Breast metastasis is fairly uncommon and prognosis is dismal. Breast metastasis might be the first symptom or may occur during the course of other malignancies dominantly arising from the contralateral breast. Leukemia, lung cancer and conjunctival melanoma may spread to the breast.

Background: Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasm affecting the gastrointestinal tract. The incidental occurrence of mesenchymal tumors and other primary tumors has not been well described in literature. The aim of this study was to evaluate the clinical and pathologic features of GIST occurring synchronously with other primary tumors. Methods: 78 patients with diagnosis of GIST treated surgically with curative intent at the department of medical oncology at HASSAN II university hospital of FEZ MOROCCO, from 2001 to 2012 were included. The patient clinical data and pathological reports were reviewed. Results: Of the 78 patients, there were 5 (6,4%) cases of synchronous GIST and other primary tumors discovered as coincidental findings. The synchronous GISTs analysed were located in the peritoneum (n = 3), and stomach (n = 1) and small intestine (n = 1), size ranging from 3 to 20 cm (median 7,4 cm). Two of the concurrent primary tumors were from gastrointestinal origin (n = 2), and the other three synchronous cancers were prostate adenocarcinoma, uterine leiomyosarcoma and germ cell carcinoma of the ovary. The synchronous GISTs immunophenotype shows positivity for CD117 (100%) and CD34 (40%). According to GIST risk category for aggressive behavior three were classified as high risk and tow low. Conclusion: The synchronous occurrence of GISTs and other primary neoplasm is not an uncommon entity and usually they are discovery incidentally. Epithelial tumors of the gastrointestinal tract are the most associated with concomitant GISTs. Further studies are required to clarify the molecular and genetic mechanisms of carcinogenesis and progression associating GIST and synchronous tumors.

Classic Kaposi's sarcoma(CKS) is a subtype that traditionally occurs in elderly HIV-negative males of Mediterranean origin. Patients with CKS characteristically present with skin lesions in the distal extremities. Involvement of the viscera is uncommon but may occur in the late stages of the disease. Patients with extensive KS can be treated with systemic chemotherapy. A number of drugs approved for treatment of AIDS-associated KS, especially Paclitaxel, have activity against CKS after failure of prior therapy. We report a patient treated with weekly Paclitaxel, as initial chemotherapy, for CKS presenting with multiple visceral involvement and having a contraindication for Bleomycin. The patient had quasi-complete response after three months of chemotherapy suggesting that weekly Paclitaxel might be effective as a first-line therapy for classical type KS with visceral involvement.

Introduction Gastric linitis plastica is a very particular malignant gastric tumor different from the usual gastric carcinoma. It refers to the diffuse proliferation of connective tissue, resulting in tissue thickening so that the stomach is constricted and rigid. Methods In this retrospective study, we reviewed the records of 34 patients diagnosed with gastric linitis between January 2008 and January 2012. The aim of this study is to identify the clinical, diagnostic and therapeutic features of this type of gastric cancer in Moroccan patients. Results The mean age at the diagnosis was 42.6 years ranged from 25 to 69 years, 22 patients were female. The clinical symptoms were mainly vomiting (73 %), epigastric pain (79 %) and deterioration of Performance Status (94 %). In all of the cases, endoscopy has revealed rigid and thickening stomach. 68 % (n=23) of the patients were metastatic at the diagnosis, sites of metastasis were: peritoneum (71 %), lymphatic nodes (53 %), lung (32 %), liver (24 %) and the ovary (6 %). Among the 34 patients, 32 % (n=11) were treated with curative strategy by total gastrectomy followed by adjuvant concomitant chemo radiotherapy (n=5), adjuvant chemotherapy (n=4) or perioperative chemotherapy (n=2). For the metastatic patients chemotherapy regimens were distributed as following: ECC (Epirubicin 50 mg/m2, Cisplatin 60 mg/m2, Capecitabine 625 mg/m2/12h) was administered to 56 % of the cases, combination of cisplatin and 5 fluorouracil (cisplatin at the dose of 75 mg/m2 and 5 fluorouracil at 300 mg/m2 for 3 days) to 22 % of the cases, capecitabine as monotherapy for 14 %, and FUFOL Mayo Clinic regimen for 4 % of metastatic patients. While 4 % of the cases received supportive care because of deterioration of the performance status and liver blood tests. Download : Download full-size image Figure 1 . Expression of AEG-1 in gastric cancer tissues by immunohistochemical staining AEG-1 expression is not detected in normal gastric mucosa (left). AEG-1 positive expression in intestinal metaplasia (middle). AEG-1 strong positive expression in gastric cancer (right). Download : Download full-size image Figure 2 . Expression of AEG-1-mRNA in gastric cancer cells by RT-PCR. Conclusion The gastric linitis plastica represent an entity with specific characteristics, which tends more toward tumor invasion depth, with nodal and peritoneal metastases. A multidisciplinary approach including cancer surgery and chemotherapy is recommended to improve the prognosis of patients with this disease.

