17 research outputs found
Cardiac Metastases of Renal Cell Carcinoma Revealed by Syncope: Diagnosis and Treatment
No full textIntroduction: Cardiac metastases from renal cell carcinoma are very rare. In this report, we describe a case of ventricular metastases in the absence of vena cava or right atrial involvement. Case Report: We report the case of a 60-year-old man who had a past history of heavy tobacco intake and well-controlled arterial hypertension. He experienced sudden-onset palpitations, lost consciousness and, as a result, was involved in an accident on the public highway. Cardiac arrhythmia was suspected and, therefore, transthoracic echocardiography was suggested, which revealed a large right ventricular mass. Chest and abdominal computed tomography demonstrated a mass in the right ventricle, but without contiguous vena cava involvement, and a right renal mass related to the probable neoplasm. An ultrasound-guided renal biopsy showed a clear-cell renal cell carcinoma. A bone scan revealed a metastatic bone disease. The patient was started on sunitinib treatment, which was well tolerated. However, approximately 8 months later, reevaluation showed pulmonary metastases. The patient was subsequently started on treatment with everolimus, which, however, was poorly tolerated. Two months later, the patient died due to terminal respiratory insufficiency. Discussion: Based on the literature and our observations in this case, targeted antiangiogenic therapy should be considered as a viable therapeutic alternative to metastasectomy for patients with inoperable cardiac metastatic disease as long as there is no baseline systolic or diastolic dysfunction. The case also emphasizes the importance of a thorough history review and physical examination in the workup of patients with syncope
Exophthalmos Revealing a Krukenberg Tumor: A Case Presentation and Review of the Literature
No full textBackground: Krukenberg tumor is a well-known ovarian metastasis, usually of signet ring cell carcinoma in female patients. In the literature, there are a few documented cases of ocular metastasis in patients with Krukenberg tumor. Case Presentation: We report the case of a 35-year-old single Moroccan woman. She presented chronic pelvic pain, hematemesis and blurring of vision in the left eye. Clinical examination showed a pelvic mass and an exophthalmos with a divergent strabismus in the left eye. Pelvic and abdominal ultrasound showed a right tissular ovarian mass. Computed tomography (CT) scan of the abdomen and pelvis revealed an ovarian tumor and bone metastasis. Orbital magnetic resonance imaging (MRI) showed a hypertrophy of the left inferior rectus muscle behind the exophthalmos. Stomach endoscopy revealed an ulcerated and protruded mass of the antro-fundic junction. Histopathology and immunohistochemistry showed an infiltration of the gastric mucosa by atypically isolated signet ring cells similar to the tumor cells found in the ovarian histopathological exams. Discussion: Krukenberg tumor is an uncommon metastatic tumor of the ovary. This article provides an overview of the major pathological manifestations of Krukenberg tumor, patient characteristics, clinical and laboratory features of the disease, prognostic factors, and current knowledge about its pathogenesis
Complications of totally implantable venous access devices: experience with 852 Moroccan cancer patients
No full textBackground: Totally implantable venous access devices (TIVADs) provide easy vascular access in cancer patients for chemotherapy administration, blood products, parenteral nutrition and blood sampling. However, they are associated with several complications which can be divided into early and late. The aim of the present study was to evaluate the various complications related to TIVADs in a single center in Morocco.Methods: This was a retrospective, observational, descriptive study conducted at the Medical Oncology Department of the Military Hospital Moulay Ismail in Meknes, Morocco, during a 6-year period, between January 1st, 2011 and December 31st, 2016. Author included all patients older than or equal to 18 years, with solid malignancies who had TIVAD placement for chemotherapy.Results: A total 852 TIVADs were placed. There were 92 complications (10.8% of patients). Early complications included 16 (1.9%) cases of pneumothorax and 12 (1.4%) cases of arterial puncture with a cervical hematoma. Infection was the most common late complications (2.8%), followed by thrombosis (1.8), extravasations of cytotoxic drugs (1.3%), mechanical dysfunction of the catheter (1.3%) and skin necrosis (0.3%).Conclusions: The results of the analysis confirm the safety and tolerability of TIVADs for chemotherapy administration in Moroccan patients, with similar rates of early and late complications compared to the published data. </jats:p
