Signet ring cell carcinoma (SRCC) is a rare and distinct subtype of adenocarcinoma. It can arise in various organs, including the stomach, colon, breast, bladder, and prostate. It may also occur as a primary pulmonary tumor. We report a case of a 65-year-old woman with no significant medical history, who presented with a two-month history of dyspnea and hemoptysis, associated with weight loss. A chest CT scan revealed a locally advanced pulmonary mass with mediastinal lymphadenopathy and bilateral pulmonary metastases. A biopsy was performed and confirmed a diagnosis of pulmonary-origin signet ring cell adenocarcinoma. Given the patient's general condition, chemotherapy with weekly paclitaxel and carboplatin (AUC2) was initiated. At the first evaluation after three cycles, the disease was stable. The patient subsequently developed a respiratory infection due to a multidrug-resistant organism, and despite appropriate antibiotic therapy, she passed away because of the infection. Primary SRCC of the lung remains a diagnostic and therapeutic challenge, with poor prognosis despite early intervention. The rapid clinical decline observed in this case highlights the aggressive nature of the disease and the importance of supportive care.

Background: Women with breast cancer vary in their self-efficacy to cope with their disease and its announcement: a variability that has proven to be associated with many factors. This study, carried out in 2023 among Moroccan women newly diagnosed with locally advanced breast cancer at the university hospital center Hassan II- Fez, aims to determine the association of their Self-efficacy with their sociodemographic, clinical, physical and psychological symptoms.

Background: Locally Advanced Breast cancer (LABC) patients who are eligible for neoadjuvant therapy (NAT) present a disorder of psychological variables during this treatment. The aim of this systematic review is to understanding depression, anxiety and psychological alterations by examining their prevalence and their change during NAT in LABC.

Les patientes récemment diagnostiquées avec un cancer du sein localement avancé (CSLA) manifesteraient des altérations de leur bien-être psychologique et spirituel. Elles souffraient généralement des pensées négatives comme la peur de la progression de la tumeur ou du décès. Par conséquent, elles adopteraient des stratégies d'ajustement psychologique, soit adaptatives ou maladaptatives. Ce résumé présente l'étude de l'association entre la stratégie d'ajustement psychologique, le coping religieux et les données sociodémographiques et cliniques. Il s'agit d'une étude transversale portant sur les données de base d'une cohorte qui est menée au service d'Oncologie médicale relevant du Centre hospitalier universitaire Hassan II de Fès au Maroc. Le recrutement a été effectué auprès des patientes récemment diagnostiquées avec le CSLA lors de la première consultation oncologique. Un questionnaire se composant entre autres de trois parties a été administré : (1) les variables sociodémographiques et cliniques, (2) l'échelle du « Mental Adjustment to Cancer Scale » (Mini MAC) qui mesure cinq stratégies, à savoir : esprit combatif, fatalisme, impuissance/désespoir, préoccupation anxieuse et évitement cognitif et (3) l'échelle « Brief Religious Coping » (Brief RCOPE). Le recueil des données a été fait par le logiciel Epi Info version 7.2.3.1 et l'analyse statistique par le logiciel SPSS version 24. La distribution normale des variables a été vérifiée par le test Skewness et Kurtosis. L'analyse bivariée des associations entre les stratégies d'ajustement psychologique a été réalisé selon la normalité des variables par le test Student, le test Mann Whitney, le test ANOVA et les tests de corrélation Pearson et Spearman. Ensuite, un modèle linéaire multivarié a été utilisé pour trouver les déterminants associés aux différentes stratégies d'ajustement psychologiques. Au total, notre population d'étude était composée de 209 femmes dont la moyenne d'âge est 47,43±9,45 ans. La stratégie de fatalisme a eu la moyenne la plus élevée (3,87±0,35), suivie de la stratégie de l'esprit combatif (3,53±0,68). L'analyse linéaire multivariée pour les stratégies adaptatives a montré que la stratégie d'esprit combatif est associée à la profession (b=0,35, p=0,01) et au Coping Religieux Négatif (CRN) (b=-0,12, p<0,001). Alors que le revenu mensuel de la famille (b=0,127, p<0,001) et le CRN (b=-0.04, p<0.001) sont associés à la stratégie de fatalisme. La stratégie de l'évitement cognitif est associée uniquement au CRN (b=-0,08, p=0,01). Concernant les stratégies maladaptatives, l'impuissance/désespoir est associée significativement au Coping Religieux Positif (CRP) (b= -0,04, p<0,05), au CRN (b=0,13, p<0,001), au revenu mensuel de la famille (b=-0,32, p<0,01), au ganglion lymphatique (b=0,22, p=0,05) et aux récepteurs d'œstrogène (b=-0,53, p<0,05). Alors que la stratégie de préoccupation anxieuse est associée à la latéralité du sein tumoral (b=-0,38, p<0,05), aux récepteurs de progestérone (b=-0,34, p=0,05), à la durée de découverte des premiers signes (b=-0,44, p<0,05) et aux autres maladies chroniques (b=-0,29, p<0,05). Les patientes atteintes de CSLA mobilisent diverses stratégies de coping. Un programme de renforcement des stratégies adaptatives s'avère nécessaire depuis le diagnostic de la maladie et aussi au cours les différentes étapes de traitement. Stratégie d'ajustement psychologique, Facteur sociodémographiqu, Facteur clinique, Cancer de sein localement avancé, Récemment diagnostiqué Les auteurs n'ont pas précisé leurs éventuels liens d'intérêts.

