70 research outputs found

    Evaluation et prise en charge de l’envahissement mandibulaire dans les carcinomes epidermoïdes de la cavite orale et de l’oropharynx

    Get PDF
    Objectif : Le but de notre Ă©tude est l’évaluation de l’atteinte mandibulaire dans les carcinomes Ă©pidermoĂŻdes de la cavitĂ© orale et de l’oropharynx. MatĂ©riel et mĂ©thodes : Il s’agit d’une Ă©tude rĂ©trospective Ă  propos de 34 patients colligĂ©s sur 6 ans (1999-2004) et ayant un carcinome Ă©pidermoĂŻde de la cavitĂ© orale et/ou de l’oropharynx avec envahissement mandibulaire confirmĂ© Ă  l’anatomopathologie. L’atteinte mandibulaire a Ă©tĂ© Ă©valuĂ©e par l’examen clinique,  l’orthopantomographie, la tomodensitomĂ©trie, et par les constatations peropĂ©ratoires du chirurgien. Tous les patients ont eu un Ă©videment ganglionnaire, une exĂ©rĂšse tumorale associĂ©e Ă  une mandibulectomie segmentaire interruptrice ou conservatrice. RĂ©sultats : L’envahissement mandibulaire a Ă©tĂ© suspectĂ© cliniquement chez 70,5% des patients devant l’adhĂ©rence de la tumeur Ă  l’os. AprĂšs examen clinique et imagerie, cette atteinte a Ă©tĂ© diagnostiquĂ©e chez 88,2% des patients. Dans 11,8% des cas, l’atteinte n’a Ă©tĂ© suspectĂ©e qu’en peropĂ©ratoire. L’examen histologique a confirmĂ© l’atteinte osseuse chez tous les patients. La mandibulectomie segmentaire a Ă©tĂ© pratiquĂ©e chez 17 patients devant l’atteinte du canal mandibulaire. Vingt-huit patients ont eu une radiothĂ©rapie postopĂ©ratoire Ă  la dose moyenne de 64 Gy. Les taux de rĂ©cidive, de mĂ©tastase et de dĂ©cĂšs Ă©taient respectivement de 11,7%, 17,6% et 17,6% pour les patients qui ont eu une mandibulectomie segmentaire, et de 23,5%, 17,6% et 23,5% pour ceux qui ont eu une mandibulectomie conservatrice. Par ailleurs, 76,5% et 29,5% des patients ayant eu respectivement une mandibulectomie segmentaire et une mandibulectomie conservatrice avaient une gĂȘne fonctionnelle importante lors de l’alimentation. Conclusion : L’examen clinique, l’imagerie et l’examen peropĂ©ratoire sont d’un apport capital dans l’évaluation de l’atteinte mandibulaire. Une atteinte Ă©pargnant le canal mandibulaire justifie une mandibulectomie conservatrice permettant d’avoir de meilleurs rĂ©sultats esthĂ©tiques et fonctionnels tout en assurant un contrĂŽle carcinologiquement satisfaisant.Mots clĂ©s : envahissement mandibulaire, carcinome Ă©pidermoĂŻde, cavitĂ© orale, oropharynx, mandibulectomie segmentaire, mandibulectomie conservatric

    Les cancers de l’orbite etude retrospective à propos de 31 cas

    Get PDF
    locorĂ©gionale rendant le traitement difficile et mutilant. Dans ce travail, nous rapportons notre expĂ©rience dans la prise en charge diagnostique et thĂ©rapeutique de ces tumeurs. MatĂ©riels et mĂ©thodes : Notre Ă©tude rĂ©trospective a concernĂ© 31 cas de cancers de l’orbite colligĂ©s sur 13 ans (1993- 2005). Tous les patients ont bĂ©nĂ©ficiĂ© d’un examen clinique complet, d’une imagerie du massif facial (TDM et/ou IRM) et d’une biopsie de la tumeur. Le traitement a Ă©tĂ© basĂ© sur la chirurgie, la radiothĂ©rapie et/ou la chimiothĂ©rapie. RĂ©sultats : La symptomatologie clinique Ă©tait dominĂ©e par les signes ophtalmologiques et les algies faciales. L’imagerie a montrĂ© dans tous les cas un processus expansif tissulaire Ă  point de dĂ©part orbitaire, avec lyse osseuse orbitaire chez 16 patients (51,6%), une extension au massif facial chez 7 patients (22,6%), endocrĂąniennes chez 6 patients (19,4%) et des formes bilatĂ©rales atteignant les deux orbites dans 3 cas (9,7%) l’anatomopathologie montrait une prĂ©dominance des lymphomes malins non hodgkiniens (32,3%) et des carcinomes Ă©pidermoĂŻdes (32,3%), suivis des rhabdomyosarcomes embryonnaires (19,4 %). Douze patients ont Ă©tĂ© traitĂ©s par chirurgie et radiothĂ©rapie postopĂ©ratoire, dix patients par une association radio-chimiothĂ©rapie, et neuf autres par une chimiothĂ©rapie nĂ©o-adjuvante. La survie globale Ă©tait de 67,8% Ă  3 ans, 48,4% Ă  5 ans et 22,6% Ă  10 ans. Conclusion : Les cancers de l’orbite sont de mauvais pronostic. Un diagnostic prĂ©coce et un traitement radical et adaptĂ© au type histologique permet d’amĂ©liorer la survie et la qualitĂ© de vie chez les patients atteints de ces tumeurs.Mots-clĂ©s : Orbite, cancer, lymphome, carcinome Ă©pidermoĂŻde, rhabdomyosarcom

