Journal africain du cancer / African Journal of Cancer

Published by Springer Verlag
Online ISSN: 1965-0825
Print ISSN: 1965-0817
Publications
Background In Algeria, the incidence of gallbladder cancer is higher and prognosis is poor. Five-year survival for all stages is less than 5%. For the past 12 years, we have adopted an aggressive surgical approach against this carcinoma. Procedure This radical surgical approach includes a bisegmentectomy for stages IV–V and extensive lymphadenectomy for invasive stages. This resection can be extended to all other organs which may be involved in the tumour (44.5%). Systemic adjuvant chemotherapy was administered postoperatively. Nodal infiltration was noted in 67 cases (51.5%). Results Morbidity and mortality were 28.5% and 18.5%, respectively. Overall survival at 5 years was 16%, with a median of 17 months. Conclusions These results (median and overall survival) encourage us to continue in this way, but a lot of effort must be made to reduce postoperative mortality and improve the management of patients with jaundice and those with the involvement of multiple organs.
 
Introduction L’utilisation, par les patients cancéreux, de traitements dont l’efficacité est non prouvée est un phénomène existant dans tous les pays du monde, il existe une certaine spécificité de ces médecines complémentaires et alternatives (CAM) selon les pays. Patientes et méthodes Le but de l’étude était de rapporter la fréquence et la raison de l’utilisation de médecines complémentaires chez des patientes suivies pour des tumeurs solides dans un service de cancérologie tunisien. Un questionnaire a été rempli par une personne non engagée dans le traitement en interrogeant des patientes en surveillance ou en cours de traitement. L’étude porte sur 150 questionnaires exploitables. Résultats Quarante-neuf pour cent des patientes disaient avoir recours à la médecine complémentaire. Les herbes traditionnelles, le mélange miel et « graine noire », la viande de serpent étaient les substances les plus utilisées. Le profil type des utilisatrices était des patientes jeunes (âge inférieur à 50 ans), scolarisées, mariées. La principale raison de cette utilisation était de traiter la maladie. Quatrevingt-dix pour cent des utilisatrices ne révélaient pas cette utilisation à leur cancérologue. Le moment d’utilisation était surtout au début et après le traitement conventionnel. Conclusion Une meilleure connaissance des CAM par les oncologues semble indispensable afin d’avertir les patients des bénéfices et risques potentiels encourus de ces traitements.
 
The frequency and the bad prognosis of broncopulmonary cancers justify the numerous studies dedicated to this pathology. To have an epidemiological and a clinical approach to these disorders, we performed a retrospective study of a series of 163 cases of bronco-pulmonary cancers collected from the anatomy pathology department of the Mohamed V Military Hospital of Instruction in Rabat (1994 to 2003).We observed in general an increase in the number of diagnosed cases every year, with a trend reversal during the later years: the adenocarcinoma and the small cells carcinoma (CPC) became more frequent than the squam cells carcinoma; a mean age of intervening of 53 years; a large masculine predominance (93%) with a high sex-ratio (12.1). The symptoms that prompted the consultation are dominated by cough, thoracic pain and haemoptysis. The effect of tobacco was found in 54% of the cases, underlining the probable role of passive tobacco and/or of other etiologic factors. Non-small cells carcinomas represent 60.8%, of which squam cells carcinoma constitute a predominant portion (37.4%), with a mean age of 54 years, followed by adenocarcinoma (21.4%), with a mean age of 48 years, and large cells carcinoma (2%) with a mean age of 53 years. Small cells carcinoma and related disorders represent 11%, with a mean age of 63 years. Immunochemistry is generally necessary to specify the histological type of a poorly differentiated form (8.6% of our series). So, pathologists in this domain must constantly keep themselves abreast of progress on the histogenesis of these disorders and the contribution of new research methods.
 
Objectives To evaluate the feasibility of radical prostatectomy, its morbidity and its short-term results. Materials and methods We carried out a descriptive study based on study of the records of the 18 radical prostatectomy cases carried out in our department from June 2004 to May 2007. We were interested in the following parameters: age, diagnostic circumstances, PSA, histological type, TNM stage, approach, operative follow-up and clinical and biological evaluation after three months. The analysis of the data was done using frequency and average calculations. Results The average age was 60.9 years (53, 68). The average total PSA rate was 31.9 ng/ml (6.1, 143.1). The rise in PSA was a result of diagnostic circumstances in 33.4 against 66.6% of urinary disorders. The tumours were localised: seven cases of cT1 (38.9%) and 11 cases of cT2 (61.1%). An adenocarcinoma was found in all patients with an average Gleason score of 6.3 (3; 8). Fourteen patients had been treated via the retropubic approach, with ganglionic curage; and in four others, a perineal approach was used, with no curage. The average intervention duration was 160.3 minutes (90: 200). The average blood loss volume was 1 071.1 ml (300; 2600). Postoperatively, we had two cases of hematuria (11.11%), two anastomotic fistulae (11.1%) and one urinary infection. The average time for catheter ablation was 13.9 days (2; 22). Erection evaluation three months postoperatively showed six cases of good erection (33.3%), three cases of semi rigid erection (16.7%) and eight cases of lack of erection (44.4%), including three cases of erectile dysfunction before surgery. Erection was not evaluated in one case. With regard to continence three months postoperatively, we noted seven cases of normal continence without leakages of urine (38.88%), eight cases of urine leakages accompanying normal micturition (44.4%), two cases of incontinence (11.1%) and one non-evaluated case. Conclusion Radical prostatectomy is an accessible treatment without serious risk for the patients. However, more remissions and cases are required for a more complete evaluation.
 
