Extra medullar Granulocytic sarcoma: a case report of an exceptional localization

Granulocytic sarcoma is a rare type of tumor composed of extramedullary immature cells. The breast location is very rare; it accounts for less than 8% of cases. The present study reports the case of a 36-year-old female with a medical history of myelodysplastic syndrome. She was referred because of a lump in the left breast. We have diagnosed a case of granulocytic sarcoma of the breast by core biopsy. Histology and immunohistochemistry showed hypercellular smears with immature myeloid cells. The blast cells were myeloperoxidase positive. The patient underwent a lumpectomy. Five months later, she developed a contralateral recurrence, treated by lumpectomy and radiotherapy. Three years later, she developed a recurrence in the left knee. We report this case for its rarity and as a note of caution to a physician to consider myeloid sarcoma in the differential diagnosis of a breast lump, to provide the correct diagnosis and avoid incorrect treatment of a curable disease

Pure dysgerminoma of the ovary: a study of 31 cases

Malignant germ cell tumors of the ovary are rare tumors characterized by their heterogeneity and occurring mostly in young women. Dysgerminoma is the most common type of these tumors. This was a retrospective study of 31 patients with pure dysgerminoma of the ovary diagnosed in Salah Azaiez institute of Tunis in Tunisia between 1970 and 2012.The median age was 22 years old. Abdominal pain was the most complaint in 45.1% of cases. An abdomino-pelvic mass was found in 83.8% of cases. Surgery was performed in all patients. The median tumoral size was 13.7 cm. Sixty four-point five percent of the patients underwent a conservative surgery. The tumor was classified stage I in 51.6% of the cases, stage II in 9.7% of the cases, stage III in 35.5% of the cases and stage IV in 3.2% of the cases. Fourteen patients received platinum-based adjuvant chemotherapy, and 10 patients had a radiotherapy. We have noticed 2 cases of recurrence and 2 cases of metastasis. Five-year and ten-year overall survival was 89.4%. Five-year disease free survival was 85.2% and ten-year disease free survival was 66.3%. Dysgerminomas of the ovary have a good prognosis. The two significant prognostic factors are the stage and the postoperative residual disease

Resectable gastric signet ring cell carcinoma: clinicopathological characteristics and survival outcomes

Background:Gastric signet ring cell carcinoma (SRCC) appears to have clinical features and survival rates particularly different from other histological types. The aim of this study was to investigate clinicopathological features and survival outcomes of SRCC and to compare them with non-signet ring cell carcinoma (NSRCC).Methods:We retrospectively studied 145 patients with non-metastatic gastric carcinoma who underwent gastrectomy in our institute from 2005 to 2015. Among them, 36 patients (9.4%) with SRCC were compared to 109 patients (90.6%) with NSRCC.Results:Patients with SRCC presented at a younger age (p=0.001) with more advanced stage III-IV disease (p=0.005) and advanced N stages with a higher rate of pN3 (p=0.0001), a higher number of invaded lymph nodes (p=0.002) and a higher rate of patients with a lymph node ratio exceeding 25% (63.9% vs 36.7, p=0.004). After a median follow up of 35.30 months, there was no significant difference in the 5 years overall (OS) survival between SRCC and NSRCC ((36.7% vs 45.7%, p=0.206).However, the 5 years progressive free survival (PFS) was significantly decreased in case of SRCC (38.7% vs 50.9%, p=0.038) with a higher rate of metastasis in (52.9% vs 29.5%, p=0.013) and peritoneal recurrence (35.3% vs 9.5%, p<0.0001). The main prognostic factors of PFS and OS in SRCC were tumoral stenosis, hypoprotidemia, tumor size, depth of invasion (p=0.001), perineural and lymphovascular invasion, the UICC stage and complete surgical resection.Conclusion:Gastric SRCC have a particular clinicopathological behavior compared to NSRCC suggesting its more aggressive character

Extreme Idiopathic gigantomastia

Gigantomastia is a rare mastopathy of unknown cause. Due to mechanical and psychological complications related to excessive breast weights and volume, effective surgical treatment is required. Most cases of gigantomastia in the literature are associated with pregnancy or puberty and very rare cases of spontaneous gigantomastia have been reported We report a 38 years old woman with an idiopathic gigantomastia treated successfully with Thorek technique

