We report a rare case of salivary duct carcinoma and we study its clinical and evolutionary features. A 64-year-old patient was referred for right peripheral facial paralysis. MRI showed suspected formation of the right parotid gland. Treatment included total parotidectomy and ipsilateral neck lymph node dissection. The histology concluded to a ductal carcinoma of the parotid with lymph node metastasis. Radiation therapy has been indicated. Salivary duct carcinoma of the parotid gland is a highly aggressive and uncommon tumor. Treatment of localized forms is based on surgery and radiotherapy.

Patients frequently report asthenia during radiation. The present study aimed at identifying the correlation between numerous clinical and tumoral factors and asthenia in breast and prostate cancer patients treated by curative radiotherapy.

FLOT-4 study recently reports that in patients with gastric cancer, perioperative chemotherapy with 5-fluorouracile, leucovorin, oxaliplatin and docetaxel (FLOT regimen) increases survival over standard ECF/ECX regimen (epirubicine, cisplatine and 5-fluorouracile [or capecitabine]). Does this study, make FLOT a new standard of perioperative chemotherapy for localized gastric cancer? Seven hundred and sixteen patients were included into that randomized study. Thirty seven per cent and 46% of the patients received the full planned treatment in the ECF/ECX group and in the FLOT group, respectively. The primary aim of FLOT-4 was met as FLOT significantly reduced the relative risk of death vs. ECF/ECX (HR: 0.77; 95% CI: 0.63-0.94; P=0.012). Median survival is increased by 15 months with FLOT (50 months vs. 35 months). FLOT also provided better complete resection rates, better complete pathological response rates, and better disease-free survival than ECF/ECX. FLOT is more likely associated with the following adverse events: diarrheas, leuco-neutropenia (including 51% of severe ones), infections (including 18% of severe ones), and peripheral neuropathy. On the contrary, ECF/ECX provided more likely severe nausea and vomiting, severe anemia, and thromboembolic events. Overall, the number of patients with related serious adverse events (including those that occurred during hospital stay for surgery) was similar in the two groups, as was the number of toxic deaths and postoperative deaths. FLOT should be regarded as the recommended perioperative chemotherapy for patients with gastric cancer or adenocarcinoma of the gastro-esophageal junction. However, some doubts remain as regards of its use in the daily practice for unselected patients.

The adjuvant treatment of biliary tract cancers has long been poorly defined. In recent years, randomized trial data have been used to define treatment references. The French Prodige 12 and Japanese BCAT trials have not demonstrated any benefit of adjuvant chemotherapy. The English BILCAP trial tested adjuvant capecitabine for six months at the usual dose in a randomized, controlled-only trial involving nearly 450 patients. Although the results in intention to treat were borderline significant on the primary endpoint, overall survival (P=0.097), sensitivity analyzes adjusted for prognostic factors and relapse-free survival analyses are clearly positive. The absolute benefit of +5%/+10% overall survival, combined with low and known toxicity profile, leads to recommending treatment for any cancer of the resected bile ducts (with the exception of gallbladder cancer pT1N0).

Desmoid tumors (TDs) are derived from mesenchymal stem cells and their pathogenesis is strongly linked to the Wingless/Wnt cascade where the deregulation of β-catenin plays a major role. A mutation of the CTNNB1 encoding β-catenin is found in the majority of sporadic TD cases and constitutional mutations of APC have been described in heritable forms in patients with familial adenomatous polyposis (FAP). Estrogens could also play a role in pathogenesis and this is the basis for the use of hormone therapy. Other signaling pathways have been involved in the development of TDs such as Notch, Hedgehog, JAK/STAT, PI3 Kinase/AKT and mTOR. Metalloproteases are expressed in TDs and play a role in invasiveness. TGF-ß, as a growth factor, stimulates the transcriptional activity of β-catenin. Future studies will need to focus on better describing and understanding the immune environment of TDs. One of the major difficulties for the experimental study of TDs is the virtual absence of a preclinical model, either in vitro or in vivo. This is partly why the interactions between the different signaling pathways presented here and their consequences for the development of TDs are still poorly understood.