Data for 20 years from Setif cancer registry provides for the health professionals and the researchers information on the cancer incidence in Setif, adjusting for the effect of age, sex, and period of diagnosis and the geographical distribution of these sites at the national and international level. These data are compared with standardized rates of cancer registries in five continents. Survival data show the level of efficiency of health system. Material and methods We study the common cancer sites in Setif from period 1986 to 2005. In this context, the cancer registry represents a data source of an incomparable richness and a great scientific quality. The objectives of the study are to describe and to supervise the cancer risk and to undertake research based on the data collected. The software used is the Can Reg 4 produced by the unit of descriptive epidemiology of the International Agency for Research on Cancer IARC of Lyon. Results During this period, lung cancer is the most common cancer registered in registry of Setif; the age-standardized rates range from 11.7 to 21.9 per 100,000 people for one year for males in the past two decades. The prostate cancer comes in second position with an increasing trend, with the standardized incidence rates increasing from 2.0 in 1986 to 7.2 per 100,000 men in 2005. Between 1986 and 2005, the numbers of new cases of colorectal cancer increase from 23 cases in 1986 to 176 cases in 2005 in men and from 17 cases to 149 cases in women. The incidence rate of the bladder cancer is also in recrudescence which quickly increases 2.2 to 8.7 per 100,000 persons for one year in men. The incidence rates of nasopharyngeal carcinoma, the stomach cancer, the lymphomas and leukemia’s remained stable during the last two last decades. In women, the incidence rates of breast cancer increases fast and is by frequency is the most common according to the cancer registry of Setif and the increase from 10.4 to 19.6 per 100,000 women for one year; the number of new cases practically doubled in 20 years, it increased from 187 cases in 1986 to 391 cases into 2005. In women, the thyroid cancer incidence rate, which has increased in the last 20 years range from 1.1 in 1986 to 4.3 per 100,000 women in 2005. The cervical cancer, the gallbladder cancers and the lymphoma incidence rates have a stable evolution. The five-year survival rate for the disease is only 40 percent according to the last Concord study 1990–1994 for the common cancers of the cancer registry; the five-year survival rates of rectum, colorectal and prostate cancers are, respectively, 25.9%; 18.2% and 19.6% in men. The five-year survival rates of breast, large bowel, rectum, colorectal cancers are, respectively, 38.5%, 30.6%, 22.5% and 22.6% in women. The rate of childhood cancer incidence has remained relatively stable since 1986. Boys and children aged 0 to 4 years are most affected. Conclusion Cancer currently constitutes one of the main issues of public health in Algeria; there is a clear increase in the cancer incidence due to smoking in men and breast, thyroid and colorectal cancers in women. Cancer mortality remains always high because the diagnosis is often late and the assumption of responsibility is difficult and expensive.
 
Nous rapportons les résultats d’une étude rétrospective portant sur les dossiers d’archives des patients ayant présenté un lymphome à Abidjan entre 1995 et 2004. Nous n’avons retenu que les patients dont le diagnostic de certitude a été réalisé à Abidjan. Nous avons recensé 1 681 sujets dont 218 cas de leucémies aiguës, soit 12,5 %, 126 cas de syndromes myéloprolifératifs, soit 7,54 % et 1 337 cas de syndromes lymphoprolifératifs, soit 80 %. Les taux standardisés étaient de 7,44 nouveaux cas/105 habitants par an chez l’homme, de 5,43 chez les femmes et de 5,98 chez l’enfant. En tenant compte du taux d’incidence standardisée, le lymphome de Burkitt était la principale hémopathie rencontrée, suivi des lymphomes malins non hodgkiniens, non Burkitt et des leucémies aiguës lymphoblastiques. La répartition chez l’enfant de 0 à 14 ans a révélé que la principale hémopathie était de loin le lymphome de Burkitt avec une incidence hospitalière de 43,9 nouveaux cas par an contre seulement 7,1 pour les leucémies aiguës lymphoblastiques, deuxième, et 2,1 pour la maladie de Hodgkin, troisième. Nous avons retrouvé des cas de leucémie à tricholeucocytes et des cas de maladie de Waldenström au cours de cette étude. Par ailleurs, la leucémie myéloïde chronique était le seul syndrome myéloprolifératif retrouvé. Les leucémies aiguës lymphoblastiques de type 1 et 2 et la leucémie aiguë myéloblastique de type 2 étaient les types cytologiques les plus fréquentes de leucémies aiguës, tandis que le type 3 de la maladie de Hodgkin et les LMNH centroblastiques étaient les formes histologiques les plus fréquentes. Les lymphomes de haut grade de malignité étaient les plus fréquents (84,4 %) et se retrouvaient surtout chez les sujets de 0 à 14 ans. Les taux que nous avons obtenus peuvent être sous-estimés, toutefois, ils sont un reflet de la réalité de l’évolution des lymphomes ces dernières années.
 
Tobacco smoking and its consequences are one of the major health problems in all regions of the world, regardless of their level of development. The extent of this problem has considerably grown over the last decade. As demand decreases in developed countries, tobacco industries target low- or middle-income developing countries and promote their products with an expected increase in consumption. In Algeria some 30,000 new cancer cases are diagnosed each year; the number of cases increased by 50% between 1986 and 2000. Tobacco prevalence was 43 in male and 6 in female. 50% of smokers are under 27 years. Awareness campaigns during “World no tobacco day”, followed by information caravans, motivated some smokers to ask for help to quit smoking. But then, these people used all sorts of products in unstructured ways, because medicines and cessation techniques in Algeria are still not well known and there is no national global policy on these issues. Responding to this need, the University hospital and the University of Setif, in collaboration with Epidaure-CRLC (Montpellier, France), the committee for French-speaking countries of the International Union Against Cancer (UICC) and the French League against cancer implemented a tobacco-smoking prevention and cessation program in the region of Setif. The objective is to promote prevention and cessation of tobacco in Setif area. The main activities are press campaigns, health formation, communication, information education, and cessation. The results after 2 years show new needs in communication. Heath authorities are favorable to develop this project in all areas in the country. There are some problems in medical, cultural, and economic concepts.
 
Changes in histological subtypes over time
Background More than 90% of children with Hodgkin lymphoma (HL) can be cured with current treatment modalities. This goal has not, however, been reached in most developing countries. We report here the results of a retrospective study of 24 years’ experience in the management of HL in children in one institution in Morocco. Procedure All cases of histologically confirmed HL in children under 17 years of age seen in our department between 1978 and 2001 were included in this study. The treatment modality varied during the 24-year period but mainly comprised combined chemotherapy and radiation therapy. Results Two hundred and three patients were included. The mean age of the patients was 10.3 years, and 46% were 10 years old or less. The male:female ratio was 2.9. The mean duration of symptoms before diagnosis was 10.4 months. Lukes-Rye histological types 2 and 3 predominated, representing 40% and 37% of cases, respectively. Advanced stages III and IV represented 55.5% of the cases. After a median follow-up of 10 years, only 134 patients were available for evaluation. The 10-year overall and relapse-free survival rates were 64% and 58%, respectively. Conclusion The results for this large series of cases of childhood HL in Morocco are similar to those observed in other developing countries. Steps must be taken, however, to reduce the numbers who abandon treatment and to improve the therapeutic results.
 
