A 53-years-old man has a dysentery since two weeks. The blood test shows Coombs-positive hemolytic anemia and inflammation. Autoimmune hemolytic anemia (AIHA) is treated with corticosteroid. A colonoscopy reveals an ulcerative colitis. The evolution of the patient is complicated by a spontaneous digestive perforation treated by total proctocolectomy. After this intervention, there is a resolution of the AIHA and the patient is gradually weaned from corticosteroids. AIHA is a rare extra-intestinal manifestation of inflammatory bowel disease essentially ulcerative colitis. Identification of this cause of secondary AIHA is important for the therapeutic strategy. However treatment is nonspecific and based on low levels of evidence.

A 53-years-old man has a dysentery since two weeks. The blood test shows Coombs-positive hemolytic anemia and inflammation. Autoimmune hemolytic anemia (AIHA) is treated with corticosteroid. A colonoscopy reveals an ulcerative colitis. The evolution of the patient is complicated by a spontaneous digestive perforation treated by total proctocolectomy. After this intervention, there is a resolution of the AIHA and the patient is gradually weaned from corticosteroids. AIHA is a rare extra-intestinal manifestation of inflammatory bowel disease essentially ulcerative colitis. Identification of this cause of secondary AIHA is important for the therapeutic strategy. However treatment is nonspecific and based on low levels of evidence.

L’épaississement de la tige pituitaire associée à un diabète insipide peut être observé en cas de pathologie tumorale, granulomateuse ou inflammatoire. Un homme de 82 ans, aux antécédents de syndrome de Tolosa Hunt (ophtalmoplégie d’origine inflammatoire), est traité par corticothérapie pour une suspicion clinique d’artérite de Horton. Sous Médrol, il développe une asthénie, un amaigrissement et des transpirations profuses. L’échographie abdominale montre un épaississement de la surrénale gauche confirmé au scanner et suspect d’être d’origine tumorale. La biopsie de la lésion surrénalienne initialement envisagée n’est finalement pas réalisée en raison de sa « diminution spontanée ». Cette évolution radiologique évoquant une relative cortico-sensibilité de l’affection sous-jacente. Deux mois après le sevrage progressif de la corticothérapie, apparaissent un diabète insipide et un panhypopituitarisme. Un nouveau bilan iconographique révèle des masses surrénaliennes bilatérales supra-centimétriques (30 UH à blanc), une lésion hypothalamique et un épaississement de la tige pituitaire hyper métaboliques au Pet scan FDG. Le patient bénéficie d’une ponction, par écho-endoscopie, de la lésion surrénalienne gauche. L’examen anatomopathologique conclut au diagnostic de lymphome de Burkitt. Les métastases hypophysaires sont rarement observées dans le lymphome (0,5 %). Elles s’observent plus fréquemment dans le lymphome B diffus à grandes cellules (DLCBL) que dans le lymphome de Burkitt. Si trois cas de patients âgés atteints de DLCBL, avec une atteinte surrénalienne bilatérale et une atteinte hypophysaire ont déjà été rapportés, c’est à notre connaissance le premier cas décrit d’atteinte simultanée de ces deux glandes endocrines en présence d’un lymphome de Burkitt.

A patient with refractory diffuse lymphoma treated for pulmonary invasive aspergillosis developed a concomitant primary cutaneous mucormycosis. The mucormycete was identified by sequencing as Mucor circinelloides. This case confirms the importance of a rapid pathogen diagnosis in immunocompromised patients and the usefulness of molecular methods for identification of rare fungal species.

Introduction: Our hospital has developed a Mobile Oncogeriatric Team (MOT) with the prime help of an oncogeriatric liaison nurse and an interdisciplinary approach to improve the oncologic care pathway of the geriatric patient, his therapeutic support and his follow up.

Introduction: Although many studies describe benefits from the comprehensive assessment of older patients, the lack of geriatricians combined with the increased number of elderly patients revealed the need for screening tools in order to detect cancer patients presenting with geriatric conditions.Objectives: (i) To assess the validity of screening tools to detect patients presenting with geriatric conditions. (ii) To analyze the relative contribution of those tools to detect some characteristics of the geriatric profile and the stage of the tumors.Materials and Methods: Two hundred eleven consecutive elderly patients were screened for the presence of geriatric conditions using the Identification of Senior At Risk score (TSAR) and the G8 score. Comprehensive geriatric assessment for functional, cognitive, mood, and nutritional status, self-perceived fatigue and comorbidities was performed. Oncological assessment included the Kamofsky performance status (KPS) and tumor staging.Results: Both scores detected an average of 80% of frail patients. The PPV and NPV of the scores to detect at least one geriatric condition were respectively 47% and 22% for an ISAR score >= 2 and 76% and 10% for a G8 <15. Area under the ROC curves between ISAR and G8 was not statistically different. In logistic models an TSAR score >= 2 was associated with comorbidity and falls whereas a G8 score <15 was associated with low KPS (<80) and the presence of generalized cancer.Conclusions: High prevalence of geriatric syndromes and comorbidities is associated with positive ISAR and G8 scores but not with the tumor stage. (C) 2012 Elsevier Ltd. All rights reserved.

Introduction: Median age of AML at diagnosis is 67 years and represents a real clinical challenge. Major problems of older AML remain lack of fitness and biological features increasing resistance to chemotherapy. However, some patients are cured with chemotherapy. We wanted to study impact of prognostic factors in order to identify these patients deserving intensive treatment.

L’espace enfants/adolescents est un lieu d’accueil à l’hôpital, mis en place en collaboration avec les équipes soignant les patients adultes atteints d’un cancer, pour leurs enfants, adolescents, familles et proches venant leur rendre visite. Ce lieu adapté aux enfants maintient le lien familial. Deux psychologues l’animent et favorisent l’expression des émotions via des médias projectifs : dessin, matériel de bricolage, trousse de docteur, « Playmobil », jeux de société… L’accès est libre tous les mercredis après-midi.