Mucoepidermoidcarcinoma (MEC) is a rare neoplasmthat arises from the exocrine glands and iscommonlyfound in the salivary glands. However, MEC of the pancreasis an exceedingly rare entity, withonly a few documented cases in the literature. Here, wepresent the case of a 69-year-old male patient whowasdiagnosedwithmucoepidermoidcarcinoma of the pancreasthathadmetastasized to the liver. MEC of the pancreasis a highlyaggressivemalignancythatisassociatedwith a poorprognosis due to itsability to invadesurrounding tissues and to metastasizeearly. In this report, wedescribe the patientsclinicalpresentation, diagnostic workup, and management, as well as a review of the currentliterature on this rare tumor.

Introduction The taxotere is an antineoplastic more used in cancerology in several gyneco-mammary, urological, digestive locations with acceptable and manageable toxicities. However, there are rare toxicities such as scleroderma which should not be neglected and taken into account as it is increasingly encountered. Observation A 78-year-old patient with a history of operated squamous cell carcinoma of the thigh, who presents with metastatic prostate cancer, treated with first-line taxotere who presents a rare complication: scleroderma confirmed on imaging, treated with corticosteroid therapy and drug cessation with good clinical outcome. Conclusion Scleroderma is a rare complication which should not be ignored in patients on taxoteric. This complication is related to the cumulative dose, discontinuation of treatment and corticosteroids constitute effective management.

Background: The Covid-19 disease is a cause for several mental alterations mainly in cancer patients who are already categorized as a vulnerable population. Aim: The objective of this study is to characterize psychological disorders caused by Covid-19 infection among cancer patients on systemic treatment. Methods: It is a cross-sectional study performed at the Department of Medical Oncology of Hassan-II University Hospital of Fez, Morocco, during a period of four months (peak of the pandemic). Symptoms of anxiety/depression and post-traumatic stress disorder in patients were screened using HADS (Hospital Anxiety and Depression Scale) and PCL-5 (post-traumatic stress disorder checklist version DSM-5) scales. Mini-MAC (mini-mental adjustment to cancer) scale was used to evaluate a mental adjustment to cancer during the context of Covid-19 infection. Results: Of the 53 patients in this study, 45.2% had posttraumatic stress disorder, 20.7% presented symptoms of depression, and 69.8% had symptoms of anxiety. Age less than 65 years, females, and the intention of treatment (curative vs. palliative intent) were predictive factors of anxiety disorders. All of our patients returned to complete their treatment after their SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection was cured. Conclusion: The prevalence of anxiety and post-traumatic stress was higher among cancer patients comparatively to general population. These results suggest the need of psycho-oncological supportive-care programs during the actual pandemic.

