We report the case of a man with a primary diagnosis of Waldenström macroglobulinemia. He secondarily presented a diffuse large B cell lymphoma (DLBCL) located in the nasal fossae, which relapsed later in the eye. The diagnosis of these two malignancies is based on a multidisciplinary biological approach using new sensitive and specific techniques. These techniques revealed that the two diseases harbor different B cell clones, indicating a distinct origin. This observation highlights the importance of targeted biological techniques for the diagnosis of these two rare hemopathies. It also shows that it is possible to prove the independent nature of the two tumor clones, thus allowing optimized therapeutic management.

Metastases are the main cause of cancer-related deaths. The chain of events leading to their development is called "the metastatic cascade". The biological and biochemical aspects of this process have been well studied but the importance of biomechanical parameters only recently became a focus in the field. Studies have shown the biological fluids (blood, lymph and interstitial fluid) to play a key role in the metastatic cascade. These fluids participate in the transport of circulating tumor cells (CTCs) as well as the factors that they secrete, while at the same time influencing the events of the metastatic cascade through the forces that they generate. The hemodynamic properties and topological constraints of the vascular architecture control the formation of metastatic niches and the metastatic potential of tumor cells. In this review, we discuss the importance of these mechanical forces and highlight the novel questions and research avenues that they open.

Preoperative chemoradiotherapy is an option for locally advanced esophageal cancer. Radiation therapy may increase postoperative pulmonary complications. Usual lungs dose constraints in radiotherapy are old and used by extrapolation of lung cancer management. Our objective is to review the literature on correlations between postoperative lung toxicity and dosimetric factors.

Erythrophagocytosis by blast cells is due to hyperactivation of blast cells. Erythrophagocytosis is associated with T cell myeloid hemopathies (8;16). This study shows an exceptional case of erythrophagocytosis by blast cells in a patient with acute T-lymphoblastic leukemia without cytogenetic abnormalities. We here report the case of A.Z, aged 19 years presenting with febrile syndrome with dizziness and phosphenes, tumor syndrome with amygdala and gingival hypertrophy. Blood count revealed hyperleukocytosis (399.5 G/L), with aregenerative anemia (Hb: 9.3 g/dl) and thrombocytopenia (platelet count: 40 g/L). Myelogram showed 90% of blast cells (MPO-negative) with erythrophagocytosis by blast cells images. Immunophenotyping confirmed T-cell LAL. Cytogenetic analysis was normal. Erythrophagocytosis by blast cells in patients with T-cell LAL appears to be a separate entity, hence the importance of images on diagnosis, prognosis and treatment of T-cell LAL.

Vulvar cancer has been rarely reported in the literature. In young women, it is most often caused by human papillomavirus (HPV), whereas in postmenopausal women, in whom this cancer is more common, it would be caused by estrogen deficiency. Moreover, HIV infection increases the risk of developing vulvar cancer in HIV-positive women as a consequence of the high prevalence of HPV infection in these subjects. Thus, in patients with suspected vulva lesion, biopsy followed by anatomo-pathological examination should be performed in order to establish the diagnosis. We here report a case of vulvar squamous cell carcinoma in a HIV-1-positive patient with first-line antiretroviral therapy (ARV) failure.

malignant germ cell tumors of the ovary (TGMO) are rare ovarian tumors. Each histological type can have clinical and therapeutic particularities which it is important to know. The objective was to report and analyze the particularities of the epidemiological, diagnostic, anatomopathological, therapeutic and prognostic data of TGMO in Tunisian context.

Neoadjuvant chemotherapy has become the first-line treatment for locally advanced breast cancers. On the one hand, it allows for increasing options of breast conservation without an increased risk of recurrence, on the other hand it allows for locoregional control of patients with inoperable cancer. However, some clinical, radiological and histological factors are associated with an increased risk of mastectomy, such as microcalcifications, multifocality, SBR1 and 2 grade, cT3 and cT4 stages and overexpressed HER2. The purpose of this study was to determine the predictive factors for mastectomy after neoadjuvant chemotherapy (NAC), whether mastectomy was justified or not histologically and what were the predictors for unjustified mastectomy. We conducted a retrospective study of 72 patients with breast cancer treated by neoadjuvant chemotherapy in the Departments of Gynecology and Medical Oncology at the Fattouma Bourguiba Hospital in Monastir, Tunisia. The rate of conservative treatment was 18.1%; 63.15% for stage T2 tumors. Mastectomy was not justified by definitive histologic diagnosis in 26.3% of cases. In our study, unjustified mastectomy predictors were negative RH status and CT2 stage. This study led to reflection on our practice and its modifications. Conservative surgery should be considered as standard therapy and should be routinely suggested to all patients treated with neoadjuvant chemotherapy for breast cancer, including the cases with multifocality, large clinical tumor size, extensive microcalcifications, in order to significantly reduce the number of unjustified mastectomies.

