S Touati

Institut Salah-Azaïz de Cancerologie, Tunis-Ville, Tūnis, Tunisia

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Publications (33)22.83 Total impact

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    ABSTRACT: Nerve tumors arising from the sympathetic chain are uncommon slow-growing tumors and represent a diagnosis challenge. Their malignant degeneration is rare. Definitive pre-operative diagnosis may be difficult as investigations are not usually helpful. We report the case of a 23-year old woman who presented with an asymptomatic solitary left cervical swelling. She was evaluated with sonography and computed tomography. Complete surgical excision of the lesion was carried out and histologic examination revealed a schwannoma. Post-operatively, the patient showed clinical findings of Horner’s syndrome. Pathologic and radiological evaluation, differential diagnosis of this neoplasm and its management are discussed.
    Egyptian Journal of Ear, Nose, Throat and Allied Sciences. 07/2014;
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    ABSTRACT: The concept of larynx preservation in locally advanced laryngeal or hypopharyngeal squamous cell carcinoma has evolved during the last three decades, especially with the advancement of nonsurgical strategies. These nonsurgical strategies include: (1) radiotherapy alone; (2) concomitant chemoradiotherapy (CCRT); and (3) induction chemotherapy followed by radiotherapy or CCRT and concurrent anti-epidermal growth factor receptor (EGFR). To date, the best approach for larynx preservation has yet to be defined. In this article, we review and discuss important recent randomized phase II/III trials investigating larynx preservation in order to facilitate the selection of an appropriate strategy in the clinical setting. However, the decision of larynx preservation should always be a multidisciplinary approach.
    Critical reviews in oncology/hematology 06/2013; · 5.27 Impact Factor
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    ABSTRACT: Because nasopharyngeal carcinoma (NPC) has a close association with Epstein-Barr virus (EBV), measuring serum EBV DNA and anti-EBV serum marker concentrations could be a feasible method for NPC diagnosis, monitoring and probably screening especially in a community at risk. The aim of this study was to determine the EBV pattern in sporadic NPC and in high risk NPC Tunisian families in order to evaluate their risk factors and help for NPC screening. The rates of anti-EBV antibodies and EBV DNA were determined in the serum of 47 healthy members randomly selected from 23 NPC multiplex families with two or more affected members, 93 healthy Tunisian community controls chosen with the same age, sex and geographic origin as unaffected individuals and 66 EBV positive sporadic NPC patients whose serum was available before and after treatment. Unexpectedly, significant lower concentrations of anti-EA (Early Antigen) IgG and anti-VCA (Viral Capsid Antigen) IgG were found in unaffected members from NPC families than in healthy controls while viral loads were negative in all the tested sera. For sporadic NPC patients, anti-EA IgG and anti-VCA IgA concentrations were significantly higher than in healthy controls and these rates decreased after treatment. The level of EBV DNA load varied according to the condition of the tumour. This study suggests that in the Tunisian NPC families, screening for malignancy is based on serum concentrations but not on EBV DNA load while in the sporadic NPC group, serologic markers and EBV DNA load are complementary for diagnosis and follow-up.
    Archives of Oto-Rhino-Laryngology 07/2011; 269(3):1005-11. · 1.29 Impact Factor
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    ABSTRACT: To assess the outcome and the management of solitary extramedullary plasmocytoma in the head and neck region. From 1997 to 2008, five cases of solitary extramedullary plasmocytoma were treated in the department of radiotherapy at Salah-Azaiz Institute. Three patients had a solitary plasmocytoma of the nasal fossa; the others were ethmoidal and submandibular node. All patients received irradiation of 40 to 45 Gy in the primary site associated to surgery in four cases. Among the five patients, two had radiotherapy after recurrence. Four complete responses were noted with a follow-up of 12, 36, 52 and 72 months. Multiple myeloma occurred in one patient 8 years after treatment. Radiotherapy is the best effective local treatment. Local control of extramedullary plasmocytoma in the head and neck region seems to be improved when the dose is at least 45 Gy. Predictive parameters of unfavourable outcome and conversion of extramedullary plasmocytoma to multiple myeloma should be better defined.