L'annonce du diagnostic de cancer du sein localement avancé (CSLA) peut entraîner une mauvaise qualité de vie et augmenter les niveaux d'anxiété chez les patientes. En règle générale, les praticiens recommandent la chimiothérapie néoadjuvante (CTNA) dans cette situation. Le but de cette étude est de déterminer la prévalence de l'anxiété et ses déterminants sociodémographiques et cliniques chez les patientes récemment diagnostiquées avec LABC et avant de commencer la CTNA. Il s'agit d'une étude transversale portant sur les données de base d'une cohorte recrutant les femmes nouvellement diagnostiquées de CSLA sans localisation métastatique. Le déroulement de l'enquête a été effectué lors de la première consultation oncologique ou au cours de la période qui précède le commencement de la CTNA. L'étude a été menée entre 2021 et 2022 à l'hôpital d'oncologie relevant du Centre hospitalier universitaire Hassan II de Fès au Maroc. Les facteurs sociodémographiques et cliniques ont été évalués à l'aide d'un questionnaire structuré. La sous-échelle Anxiété de « Hospital Anxiety and Depression Scale » (HADS-A, seuil≥10) a été utilisé pour mesurer l'anxiété. Le recueil des données a été fait par le logiciel Epi Info version 7.2.3.1 et l'analyse statistique par le logiciel SPSS version 24. La distribution normale des variables a été vérifiée par le test Skewness et Kurtosis. Une analyse descriptive généralisée et la régression logistique ont été utilisés pour déterminer la prévalence de l'anxiété et ses facteurs associés. Au total, notre population d'étude était composée de 209 femmes dont la moyenne d'âge est 47,43±9,45 ans. La prévalence de l'anxiété dans cette étude était de 47,8 % (CI 95%: 41 %-54,8 %) (n=100) parmi les personnes interrogées. Selon l'analyse multivariée, l'anxiété est associée à l'âge et à latéralité du sein cancéreux. En effet, les patientes ayant mois de 50 ans sont 2,21 plus susceptible de développer l'anxiété que celles ayant plus de 50 ans (OR Ajusté=2,21; CI 95%:1,18-4,13; p=0,01). De plus, les patientes ayant le CSLA au côté droit ont deux fois plus de risque de développer l'anxiété que celles ayant le CSLA au côté gauche (OR Ajusté=0,79; CI 95%: 1,11-3,65; p=0,02). La prévalence de l'anxiété parmi les patientes incluses dans cette étude montre qu'elles souffrent psychologiquement et qu'elles méritent des interventions lors de la première consultation oncologique. De plus, de telles interventions face à l'anxiété devraient prendre en considération l'âge des patientes et la latéralité du sein cancéreux. Anxiété, Facteurs sociodémographiques, Facteurs cliniques, Cancer du sein localement avancé, Nouvellement diagnostiqué Les auteurs n'ont pas précisé leurs éventuels liens d'intérêts.

Introduction : La Covid-19 constitue une cause de plusieurs affections mentales, notamment chez les patients atteints de cancer qui sont déjà considérés comme une population vulnérable. Ainsi, l’objectif de la présente étude était d’évaluer les troubles psychologiques des patients suivis pour une maladie tumorale maligne, sous traitement médical systémique, ayant eu une infection au SARS-CoV2 ; ainsi que les conséquences que ces troubles psychologiques peuvent avoir sur l’adhésion aux soins oncologiques. Méthode : Il s’agit d’une étude transversale sur une période de quatre mois (pic de la pandémie) menée au département d’oncologie médicale du centre hospitalier universitaire Hassan-II de Fès, Maroc. Les symptômes anxieux/dépressifs et le stress post-traumatique ont été évalués avec les échelles HADS, PCL-5. L’échelle mini-MAC était utilisée afin d’évaluer l’ajustement psychologique des patients atteints de cancer dans le contexte d’infection à la Covid-19. Résultats : Au total, 53 patients ont été rencontrés : 45,2 % des patients présentaient des symptômes significatifs de stress post-traumatique et 20,7 % une symptomatologie dépressive. Une symptomatologie anxieuse importante était objectivée chez 69,8 % des patients. L’âge inférieur à 65 ans, le sexe féminin et la stratégie thérapeutique envisagée (curative versus palliative) étaient des facteurs prédictifs de survenue de troubles anxieux. Tous les patients sont revenus pour reprendre leurs soins oncologiques après l’épisode infectieux. Conclusion : Les troubles anxieux et le stress posttraumatique sont très fréquents chez les patients atteints de cancer et positifs à la Covid-19 par rapport à la population générale. Nos résultats suggèrent la nécessité de mettre en place des soins de support psycho-oncologiques personnalisés durant le contexte pandémique.

