. Primary pleural leiomyosarcoma is extremely rare. To the best of our knowledge, only nine cases have been published to date. Because of the rarity of pleural leiomyosarcoma and its similarity (clinical and histological) to other pleural neoplasms, particularly sarcomatous mesothelioma, diagnosis is often difficult.</p> <p>Case presentation</p> <p>A 58-year-old North African man was admitted with complaints of dyspnea and chest pain to our hospital. Chest computed tomography revealed right pleural effusion and pleural thickening. A transthoracic needle biopsy yielded a diagnosis of leiomyosarcoma, and tumor cells were strongly and uniformly positive for vimentin, a smooth muscle actin at immunohistochemical analysis. A general examination did not show any metastatic lesions in other areas. One month after diagnosis, the tumor grew rapidly, with pulmonary invasion, and therefore he was treated only by palliative care. He died from respiratory failure one month later. Because no organ of origin of the leiomyosarcoma, other than the pleura, was detected, this case was diagnosed as a primary pleural leiomyosarcoma.</p> <p>Conclusions</p> <p>Although leiomyosarcoma originating from the pleura is rare, this entity is increasingly described. The purpose of presenting this case report is to raise awareness among clinicians to consider this clinical entity as a differential diagnosis when a pleural mass is identified.</p

Classic Kaposi's sarcoma in morocco: clinico -epidemiological study at the national institute of oncology

<p>Abstract</p> <p>Background</p> <p>Classic Kaposi's sarcoma (CKS) is a rare disease likely associated with human herpes virus 8 (HHV-8) infection, and occurs predominantly in Jewish, Mediterranean and middle eastern men .There is a dearth of data in Moroccan patients with CKS regarding epidemiology, clinical characteristics and outcomes. This report examines a cohort of patients with CKS evaluated at the national institute of oncology over 11-year period.</p> <p>Methods</p> <p>A retrospective analysis of patients referred to the national institute of oncology with classical Kaposi sarcoma, between January 1998 and February 2008, was performed. Reviewed information included demographics, clinical and pathological staging, death or last follow-up.</p> <p>Results</p> <p>During the study period, 56 patients with a diagnosis of CKS have been referred to our hospital. There were 11(19,7%) females and 45 (80,3%) males (male-to-female ratio: 4:1). Mean age at diagnosis was 61,7 ± 15 (range: 15- 86 years). Nodules and/or plaques were the most frequent type of lesion. The most common location was the lower limbs, particularly the distal lower extremity (90%). In addition to skin involvement, visceral spread was evident in 9 cases. The most common visceral involvement sites were lymph nodes (44%), lung (22%), and gastrointestinal tract (22%). Associated lymphoedema was seen in 24 (42%) of the patients. There were 18 stage I patients (32,14%), 8: stage II (14,28%), 21 stage III(37,5%) and 9 stage IV (16,07%). A second primary malignancy was diagnosed in 6 cases (10,7%), none of the reticuloendothelial system.</p> <p>With a median follow-up of 45 months, 38 (67,8) patients are alive, of whom 25 (65,78%) patients with stable disease, five with progressive disease currently under systemic chemotherapy and 8(21,05%) are alive and free of disease, over a mean interval of 5 years.</p> <p>Conclusion</p> <p>This is the largest reported series in our context. In Morocco, CKS exhibits some special characteristics including a disseminated skin disease at diagnosis especially in men, a more common visceral or lymph node involvement and a less frequent association with second malignancies.</p

Facteurs pronostiques du carcinome indifférencie du cavum localement avance.

L’UCNT du cavum diffère des autres carcinomes épidermoïdes de la tête et du cou par son histologie caractéristique, son épidémiologie, sa répartition géographique et sa relation avec le virus d’Epstein Barr. Environ 70% des carcinomes nasopharyngés sont localement avancés au diagnostic. Il existe plusieurs facteurs pronostiques cliniques, biologiques et radiologiques liés au malade, à la maladie ou au traitement, affectant la survie ont été étudiés avec des données parfois controversées selon les différentes séries. Le Maroc à l’instar des autres pays nord africains se situe en zone d’endémie de l’UCNT avec une incidence considérée comme intermédiaire par l’OMS. L’objectif de notre étude est d’étudier les facteurs pronostiques de l’UCNT et de dresser le profil épidémiologique dans la population marocaine. Il s’agit d’une étude rétrospective ayant inclus 339 patients atteints d’un UCNT du cavum classés du stade II au IVB selon la classification TNM adoptée par l’UICC ( 6ème édition) et traités à l’Institut National d’Oncologie de Rabat entre janvier 2003 et Décembre 2005. Les caractéristiques des patients ont été corrélées à la survie en analyse univariée et multivariée. Il s’agissait de 122 femmes et 217 hommes, l’âge médian est 43 ans. Pour la classification TNM, 42 patients étaient classés T1, 159 T2, 64 T3 et 69 T4, 65 N0, 49 N1, 128 N2 et 95 N3. L’atteinte ganglionnaire était un important facteur pronostique affectant la survie (p= 0,02), Le stade T paraissait également affectait significativement le pronostique des patients en défaveur du stade T4 L’atteinte parapharyngée ne constituait pas un facteur pronostique dans notre série L’âge ne paraissait pas être un facteur pronostique alors que le sexe n’était significatif qu’en terme de survie sans rechute en favorisant les femmes. Le type de traitement par radiothérapie et chimiothérapie de manière séquentielle ou concomitante ne constituait pas un facteur pronostique. L’étalement de la radiothérapie n’était un facteur significatif en terme de survie sans rechute. Nos résultats concordaient parfaitement avec les données de la littérature et donc il s’avère nécessaire de mener des études prospectives dans notre contexte pour mieux les étudier

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