    Cancer/Radiothérapie 12/2010; 14(8):755-8. · 1.48 Impact Factor
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    ABSTRACT: Inflammatory myofibroblatic tumor is a recently caracterized solid mesenchymal tumor. They are frequently localised in the lung. However, the head and neck forms are uncommon. To report a new case of inflammatory myofibroblastic tumor of the larynx. This 47-year old man presented with dysphonia without dyspnea. Laryngoscopy showed a tumor of anterior vocal cord. CT scan of larynx confirmed diagnosis. The patient had a cordectomy. Histology concluded to the diagnosis of inflammatory myofibroblastic tumor. No relapses have been noted after 4 months. Only a few cases of laryngeal inflammatory myofibroblastic tumor have been reported in the literature. Clinical presentation depends of tumor location. Radiological images are not specific and diagnosis is based on histology. The expected course is essentially marked by the risk of local recurrences. Surgical excision seems to be the treatment of choice.
    La Tunisie médicale 12/2010; 88(12):942-4.
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    Feuillets de Radiologie 06/2010; 50(3):144-147. · 0.17 Impact Factor
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    ABSTRACT: PurposeTo assess the outcome and the management of solitary extramedullary plasmocytoma in the head and neck region.
    Cancer Radiotherapie - CANCER RADIOTHER. 01/2010;
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    ABSTRACT: This study evaluated the prognostic value of the Para pharyngeal space involvement in nasopharyngeal carcinoma T 2 disease (UICC 1997 classification). From January 1997 and December2001; 32 patients with nasopharyngeal carcinoma were examined by CT scan and according to the 1997 International Union Against Cancer (UICC) staging system, 15 had stage T2a M0 (G1) and 17 T2bM0(G2). The median age was 47 years. The male to female ratio was 1.81 (G1); 4.3 (G2). All patients were pathologically confirmed by biopsy from the nasopharynx as having UCNT in 100% (G1) and 94% (G2). The node involvement was 52% for the G1 (N2: 26%, N3: 26%) and 80% for the G2 (N2: 47%, N3: 41%). Both neoadjuvant chemotherapy and radiotherapy were performed for advanced N disease and only radiotherapy for NO. Examination and CT scan were performed for the evaluation of the treatement. The completely clinical remission after chemotherapy was 12.5% (G1) and 53% (G2), partial remission was 25% (G1) and 35% (G2). The CT scan control wasn't performed for all patients. The complete response was 69% (G1) and 53% (G2); partial response was 6% for both two groups. The median follow up was 79 months. Disease free survival rates were 70% for G1 (T2a) and 48% for G2 (T2b). Distant metastasis rates were 26% (G1) vs 6% (G2) and more likely in the presence of advanced N disease. Five years overall survival was 78% (G1) T2a vs. 55% (G2) T2b.The N disease was correlated to metastasis as overall survival was 66.7% for N3 disease vs 85.7% for N0. Parapharyngeal tumor involvement affects local and regional tumor failure. Subclassification of T2 disease into T2a/T2b should have an impact on treatment strategies.
    La Tunisie médicale 12/2009; 87(12):814-7.
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    ABSTRACT: The aim of this review is to study natural history, presentation, treatment and prognosis of head and neck liposarcomas. We carry a retrospective study about 15 patients diagnosed and treated in our department between 1969 and 2001. Therapeutic modalities included surgery, radiotherapy and chemotherapy. Tumors were mostly localized at the neck (4 cases) and the scalp (3 cases). Cervical lymphadenopathy was found in 1 case. Chest X-ray found showed metastases in 2 cases. Histological types of liposarcomas were the following: myxoid (5 cases), well differentiated (4 cases), pleomorphic (4 cases), round cell (1 case) and dedifferentiated (1 case). Twelve patients underwent surgery. Complete excision was performed in 7 cases. In the other 5 cases, exeresis was incomplete and 4 of them received postoperative radiotherapy. Three patients were not operated because of vascular involvement (1 case) or metastasis (2 cases), and they all received radiotherapy alone. After initial treatment, complete remission was achieved in 7 cases (46.7%). A recurrence occurred in 8 cases (53.3%). Two of these patients were reoperated and another one received chemotherapy. In the other 5 cases, the tumor was uncontrollable and no additional treatment has been proposed. Five-year survival rate was 87% for patients who underwent surgery alone, 75% for those who underwent surgery and postoperative radiotherapy, and 0% for those treated by radiotherapy alone. The mainstay of treatment of head and neck liposarcomas is surgical excision and the prognosis is largely determined by the histological grade and the clinical stage.
