Hematologic malignancies often present with nonspecific symptoms, and the increasing use of MRI for various indications has led to the incidental detection of bone marrow signal anomalies, which can prompt further diagnostic evaluation. When such anomalies are identified, additional investigations, including bone marrow examination, may be necessary to exclude a neoplastic process. However, some signal anomalies are physiological, potentially leading to unnecessary further assessments. The incidence of these anomalies is currently unknown, no guidelines exist for their management and they are an increasingly source of costly investigations. This article illustrates the difficulties of interpreting these MRI anomalies through clinical cases, and proposes a multidisciplinary diagnostic approach.

The treatment of rectal cancer has evolved dramatically in recent years. Today, specialists have more options to choose from, ranging from primary surgical resection with or without neoadjuvant treatment to an organ-preserving strategy (such as Watch-and-Wait) after total neoadjuvant treatment. The aim of this article is to review the advantages, limits, and risks of the Watch-and-Wait strategy for the treatment of rectal cancer.

The incidence of thyroid cancer has risen sharply in recent decades. While most thyroid cancers are low-risk and have an excellent prognosis, a minority of patients develop advanced-stage disease with increased morbidity and mortality. An individualized approach is essential to optimize oncological outcomes while minimizing treatment-related complications. Molecular biology plays a growing role in the preoperative assessment of malignancy risk. Therapeutic de-escalation has been underway for a decade with active surveillance of thyroid cancer <10 mm, a decrease in the extent of initial surgery, and a decrease in postoperative radioactive iodine administration. Close collaboration between endocrinologists, pathologists, nuclear medicine physicians, radiologists, and surgeons remains critical to diagnosis and management.

Locoregional treatment of breast cancer is based on surgery of the breast and axilla, radiotherapy of the breast or chest wall and regional lymph node areas. A progressive therapeutic de-escalation was carried out in order to reduce the impact of the treatments. This de-escalation will be considered for breast treatment and for lymph node area during primary surgical treatment and for neo-adjuvant chemotherapy.

The ear and the petrous pyramid extend from the external auricle to the center of the cranial cavity, featuring a complex anatomy and significant neurovascular relationships. The ear houses essential structures involved in hearing, balance, and facial mobility. Due to its rich histological composition, the ear can be affected by a wide range of tumors, from benign lesions to aggressive cancers.

Oncoplasty techniques have been progressively and widely carried out in clinical practice after the description of the different procedures adapted to breast volumes and tumor locations. Surgery with oncoplasty makes it possible to reduce the rate of reoperation, for large tumors, with a local recurrence rate and overall survival rate at least equivalent to standard conservative surgeries. When surgery with oncoplasty is offered as an alternative to a mastectomy, the therapeutic implications must be the subject of informed and precise information so that the patient can make a choice between these two possibilities. Surgical expertise is necessary with the completion of initial and/or secondary, theoretical and practical training. If a total mastectomy is indicated for therapeutic or prophylactic purposes, it is more and more often possible to offer the patient immediate breast reconstruction if she wishes. Radiotherapy to the reconstructed breast and the need for adjuvant chemotherapy are no longer obstacles to this treatment proposal to the extent that the patient is requesting it and the risks of complications have been assessed and accepted. Reconstruction by breast implant remains the most used but autologous techniques and in particular lipomodeling make it possible to postpone the placement of foreign bodies.