Pancreatic ductal adenocarcinoma in a Moroccan population: analysis of six years experience
No full textBackground: Few studies have been done to investigate pancreatic cancer in Morocco. Therefore, the aim of our study was to describe the epidemiological, clinical and therapeutic features of pancreatic ductal adenocarcinoma in Moroccan population.Methods: Author retrospectively reviewed the medical data of pancreatic ductal adenocarcinoma patients presented to the Medical Oncology Department of the Military Hospital Moulay Ismail in Meknes, Morocco, from January 2011 to December 2016.Results: The study included 67 cases of pancreatic ductal adenocarcinoma. The mean age of patients was 61.24±10.35 years. Male/female ratio was 3.2/1. 20.9% of patients were cigarette smokers, 10.5% alcoholics. 23.9% diabetics, 3.0% with a positive family history of pancreatic cancer and 25.4% with a family history of diabetes mellitus. The main symptoms for consultation were weight loss (68.6%), abdominal pain (64.2%), jaundice (53.7%) and vomiting (25.4%). The tumour was located to the pancreatic head in 71.6% of cases. Stage IV disease was the most common stage representing 47.8% of patients. Biliary and duodenal stent placements were respectively performed in 10.4% and 3.0% of patients. 23.9% of patients underwent curative surgery, 7.5% had palliative surgery and 86.6% received chemotherapy. The median overall survival for the entire cohort was 9.3 months (95% CI 7.2-12.1 months) with a median follow-up of 9.7 months (2-63 months).Conclusions: The data on pancreatic ductal adenocarcinoma in Moroccan population are similar to the epidemiologic literature data. With multimodality treatments, the results in terms of survival benefit seem to be similar to those in Asian and Caucasian populations.</jats:p
Spinal Cord Ischemia Secondary to Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma
No full textTranscatheter arterial chemoembolization (TACE) is accepted worldwide as an effective treatment for patients with unresectable hepatocellular carcinoma. Although considered relatively safe, TACE has been associated with several complications. Spinal cord ischemia secondary to TACE is an extremely rare but disastrous complication. We report a very rare case of spinal cord injuries after TACE, together with a literature review. During the procedure, the patient suddenly experienced sensory impairment below the T10 dermatome and bilateral lower extremity motor weakness. She was given high-dose steroids and supportive therapy. The sensory deficits nearly improved completely, but motor strength remained unchanged. Thereafter, a chest computed tomography scan showed tumor metastasis to the lungs. The patient is now receiving sorafenib and follow-up
An Unusual Case of Isolated Peritoneal Metastases from Lung Adenocarcinoma
No full textIntroduction: Peritoneal metastases from lung cancer are a rare event. In this paper, we report the case of a patient with adenocarcinoma of the lungs who had isolated peritoneal metastases at the time of diagnosis. Case Report: We report a 55-year-old female who presented with shortness of breath, decreased effort tolerance, cough, and weight loss. Her initial chest X-ray and subsequent chest CT showed a 12 × 9 × 8 cm mass in the middle lobe of the right lung. The histopathological examination of her biopsy material was consistent with a thyroid transcription factor-1 positive lung adenocarcinoma. In the abdomen, a 5.3-cm mass was identified. A biopsy and immunohistochemistry revealed a lung adenocarcinoma. The patient was administered chemotherapy based on carboplatin-paclitaxel-bevacizumab, but only with a partial response. Six months later, the patient showed brain metastases. Therefore, a second-line treatment based on pemetrexed was administered for 