    Auris, nasus, larynx 10/2009; 37(3):347-51. · 0.58 Impact Factor
  • Journal de Chirurgie 10/2009; 146(5):520-1. · 0.50 Impact Factor
  • La Tunisie médicale 10/2009; 87(10):716-7.
  • Journal De Chirurgie - J CHIR. 01/2009; 146(5):520-521.
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    ABSTRACT: The sarcomatoid carcinoma of the superior aerodigestive tracts is a rare malignant tumour which presents diagnostic and therapeutic challenges. We report 11 cases of spindle cell carcinomas of the upper airways. Sex-ratio was 10:1 and the mean age was 57.3 years (30 - 75 years). Nine patients were smokers and 4 presented with a history of radiation exposure. Tumoral locations were as follows: larynx: 6, hypopharynx: 1, oropharynx: 1, nasopharynx: 1, oral cavity: 2. Histological diagnosis in 3 cases required the use of immunohistochemical studies. Four patients were first seen at an advanced stage. This left 9 patients and among them 7 received a curative treatment: 5 by surgery alone, 1 by surgery and radiotherapy, 1 by radiotherapy, 1 by chemo-radiotherapy for the nasopharyngeal lesion and 1 by chemotherapy alone. Two patients died from their disease before treatment. With an average delay of 15.4 months, the rates of global survival and disease-free were 5/9 and 4/9 respectively. The sarcomatoid carcinoma of the upper airways is rare, but not unusual. Its diagnosis benefits from progresses in immunohistochemistry, but also from advances in the field of molecular biology. Its treatment and natural evolution remain controversial.
    Revue de laryngologie - otologie - rhinologie 02/2008; 129(3):191-5.
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    Acta Oncologica 02/2007; 46(6):834-7. · 2.87 Impact Factor
  • Cancer/Radiothérapie 11/2006; 10(6):533-533. · 1.48 Impact Factor
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    ABSTRACT: To report the epidemiological and clinical features of nasal and paranasal sinus cancers collected during a period of 35 years at the Salah Azaiez Institute of Tunis. This retrospective study concerned patients with histologically confirmed nasal and paranasal sinus cancers treated at our institute from 1969 to 2004. We collected the following data: age, sex, residence (rural or urban), site, occupation and professional exposure, histological type and tumor extension. We identified 265 cases (163 M; 102 F; Sex-ratio=1.65) with a mean age of 60 years (3 months - 91 years). Epidermoid carcinoma (47%) and adenocarcinoma (16%) predominated followed by sarcoma (14%) and melanoma (6%). We observed only 2 cases (0.7%) of ethmoidal adenocarcinoma. Nasal and paranasal cancers in Tunisia are linked more to chronic rhino-sinusal inflammation than professional exposition (wood).
    Annales d Otolaryngologie et de Chirurgie Cervico-Faciale 07/2006; 123(3):115-9.