Despite advances in drug therapy, pain management for patients with lung cancer remains complex. Lung cancer is known to be one of the most painful cancers. Objective: In this study we evaluate the management of pain in patients treated for lung cancer, all stages combined, in the oncology department of the Hassan II University Hospital of Fez. Mean : cross-sectional study of 71 patients collected over a period of one year using a questionnaire specifying the characteristics of the pain, its etiology, the stage of the disease, the analgesic treatments prescribed and the relief obtained by the treatment. Results: The mean age of the patients was 63.5 years with extremes ranging from 48 to 85 years. Male gender was predominant (68%), 67% of patients had metastatic cancer: 42% had bone metastases. Nociceptive pain was assessed by the visual analog scale (VAS) and neuropathic pain by the DN4 Questionnaire. Severe pain, characterized by a VAS score higher than 7, or of moderate intensity with impact on sleep and daily activity, was reported in 60.5% of our patients, mostly young subjects, all with advanced cancer. The pain was acute in 5% of cases, subacute in 32% of patients and chronic in 63% of cases. Neuropathic pain was found in 23% of patients. The pain was controlled by analgesics, level II, in association with an anti-inflammatory agent or antidepressants in 37.3%. 62.7% of patients required morphine. An average daily dose of 60mg of morphine was required to relieve pain, 15 patients reported paroxysmal pain attacks of strong intensity requiring the prescription of sublingual Fentanyl. The use of analgesic radiotherapy in combination with morphine was noted in 10 patients (9.8%). However, a small percentage (2.8%) of patients were resistant to the above-mentioned analgesics, requiring the use of non-drug techniques to relieve them. Conclusion: Our survey confirms the persistent problem of inadequate management of cancer pain. An interesting approach is to improve.