BACKGROUND:Situs inversus totalis represents an unusual anomaly characterized by a mirror-image transposition of the abdominal and thoracic viscera. It often occurs concomitantly with other disorders that make difficult diagnosis and management of abdominal pathology. The relationship between situs inversus totalis and cancer remains unclear.CASE PRESENTATION:We describe a 33-year old Guinean man with situs inversus totalis who presented with obstructive jaundice. Imaging and endoscopic modalities demonstrated a mass of distal common bile duct which biopsy identified an adenocarcinoma. The patient was successfully treated by cephalic pancreaticoduodenectomy followed by adjuvant chemoradiation and he is doing well without recurrence 8 months after surgery.CONCLUSION:The occurrence of bile duct adenocarcinoma in patient with situs inversus totalis accounts as a rare coincidence. In this setting, when the tumor is resectable, surgical management should be considered without contraindication and must be preceded by a careful preoperative staging.

ABSTRACT Introduction Bone metastases (BM) are a common event in advanced cancers of the breast, lung, prostate, kidney and thyroid. In gastric cancer, metastases are considered to be mainly to the peritoneum, liver, or lymph nodes; while BM occur only rarely and they are known to have a very poor prognosis. The clinicopathological manifestations and treatment outcomes of BM of gastric cancer are largely unknown. This retrospective study aimed to evaluate clinical, radiological and therapeutic features in BM of gastric cancer, and to examine their correlation with histology and lymph node extension of the gastric tumor. Then, we review the possible mechanisms and risk factors underlying this rare condition. Methods Between April 2007 and October 2011, 12 patients were collected in the department of medical oncology at Hassan II university hospital and were retrospectively analyzed in terms of Clinicopathological features of the gastric Cancer and bone metastasis. Results From April 2007 to October 2011, we retrospectively reviewed 12 patients with bone metastases from gastric cancer, 8 men and 4 women (sex-ratio: 2).The mean age at the time of diagnosis of gastric cancer was 50 years (range: 30-77 years). BM were synchronous to gastric cancer in 9 patients; in 3 patients, bone involvement occurs over a period ranging from 2 to 15 months after primary tumor diagnosis. Concerning the histological types of gastric tumor, undifferentiated histology was predominant, it was observed in 6 cases (50%); there were 4 cases (33.3%) of moderately differentiated carcinoma and 2 cases (16.6%) of poorly differentiated carcinoma. Positive nodal status was found in 9 cases (75%). BM were associated to: lung metastases in 5 cases (41.6%), to liver metastases in 2 cases (16.6%) and pancreatic metastases in one case (8.3%); Peritoneal dissemination was noted in 2 cases (16.6%). Only one patient had BM without other distant dissemination. Diagnosis of BM was made in 8 patients (66.6%) by computed tomography (CT) only, in 2 patients (16.6%) by CT and magnetic resonance imaging (MRI); and two patients were diagnosed by bone scintigraphy. All patients had diffuse and osteolytic bone lesions; the area of BM was in the order of the vertebrae (9 cases, 75%), costa (7 cases, 58.3%) and extremities (5 cases, 41.6%). 10 patients had symptoms related to bone involvement: bone pain in 10 patients (83.3%), spinal cord compression in 2 patients (16.6%) and hypercalcemia in 2 patients (16.6%). Management of BM included analgesic agent in 10 cases, palliative chemotherapy in 11 cases, radiotherapy in 1 case and bisphosphonates in 2 cases. As it has been reported in other series of BM caused by gastric cancer, all our patients died within period ranging from 1 to 4 months from the diagnosis of BM. Conclusion These data confirmed that the prognosis of BM from gastric cancer is uniformly poor. Hence, tests to assess for bone metastasis are required for gastric cancer patients at the time of the initial diagnosis and the postsurgical follow-up observation mainly in the setting of undifferentiated tumor and nodal involvement.