Primary low-grade dural marginal zone lymphoma is an indolent low grade lymphoma occurring especially among middle-aged immunocompetent women, and is not associated to an infectious process, contrary to gastric or intestinal marginal zone lymphomas. Dural location is rare since only 105 cases have been reported so far. We report herein on two additional cases, a 72-year-old woman and a 36-year-old man whose lymphoma was revealed by partial seizures and headaches. Morphological analysis of surgical specimens displayed a tumoral proliferation made of small lymphocytes arranged in sheets or in nodules with CD20, CD79a and BCL2-immunopositivity, but CD5 and CD10 negativity. Molecular analysis using a panel of 34 genes involved in lymphomagenesis disclosed a deletion of SOCS1 and TNFAIP3 genes, implicated in the JAK/STAT and NFκB pathways respectively in the first patient that could explain unfavourable prognosis despite complementary radiotherapy. No anomaly was identified in the second patient who is alive with no recurrence or progression seven years after the diagnosis. Currently, there are no standardized treatment schedules, but the vast majority of patients are treated by surgery, then radiotherapy followed by adjuvant chemotherapy using methotrexate alone or in combination with rituximab. Literature review indicates that five-year survival has been estimated at 96.7%, suggesting a better prognosis compared to other locations.

In the last classification of the World Health Organization (WHO) 2016, T-cell large granular lymphocyte (LGL) leukemia is a type of mature natural killer T (NKT) cell lymphatic hematologic disease. T-LGL leukemia is characterized by CD3+ T-cell phenotype and TCR gene rearrangement (T lymphocyte receptor). It is a rare disease, mainly affecting people living in the Western world. We report the case of a 60-year old Moroccan patient presenting with 1-month history of generalized jaundice with diffuse petechiae and impaired general condition. Initial clinical examination showed ascites of average abundance and hepatosplenomegaly; paraclinical examination objectified hepatocellular failure with neutropenia and thrombocytopenia. The diagnosis of T-LGL was retained based on cytological and immunophenotypic study of bone marrow blood as well as on the detection of TCR rearrangement using molecular test. The patient received cyclophosphamide associated with symptomatic treatment. The patient died within three months of the diagnosis due to septic shock with cachexia. T-LGL often has an indolent behavior and initial clinical status at diagnosis is generally moderate, with progressive onset but that was not so for our patient. Hepatocellular failure exceptionally results in T-cell large granular lymphocyte (LGL) leukemia.

Krukenberg tumours are rare, often bilateral ovarian malignant tumours secondary to muco-secreting gastric cancer, in 90% of cases. We collected data from patients' medical records over a period of 17years, between January 2002 and January 2019. These patients had Krukenberg tumors for which they were treated in the Department of Hepato-Gastro-Enterology at the Ibn Rochd Hospital University. The purpose of this retrospective, descriptive study was to update the current understanding of this type of neoplasm characterized by poor prognosis, in order to improve diagnostic performance and therapeutic treatment. The average age of our patients was 42 years, ranging between 25 and 61 years. Ascites was the most common manifestation and was reported in 80% of cases. Radiological assessment highlighted ovarian tumor of variable size and echo structure, unilateral in 60% of cases. Oeso-gastroduodenal fibroscopy showed gastric process in 4 patients. Surgical exploration and immunohistochemical examination of biopsic specimens resulted in the correct diagnosis of cancer of the transverse colon with massive locoregional extension and gastric infiltration in one case. The fifth patient underwent exploratory laparotomy which revealed metastatic colonic neoplasia. Radical surgery could be performed only in two patients, in the other two cases only biopsies were performed due to the late stage of the disease. One patient had profoundly altered general state and was at high-risk for anaesthetic, then surgical procedure could not be performed. Only two patients received postoperative chemotherapy. Fatal outcome was reported in 100% of cases. This study reconfirms the catastrophic prognosis of Krukenberg tumor based on its insidious evolution often leading to late diagnosis and to a clear misunderstanding of its etiopathogenesis. We conclude that the improvement of survival chances is based on systematic assessment of ovaries in patients with digestive neoplasia. Some authors also affirm that prophylactic ovariectomy should be performed in women older than 40 years who have undergone gastrointestinal cancer surgery.

In Senegal, the studies on scalp tumors are almost non-existent. The purpose of our study was to determine the epidemiological and anatomoclinical features of scalp tumors in dermatology.