Active surveillance (AS) of sporadic renal angiomyolipomas (AML) is under-utilised because of an old dogma fearing a life-threatening retroperitoneal hemorrhage when tumour size exceeds 4cm. The objective of this study was to report the outcome of AS in patients with sporadic AML greater than 4cm.

A single immediate instillation of mitomycin C is recommended after a complete transurethral resection of the bladder (TURB) in low- and intermediate-risk patients with NMIBC. Actually, post-TURB instillation is seldom used due to logistical difficulties and surgical contraindications. Our aim was to compare patients with single pre-TURB intra-vesical instillation and patients with a single, immediate post-TURB intra-vesical instillation of mitomycin C.

Hypersensitivity pneumonitis (HP) is an interstitial lung disease due to an immunological reaction to exposure, by inhalation, to a large variety of antigens. The patho-physiological mechanism remains poorly understood. The diagnosis can be challenging and requires a detailed medical history taking especially when the clinical presentation is atypical or when the causal agent remains unknown.

Hepatocellular adenomas (HA) are rare benign liver tumors known to affect mainly women of reproductive age taking oral contraception. They can be complicated by hemorrhage or malignant transformation to hepatocellular carcinoma, especially when the size of the lesion exceeds 5 cm. Magnetic resonance imaging is the most specific tool for the non-invasive characterization of HA. The discovery of mutations underlying different specific HA phenotypes has allowed the establishment of a molecular classification that modified the management of this pathology.

Osteoblastoma is an uncommon primary bone tumor. Its occurrence in the cranial vault is extremely rare. We here report our first case of right parietal bone osteoblastoma in a 46-year old woman with a history of benign cranial traumas. She reported progressive painful, non-inflammatory right parietal bone swelling. Craniocerebral CT scan showed hyperdense bone lesion with sparing of the internal table of the right parietal bone. The patient first underwent biopsy, then complete resection of the bone lesion with methyl-methacrylic cement cranioplasty. The postoperative course was uneventful. Anatomopathological examination showed osteoblastoma with no sign of malignancy. This study and literature review highlight the clinical manifestation, the radiological and anatomopathological features as well as the management of osteoblastoma of the parietal bone of the cranial vault.

Sclerosing pneumocytoma is a benign and rare lung tumor affecting epithelial cells. In most cases, patients are asymptomatic and the diagnosis is made on an X ray or a CT scan performed for other enquiry. Sex ratio favors women. Epidemiological studies report that middle-aged Asian women are more frequently affected. Radiological investigations find a solitary nodule or a mass with peripheric localization. When performed, histological analysis shows a tumor composed of at least two of the four following architectures: papillary, sclerosing, hemangiomatous and solid, with two types of cells that can be round or cubic cells.

The management of early metastatic prostate cancer is based on systemic treatment by androgen deprivation therapy with or without chemotherapy or next-generation anti-androgen therapies. Local treatment of the prostate was initially used only to alleviate local symptoms. However, local radiotherapy of the prostate has been the subject of retrospective and prospective studies in patients with better prognostic factors, particularly in oligometastatic status. The results of these studies support that prostate radiotherapy can prolong the survival of patients with a low metastatic burden. This article states the biological bases, the main published and future published studies aimed to embed this strategy to optimize therapeutic management.

Pulmonary synovial sarcoma is a rare malignant tumor accounting for 10% of soft tissue sarcomas. It usually arises from the limbs and its occurrence in the lung is exceptional. We here report a clinical case of pulmonary synovial sarcoma in a 54-year-old man detected at a localised stage. This extremely rare tumor has a specific immunohistochemical phenotype. This provides strong support for diagnosis. Cytogenetic study confirms the diagnosis by showing the presence of specific translocation t (X; 18). This is highly characteristic of synovial sarcoma regardless of its anatomical location. This study highlights the anatomo-clinical, therapeutic and prognostic characteristics of this rare tumor often unknown to clinicians.

Primary malignant melanoma of the female genital tract is an extremely rare tumor. It most commonly affects the vulva then the cervix and the vagina. Vulvar cancer accounts for about 1% (all sites) of melanomas. In order of frequency, it occurs in the vagina, uterus and ovary. Less than 200 cases of vulvar cancers have been described worldwide. We here report a clinical case of malignant vulvar melanoma in a 72-year-old postmenopausal woman. Partial hemivulvectomy and bilateral superficial inguinal lymphadenectomy were performed. The postoperative course was favorable and the patient was discharged on postoperative day 15.