ABSTRACT Introduction Biliary tract cancers (BTC) are relatively rare (3% of digestive cancers), they mainly affect older women and are located in the gallbladder in about 70% of the cases. Methods In this retrospective study, we reviewed 70 cases of BTC admitted in the medical oncology unit of HASSAN II university hospital between January 2008 and January 2012. The aim of this study is to define epidemiologic, diagnostic and therapeutic aspects of this disease in a Moroccan population. Results In our study, BTC account for 4.8 % of digestive cancers. The mean age of our patients was 62.4 years ranged from 32 to 81 years, female gender represent 71 %. The tumors were located in the gallbladder (GB) in 72 % of the cases divided into adenocarcinoma (77 %) and squamous cell carcinoma (23 %). The other locations were hilar cholangiocarcinoma (21 %) and intrahepatic cholangiocarcinoma (7 %). Concerning the radiological finding, abdominal ultrasonography was performed in all of the patients but it allowed to suspect cancer in only 47% of the cases. Magnetic resonance cholangiographic was performed (n=16) and allowed to suspect cancer in all of these patients. Incidental finding of gallbladder cancer at surgery was recorded in 24 patients: intraoperatively in 10 cases or after pathological study in 14 cases. For all the cases of BTC, Staging of the disease was based on the thoraco-abdomino-pelvic scan and divided into localized stage (7 %), locally advanced stage (14 %) and metastatic stage (79 %). The site of metastases was as following: liver (85 %), lymph nodes (43 %), lung (35 %), peritoneum (25 %), bone (7.5 %), and soft subcutaneous metastasis (5 %). An initial complete surgery in gallbladder cancer (extended cholecystectomy including en bloc hepatic resection and lymphadenectomy with or without bile duct excision) was performed in 7 patients. A second curative surgery was performed in 8 patients. A complete surgery in cholangiocarcinoma cases (n=20) was performed in 6 patients. A palliative surgery was done in 24 patients of all BTC: cholecystectomy (n=9) and biliary drainage (n=15). In all the BTC metastatic patients (n=55), a palliative chemotherapy was administered as following: combination of cisplatin and gemcitabine (n=22), gemcitabine alone (n=10), combination of oxaliplatin and gemcitabine (GEMOX) (n=5), combination of cisplatin and 5 fluorouracil (n=4), capecitabine alone (n=4), combination of capecitabine and oxaliplatin (XELOX) (n=2), and FUFOL Mayo clinic (n=2). While 9% of the patients received supportive care because of their comorbidities and the deterioration of the performans status and liver blood tests. Conclusion Because of the silent evolution of BTC, the diagnosis is therefore delayed, the prognosis is poor and treatment is usually palliative. Our results are consistent with those of the literature concerning the epidemiological finding and diagnosis aspects. A multidisciplinary approach including methods for early diagnosis, oncologic surgery and chemotherapy is recommended to improve the prognosis of patients with biliary tract cancers.

Desmoplastic small round cell tumor (DSRCT) is a rare and highly aggressive variety of sarcoma arising typically from abdominal or pelvic peritoneum. Diagnosis and treatment approaches of this entity are complex and require a skilled, experienced, multidisciplinary team. Authors report their experience with a case of an intraabdominal DSRCT arising in a 37-year-old young man in order to discuss the clinico-pathological and radiological behavior of this tumor and underline diagnostic and therapeutic difficulties.

Coeliac disease is associated with an increased risk of malignancy, not only of intestinal lymphoma but also of small intestinal adenocarcinoma which is 82 times more common in patients with celiac disease than in the normal population. We report three additional cases of a small bowel adenocarcinoma in the setting of coeliac disease in order to underline the epidemiological features, clinicopathological findings, and therapeutic approaches of this entity based on a review of the literature. The three patients underwent a surgical treatment followed by adjuvant chemotherapy based on capecitabine/oxaliplatin regimen, and they have well recovered.