    Post-radiation dedifferentiation of meningioma into osteosarcoma.

    Get PDF
    BACKGROUND: A number of osteoblastic meningiomas, primary osteosarcomas of the meninges, and post-radiation osteosarcomas of the head have been reported. However, postradiation dedifferentiation of meningioma into osteosarcoma has not been reported previously. CASE PRESENTATION: In 1987 a caucasian man, then 38 years old, presented with a pituitary macroadenoma. He underwent a subtotal resection of the tumor and did well until 1990 when a recurrent tumor was diagnosed. This was treated with subtotal resection of the tumor, followed by radiation therapy for six weeks to a total of 54 Gy. He was considered "disease-free" for nearly ten years. However, most recently in July 2000, he presented with a visual field deficit due to a second recurrence of his pituitary macroadenoma, now with suprasellar extension. At this time, as an incidental finding, a mass attached to the dura was noted in the left parietal hemisphere. This dura–based mass had grown rapidly by January 2001 and was excised. It showed histological, immunohistochemical, and electron microscopic features of malignant meningioma and osteosarcoma with a sharp demarcation between the two components. CONCLUSIONS: We report a rare case of a radiation induced dedifferentiation of meningioma into osteosarcoma, which has not been reported previously

    A review of the international early recommendations for departments organization and cancer management priorities during the global COVID-19 pandemic: applicability in low- and middle-income countries.

    Get PDF
    Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a new virus that has never been identified in humans before. COVID-19 caused at the time of writing of this article, 2.5 million cases of infections in 193 countries with 165,000 deaths, including two-third in Europe. In this context, Oncology Departments of the affected countries had to adapt quickly their health system care and establish new organizations and priorities. Thus, numerous recommendations and therapeutic options have been reported to optimize therapy delivery to patients with chronic disease and cancer. Obviously, while these cancer care recommendations are immediately applicable in Europe, they may not be applicable in certain emerging and low- and middle-income countries (LMICs). In this review, we aimed to summarize these international guidelines in accordance with cancer types, making a synthesis for daily practice to protect patients, staff and tailor anti-cancer therapy delivery taking into account patients/tumour criteria and tools availability. Thus, we will discuss their applicability in the LMICs with different organizations, limited means and different constraints

    Relapse profile of early breast cancer according to immunohistochemical subtypes: guidance for patient’s follow up?

    No full text
    Purpose: To analyze the profile of annual recurrence rate (ARR) of patients with early breast cancer (BC) in Tunisia. Patients and methods: We classified 293 patients with histologically confirmed early BC relapsing after 1 year of follow up into three subgroups: hormone receptor (HR)+ ‘HR’ [estrogen receptor (ER)+ or progesterone receptor (PR)+ and human epidermal growth factor receptor 2 (HER2)–], triple negative ‘TN’ (ER–, PR– and HER2 score 0/1 or fluorescence in situ hybridization (FISH)/chromogenic in situ hybridization negative) and HER2 overexpression ‘HER2’ (HER2+). ARR was restricted to follow-up contribution of each specified time interval. The HR group was the reference group for comparison. Results: A higher proportion of patients who were up to 35 years old (18% versus 10%, p = 0.04), and patients with obesity (46% versus 26%, p = 0.045) was seen in the TN group. Median time to relapse (MTR) was shorter in TN and HER2 groups than in HR patients (20 and 29 months compared with 56 months, respectively, p < 0.001). In the HR group, the ARR was 22%, 16% and 10% at 3, 4 and 5 years respectively, becoming less than 3% at 7 years. In the TN group, 71% of patients relapsed during the first 2 years and the ARR declined rapidly to less than 1.5% after 4 years. In the HER2 group, the ARR peaked at 2 years (29%) and decreased significantly to 7% and 3% at 5 and 7 years respectively. Adjuvant trastuzumab delayed the MTR from 24 to 34 months ( p = 0.022). Conclusion: The relapse risk in Tunisian patients is higher in young women and patients with HER2+ and TN tumors. A long and close follow up is recommended for patients with HR and HER2. Conversely, we suggest that follow up in patients with TN could be spaced after 4 years (ARR being <1.5% after this period)
    • 

    corecore