Objective This retrospective study aimed at discussing epidemioclinical criteria and therapeutic results of persistent gestational trophoblastic disease (PGTD) and choriocarcinoma throughout a series of 26 patients treated between 1990 and 2002. Patients and methods We reviewed the epidemioclinical records of all the patients. After aspiration, pretherapeutic work-up, and hebdomadary dosage of plasmatic HCG, patients were divided into three prognostic groups according to the Gustave-Roussy Institute (IGR) classification (hydatidiform mole, low-risk tumors, and high-risk tumors). They were treated with different chemotherapy regimens: monodrug methotrexate therapy, AE protocol (actinomycin and etoposid), and APE protocol (actinomycin, etoposid, and cisplatinum) adapted to each group. Results The mean age was 32 years (extremes: 20 and 49). Metrorragia and pelvic pain were themost frequent symptoms. There were 20 cases of PGTD (mole retention: three cases, invasive moles: 16 cases, and choriocarcinoma: one case) and six primary choriocarcinomas. All the evaluable patients were cured with the first-line chemotherapy or after salvage chemotherapy in patients with considerable risk for the disease who showed a resistance to monodrug methotrexate therapy. We recorded two toxic deaths with APE protocol. Conclusions The epidemioclinical criteria did not have any particularity. We confirmed the effectiveness of chemotherapy in PTGD. However, if we consider efficacy/toxicity ratio and the recent data of the WHO classification modified by FIGO, therapeutic deescalate may be justified at least in patients with good observance.
 
Childhood cancers are rare. The aim of our work was to describe the epidemiological and histological aspects of these tumors in Togo. We made a retrospective review of the epidemiologic and pathologic features of solid cancers in childhood (less than 15 years), observed from 1984 to 2008 at the laboratory of pathology of the Tokoin Teaching Hospital in Lomé, Togo. During our study period, we observed 365 cases of childhood solid cancers that represent 7% of all cancers. The average age of occurring was 8.1 years and the sex-ratio was 1.5. Histologically, it was non-Hodgkin lymphomas in 51.5% of cases (including 27.9% of Burkitt lymphoma), Hodgkin disease in 9.3% of cases, and retinoblastoma in 8.5% of cases. This study showed that childhood solid cancers are frequents in Togo dominated by Burkitt lymphoma.
 
Introduction: The use of pectoralis major myocutaneous flap in head and neck oncology allowed the excision of large tumors Materials and methods It is a retrospective study which concerns a period of 13 years in the course of which, 37 pectoralis major myocutaneous flaps were performed at the private hospital of ENT of Dakar. Results The mean age of our patients was 51 years with a sex ratio of 5.16. To the clinical plan, the pharyngo-laryngeal tumors prevailed in 64.87% of cases. The cancers of larynx expanding into the skin and requiring a square laryngectomy were our main indication (37.86%). It was followed by the surgical cure of pharyngostoma (18.92%). To the anatomical plan, we obtained a healing of first intention in more than half of our patients (54.05%). Conclusion Thanks to its qualities, the pectoralis major myocutaneous flap has already supplanted the other flaps and it finds its main use in the reconstruction after square laryngectomy.
 
Objective The purpose of this study is to analyze the oncologic outcome of immediate reconstruction after mastectomy for breast cancer and the impact of adjuvant treatments on cosmetic results. Patients and methods This retrospective study concerns 38 consecutive advanced abdominal flap with breast prothesis, realized immediately after mastectomy for breast cancer by one surgeon between 1997 and 2008. Results The average retrospective period was 34.5 months. Recurrence was observed in three caseswithout late diagnosis. It was local in two cases and systemic in one case resulting in death 18 months after reconstruction. Breast tumor in these cases had several initial poor prognostic factors. Delayed scarring was noted in one case due to post-radiation cutaneous necrosis. Capsular contracture was also observed in two women who received postoperative radiotherapy. In our study, esthetic results were considered poor in three cases because of prothesis removal in these cases, acceptable in 10 cases, good in 20 cases, and excellent in 5 cases. Conclusion Immediate breast reconstruction using advanced abdominal flap associated to a prothesis doesn’t affect neither local and systemic recurrence rates nor overall survival. Cosmetic results are overall good.
 
The multiple myeloma (MM) or Kahler disease is a clonal malignant proliferation of plasmocytes in bone marrow with monoclonal immunoglobulin proliferation. The aim of this study is to describe the clinical presentation of MM in the Department of Internal Medicine of Dakar (Senegal). Patients and method It is a descriptive study conducted over a period of eight years. Any patient who presented with biological, cytological, or histological criteria of MM was included in the study. Results The average age at diagnosis was 55.7 years. Clinically, bone syndrome was found in 69% of the cases, and pathological fractures in 30.9% of the cases. Paraclinically, anemia was found in 57.7% of the patients, hyperprotidemy in 48.3%, hypercalcemia in 69%, and kidney disease in 28.6% of the cases. Electrophoresis of serum protein had revealed a high level of gammaglobulins in 55% of the cases. In urine samples, we noted the existence of light chains of lambda type in 80% and kappa type in 20% of cases. Conclusion Clinical presentation of MM in Dakar showed that complications were present at the diagnosis; it reflects slow diagnosis and thus the management of the disease.
 
Objective To analyze the epidemiological characteristics and clinicopathologic features of breast lobular carcinomas in the Central Region of Tunisia. Patients and methods A retrospective study was carried out on all breast lobular carcinomas cases diagnosed in the Department of pathology, CHU Farhat Hached Sousse (Tunisia) from 1990 to 2005. The demographic, clinical, histological and treatment were analyzed. The probability of survival or recurrence was calculated using the Kaplan-Meier method. Prognostic factors were studied using the log-rank test. Results The mean age was 51 years old and half of the patients were postmenopausal. The average clinical tumor size at diagnosis was 49.9 mm. Seventy five percent of the patients were seen at an advanced stage of the disease (stages T3 an T4). The histological diagnosis was based in all cases on preoperative biopsies. It was in most cases the classical form (94.6%), a low histological grade (64.8%) and hormone receptor positive (65.5%). Surgical treatment was performed in 74.3% cases. Overall survival and disease-free survival at 5 years were respectively 94 and 70.9%. No local recurrence was observed after conservative treatment. Metastasis to lymph node, the clinical stage, the histological grade and non-expression of hormone receptors were significant factors influencing disease-free survival. Conclusion Our results were compared with data from literature and show that lobular carcinoma is rare, its diagnosis is often difficult and late, surgical treatment and its prognosis do not currently appear to differ from ductal carcinomas.
 