Introduction Signet ring cell carcinoma (SRCC) of the stomach is a histological type based on microscopic characteristics, and its clinicopathologic characteristics and treatment are still controversial. Methods In this retrospective study, we reviewed the records of 86 consecutive patients diagnosed with gastric SRCC and treated in the Medical Oncology Department of Hassan II university hospital (Fez, Moroocco) between January 2008 and January 2012. The aim of this study is to identify the epidemiological, clinical and therapeutic features of this type of gastric cancer in a Moroccan population. Results In our study, SRCC of the stomach represent 38 % of the gastric cancer and 11 % of all the digestive tract cancer. The mean age at the diagnosis was 46 years ranged from 25 to 80 years, 64 % were female. The clinical symptoms were mainly vomiting (73 %), epigastric pain (71 %) and deterioration of performance status (94 %). 69 % (n=59) of the patients were metastatic at the diagnosis, sites of metastasis were: peritoneum (85 %), lymphatic nodes (46 %), liver (39 %), lung (32 %), ovaries (10 %), adrenal glands (7 %), bone (5 %) and the kidney (1.6 %). 31 % of the patient had non metastatic disease: localized to the stomach in 19 cases and locally advanced in 8 cases. These patients were treated with curative strategy by total gastrectomy (+/- extended to adjacent organs) followed by adjuvant concomitant chemo radiotherapy (n=9), adjuvant chemotherapy (n=7) or perioperative chemotherapy (n=11). For the metastatic patients, chemotherapy regimens were distributed as following: ECC (Epirubicin 50 mg/m2, Cisplatin 60 mg/m2, Capecitabine 625 mg/m2/12h) was administered to 44 % of the cases; Capecitabine as monotherapy for 17 %, Cisplatine-5FU to 13 % of the cases; FUFOL Mayo clinic regimen for 9 % and EOX (Epirubicin 50 mg/m2, Oxaliplatin 130 mg/m2, Capecitabine 625 mg/m2/12h) for 9 % of the cases. Five metastatic patients were oriented to supportive care given the deterioration of their Performance Status. A second line of chemotherapy was administered to 11 patients based on XELIRI (Irinotecan 250 mg/m2 and Capecitabine 2000mg/d for 14 days) in 5 patients, XELOX (Oxaliplatin 85 mg/m2 and Capecitabine 2000mg/d for 14 days) in 3 patients and FOLFOX4 in the 2 other cases. Conclusion The gastric Signet ring cell carcinoma represents an entity with specific characteristics, which tends more toward tumor invasion depth, with nodal and peritoneal metastases. Our results are consistent with those of the literature concerning the epidemiological finding and diagnosis aspects. A multidisciplinary approach including cancer surgery and chemotherapy is recommended to improve the prognosis of patients with this disease

Unlike primary pancreatic carcinoma, metastatic lesions of the pancreas are uncommon and account for approximately 2% of pancreatic malignancies. Small-cell lung carcinoma (SCLC) represents a group of highly malignant tumors giving rise to early and widespread metastasis at the time of diagnosis. However, the pancreas is a relatively infrequent site of metastasis by this neoplasm, and reports on metastatic small-cell carcinoma (SCC) in the pancreas, either of pulmonary or extrapulmonary origin, to be diagnosed by CT-scan-guided trucut biopsy (CT-TCB) are very rare. A 56-year-old man presented with a laterocervical lymphadenopathy associated to a mixed-density lung mass and a mass in the pancreatic body. CT-TCB slides from the pancreatic mass contained small, round tumor cells with extensive nuclear molding. The cytomorphological and histological diagnosis was metastatic SCC. Immunocytochemical staining showed that a variable number of neoplastic cells were positive for cytokeratin 7, TTF1, chromogranin A, and synaptophysin but negative for leukocyte common antigen and cytokeratin 20 with a very high expression of KI67. The transbronchial needle biopsy confirmed the diagnosis of an SCC. This case represents a rare metastatic lesion in the pancreas from SCLC, diagnosed by CT-TCB histological and immunohistochemical studies.

e11516 Background: Inflammatory breast cancer (IBC) is the most virulent type of breast cancer. It represents 1 to 6% of all the breast cancer in Western countries. It is speculated that the incidence of IBC is greater in emerging countries especially in North Africa. The management of this disease requires a multidisciplinary. Methods: We recorded the cases of 80 patients with IBC admitted in the Medical Oncology Unit between January 2007 and August 2011. We included patients with IBC classified as T4d using criteria based on the tumor-node-metastasis (TNM) classification . The aims of this study is to evaluate the epidemiological, clinical, histopathological and therapeutic aspects of this disease. Results: The median age of our patients was 44.5 years ranged from 24 to 88 years. The incidence of IBC in our study was 7.8%. The lymph node involvement was noted in 60% distributed as following: N0 in 40%, N1 in 30%, N2 in 19%, N3 in 11%. For histology, ductal carcinoma represents 96% of all cases. Human epithelial receptor 2 (HER 2) was positive in 32% of the cases. Hormonal receptors were negative in 22% of the cases. The grade of the tumor according to the Scarff Bloom Richardson classification was as following: grade I ( 2.5%), grade II (52%), grade III (45.5%). All patients received neoadjuvant chemotherapy. 45% received chemotherapy with anthracyclines, 35% were treated with docetaxel and anthracycline and 10% with the association chemotherapy Trastuzumab. According to RECIST classification, a partial or total clinical response was noted in 80% of cases, 10% of patients had stability, and 10% clinical progression. According to Sattalof classification, a histological response greater than 50% in the tumor (TB) was noted in 45%. A complete pathological response (TANA or TANB) was obtained in 15% of cases. After a median follow up of 2 years 35% of the patients had a metastatic or locoregional reccurence, 45% of the cases remain in complete remission. Conclusions: The result of our study is concordant with the litterature. The incidence of IBC was greater than the incidence in western countries. The IBC was also associated with high grade and younger age. Despite a good clinical and pathological response to chemotherapy, outcomes were poor.

