Total neoadjuvant treatment (TNT) has become a standard treatment approach for locally advanced rectal cancer (LARC). Patients achieving pathological complete response (pCR) following TNT have better outcomes (overall survival, relapse free survival). However, not all patients treated for LARC with neoadjuvant treatment achieve pCR. The aim of our study was to assess the rate and predictors of pCR. We performed a retrospective study at medical oncology unit in a tertiary care teaching hospital. All consecutive LARC patients without any evidence of distant metastasis who underwent neoadjuvant chemoradiotherapy and surgery between June 2020 and January 2023 were included in the research. Pathological response to neoadjuvant treatment was assessed using Mandard grading system and response was categorized as pCR or not‑pCR. Two different standardized protocols for the neoadjuvant treatment were used: the first group was treated with induction chemotherapy followed by short course radiotherapy and the second group was treated with the RAPIDO protocol. Correlation between different studied parameters and pCR was determined using univariate and multivariate logistic regression analysis. The mean age of the 91 included patients (46 men and 45 women) was 58.53 ± 10.3 years. Twenty (22
Adrenal extramedullary plasmacytoma (EMP) is an exceptionally rare plasma cell neoplasm with fewer than 20 documented cases worldwide. The clinical presentation, optimal management strategies, and long-term outcomes remain poorly defined. We report the case of a 51-year-old woman with synchronous bone and adrenal EMP, without multiple myeloma. The initial presentation involved pathological humeral fracture following minor trauma, with the subsequent discovery of a 40 mm left adrenal mass on staging CT. Emergency orthopedic fixation and bone biopsy confirmed the diagnosis of EMP. Immunohistochemical findings showed CD138, MUM1, and kappa light-chain restriction positivity, with negative lambda staining. After declining initial surgical intervention, the patient was lost to follow-up for two years, during which the adrenal lesion enlarged to 70 mm. Comprehensive staging including bone marrow biopsy, FDG-PET/CT, and laboratory workup confirmed absence of multiple myeloma features according to International Myeloma Working Group criteria. Complete laparoscopic left adrenalectomy was successfully performed, with uncomplicated recovery. Histopathological examination revealed a 75 × 55 × 30 mm encapsulated mass with characteristic plasma cell morphology and extensive hemorrhagic foci. The Ki-67 proliferation index was < 10
INTRODUCTION:Gastric squamous cell carcinoma (GSCC) is a rare condition. We present the case of a locally advanced GSCC with dissociated response after neoadjuvant chemotherapy. CASE REPORT:We present the case of a 34-year-old female patient who presented with a two-month history of epigastric pain and vomiting. Esophagogastroduodenoscopy identified a fundic lesion. Biopsy revealed a GSCC. CT scan showed a locally advanced expansile nodular process on the greater curvature of the stomach. Due to the locally advanced nature of the tumor, surgery was deemed excessively mutilating, and chemotherapy was initiated. The endoscopic evaluation showed complete resolution of the fundic mass. CT imaging demonstrated a 37 % reduction in the volume of target lesions. The patient subsequently underwent diagnostic laparoscopy, revealing a locally advanced unresectable tumor accompanied by diffuse peritoneal carcinomatosis. Palliative chemotherapy was initiated. The patient passed away two months after surgery. DISCUSSION:GSCC is a rare condition. The exact origin of this tumor remains unclear. Clinically, GSCC presents similarly to other gastric tumors. Due to its rarity, there is no consensus on the optimal treatment for primary gastric squamous cell carcinoma, and the existing evidence is primarily based on case reports and small case series. Radical surgical excision with lymph node dissection remains the primary therapeutic approach. While neoadjuvant chemotherapy appears beneficial and effective, the available data remain limited. GSCC is known for its locally aggressive behavior and poor short-term prognosis. CONCLUSION:Additional research is crucial to establish the most effective treatment strategies.
Peritoneal tuberculosis is one of the most challenging forms of extrapulmonary tuberculosis to diagnose, especially, in women as it often mimics an advanced ovarian carcinoma. Many authors had documented cases where peritoneal tuberculosis was initially misdiagnosed as advanced ovarian carcinoma, but only four cases had reported the coexistence of both conditions. We present the fifth case in the literature of concurrent peritoneal tuberculosis and serous cystadenocarcinoma of the ovary. A 61-year-old female patient presented with diffuse abdominal tenderness. Physical examination revealed an abdominal distension. Computed tomography scan showed a heterogeneous, poorly defined right latero-uterine mass associated with ascites and nodular peritoneal infiltration. The level of cancer antigen 125 was elevated. Therefore, a diagnosis of advanced ovarian carcinoma was highly suspected. A diagnostic laparoscopy was performed. Peritoneal biopsy confirmed the diagnosis of peritoneal tuberculosis without any histological evidence of malignancy. The patient subsequently underwent a right adnexectomy, which revealed serous cystadenocarcinoma of the ovary. She received 6 months of antituberculosis treatment complicated with renal dysfunction. Computed tomography scan control showed no abnormalities. Tumor markers levels decreased to the normal range. The patient refused further surgery and chemotherapy was recommended. Female patients presenting with ascites, adnexal masses, and elevated levels of cancer antigen 125 are usually presumed to have advanced ovarian carcinoma. There are a few discriminating features that suggest the diagnosis of peritoneal tuberculosis rather than peritoneal carcinomatosis of an advanced ovarian carcinoma. Eventually, their coexistence should be considered as a differential diagnosis, particularly in developing countries where tuberculosis is still endemic as it is the case of Tunisia.