Répartition des lymphomes hodgkiniens et non hodgkiniens selon l'âge 
Purpose Lymphomas are common and serious diseases. The aim of our work was to describe the epidemiology and histological features of these tumours in Togo. Material and methods Retrospective review of the lymphomas observed from 1984 to 2008 at the laboratory of pathology of the Tokoin Teaching Hospital in Lomé, Togo. Results During our study period, we observed 755 cases of lymphomas (including 92 Hodgkin diseases and 663 non-Hodgkin lymphomas) that represent 14.4% of all cancers. The average age of occurring was 26.2 years and the sex-ratio was 2 for the Hodgkin disease, and 32 years for non-Hodgkin lymphomas with a sex-ratio of 1.4. The Hodgkin disease was dominated by lymphocytic depletion (33.7%) and nodular sclerosis (28.2%) types. Non-Hodgkin lymphomas were extranodal in 256 cases (38.7%) and dominated by centroblastic type (27.1%) and Burkitt lymphoma (21.1%). Conclusion Lymphomas are frequents in Togo, occurring usually in young men.
 
De par son incidence, le cancer du sein reste le cancer le plus fréquent chez la femme. Cette incidence est faible avant 35 ans et augmente avec l’âge. Il s’agit d’une pathologie mammaire hétérogène avec des variations inter-individuelles. Notre étude a porté sur une analyse histopathologique de 81 cas de tumeurs mammaires malignes colligées au niveau du laboratoire d’anatomie pathologique du Pr Bourouis (Oran, Algérie). L’objectif de cette étude est de déterminer les fréquences de chaque type tumoral et d’analyser son aspect histologique et pronostique. Les résultats obtenus ont révélé deux cas de sarcomes et 79 cas de carcinomes. Le type histologique le plus fréquent est le carcinome canalaire infiltrant avec un pourcentage de 76,54 % des cas. Selon la classification histopronostique Scarff-Bloom-Richardson (SBR), 70 % des cas appartiennent au grade III. L’examen des curages ganglionnaires indique que 80 % de ces derniers sont envahis par le processus tumoral. Through its impact, breast cancer remains the most frequent in woman. This incidence is low before 35 years and increases with age. It is a heterogeneous mammary disease with variations between individuals. Our study has focused on a histopathological analysis of 81 cases of malignant mammary tumors collected in the Laboratory of anatomy pathological (Pr Bourouis Oran, Algeria). The objective of this study is to determine the frequency of each type of tumor and its histological analysis and prognosis. The results obtained revealed two cases of sarcomas and 79 cases of carcinomas. The current histological type is the infiltrating ductal carcinoma with a percentage of 76.54% of cases. According to the histopronostical classification Scarff-Bloom-Richardson (SBR), 70% of the cases belonged to grade III. An examination of lymph node indicates that the tumoral process invaded 80% of them.
 
Objective To study the role of radical prostatectomy in the treatment of prostate cancer. Patients and methods It was a retrospective multicenter study of 5 years on 91 radical prostatectomies performed at Medico-Surgical Center le Bois of Chaumont in France and at Notre-Dame-de-la-Paix in Burkina Faso. Results In 5 years, 91 patients underwent radical prostatectomy with curative intent, 85 at Medico-Surgical Center le Bois in France and 6 at Notre-Dame-de-la-Paix in Burkina Faso. Their average age was 66.52 years. Clinically, the patients were classified as stage A (2.2%) or B (98.8%) of Whitemore-Jewett. The average PSA (prostatic specific antigen) was 9.25 ng/ml. Endorectal ultrasound, CTabdominopelvic bone scan, magnetic resonance imaging, and histology of biopsy pieces were able to classify all patients as T1a to T2b N0M0. It was adenocarcinoma, and the average Gleason score was 6. Surgical treatment was radical prostatectomy. After pathologic study of surgical specimens, 2.2% were classified as pT1, 76.92% pT2, 21.92% pT3, and 1.10% pT4. The rate of PSA, six months after radical prostatectomy, was undetectable in 81.32%. In addition to radical prostatectomy, patients received hormone therapy (4 cases), radiation therapy (9 cases), and radiotherapy-hormone therapy (2 cases). The operative mortality was zero. The average length of hospital stay was 8 days. Complications such as seromas (6.60% patients), erectile dysfunction (47.25%), urinary incontinence (32.97%), and acute retention (2.2%) were noted. The 3-year survival rate was 78.33% after radical prostatectomy alone and 100% after radical prostatectomy associated with radiotherapy and/or hormone therapy. Conclusion Radical prostatectomy allowed to control prostate cancer, and it requires early diagnosis. The addition of radiotherapy and/or hormone therapy optimizes the prognosis.
 
L’incidence des hémopathies malignes, maladies des cellules sanguines et ganglionnaires, est en augmentation constante depuis 20 ans. Des anomalies chromosomiques récurrentes de ces pathologies ont été révélées par l’analyse cytogénétique conventionnelle et moléculaire. Une étude statistique a été réalisée chez des patients atteints d’hémopathies malignes, certains parmi ces patients ont fait l’objet d’une analyse cytogénétique moléculaire (FISH: hybridation fluorescente in situ). Une progression de l’incidence des hémopathies malignes a été constatée dans la région de Sidi-Bel-Abbès (Ouest algérien) avec une prédominance masculine. La fréquence des hémopathies malignes est semblablement la même entre 18 et 69 ans, avec une légère prédominance entre 61–69 ans. Les lymphomes non hodgkiniens (LNH) et les lymphomes de Hodgkin (LH) sont les hémopathies les plus fréquentes dans cette région. Par la technique de cytogénétique moléculaire (FISH), on a pu détecter deux translocations fréquentes dans les lymphomes malins, la t(11; 14)(q13; q32) et la t(8; 14)(q24; q32).
 
Les fibromatoses agressives ou tumeurs desmoïdes sont des proliférations fibreuses infiltrantes, récidivantes mais non métastasiantes, se développant à partir des fascias et des aponévroses musculaires. Le traitement nécessite une prise en charge multidisciplinaire faisant appel aux chirurgien, oncologue et radiothérapeute. Généralement, le pronostic reste bon. Entre 1997 et 2008, quatre cas de tumeurs desmoïdes ont été colligés à la clinique chirurgicale B du CHU Ibn-Sina de Rabat. Le contexte clinique et l’imagerie avaient évoqué le diagnostic dans tous les cas. Une tumorectomie passant en zones saines a été réalisée chez les quatre malades. L’histologie avait confirmé le diagnostic dans tous les cas. Parmi les facteurs étiologiques, un traumatisme, des désordres hormonaux semblent être impliqués. La première considération thérapeutique consiste à prévenir la récidive locale. Un complément thérapeutique par radiothérapie ou chimiothérapie reste à définir. Les tumeurs desmoïdes sont des tumeurs rares avec un profil génétique, éthiopathogénique et évolutif très distinctif. Douées d’une bénignité histologique contrastant avec une véritable malignité locale et une tendance aux récidives, une meilleure compréhension de leur physiopathologie avec une prise en charge multidisciplinaire est fondamentale pour une approche thérapeutique adéquate.
 
