Background. Adult granulosa cell tumors (AGCTs) are the most common sex cord-stromal tumors. Unlike epithelial ovarian tumors, they occur in young women and are usually detected at an early stage. ...The aim of this study was to report the clinical and pathological characteristics of AGCT patients and to identify the prognostic factors. Methods. All cases of AGCTs, treated at Salah Azaïz Institute between 1995 and 2010, were retrospectively included. Kaplan-Meier’s statistical method was used to assess the relapse-free survival and the overall survival. Results. The final cohort included 31 patients with AGCT. The mean age was 53 years (35–73 years). Patients mainly presented with abdominal mass and/or pain (61%, n=19). Mean tumor size was 20 cm. The majority of patients had a stage I disease (61%, n=19). Two among 3 patients with stage IV disease had liver metastasis. Mitotic index was low in 45% of cases (n=14). Surgical treatment was optimal in almost all cases (90%, n=28). The median follow-up time was 14 years (1–184 months). Ten patients relapsed (32%) with a median RFS of 8.4 years (6.8–9.9 years). Mean overall survival was 13 years (11–15 years). Stage I disease and low-to-intermediate mitotic index were associated with a better prognosis in univariate analysis (resp., p=0.05 and p=0.02) but were not independent prognostic factors. Conclusion. GCTs have a long natural history with common late relapses. Hence, long active follow-up is recommended. In Tunisian patients, hepatic metastases were more frequent than occidental series. The prognosis remains good and initial staging at diagnosis is an important prognostic factor.
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FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK
Objective： To assess the response rate of patients with rectal adenocarcinoma to neoadjuvant therapy and to identify the predictors of histological regression after neoadjuvant radiotherapy （RT） or ...concurrent chemoradiotherapy （CCRT）. Methods： This study recruited 64 patients. The patients had resectable cancer of the lower and the middle rectum （T3/T4 and/or N＋） without distant metastasis and received neoadjuvant RT or CCRT followed by radical surgery with total mesorectal excision （TME） between January 2006 and December 2011. The patients were classified into non-response （NR）, partial response （PR）, and pathologic complete response （pCR） based on the Dworak tumor regression grading system. Results： The median age of patients was 57 years （ranging from 22 to 85）. A total of 24 patients were treated with neoadjuvant CCRT, whereas 40 patients were treated with RT alone. Abdominoperineal resection （APR） was performed on 29 patients （45%）. Anterior resection with TME was performed on 34 patients （53~6）. One patient had local resection. Histologically, 12 （19%）, 24 （73%）, and 28 （44%） patients exhibited pCR, PR, and NR, respectively. Univariate analysis revealed that the predictors of tumor regression were as follows： the absence of lymph node involvement from initial imaging （cN0） （P=0.021）; normal initial carcinoembryonic antigen （CEA） level （P=0.01）; hemoglobin level 〉12 g/dl （P=0.009）; CCRT （P=0.021）; and tumor downstaging in imaging （P=-0.001）. Multivariate analysis showed that the main predictors of pCR were CT combined with neoadjuvant RT, cN0 stage, and tumor regression on imaging. Conclusions： Identifying the predictors of pCR following neoadjuvant therapy aids the selection of responsive patients for non- aggressive surgical treatment and possible surveillance.
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FFLJ, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, UL, UM, UPUK
Objective Recent studies have identified challenges facing women oncologists in Western contexts. However, similar studies in Africa have yet to be conducted. This study sought to determine the most ...common and substantial challenges faced by women oncologists in Africa and identify potential solutions. Methods and analysis A panel of 29 women oncologists from 20 African countries was recruited through professional and personal networks. A Delphi consensus process identified challenges faced by women oncologists in Africa, and potential solutions. Following this, focus group discussions were held to discuss the results. Descriptive statistics were used to identify the most common challenges indicated by participants and thematic analysis was conducted on focus group transcripts. Results African women oncologists experienced challenges at individual, interpersonal, institutional and societal levels. The top-ranked challenge identified in the Delphi study was ‘pressure to maintain a work–family balance and meet social obligations’. Some of the challenges identified were similar to those in studies on women oncologists outside of Africa while others were unique to this African demographic. Solutions to improve the experience of women oncologists were identified and discussed, including greater work flexibility and mentorship opportunities. Conclusion Women oncologists in Africa experience many of the challenges that have been previously identified by studies in other regions. These challenges and potential solutions exist at all levels of the social-ecological framework. Women oncologists must be empowered in number and leadership, and gender-sensitive curricula and competencies must be implemented. A systems-level dialogue could bring light to these challenges and foster tangible action and policy-level changes.