Leptomeningeal disease (LMD) from breast cancer is defined by the invasion of the leptomeninges and cerebrospinal fluid (CSF) by tumor cells. Historically associated with a very poor prognosis and survival measured in weeks, their management has evolved considerably. Therapeutic advances, such as the introduction of targeted therapies, and a better understanding of the pathophysiology of LMD now enable earlier diagnosis through dedicated MRI sequences and optimized CSF analysis. The EANO-ESMO classification notably distinguishes type I LMD (cytology-positive), which carries a worse prognosis but is more sensitive to intrathecal (IT) treatments, from type II LMD (negative or uncertain cytology), often more responsive to local-regional approaches like radiotherapy. Data from large retrospective cohorts highlight the importance of combination therapies: systemic treatments, IT injections, radiotherapy, as well as early symptomatic and palliative care. This multidisciplinary approach improves median survival, now reaching several months, and can even surpass 10 months in HER2+ cases. Innovative clinical trials, such as ETIC-LM (NCT05800275) - a French phase II study evaluating the combination of IT trastuzumab, oral tucatinib, and oral capecitabine offer encouraging new strategies for patient care. Although the prognosis remains poor, recent advancements suggest a more hopeful future, providing better disease control and improved quality of life for patients with LMD from breast cancer.

Renal cysts are common. They include asymptomatic simple cysts and cystic or secondarily cystic tumors. Radiological criteria allow differentiation between benign cysts and cysts suspect of malignancy, which require excision and histopathological confirmation.

Cysts are common abnormalities in imaging, exhibiting a wide range of localizations and pathophysiological mechanisms. Their classification is based on morphological and clinical criteria guiding both diagnostic and therapeutic management. This article primarily focuses on pulmonary cysts, while briefly addressing hepatic and pancreatic cysts. Pulmonary cystic lesions are often the result of infectious, inflammatory, neoplastic or lymphoproliferative processes. Thoracic computed tomography is the key diagnostic tool for their evaluation, helping to differentiate these lesions from other pulmonary abnormalities, such as emphysema or bronchiectasis. Depending on clinical and radiological features, pulmonary cysts may be associated with specific disorders including lymphangioleiomyomatosis, Langerhans cell histiocytosis, or Birt-Hogg-Dubé syndrome. Although surgical pulmonary biopsies are rarely necessary, they may be essential for definitive diagnosis when imaging fails to provide a definitive conclusion. Such biopsies should be targeted based on CT images, with adequate tissue sampling to optimize diagnostic yield. In hepatopancreatic imaging, the detection of cystic lesions with enhancement, septations, or thickened walls, in the absence of an infectious context, warrants a multidisciplinary evaluation to assess the need for targeted sampling and to refine the etiological diagnosis, particularly in cases of suspected malignancy. Close collaboration between radiologists and pathologists is essential to ensure an accurate diagnostic characterization of cystic diseases, integrating radiologic-pathologic correlations necessary for optimal patient management.

Lung cancer is the leading cause of death worldwide. It occurs mainly in smokers, but also in 25% of cases in non-smokers. As regards metastatic stages, while immunotherapy has led to improved overall survival, smoking status may potentially influence its effectiveness. The objective of this study was to analyze its effectiveness as first-line treatment for advanced non-small cell lung cancers (NSCLC) according to patient smoking status.

Radiotherapy is an essential part of the multidisciplinary management of cancer. We will review recent advances in breast cancer radiotherapy, highlighting how modern breast cancer radiotherapy is now an adapted-risk approach based on the individual patient's risk. We will also discuss how advances in technology and clinical research have made it possible to deliver radiotherapy in a less toxic and more comfortable manner for our patients.

Lung cancer is a common disease with a high mortality rate. It is often diagnosed at an advanced stage, with a median survival of 12 to 16 months. Immune checkpoint inhibitors are part of the first-line therapeutic armoury in metastatic stages. They have been shown to improve overall survival, including in patients aged 64 to 75, but the results are less clear in older patients, who are underrepresented in clinical trials. Although the management of adverse events associated with these treatments is now well protocolized, the accumulation of toxicities, even low-grade toxicities, can have an adverse impact on the quality of life of the most frail elderly patients. Geriatric assessment is essential for adapting treatments and anticipating adverse effects.