Un cancer du sein localement avancé (CSLA) peut croitre lentement ou proliférer rapidement et agressivement. La chimiothérapie néoadjuvante (CTNA) est le traitement principal du CSLA. Lors des premières consultations en oncologie, ces patientes présenteraient souvent des symptômes psychologiques. Le but de cette étude est de déterminer la prévalence de la dépression et leurs facteurs sociodémographiques et cliniques chez les patientes récemment diagnostiquées avec CSLA et avant de commencer la CTNA. Il s'agit d'une étude transversale portant sur les données de base d'une cohorte recrutant les patientes (âge ≥18 ans) nouvellement diagnostiquées de CSLA sans localisation métastatique. L'enquête est menée lors de la première consultation oncologique et au cours de la période qui précède le commencement de la CTNA. Le recrutement est effectué entre 2021 et 2022 à l'hôpital d'oncologie relevant du Centre hospitalier universitaire Hassan II de Fès au Maroc. Le questionnaire utilisé se compose d'un volet lié aux facteurs sociodémographiques et cliniques ont été évalués à l'aide d'un questionnaire structuré. De plus, la sous-échelle Dépression de « Hospital Anxiety and Depression Scale » (HADS-D) a été intégrée dans ce questionnaire pour mesurer la dépression. Le logiciel Epi Info version 7.2.3.1 a été employé pour saisir les données, alors que le logiciel SPSS version 24 est utilisé pour l'analyse statistique. La distribution normale des variables a été vérifiée par le test Skewness et Kurtosis. Une analyse descriptive généralisée et la régression logistique ont été utilisés pour déterminer la prévalence de la dépression et ses facteurs associés. Au total, notre population d'étude était composée de 209 femmes dont la moyenne d'âge est 47,43±9,45 ans. L'analyse descriptive a montré que la prévalence de dépression était 59,6 % (IC 95%: 52,6 %-66,3 %) (n=124) parmi les personnes interrogées. L'analyse multivariée (AM) a montré que la dépression était associée à l'âge et à l'assurance médicale. En effet, 1) les patientes ayant moins de 50 ans sont 2,19 fois plus susceptibles de développer la dépression que celles ayant plus de 50 ans (OR ajusté=2,19; IC 95%: 1,13-4,23; p=0,01). De plus, 2) les femmes pauvres et/ou socio-économiquement vulnérables ayant une assurance médicale totale ont 3,64 fois plus de risque d'avoir la dépression (OR ajusté=3,64; IC 95 %: 1,18-11,26; p<0,05). L'implémentation d'un programme de soutien psychologique des patientes ayant le CSLA devient une nécessité depuis le diagnostic de la maladie cancéreuse afin de surmonter les niveaux élevés de dépression et aussi pour préparer les patientes aux différentes étapes de prise en charge en oncologie médicale

Breast cancer is a serious worldwide public health problem and is currently the most common cancer overall. Its endocrine therapy is related to the expression of the steroid hormones, estrogen receptor (ER), and progesterone receptor (PR). Breast cancers can be presented under multiple profiles of steroid hormones: ER(−)/PR(+), ER(+)/PR(−), double-positive/negative ER, and PR. 2–8% of all breast cancers express only PR (ER−/PR+) which is an abnormal phenotype, with less known about their behaviors and outcomes. Our study was performed on a large and well-characterized database of primary breast cancer from 2012 to 2019, up to 1159 cases. These cases were divided according to ER and PR expression, as we put all of our focus on ER-negative/PR-positive group, more specifically ER−/PR+/HER2+ and ER−/PR+/HER2− gene expressions, to highlight their features and find a pattern that links HR (hormone receptors) profiles and breast cancer subtypes. Out of the informative cases, 94 patients (8%) had ER−/PR+ breast cancers, while 676 (58.4%) had ER+/PR+, 88 (7.6%) had ER+/PR−, and 164 (14.2%) had ER−/PR− tumors. The ER−/PR+ group was statistically correlated with a high risk of recurrence and death in midway between the double-negative and double-positive HR. According to HER2 status, a low DFS was observed in patients ER−/PR+/HER2−, which is closer to the DFS of TNBC cases but worse than ER+/PR any. On the other side, the ER−/PR+/HER2+ showed also a poorer DFS closer to the HER2+ subgroup in between TNBC and ER+/PR any. The clinicopathological features of the ER−/PR+/HER2− and ER−/PR+ HER2+ have distinguished the patients into two groups with a difference in some clinicopathological characteristics: both groups had closer OS estimation, which was worse than ER−/PR any and better than TNBC and HER2. The ER−/PR+/HER2− seems to increase the risk of recurrence than ER−/PR+/HER2+ when compared to ER+/PR any. On the other hand, the ER−/PR+/HER2+ seems to increase the risk of death more than ER−/PR+/HER2− in comparison with ER+/PR any. Our results support that ER−/PR+ tumors really exist and are rare and clinically and biologically distinct subtypes of breast cancer. In addition, our analysis, which was based on dividing the groups according to HER2 expression, has revealed the existence of two distinct groups; this gave the ER−/PR+ subgroup a heterogeneity characterization. Moreover, this breast cancer subtype should not be treated as a luminal tumor but rather according to the HER2 expression status.