The World Health Organization approximately estimates an increase of 100% of the number of cancers by around a quarter of a century in the developing countries. In Congo, since 2000, a pilot project of controlling the cervix cancer is under implementation. The purpose of this work is to present the anatomico-clinical outcomes of this project and to consider the prospects for controlling the cervix cancer in Congo. Within the framework of a project, women living in Brazzaville, age ranging between 29 and 59 years, benefited from a screening test of the cervix cancer through the visual methods. The positive cases had a colposcopy with an anatomico-pathological examination of the biopsies followed by a medical or surgical care according to the type and the extent of the lesions. For 32 months, 7,694 women were examined and 1,021 among them (13.3%) had a biopsy directed. A morbid state was observed in 78% (N = 797) of the whole of the biopsies, including 71.8% (N = 734) of precancerous and cancerous lesions. Eighty-five percent of the cases were young women, with a socio-economic level relatively low; 65% of these women had never used oral contraceptives. Among these precancerous and cancerous lesions, there were: 43.4% of CIN2; 16.4% of CIN1; 10.7% of CIN3, and 17% of condyloma. In addition, there were: 4% (N = 30) of epidermoid carcinoma; 2.1% (N = 16) of in situ carcinomas, and 0.8% (N = 6) of adenocarcinomas. In the light of this high rate of detection of anomalies within a population of asymptomatic women, this method of simple and not very expensive tracking deserves to be implemented worldwide. In the therapeutic plan, the methods used were: the resection with the diathermy snare and the cryotherapy for the precancerous lesions of low rank; surgery for the precancerous lesions of high rank and cancers.
 
Depuis que la technique de duodénopancréatectomie céphalique (DPC) a été décrite par Whipple et al. en 1935, le traitement chirurgical du cancer du pancréas a fait des progrès indiscutables en matière de qualité de résection. L’exérèse de la marge rétropéritonéale (MRP) avec abord premier de l’artère mésentérique supérieure (AMS) permet une chirurgie pancréatique complète et donne une idée plus claire sur le pronostic. L’impact de cette technique sur la survie reste à évaluer. Since Whipple et al. described the technique of cephalic duodenopancreatectomie in 1935; the surgical treatment of pancreatic cancer has made gains in quality of resection. The excision of the retroperitoneal margin with first approach of the superior mesenteric artery allows complete pancreatic surgery and gives a clearer idea about the prognosis, the impact of this technique on survival remains to be assessed.
 
Introduction For some years, therapeutic management of metastatic renal cancers benefits from considerable progress. Point Define the efficiency of antiangiogenic molecules and the new recommendations of the treatment of metastatic renal cancer. Material and methods An English bibliographical search was realized from the data bank Medline (PubMed) using the following keywords: renal cell carcinoma, immunotherapy, antiangiogenic drugs, and tyrosine kinase inhibitors, and about 20 published articles were consulted including phases II and III randomized trials. Results Since 2004, the treatment ofmetastatic renal cancer is constantly changing. Before, the treatment was based essentially on the use of cytokines determining the era of the immunotherapy. At present, the studies of the tumoral biology as well as the genetic aspects of the pathology showed the utility of new molecules with the antiangiogenic properties, which were able to define new therapeutic standards. The results of these targeted therapies concern especially the improvement of the progression-free survival with the sunitinib or the bevacizumab used in the first line of treatment, or with the sorafenib used in second line. The inhibitors of m-TOR (temsirolimus) can be usedwith a benefit on the overall survival in the cases of metastatic renal cancers with bad prognosis. Conclusion In spite of the current therapeutic progress, the prognosis of metastatic renal cancer is still bad. Consequently, it is important to intensify the researches and to follow any therapeutic development.
 
Les tumeurs stromales gastro-intestinales (GIST) sont les tumeurs mésenchymateuses les plus fréquentes du tube digestif. Le développement synchrone ou métachrone d’une tumeur stromale et d’une tumeur épithéliale du tube digestif est rare et découvert de façon fortuite durant le traitement chirurgical des carcinomes gastro-intestinaux, et ces tumeurs sont réputées être de faible potentiel de malignité. L’observation que nous rapportons concerne un homme de 66 ans, présentant un adénocarcinome sigmoïdien avec une GIST de développement métachrone découverte fortuitement lors d’une récidive tumorale de l’adénocarcinome. Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the digestive tract. Metachronous or synchronous occurrence of GISTs and epithelial tumors of the digestive tract is rare and usually discovered incidentally during gastrointestinal surgery for carcinomas. GIST accompanied by other neoplasms have usually very low risk of aggressive behavior compared with a GISTalone. We present here a case of a 66-year-old patient with recurrent sigmoid adenocarcinoma and metachronous gastrointestinal stromal tumor discovered incidentally during surgical treatment of the recurrent adenocarcinoma. Mots clésGIST-Adénocarcinome-Tractus digestif KeywordsGIST-Adenocarcinoma-Digestive tract
 
Aspect tomodensitométrique en coupe transversale (sans injection du PC) : processus lésionnel hétérogène, de densité tissulaire, mesurant 50 × 40 mm, aux dépens de la grande et petite courbure gastrique, à développement exogastrique + kyste biliaire du segment V du foie
GIST gastrique (HE × 40)
Background Gastointestinal stromal tumors (GISTs) are rare neoplasms. They represent less than 1% of all gastrointestinal tumors. Little is known about their association with other tumors of different histogenesis. Coexistence of GISTs, especially with metachronous or synchronous colorectal cancer, is a phenomenon with increasing number of relative reports in the last five years. Case report We report a 64-year-old man, with no history of disease, presenting with colorectal adenocarcinoma, treated with concomitant chemoradiotherapy, anterior resection of rectum, and adjuvant chemotherapy. After 9 months, he developed a locally advanced recurrent tumor. The patient received a second-line chemotherapy. Radiology estimate after six cycles discovered incidentally an antral gastric mass, which measured 5/4 cm in tomodensitometry imaging. Histological examination of mass’s biopsy revealed a GIST, and immunohistochemistry proved positive CD117. The patient continued to receive chemotherapy because of both malignant progress of colorectal adenocarcinoma and poor prognosis. Surgery of GISTs will be considered if complete or partial responses to chemotherapy of colorectal cancer are achieved. Discussion The coexistence of GISTs and other primary tumors is usually discovered incidentally during GI surgery for carcinoma, or during work-up for radiological or endoscopy exploration. The known genetic pathways of tumorigenesis are different for the two neoplasms: c-kit appears to be occasionally overexpressed in colorectal cancer, and it is not clear if the protein is indeed a key player in the carcinogenetic process, as it is in GISTs. Other studies are necessary to assess if tyrosine-kinase inhibitors could be used in a multimodality regimen in colorectal cancer.
 