Isolated malignant extramedullary plasma cell proliferations known as plasmocytomas are rare. They usually occur in the head and the neck (80% of cases) and exceptionally elsewhere. We report the case of a 62-year old patient with solitary plasmacytoma of the lung initially mimicking primary lung cancer. The purpose of this study was to describe our therapeutic approach and to emphasize the rarity of this case, the prognostic factors as well as the management of these tumors based on a literature review.

The epidemiological, clinical and biological characteristics of chronic lymphocytic leukemia (CLL) are little studied in Togo. The purpose of this study was to describe these characteristics at the time of diagnosis. We conducted a retrospective and descriptive study of patients diagnosed at the University Hospital Campus from January 1999 to December 2018. Over the past two decades, 87 patients were seen for CLL (20% of patients with hematological malignancies) with an annual prevalence of 4.35 new cases. The average age of patients was 61 +/- 12,48 years (ranging from 17-85 years); 55 women and 32 men (sex ratio M/F 0.58) were enrolled. Clinically, 16 patients (18%) had no tumor syndrome, 33 patients (38%) had lymphadenopathy, 62 patients (71%) splenomegaly and 23 patients (26%) hepatomegaly. Biologically, the mean blood and medullary lymphocyte count was 87188/mm3 (ranging from 7000-481780/mm3) and 75.75% +/- 12,88 (ranging from 44,5-96,5%) respectively; 65 patients (75%) had haemoglobin less than 10g/dl and 20 patients (23%) had platelet count below 100000/mm3. At the time of diagnosis, 67 patients (77%) had Binet stage C, 7 patients (8%) stage B and 13 patients (15%) stage A. The study of biological prognostics factors showed that 66% of cases had β2-microglobulin level higher than normal and 95% of cases had LDH higher than normal. CLL is a reality in Togo with a predominance of women and an average age of 61 years. Most patients are seen at Binet stage C and their assessment has revealed huge tumor mass with increased LDH and β2-microglobulin. The current follow-up of these patients will enable us to assess their overall survival.

Cutaneous metastases from cervix cancer are rarely described, and can appear years after a complete remission of the cancer. They may have multiple presentation as nodules, papules or telangiectasies. Unfortunately, these are associated with poor prognosis. We here report the case of a woman who developed cutaneous metastasis in the situation of a cervix cancer that appears to be stable under bevacizumab.

The salivary glands cytology is one of the most challenging area in cytopathology because of the wide diversity of benign and malignant tumors also because of their heterogeneity. However, fine needle aspiration cytology, with magnetic resonance imaging, represents a first-line examination to guide a possible surgical procedure and its extent. An accurate diagnosis of a specific tumor is sometimes difficult to assess in cytology. Also, as for gynecological, thyroid or urinary cytologies, a panel of experts met to develop a cytological classification of salivary gland lesions associated with a risk of malignancy and management proposals. The Milan System for Reporting Salivary Gland Cytopathology was published in 2018. The French Society of Clinical Cytology (SFCC) offers here an official summarized French version oh this terminology and recommends its use.

A growing number of studies suggest a tumor suppressor role for the SWI/SNF complex involved in the remodeling of chromatin. Alterations of this complex have been found in many tumors of different origins, with topographic, morphologic and phenotypic diversity. Notably, they define 2 types of thoracic tumors: SMARCA4-deficient non-small cell lung carcinoma and SMARCA4-deficient sarcoma. Some clinical features appear to be common to both, such as intrathoracic localization, smoking exposure, male predominance and poor prognosis. However, the histological distinction between these two entities is sometimes difficult and it is not excluded that these entities belong to the same tumor spectrum with different degrees of differentiation. The therapy of these tumors is not yet codified. These tumors do not seem associated with oncogenic driver mutations allowing the prescription of targeted therapy, but immunotherapy has been shown to be effective in rare reported cases. More specific treatments using EZH2 inhibitors also seem promising in SMARCA4 deficient sarcomas.

Biosimilars have demonstrated their equivalence with biologic originators, according to rigorous specifications imposed by the regulatory agencies, the FDA and the EMA. Their development is justified by the very high cost of biopharmaceuticals, and strong incentives for their prescription lead us to hope substantial savings, allowing to finance other innovative molecules. Trastuzumab marked history of the treatment of breast cancer. Four biosimilars of trastuzumab are available for routine use and we will detail the key points of their development.