Background: Breast cancer is a major public health problem worldwide. It's the most common cause of death from cancer in women, it considers a heterogeneous disease, shows variable morphological and biological features, they have different clinical behavior, and prognoses, and respond to therapy differently despite similarities in histological types, grade, and stage. The classication aims for an accurate diagnosis and prediction of behavior, however, histological classication isn't enough in this era of personalized medicine, this results in « overtreatment » of many patients, so, molecular proling allows tumors to be dened by the expression pattern or genomic alteration of thousands of genes. A Methods: retrospective, descriptive and analytic study was performed among 1040 women with invasive breast carcinoma, which was diagnosed in the department of surgical pathology at University Hospital Center of Hassan 2 of Fez in Morocco, during a period ranging from 2012 to 2019. The prevalence of different molecular subtypes of breast carcinoma was estimated, in addition, clinicopathological features such as age, tumor size, tumor grade, lymph node involvement, hormonal receptors prole, and HER2 status have been compared. The mean age of diagnosis was Results: 49.5 years (DS12,5 years, 17-88 years), among these, 637 (55%) were under 50 years. NOS invasive breast carcinoma was the histological type the most common in 1030 (89%), with an SBR II in 60% of cases. The Mean tumor size was 2.8cm. Axillary lymph nodes (LN) were metastatic in 60% of cases. 76% of cases showed positive staining for estrogen receptors, 75,5% for progesterone receptors, and 18,5% for HER2/neu. Luminal A subtype was found in 22% of patients while Luminal B was present in 62,5% of patients, HER2 enriched in 5%, and triple-negative (TN) in 10,5 % of cases. There is signicant difference between the 4 subclasses by age (P=0.02), SBR grading (p<0,0001), tumor size (p=0,05), lymph node metastasis (0,0001). There are more young women in HER2 enriched and luminal B subtypes than in luminal A and TN subtypes, while the rate of older women is increased in luminal A subtypes. The proportion of patients with histological grade III in the TN subtype and HER2 subtype, is signicantly increased (P<0.0001) while grade I is signicantly increased in the luminal A subtype. LN metastasis in the luminal B and Her2 cancers are more signicant than in luminal A and TN. Disease-free survival (DFS) among older women above 50 years is signicantly greater among young women under 40 years ( p=0,021). Regarding SBR grading, and DFS, we found that survival was signicantly highest for patients with grade I, followed by those with grade II and then grade III (P<0.0001). According to molecular subtypes, we noted that DFS was signicantly highest for patients with luminal-A subtype, followed by those with luminal B subtype, then HER2 and TN cancers (P<0.0001). The Conclusion: present study shows the particularities of women breast carcinoma in our countryo, through our results, we found that BC is diagnosed at a younger age, a decade earlier than in developed countries, and we found a predominance of luminal B subtype in contrary with others studies suggesting that there are clinico-biological differences, as well as disparities in the expression proling in our population. This highlights the importance of early screening and the need to improve women's awareness of breast cancer in our region and additional research is needed to understand these results in hopes of adopting more effective therapies.

Introduction: Ewing's sarcoma is seen primarily in children and young adults, more common in boys. Tumors developed from the bones of the face represent less than 5% of all cases of Ewing's sarcoma. Observation: A 16-year-old patient with no notable pathological history, who consulted for headache, a binocular diplopia. Radiological exploration by magnetic resonance imaging objective a lesional process centered on the large wing of the sphenoid and the upper wall of the right orbit, the bony origin is primarily a sarcoma. The patient received a biopsy, which pathological examination with immunohistochemistry confirmed the diagnosis of orbital Ewing sarcoma. The interest of this file lies in the unusual location of the tumor. Conclusion: Ewing's sarcoma requires management depending on the different locations. Curative radiotherapy is widely used in this location but cannot compensate for limited surgery.

Clear cell carcinoma in lung is an extremely rare subtype of lung tumors; first described by Liebow and Castle man in 1963 and since only 60 cases have been reported in the literature. CCLC (Clear cell lung carcinoma) was considered by the 2011 WHO classification of lung tumors as a rare cytologic feature of squamous cell or adenocarcinomas. We describe a rare case of a clear cell tumor of the lung, in a 63 year-old male patient, and a brief literature review. The main of this presentation is to emphasize the importance of a multidisciplinary approach including pathologists, oncologists and radiologists to confirm the diagnosis as well for an adequate therapeutic management of this unusual entity of lung cancer.