Salivary gland cancers are very rare tumors. They are characterized by a histologic heterogeneity and a poor outcome. According to this rarity, few prospective data are available to date. No standard ...recommendations could be held for the use of systemic therapy in these tumors. Several case reports and small studies have investigated the contribution of different agents of chemotherapy. With the extension of molecular biology approach in oncology several signaling pathways have been discovered in different cancers including salivary gland cancers; thus a number of targeted therapies have been investigated. This paper reviewed exhaustively the studies investigating the role of systemic therapies (chemotherapy, targeted therapy, hormone therapy) in salivary gland cancers.
Primary leiomyosarcomas of the thyroid gland are extremely rare. We report a case of a 32 year-old women with a multinodular goiter. She underwent total thyroidectomy. The tumor histology showed ...spindle-shaped cells that expressed desmine, caldesmone and smooth muscle actine but were negative cytokeratins.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Cutaneous metastases are rare and represent a sign of poor prognosis. They are a sign of widespread disease. Breast cancer is the most common neoplasm leading to their appearance. Palliative care is ...the treatment of choice.
Cutaneous metastases are rare and represent a sign of poor prognosis. They are a sign of widespread disease. Breast cancer is the most common neoplasm leading to their appearance. Palliative care is the treatment of choice.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
The gastric location of EBVMCU is extremely rare. The pathology examination and immunochemistry are mandatory for the diagnosis. It is essential that physicians be aware of this new entity to ...accurately diagnose and handle this disease.
The gastric location of EBVMCU is extremely rare. The pathology examination and immunochemistry are mandatory for the diagnosis. It is essential that physicians be aware of this new entity to accurately diagnose and handle this disease.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
RésuméLes lymphomes pulmonaires primitifs sont des tumeurs rares représentant moins de 1% des tumeurs malignes du poumon. La forme la plus fréquente est le lymphome de type Mucosa-Associated Lymphoid ...Tissue (MALT). L'atteinte oculaire est aussi rare et elle est dans la plupart du temps localisée dans les glandes lacrymales. Nous rapportons l'observation d'un patient ayant présenté un lymphome pulmonaire de type MALT associé à une atteinte synchrone des glandes lacrymales. Cette observation illustre les aspects cliniques, radiologiques et évolutifs de cette entité qui sont peu spécifiques.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Gestational trophoblastic disease (GTD) develops from abnormal cellular proliferation of trophoblasts following fertilization. It includes benign trophoblastic disease (hydatidiform moles (HM)) and ...the malignant trophoblastic diseases or gestational trophoblastic neoplasia (GTN). The frequency of the GTD in Tunisia is one per 918 deliveries. The aim of this study is to analyze the clinical characteristics, treatment and outcomes of GTD at Salah Azaiez Institute (ISA). Medical records of women diagnosed with GTD at ISA from January 1
, 1981 to December 31
, 2012 were retrospectively reviewed. FIGO score was determined retrospectively for patients treated before 2002. One hundred and nine patients with GTN were included. Patients presented with metastases at 43% of cases. The most common metastatic sites were lung (30%) and vagina (13%). Fifty six (56 (51%) patients had low-risk and 21 (19%) cases had high-risk, the FIGO score was not assessed in 32 cases. After a median follow-up of 46 months, 21 patients were lost to follow-up, 12 patients died, 19 progressed and 8 relapsed. At 10 years, the OS rate was 85% and the PFS rate 79%. OS was significantly influenced by the presence of metastases at presentation (M0 100 % vs. Metastatic 62 %; p < 0.0001), FIGO stage (I-II 100% VS 61% and 65% for stage III and IV; p < 0.001), FIGO score (low-risk 99 % vs. high-risk 78 %; p < 0.001). GTN is a significant source of maternal morbidity with increased risk of mortality from complications if not detected early and treated promptly.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Background: Osteosarcoma is a rare malignant tumor of the mesenchymal tissue that accounts for 5% of all malignant tumors in children and teenager. The purpose of our study was to describe the ...epidemiological and evolutionary characteristics of osteosarcoma in Tunisia.Methods: It's a retrospective study performed in the Oncology Department of Salah Azaiez Institute from January 1980 to December 2016. We analyzed records of 200 cases of patients with primary high-grade osteosarcoma.Results: The mean incidence was 6 cases per year. The mean age at the time of diagnosis was 19 years with a slight male predominance (55%). The distribution had a single peak during adolescence and a plateau during adulthood. The average consultation period was 3.4 months. The most common reasons for consultation were the pain (82%), followed by swelling (74%), trauma (10%), fracture (6.5%), and functional impairment (5.5%). Mean tumor size was 11 cm. Preferred site was long bones in young patients and flat bones in elderly ones. Common osteosarcoma was the most frequent (85%). Overall survival and progression-free survival at 5 years were respectively 78% and 90.5%.Conclusion: In summary, this study is a large national population-based incidence report of osteosarcoma in Tunisia.
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