ABSTRACT Introduction The management of colorectal cancer in the elderly patients is becoming a major problem of public health. The principles of treatment of colorectal cancer in patients aged 70 years old and over are the same as those of younger ones, but therapeutic indications should be adjusted according to physiological age, general condition, and the existence of co morbidities. Methods In this retrospective study, we reviewed 62 cases of colorectal cancer in patient aged 70 years old and over admitted in the medical oncology unit of HASSAN II university hospital between January 2009 and January 2012. The aim of this study is to determinate epidemiologic, clinical and therapeutic aspects of this disease in the elderly Moroccan population. Results 62 cases of colorectal cancer were diagnosed in patients aged 70 years old and over representing 27, 5% of all colorectal cancers. 70% of our patients are aged between 70 and 74 years old (n= 43), 20% between 75 and 79 years old, and 10% 80 years old and over. 20% of cases had antecedent of cardiovascular disease, and 8 % had a history of cancer family. The average time of diagnosis was 7.3 months, the clinical symptoms were mainly rectal bleeding (53%), abdominal pain (43%). 37 % of the patients were metastatic at the diagnosis (n=23), sites of metastasis were liver in 10 cases (43%), lung in 7cases (30%), peritoneum in 6 cases (26%), lymph nodes in 5 cases (21%). 20% of patients (n=13) presented a stage III disease, stage II was noted in 35% (n=22), and stage I in 6% (n=4). Left resection of the colon was performed in 24 % of cases, right hemi-colectomy was done in 22%, surgery of rectum was performed in 20%, and metastatic liver resection was done in 5% of all metastatic patients. Preoperative concomitant chemo radiotherapy was performed in 13% for lower and middle rectum. Adjuvant chemotherapy based on Capecitabine alone was administrated in 12 cases, and XELOX in 4 cases, with 25% of diarrhea (n=4), 18 % of hand and foot syndrome (n=3), 18% of non-febrile neutropenia (n=3), and 12% of peripheral neuropathy (n=2). 11% of our patients received metastatic chemotherapy based on XELERI+BEVACIZUMAB (n=7) with 2 cases of diarrhea grade 2, 11% patients received chemotherapy based on XELOX with one death secondary to thrombocytopenia grade 4 after first cycle, and 3% chemotherapy with CAPECITABINE alone. We opted for no treatment in 11% of patients (n=7): Cardiac failure in four cases, 2 cases because of deterioration of performance status, and terminal renal failure in one case. Conclusion All patients with colorectal cancer aged 70 years old and over should receive the most appropriate treatment thought to be effective and safe, according to their biological age and co morbidities. Geriatric assessment is essential in the care for elderly patients with colorectal cancer.

la radiothérapie adjuvante joue un rôle essentiel dans la prévention des récidives locales du cancer du sein. Les sarcomes radio-induits représentent une complication tardive et exceptionnelle de la radiothérapie du cancer du sein, retrouvée dans 0,23 % des cas.

Background. Kaposi's sarcoma (KS) in transplant recipients is about 400 to 500 times rate in the general population. It is strongly associated to Human herpesvirus-8 (HHV-8) infection which has been found in 95% of KS lesions. The optimal approach to managing posttransplantation KS is to reduce or discontinue immunosuppressive therapy but this strategy carries a risk of the acute rejection of the graft. Recently, the use of an mTOR inhibitor has added new opportunities for KS treatment and prevention. Case Report. We report a case of 24 years-old Turkish woman with visceral HHV-8-associated Kaposi's sarcoma after orthotopic liver transplantation. Conclusion. Posttransplantation KS is considered an experimental model of virus induced tumor suggesting the usefulness of HHV-8 screening in transplant recipient and donor. Therapeutic approaches are complex and require a multidisciplinary team.