Background: Parotid melanoma is a very rare disease. Primitive intra-parotid localization is unusual. We report the case of a patient with a parotid localization melanoma without a known primary. Case presentation: A 57-year-old woman who consulted for a progressively increasing left lateral cervical mass. A mass biopsy was performed. The histological and immunohistochemical analysis was in favor of melanoma. A complementary assessment in search of the primitive was without anomaly. The tumor is found to be unresectable after discussion of the case at a multidisciplinary consultation meeting. The therapeutic decision was to do palliative chemotherapy such as Carboplatine AUC2-Paclitaxel 80 mg/m2 J1J8J1=J21 given the deteriorated general condition of the patient. The median of overall survival was 10 weeks. Conclusion: Through this work, we have reported a rare and very aggressive case of intraparotid melanoma of unknown primary.

Breast cancer is the most common malignancy and the first leading cause of death from cancer in Moroccan women.Breast cancer most commonly metastasizes to the bone and has a particular affinity with the spine, accounting for 2/3 of osseous metastases discovered.With significant improvements in cancer therapies, the number of patients at risk for symptomatic spinal metastases is likely to increase.Patients may suffer from intractable pain and neurological dysfunction, negatively influencing their quality of life.Timely diagnosis of patients is crucial and has been aided by several breakthrough advances in imaging techniques which aid in detection, staging, and follow-up of bone metastases.Breast metastases are usually responsive to hormonal therapy and pharmacologic interventions, but skeletal metastases often require surgical intervention.The treatments are palliative but goals include the preserving or restoring neurologic function, ensuring spinal stability, and relieving pain.In this case report, the clinical presentation, diagnosis, patient selection, and management of breast cancer metastatic to the spine are discussed.

lung cancer is considered as the most common cause of cancer death in world. Adenocarcinoma (ADK) is currently the most common histological subtype of this disease, accounting for 85% of all lung cancer cases. The majorities of patients with lung adenocarcinoma have advanced disease and are not candidates for local therapy. The epidermal growth factor receptor (EGFR) represents a potential molecular target for personalized therapy with (ITKs) in Lung ADC. The aim of this study is to define the association of EGFR mutations with predominant histological pattern lung adenocarcinoma in Moroccan population. 135 FFPE tumours diagnosed with lung adenocarcinoma were included between November 2017 and May 2020. Histological subclassification was registered by a pathologist. Automatic direct sequencing was performed for samples with Tumor cells >30% ; The therascreen EGFR RGQ Kit was used for specimen with tumor cells <30%. 27 lung adenocarcinoma were EGFR mutated, more frequently found among women (30%) than in men (15,7%) and non-smokers (non-smokers vs active smokers, 35.7% against 8%). Regarding histological subtypes, the most frequent one was acinar (40%), followed by solid (35,25%), papillary (14.28%) and lepidic (5,71%). EGFR mutation tend to be common in papillary predominant (40%), followed by acinar predominant (33,33%), lepidic predominant (16,6%) and solid predominant (8,1%). EGFR exon mutation distribution was similar to that generally reported in the literature. The main types were in-frame deletions in exon 19 (55,55%), followed by the missenses substitutions in exon 21 (37,03%), exon 20 mutations (11,11%) and exon 18 (3,7%). Exon 19 were significantly more frequent in tumors with papillary pattern (p=0,048), while exon 21 substitutions tend to be associated with acinar predominant pattern (p=0,017). Thyroid transcription factor-1 expression wasn't seen in two EGFR-mutant-positive tumors. A significant association was revealed between EGFR mutations and female gender (p < 0,05), non-smokers (p <0.001), acinary predominant pattern. (p = 0.03). In our population, the female gender, non smoking status and acinar predominant pattern may predict the presence of EGFR mutation in lung adenocarcinoma.