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    ABSTRACT: Objectif Rapporter le profil épidémiologique et clinique sur une série de 265 cas de cancers du massif facial colligés sur une période de 35 ans à l’institut Salah Azaiez (ISA) de Tunis. Matériel et méthodes Notre étude rétrospective a concerné les cancers du massif facial (CMF) confirmés histologiquement et traités à l’ISA de 1969 à 2004. Nous avons recueilli les informations suivantes : âge, sexe, origine rurale ou urbaine, profession avec notion d’exposition professionnelle, siège, histologie et extension des lésions. Résultats Nous avons colligé 265 cas de CMF représentant 2,9 % des cancers des VADS à l’ISA, avec une incidence de 0,2/100 000. Il s’agissait de 162 hommes et 103 femmes (Sex-ratio = 1,65), ayant un âge moyen de 60 ans. La répartition histologique de nos patients montrait une prédominance des carcinomes épidermoïdes (47 %) à localisation ethmoido-maxillaire suivi des adénocarcinomes (16 %), des sarcomes (14 %) et des mélanomes malins (6 %). Il y avait seulement 2 cas (0,7 %) d’adénocarcinomes de l’ethmoïde. Conclusion Les cancers du massif facial en Tunisie semblent faiblement liés à une exposition professionnelle au bois. Le rôle de l’inflammation chronique de la muqueuse naso-sinusienne pourrait jouer un rôle favorisant.
    Annales d Otolaryngologie et de Chirurgie Cervico-Faciale 06/2006; 123(3):115-119.
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    ABSTRACT: We report three cases of Hodgkin's disease (HD) involving the nasopharynx. Their clinical presentations, morphological and immunohistochimical features and their therapy modalities are discussed. The patients were aged 36, 41 and 77, presenting with increasing bilateral nasal obstruction in one case and a cervical mass in the two others. Histological study showed mixed cellularity type of HD in all cases. The Reed Sternberg cells expressed both of CD15 and CD30 in one case, and only one of them in the other cases. In one case, LMP1 was detected, CD20 and CD3 were not. HD of nasopharynx should be differentiated from EBV-associated lymphoproliferations. The treatment is based on radiotherapy that can be associated to neoadjuvant chemotherapy if nodes are involved.
    Cancer/Radiothérapie 06/2006; 10(3):142-4. · 1.48 Impact Factor
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    ABSTRACT: We report three cases of Hodgkin's disease (HD) involving the nasopharynx. Their clinical presentations, morphological and immunohistochimical features and their therapy modalities are discussed. The patients were aged 36, 41 and 77, presenting with increasing bilateral nasal obstruction in one case and a cervical mass in the two others. Histological study showed mixed cellularity type of HD in all cases. The Reed Sternberg cells expressed both of CD15 and CD30 in one case, and only one of them in the other cases. In one case, LMP1 was detected, CD20 and CD3 were not. HD of nasopharynx should be differentiated from EBV-associated lymphoproliferations. The treatment is based on radiotherapy that can be associated to neoadjuvant chemotherapy if nodes are involved.
    Cancer/Radiothérapie 05/2006; 10(3):142-144. · 1.48 Impact Factor
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    ABSTRACT: Interindividual differences observed in the metabolism of xenobiotics have been attributed to the genetic polymorphism of genes, which code for enzymes involved in detoxification. This genetic variability seems to be associated with the individual's susceptibility to certain cancers, including nasopharyngeal carcinoma. In this study, we have investigated the genotypic frequencies of DNA polymorphisms of two detoxification's genes: the gluthatione-S-transferase (GST) and the N-acetyl transferase 2 (NAT2). The study has included 45 patients with nasopharyngeal carcinoma compared to 100 healthy Tunisian controls. The presence of the GSTM1 null and GSTT1 null polymorphism was screened by using a multiplex PCR procedure. A PCR-RFLP method was used to detect polymorphism for the most common alleles of the NAT2 gene. Allelic frequencies between the two groups were compared using a chi2 test and odds ratio with 95% confidence intervals were calculated. The results indicate that the genotypic frequency of GSTM10/0 between controls and patients was significantly different. This genotype confers an increased risk of nasopharyngeal carcinoma (Odds Ratio = 2.12, [0.64-4.7]). However, genotypic frequencies of NAT2*6/NAT2*6 were significantly higher in the group of nasopharyngeal carcinoma patients. The calculated Odds Ratio showed an association between this genotype and nasopharyngeal carcinoma. In conclusion, the increase of nasopharyngeal carcinoma risk in Tunisia seems to be associated with GSTM10/0 and NAT2*6/6 genotype.
    Bulletin du cancer 04/2006; 93(3):297-302. · 0.61 Impact Factor