Pancreatic cancer (PC) is an aggressive disease with a poor prognosis, characterized by a median survival of 6 to 8 months and a 5-year survival rate of approximately 15%. In Switzerland, around 1,700 new cases and 1,400 deaths are reported each year. Late diagnosis- largely due to the absence of specific symptoms and validated biomarkers-limits the availability of curative treatment options. This article summarizes recent advances in the multidisciplinary management of PC, detailing the diagnostic workup and therapeutic approaches: imaging, endoscopic techniques, pathology, minimally invasive surgery, ablative radiotherapy, and standard or molecularly guided systemic therapies. Despite notable progress and promising prospects, PC remains a significant challenge in oncology.

Multiple myeloma (MM) is a malignant bone marrow plasma cell dyscrasia, associated with the secretion of a monoclonal immunoglobulin (Ig). The purpose of this study is to describe the epidemiological, clinical, biological and prognostic features of a cohort of patients with multiple myeloma, whose data were collected at the Laboratory Department of Habib Thameur Hospital in Tunis. We conducted a retrospective descriptive study of patients with MM in the Laboratory Department of Habib Thameur Hospital in Tunis over a period of 10 years (2003-2023). Data collection and analysis were performed using patient records and Microsoft Excel 2010 software. A total of 60 patients were included, with a mean age of 67.61 ± 8.7 years and a male-to-female ratio of 0.76. Bone pain was the most common presenting symptom, occurring in 75% of cases. Radiological abnormalities were identified in 50 patients (83%), predominantly affecting the spine (57%). Laboratory tests showed anemia in 74% of patients, thrombocytopenia in 17% of patients, an elevated erythrocyte sedimentation rate (ESR) in 90% of cases. Myelogram confirmed the diagnosis in 70% of cases. The monoclonal immunoglobulin identified was IgG in 62% of cases, IgA in 22%, IgM in 2%, and light chain in 12%, one patient presented with biclonal MM. According to the Durie and Salmon classification, the majority of patients (74%) were diagnosed at stage III. This study provides a better understanding of the epidemiological, clinical, and biological characteristics of MM. Despite significant advances made over the past two decades, multiple myeloma remains a disease with a poor prognosis.

Interpreting follicular helper T cell (Tfh) markers in the skin is challenging, raising the question of whether their expression is physiological or pathological. This review has two objectives: (1) to summarize current knowledge on Tfh lymphocytes, including circulating Tfh (cTfh) and peripheral helper T cells (Tph), and (2) to propose a practical approach for analyzing Tfh-rich skin infiltrates. Our method consists of two complementary entry points: histological and clinical. The histological approach classifies infiltrates into three patterns: (1) predominantly T-cell proliferation, suggesting a reactive infiltrate or hematodermia, (2) mixed B- and T-cell populations with a diffuse architecture, raising suspicion of a primary cutaneous CD4-positive small/medium T-cell lymphoproliferative disorder or Tfh lymphoma (primary or secondary), (3) B-cell nodules within a diffuse T-cell infiltrate, characteristic of reactive lymphoid hyperplasia, marginal zone B-cell lymphoproliferative disorders, or marginal zone lymphomas. In these cases, anti-IgM and anti-IgD immunolabeling is useful. Beyond Tfh-associated lymphocytes, the expression patterns and intensity of some Tfh markers (e.g., PD-1 in Sézary syndrome) help in reaching a diagnosis. The clinical algorithm categorizes presentations into three groups: (1) a solitary nodule or plaque, (2) multiple lesions (papules, plaques, or nodules/tumors), and (3) diffuse plaques or erythroderma. These histological and clinical algorithms are intertwined and complementary, providing a structured approach to evaluate Tfh-rich infiltrates in the skin.