Fertility sparing surgery for stage Ic ovarian cancer: An eight case series

Introduction. One case out of 3 cases of primary ovarian cancer is diagnosed at an early stage. Almost 15% of ovarian cancers are diagnosed in women who are within the range of procreation age, raising the debate on the feasibility of fertility-sparing surgery (FSS) for those tumors. In the case the patient is admitted with stage 1A or 1B in most histologic types, it is still controversial in stage 1C. Results and Discussions. This is an eight-patient-case series. The median age is 27 years old (ranging from 18 to 42). The main clinical manifestation was pelvic pain (87.5%). Four patients (50%) presented with tumor torsion. All patients underwent FSS; five of them (62.5%) had conservative staging, two (25%) underwent salpingooophorectomy and one (12.5%) ovariectomy, type histo + stade Figo. The chemotherapeutic treatment was administered to four patients (50%) following surgery without major side effects. One patient (12.5%) presented a loco regional recurrence that occurred 14 months later. She was treated with combined chemotherapy and radical surgery. One patient out of eight (12.5%) achieved a natural pregnancy after the treatment and another one (12.5%) was submitted to an assisted reproductive procedure which did not result in a viable pregnancy. Conclusion. FSS seems to be a suitable approach for stage 1C ovarian cancer. However, more case series and meta-analyses should be conducted

Chemoradiotherapy or chemotherapy as adjuvant treatment for resected gastric cancer: should we use selection criteria?

Background: The management of gastric adenocarcinoma is essentially based on surgery followed by adjuvant treatment. Adjuvant chemotherapy (CT) as well as chemoradiotherapy (CTRT) have proven their effectiveness in survival outcomes compared to surgery alone. However, there is little data comparing the two adjuvant approaches. This study aimed to compare the prognosis and survival outcomes of patients with gastric adenocarcinoma operated and treated by adjuvant radio-chemotherapy or chemotherapy Materials and methods: We retrospectively evaluated 80 patients with locally advanced gastric cancer (LGC) who received adjuvant treatment. We compared survival outcomes and patterns of recurrence of 53 patients treated by CTRT and those of 27 patients treated by CT.  Results: After a median follow-up of 38.48 months, CTRT resulted in a significant improvement of the 5-year PFS (60.9% vs. 36%, p = 0.03) and the 5-year OS (55.9% vs. 33%, p = 0.015) compared to adjuvant CT. The 5-year OS was significantly increased by adjuvant CTRT (p = 0.046) in patients with lymph node metastasis, and particularly those with advanced pN stage (p = 0.0078) and high lymph node ratio (LNR) exceeding 25% (p = 0.012). Also, there was a significant improvement of the PFS of patients classified pN2–N3 (p = 0.022) with a high LNR (p = 0.018). CTRT was also associated with improved OS and PFS in patients with lymphovascular and perineural invasion (LVI and PNI) compared to chemotherapy. Conclusion: There is a particular survival benefit of adding radiotherapy to chemotherapy in patients with selected criteria such as lymph node involvement, high LNR LVI, and PNI

Fertility-Sparing Surgery in Infiltrative Mucinous Carcinoma of the Ovary

Introduction: Mucinous ovarian carcinoma is often diagnosed early and can affect young patients. The preservation of the female reproductive organ is one of the critical issues, especially for nulliparous women. This case report aims to reconsider the safe outcome of fertility-sparing surgery for infiltrative type mucinous ovarian carcinoma. Case Presentation: A 28-year-old woman with a right mucinous ovarian carcinoma, infiltrative subtype stage IA was treated by right salpingo-oophorectomy, omentectomy, and lymph nodes staging. A 5-year follow-up showed no signs of relapse, and she completed two full-term natural pregnancies. Conclusion: Conservative surgery is a crucial matter for this patient category. The infiltrative type has a poorer prognosis, but few papers have reported the outcome and the safety of fertility-sparing surgery in this context

Extreme Idiopathic gigantomastia

Gigantomastia is a rare mastopathy of unknown cause. Due to mechanical and psychological complications related to excessive breast weights and volume, effective surgical treatment is required. Most cases of gigantomastia in the literature are associated with pregnancy or puberty and very rare cases of spontaneous gigantomastia have been reported We report a 38 years old woman with an idiopathic gigantomastia treated successfully with Thorek technique