Positive estrogen and progesterone receptors (ER, PR) breast cancers (BC) require endocrine therapy and were associated to favorable outcomes. Hormone receptors (HR) status is considered a crucial predictive factor. The ER−PR+ group is reported to be only 1–5% of all BCs and remains poorly understood and was associated to poor outcomes The aim of this study was to compare the clinical outcomes of patients with single HR positive BC to those with ER+PR+ tumors and TNBC. It is a retrospective study including 700 women with invasive Her2 negative breast carcinoma were included. Patients were stratified according to ER and PR expression as double HR+ (ER + PR+), single HR+ (ER + PR- and ER-PR+) and triple negative HR-negative (HR-, ER-PR-) We reviewed the clinicopathologic characteristics of patients, including biologic factors, such as ER, PR, and Ki-67 Survival was analysed using the Kaplan-Meier method. Hazard ratios were estimated using a Cox regression for OS in a multivariate analysis. 700 patients with negative Her2 disease were included, 421 (60.1%) were ER + and PR +, 111 (15.8%) cases were single HR+ tumors, of which 48 (43.2%) ER-PR+ and 63 (56.7%) were ER + PR- Single HR+ tumors were grade III in 45%, KI67 were > 20% in 70%, T3 in 23% and T4 in 35% and metastatic in 25% of cases. The multivariate analysis revealed that patients with ER + PR- tumors were associated with shorter survival compared with ER + PR+ tumors, with a hazard ratio of 3.69 for overall survival (OS). Patients with ER-PR+ tumors had higher risk of death compared with ER + PR+ tumor, with a hazard ratio of 6.23 for OS. While OS of ER- PR+ patient was statistically non different from the one of triple negative breast cancer. Single HR+ tumors without HER2 overexpression (ER + PR-or ER-PR + ) were associated with more aggressive clinic-pathological features and poorer survival than ER + PR + tumors, and had comparable poor survival to triple-negative breast cancer.

Malignant tumors of the small intestine are uncommon, accounting for less than 2% of digestive tract cancer. However, it is the first etiology for endocrine tumors, lymphomas or stromal tumors. They are characterized by anatomopathological heterogeneity and non-specific symptomatology. This causes a diagnostic delay and a fairly severe prognosis. This is a retrospective study that included patients with small intestine cancer who were treated in the Medical Oncology department from January 2015 to June 2019. The objective was to study the epidemiological, diagnostic and therapeutic and prognostic factors of small intestine cancer and to relate our experience in their therapeutic management. Forty-three cases were reported, with median age 58.2 years (37 to 86 years), with a male predominance (the sex ratio M/F of 1.3). 20,9 % of patients were diagnosed with complications such as acute occlusive syndrome or intestinal perforation. The tumor localization was 23.2% in the jejunum, 32.5% duodenal and 44.1% ileal. Histologically, adenocarcinoma was the most common type (51.2%) followed by neuroendocrine carcinoma (27.9% of cases) and stromal tumors (16.2% of cases). The majority of cases were diagnosed with advanced metastatic disease (55.8% of cases). The sites of metastasis were respectively the liver (30.4%), the lung (16.6%) bone and the peritoneum (8.3%). The treatment was surgical in 44.1% of cases and consisted of a segmental intestinal resection, followed by a terminally terminal anastomosis. Seventy-nine percent of patients were eligible for systemic treatment, of which 23.6% were in the adjuvant setting and 55.8% in palliative cases. The chemotherapy protocol depended on the histological type and was dominated by the 5FU-oxaliplatin combination in carcinomas, while the stromal tumors received TKI. After a median follow-up of 52.7 months, the median progression-free survival was 11.2 months and the median overall survival was 16.8 months all histological types combined. Malignant tumors of the small intestine pose diagnostic problems because of their scarcity and the absence of specific clinical signs. They are often operative discoveries in the event of an acute complication. The curative treatment is surgical resection regardless of the histological type. The prognosis remains reserved because of the late diagnosis of the tumor.