Our study was about a survey of 992 cases of breast diseases conducted from January 2001 to December 2006 in the different departments of pathology of Ouagadougou. The main objective was to determine the histological and epidemiological aspects of breast disease in Ouagadougou. The following results were obtained. 1) The number of the cases has increased with the time. 2) The three-quarters of diagnosed lesions were minor. 3) The average age of patients was 34.4 years for breast disease in general. With regard to men, the age was 70 years for carcinoma, and the average age during the minor lesion diagnosis was 29 years. 4) The lesion was located mostly on the right side with 49.2% of the cases. 5) At the histological level, adenofibroma with 37.2% of the cases was considered as the highest occurrence followed by infiltrated canal carcinoma with 16.8% of the cases. The grade II by Scarff-Bloom-Richardson was found most of the time with 49.3% of the cases. 6) The fibrocystic lesion having 12.1% was ranked third. Breast tuberculosis was a rare disease with 0.4% of breast disease. 7) As far as men were concerned, the minor chest disease was shown by gynecomastia, representing 0.6% of breast disease cases. A single case of malignant tumor namely the bilateral infiltrating carcinoma canal was diagnosed.
 
Cancer incidence in Africa is increasing as a result of aging populations, lifestyle changes, and improved detection. However, cancer etiology, prevention, and control in Africa are poorly understood, and survival rates from cancer are among the lowest in the world. Poor cancer survival suggests that improvements in health care, patient education, and relevant research are critically needed. An increase in research infrastructure is required to achieve adequate screening, diagnosis, and treatment of cancer in Africa. While research is a basis for clinical practice and policy changes in resource-abundant areas, the research infrastructure in Africa is deficient in many areas. Building infrastructure for research includes creating supportive environments for research endeavors, securing funding for resources and research personnel, developing training and mentorship opportunities, and building collaborative research with other institutions. Goals for the development of cancer research in Africa may include research on cancer incidence and mortality, cancer etiology and risk factors, clinical research with a focus on early diagnosis/ treatment and palliative care, health economics, and community-based participatory research. An understanding of the environmental and cultural framework by which cancer is diagnosed and managed is critical for developing interventions that will be effective in African populations.
 
Cancer is an increasingly significant public health problem worldwide. The majority of new cancer cases and cancer related morbidity and mortality are now occurring in developing countries, especially in Africa. This paper outlines the situation in the WHO African region and describes the priority interventions needed to address the problem. It advocates for the allocation of increased national and international resources for a more equitable access to optimal cancer prevention, diagnosis, care and management. The WHO is committed to supporting capacity-building in Member states with respect to cancer prevention and control and to sharing good practice with respect to integrated approaches to the prevention, treatment and monitoring of cancer and other non-communicable diseases. An impassioned plea for resource mobilization, collaboration and partnership will result in improved cancer prevention and control in Sub-Saharan Africa.
 
Le code de Nuremberg, les différentes versions de la déclaration d’Helsinki, la déclaration de Manille et tous les autres textes élaborés par des instances comme l’Association médicale mondiale mettent en avant des concepts dits « internationaux » d’éthique médicale. Alors que l’on parle de plus en plus de mondialisation, et que, paradoxalement, l’écart se creuse entre pays « développés » et pays du « Sud », il est important de nous interroger sur l’aspect que revêtent ces grands concepts éthiques dans la réalité africaine. Compte tenu d’un contexte culturel et socioéconomique très différent, il nous semblait utile d’éprouver ces principes et de voir si, pour le continent africain, les enjeux éthiques se situaient au même niveau que celui vers lequel tend l’actuelle éthique médicale occidentale. Autrement dit, la question pour nous était de savoir si aujourd’hui, il était pertinent, en Afrique, de se battre pour imposer des notions très en vogue dans les pays industrialisés, telles que l’incontournable « consentement du patient », ou si actuellement les priorités éthiques devaient se situer à d’autres niveaux. Les éléments de réponse nous sont venus de plusieurs jours passés sur le terrain africain, dans des services d’oncologie pédiatrique, dans le cadre de missions d’investigation pour le Groupe franco-africain d’oncologie pédiatrique (GFAOP). Cet article, centré sur une maladie aussi singulière que le cancer de l’enfant, livre une réflexion issue d’une immersion dans la réalité sanitaire africaine.
 
Le carcinome du nasopharynx (NPC) constitue le premier cancer ORL en Algérie. Les composantes génétiques et virales sont essentielles dans l’étiopathogénie de cette tumeur par la fréquence de cas familiaux et sa liaison constante avec le virus d’Epstein-Barr dont l’utilisation des marqueurs sérologiques pour le dépistage précoce du NPC a donné des résultats prometteurs. L’objectif de notre étude est de définir les indications et les limites du dépistage du NPC chez les populations nord-africaines. Il s’agit d’une enquête épidémiologique portant sur 102 cas de NPC et comprenant trois étapes. Les deux premières portent sur l’étude des cas familiaux de cancer par l’étude de la généalogie du groupe familial chez 30 familles ayant un cas vivant de NPC, suivie d’une enquête comparative entre 72 cas de NPC appariées à 72 témoins selon l’âge, le sexe et la localité de résidence. La troisième étape est une étude de la faisabilité du dépistage sérologique du NPC portant sur 600 sujets de l’entourage familial des malades. Les résultats montrent une fréquence de cas familiaux de cancer élevée notamment la localisation nasopharyngée et qui sont associés significativement à un risque élevé de NPC. Concernant l’enquête de dépistage, le taux de participation est faible à cause d’une perception du NPC comme fatalité et maladie systématiquement létale. Si ces éléments devraient être en faveur d’un dépistage précoce du NPC, l’endémicité modérée dans les pays d’Afrique du Nord faisant que cette affection ne constitue pas une priorité sanitaire, la perception culturelle de la maladie et la mauvaise acceptabilité des tests constituent, pour ce type d’actions, des limites considérables.
 