9 courses, and a clinical and radiological response was observed. The chemotherapy was stopped and the patient did not exhibit any symptoms of progression while waiting for a new evaluation. Discussion: The incidence of peritoneal involvement of lung cancer without metastases in other parts of the body is scarcely encountered in clinical practice. Out of the different types of lung cancers, adenocarcinoma and large cell carcinoma are most likely to metastasize in the peritoneum. Immunohistochemical staining patterns were important in the differential diagnosis with the other etiologies for peritoneal metastasis and the mesothelioma. Peritoneal metastases are indicative of a disseminated disease and prognosis is extremely poor
Gastrointestinal stromal tumors: real-life experience of a Moroccan center
No full textIntroduction : Les tumeurs stromales gastro-intestinales (GIST) sont des tumeurs mésenchymateuses rares qui ont connu récemment beaucoup de progrès tant sur le plan diagnostique que thérapeutique. Matériel et Méthodes : Notre expérience porte sur 23 cas de GIST colligés à l’hôpital militaire Moulay Ismail de Meknès sur une période de 6 ans (depuis janvier 2011 jusqu’à décembre 2016). Résultats : L’âge moyen de nos patients était de 54,2 ans (de 28 à 73 ans) avec une prédominance masculine plus marquée (16 hommes/7 femmes). Les épigastralgies constituaient le principal mode de révélation de la maladie (73,9 %). La localisation gastrique était la plus fréquente (69,6 %). A l’endoscopie digestive, Il s’agissait le plus souvent d’une masse sous muqueuse (21,7 %). Le type cellulaire fusiforme était prédominant (73,9 %). La tumeur était localisée dans 47,8 % des cas, localement avancée dans 8,7 % des cas et métastatique dans 43,5 % des cas. Le traitement a consisté en une résection chirurgicale carcinologique complète dans 65,2 % des cas. Le traitement médical à base d’imatinib était préconisé chez 20 cas dont 12 cas en situation adjuvante et les autres en situation métastatique. Avec un recul moyen de 3 ans, une rémission complète a été obtenue dans 52,2 % des cas. Conclusion : Les GIST sont des tumeurs rares au Maroc. Elles sont souvent localisées dans l’estomac. La chirurgie dans les GIST localisées doit être macroscopiquement complète. L’imatinib est un traitement « à la carte ». Une étude multicentrique à l’échelle nationale permettrait une analyse plus approfondie du profil des GIST au Maroc.Introduction: Gastrointestinal stromal tumors (GIST) are rare mesenchymal tumors that have recently undergone much progress both diagnostically and therapeutically. Material and methods: Our experience concerns 23 cases of GIST collected at the Moulay Ismail military hospital in Meknes over a period of 6 years (from January 2011 to December 2016). Results: The average age of our patients was 54.2 years (28 to 73 years) with a higher male predominance (16 men / 7 women). Epigastralgia were the main mode of disclosure of the disease (73.9%). Gastric localization was the most common (69.6%). Digestive endoscopy most often showed a submucosal mass (21.7%). The fusiform cell type was predominant (73.9 %). The tumor was localized in 47.8% of cases, locally advanced in 8.7 % of cases and metastatic in 43.5% of cases. Therapeutic management consisted of complete surgical resection in 65.2% of cases. Medical treatment with imatinib was recommended in 20 cases including 12 cases in adjuvant situation and the others in metastatic situation. With a mean follow-up of 3 years, complete remission was obtained in 52.2% of cases. Conclusion: GIST are rare tumors in Morocco. They are often located in the stomach. Surgery in localized GIST should be macroscopically complete. Imatinib is an “at card” treatment. A multicenter nationwide would allow further analysis of GIST profile in Morocco
Primary malignant melanoma of the nipple: a case report
No full textPrimary melanoma originating on the female nipple remains an extremely rare variant of malignant melanoma and only a few cases haves been reported in the literature. We describe a case of a patient admitted for a black pigment deposition on the left nipple. Surgical resection of the left nipple and areola with clear margins and an axillary lymph node dissection was performed confirming the diagnosis of non-invasive superficial spreading melanoma