Parasites can form true tissular cysts, with cavity(ies) delimited by a wall, covered by a specialized parasitic epithelium. In humans, these tissue cysts are caused by cestodes (segmented flatworms), which cannot complete their full cycle (e.g., in hydatidosis, alveolar echinococcosis or cysticercosis). Parasites can also form tissue pseudocysts, the wall of which consists of a resorptive granulomatous reaction to the presence of the parasite. In humans, these pseudocysts are caused by both nematodes (roundworms) and cestodes. These pathogens are rarely encountered by pathologists, and their diagnosis can be difficult, with many morphological pitfalls. This can lead to major diagnostic difficulties, resulting in misdiagnosis, and a negative impact on patient care. In case of diagnostic difficulties, a histopathological review of the slides by an infectious disease pathologist and/or confrontation with a parasitologist accustomed to diagnosis ontissue sections is necessary, and shouldbe completed, if possible, by an integrated histo-molecular diagnosis. The aim of this chapter is to detail the histopathological features of the main pathogens responsible for cysts/pseudocysts observed by the pathologist. The morphology of different infectious diseases forming cysts within tissues (hydatidosis, alveolar echinococcosis, and cysticercosis) and pseudocysts will be detailed.

Molecular imaging plays a crucial role in the diagnosis, staging, and monitoring of breast cancer. The most commonly used tracer at present is 18F-FDG, a marker of cellular metabolism, making 18F-FDG PET/CT a major imaging modality in the management of breast neoplasms. However, this tracer has limitations, particularly for low-grade ductal or lobular neoplasms, which exhibit low avidity for 18F-FDG. The 68Ga-FAPI tracer, which targets activated fibroblasts and whose uptake is independent of tumor aggressiveness, is currently under investigation and could serve as an excellent alternative to 18F-FDG in certain cases. Additionally, new tracers targeting novel biological pathways of the tumor, including hormonal receptors or HER2, are being developed. These tracers enable whole-body assessment of specific biomarker expressions on cancer cells, offering a more precise understanding of the disease. This approach could help tailor treatments to the molecular characteristics of each tumor, enabling personalized strategies that improve therapeutic efficacy and patient quality of life. Finally, inspired by the model of 177Lu-PSMA used in prostate cancer, researchers are exploring the potential to couple these tracers with therapeutic agents to develop targeted radionuclide therapy for breast neoplasms.

Plasma cell leukemia (PCL) is a rare lymphoproliferative disorder characterized by clonal proliferation of plasma cells in the bone marrow and peripheral blood. In 2021, the International Myeloma Working Group (IMWG) redefined LCP as the presence of 5% or more circulating plasma cells in patients otherwise diagnosed with multiple myeloma. In this work, we report five cases of PCL collected in the hematology laboratory of the Mohammed VI University Hospital in Oujda. The interest of this work is to elucidate the importance of hematological cytology in diagnostic guidance as well as therapeutic innovation concerning this rare pathology.

Female pelvic masses could be difficult to diagnose given the fact that there are so many structures within the pelvis that could be related to the mass. These benign or malignant neoplasms could be diagnosed through careful and systematic evaluation by history, biochemical, imaging, and surgical approaches. Although an ultrasound scan is often the first-line imaging modality for the evaluation of pelvic masses, it could be limited by poor acoustic windows and poor depth penetration. However, in low-resource settings, its usage is nonnegotiable. The case of a 26-year-old female with a 5-year history of lower abdominal swelling is hereby presented. The swelling was gradual in onset and associated with occasional dull lower abdominal cramps that radiate to the back, urinary retention, dysuria, and urinary frequency. An ultrasound scan diagnosed an ovarian mass and uterine fibroid with the suspicion of a bladder mass. She had a laparotomy, in which a left ovarian mass and a huge calcified pelvic mass extending from the region of the isthmus of the uterus through the posterior bladder wall and the anterior vaginal wall were discovered. Left ovariectomy and removal of the mass were done; a histologic diagnosis of mature ovarian teratoma and cervical fibroid was made. She had a smooth postoperative recovery on antibiotics and analgesics. The diagnostic challenge of pelvic masses even with the use of USS is demonstrated, and laparotomy has shown to be a diagnostic procedure here. Preoperative magnetic resonance imaging could be helpful when available and affordable.