La pénurie des personnels de santé n’est pas un phénomène nouveau dans les pays en développement où les normes de l’OMS sont rarement satisfaites dans ce domaine. Son importance, au point de parler de « crise » des ressources humaines, est révélée dans les années 2000, alors que les pays du Sud ont peine à réaliser les objectifs du millénaire pour le développement, tant les personnels de santé manquent. La situation est d’autant plus préoccupante que coexistent désormais pathologies infectieuses et maladies chroniques, dont le cancer. Les déterminants de la pénurie sontmultiples et complexes, alliant difficultés de management, de formation, de répartition, en même temps que celles liées à la migration des personnels du secteur public vers le secteur privé, de la campagne vers la ville et d’un pays à l’autre. La migration doit être envisagée comme un problème mondial où les pays de l’OCDE apportent des réponses concrètes à leurs propres déficits en médecins et personnels paramédicaux sans puiser dans les ressources intellectuelles des pays du Sud. N’oublions pas que parfois les médecins sont amenés à exercer d’autres métiers que soigner soit parce qu’ils sont au chômage, soit parce qu’ils font de la santé publique et de la gestion de projets d’aide publique au développement. Face à cette situation de pénurie, les réactions internationales sont dynamiques, mais des initiatives concrètes financées à l’échelle locale continuent de manquer près de trois ans après la Conférence de Douala et un an après le Premier Forum mondial sur la crise des personnels de santé réuni à Kampala en mars 2008. Les pays concernés par la crise attendent des ministres des Finances et de la Communauté internationale une contribution au financement des systèmes de santé dans leur ensemble.
 
ObjectifsDéterminer la prévalence du cancer du col chez les femmes séropositives au virus de l’immunodéficience humaine (VIH), décrire les déterminants de l’association VIH et cancer du col et faire des recommandations par rapport au dépistage et à la prise en charge du cancer du col chez ces patientes. MéthodologieNous avons procédé à une revue non systématique de la littérature de 2004 à 2008 des publications pertinentes, en français ou en anglais sur le cancer du col chez les femmes infectées par le VIH en Afrique subsaharienne, à travers une recherche dans Pubmed, Hinari, Médecine d’Afrique Noire et African Journal On Line (AJOL). RésultatsSur 20 publications retrouvées, nous en avons retenu 15 qui traitaient du dépistage et/ou de la prise en charge des lésions précancéreuses et cancéreuses du col. La prévalence du cancer du col varie de 1,87 à 14 %. Quant à la prévalence moyenne du VIH chez les femmes atteintes de cancer du col utérin, elle est de 25,73 % et est généralement plus élevée que chez les femmes non infectées par le VIH. Les différentes études rapportent également de forts taux d’infection par le virus human papilloma virus (HPV) (60,0 à 85,3%) avec une grande diversité des sérotypes. La radiothérapie dans les stades avancés de cancer du col, ainsi que l’hystérectomie radicale dans les stades précoces sont préconisées comme étant des alternatives thérapeutiques raisonnables. ConclusionLe dépistage du cancer du col doit désormais être systématique chez toute femme infectée par le VIH. Le rythme du dépistage devrait être annuel. Il apparaît nécessaire d’intégrer la lutte contre ces deux pathologies. Dans une perspective d’un continuum des soins, il est souhaitable de proposer systématiquement le dépistage du VIH aux femmes enceintes pour la prévention de la transmissionmère-enfant, et le dépistage du cancer du col de l’utérus dans le post-partum. ObjectivesAssess the prevalence rate of cervical cancer in HIV positive women. Describe the underlying factors of such an association. Provide recommendations for the screening and management of cervical cancer in HIV positive women. MethodsThis was a non-systematic review of all publications on cervical cancer and HIV in Sub-Saharan Africa over the last five years (2004–2008). We searched Pubmed, Hinari, Médecine d’Afrique Noire and African Journal On Line (AJOL) for the relevant papers either in English or in French. ResultsTwenty papers were found and only 15 matched the selection criteria. Prevalence rates of cervical cancer ranged from 1.87 to 14%. The mean HIV prevalence rate in cervical cancer patients was 25.73% and this was generally higher than in non-HIV positive women. High HPV infection rates (60 to 85.3%) were also reported along with a large variety of serotypes. Radiotherapy was considered a reasonable therapeutic option in advanced cervical cancers in HIV positive women with hysterectomy for cancers at an earlier stage. ConclusionCervical cancer screening should be systematic in HIV positive women. The frequency of screening should be annual. There is a need for integrating cervical cancer and HIV control programs. The continuum of care requires HIV screening for PMTCT during antenatal care and cervical cancer screening during the post-partum period.
 
Nous rapportons un cas d’adénocarcinome du corps du pancréas révélé par un épisode de pancréatite aiguë chez une femme de 52 ans aux antécédents de cholécystectomie. Il s’agit là d’une présentation rare du cancer du pancréas. Dans cette observation, c’est l’imagerie par résonance magnétique (IRM) et la biopsie pancréatique qui ont permis de faire le diagnostic. La patiente a été traitée par radiochimiothérapie avec une survie de 19 mois. We report a case of an adenocarcinoma in the body of the pancreas, revealed by an episode of acute pancreatitis in a 52-year-old woman with a past history of cholecystectomy. It is a rare presentation of pancreatic cancer. The diagnosis was done by magnetic resonance imaging (MRI) and pancreatic biopsy. The patient was treated by chemoradiotherapy with a survival of 19 months. Mots clésPancréatite aiguë–Cancer du pancréas–Imagerie par résonance magnétique–Biopsie pancréatique–Radiochimiothérapie KeywordsAcute pancreatitis–Pancreatic cancer–Magnetic Resonance Imaging–Pancreatic biopsy–Chemoradiotherapy
 
Since the first descriptions, morphologic classification of LAM has been accepted. The WHO classification incorporates morphology, immunophenotype, cytogenetic, and molecular features to adapt treatment and predict prognosis. The purpose of this study is to describe epidemiologic, clinical, cytological, and cytogenetic characteristics of blood and bone marrow in myeloid acute leukemia (AML): 281 of 484 cases of acute leukemia diagnosed between January 1998 and December 2008 in the center of Tunisia. The hemograms were done on Coulter MAXM and Coulter LH 750. Slides for peripheral blood and bone marrow were done for each patient separately by three morphologists. Patient’s age varies from 10 months to 93 years with predominance of male patients (ratio: 1.25). Fifteen percent of patients presented generalized leukemic tumor. Blasts in peripheral blood are present in 92% of cases. The morphologic exam of the slides for peripheral blood and bone marrow and myeloperoxydase shows predominance of AML1 (20.6%) and AML2 (23.8%). Seventeen percent of cases are unable to classify according to criteria of FAB group. Karyotype was revealed t(8;21) in 13.9% of cases. During the last 20 years, Tunisia entered in a new phase of demographic transition: AML are on the rise. Few national informations about acute leukemia were provided because of the absence of malignacies registration; hence the necessity of epidemiologic studies.
 
En vue de connaître le profil épidémiologique de la maladie cancéreuse en Algérie, à partir de la fin des années 1980, des registres du cancer ont été mis en place dans différentes régions du pays, ce qui a permis de connaître les localisations néoplasiques prévalentes aussi bien dans le sexe masculin que féminin et surtout d’engager un certain nombre d’actions entrant dans le cadre de la lutte anticancéreuse telles que campagnes de dépistage du cancer du col et du sein, érection de nouveaux centres anticancéreux, formation médicale en oncologie ainsi que renforcement du parc en machines de radiothérapie. Ces registres du cancer qui, jusqu’à ce jour, ne font que de l’épidémiologie descriptive, devraient dans l’avenir évaluer les résultats de ces actions (épidémiologie évaluative) et lancer des études d’épidémiologie causale. To assess cancer epidemiology in Algeria, cancer registers were established in the 1980s in various parts of the country. These registers enabled the most prevalent cancers in both men and women to be recorded and a certain number of anti-cancer actions to be undertaken, including screening for cervical and breast cancers, the building of anti-cancer centers, training in oncology and capacity strengthening with respect to radiotherapy services. So far the cancer registers have only served to describe the epidemiology of the cancers, but in the future they should be used to assess the impact of the actions undertaken and as a basis for research into causal epidemiology.
 
IntroductionLes trihalométhanes (THMs) sont une classe des sous-produits de désinfection d’eau potable, formés lorsque le chlore résiduel libre réagit avec lamatière organique présente dans l’eau pendant la désinfection. La concentration maximale acceptable proposée (CMA) pour les THMs dans l’eau potable est de (100 μg/l), ainsi, l’Organisation mondiale de la santé a établi des valeurs guides pour le chloroforme (CHCl3) de 200 μg/l, le bromodichlorométhane (CHBrCl2) de 60 μg/l, le chlorodibromométhane (CHClBr2) de 100 μg/l et le bromoforme (CHBr3) de 100 μg/l. Ces composés sont considérés comme des agents cancérigènes pour l’homme. De nombreuses études épidémiologiques ont été réalisées afin d’évaluer le risque de cancer de la vessie chez les consommateurs d’eau hyperchlorée. Cette problématique nous amène à entreprendre une étude portée sur l’hyperchloration et le dosage des THMs dans l’eau de consommation distribuée dans la région de Mostaganem (Ouest algérien). En parallèle, nous avons réalisé une étude épidémiologique couvrant une période de 15 ans à partir des données collectées sur le cancer de la vessie au niveau des services d’urologie, de gastrologie et de chirurgie de l’hôpital Che Guevara de Mostaganem. MéthodologieDifférents échantillons d’eau provenant de localités éloignées ont été dosés par la microextraction en phase solide d’espace libre (HS-SPME). RésultatsSur plusieurs échantillons collectés et analysés, il a été enregistré un maximum de 172,61 μg/l dans la région de Achaacha, située à 10 000 m du rivage, contre un minimum de 17,54 μg/l dans la région de Salamendre, située à 900 m du rivage; alors que les résultats de l’étude rétrospective sur le cancer de vessie prouvent la dominance masculine avec 94 contre seulement 6 % pour le sexe féminin. ConclusionL’eau distribuée aux consommateurs de la région de Mostaganem renferme une quantité considérable en THMs, le dibromochlorométhane (CHClBr2) et le bromoforme (CHBr3) constituent la majeure partie des THMs totaux. IntroductionTrihalomethanes (THMs) are a commonly monitored class of drinking water disinfection by products (DBPs). They are formed when free available chlorine reacts with natural organic matter in raw water during water disinfection. The proposed maximum acceptable concentration (CMA) for THMs in drinking water is 100 μg/l. The World Health Organization has established guidelines for the concentration of chloroform (CHCl3) at 200 μg/l, bromodichloromethane (CHBrCl2) at 60 μg/l, chlorodibromomethane (CHClBr2) at 100 μg/l, and bromoform (CHBr3) at 100 μg/l. These compounds are considered carcinogens in humans. Numerous epidemiological studies have been conducted to assess the risk of bladder cancer among consumers of water hyperchlorinated. This problem leads us to undertake a study on the scope hyperchloration and the occurrence of some types of cancers such as colon and bladder cancer in the region of Mostaganem (West Algeria). MethodologyDifferent water samples from remote locations have been determined by the headspace solid-phase microextraction. ResultsA total of 18 samples collected and analyzed shows that 172.61 μg/l is registered as a maximum value at the region of Achaacha situated at 10,000 from the coast, against a minimum of 17.54 μg/l registered at the region of Salamender located at 900 m from the coast. The epidemiological results show the dominance of men bladder cancer with 94% than that of woman with only 6%. ConclusionDrinking tap water of Mostaganem region contains a considerable amount of THMs, dibromochloromethane, bromoform, and Dibromochloromethane and bromoform constitute a major portion of total THMs. Mots clés EauTHMs-Mostaganem-Consommateurs-Cancer de la vessie KeywordsWater-THMs-Mostaganem-Consummators-Bladder cancer References
 
Nasopharyngeal carcinoma (NPC) is one of the most important cancers in Algeria with 8 to 12 cases/ 100,000 persons a year. The pathogenesis of NPC is not clear. In Algeria and Tunisia, it represents the first most common cancer of the larynx in women and the second most common tumor inmen. This is a retrospective epidemiological study of the NPC in the North-East of Algeria and evaluates the impact of the consumption of some foods, tobacco and alcohol on the risk of development of NPC. The study of a group of 160 patients affected by NPC, using 205 people as a control group, has shown that this cancer was predominant in men, particularly in the population between 40- and 59-years-old. The analysis has shown that preservatives such askhliiseem to be a statistically significant factor related to NPC. Our results also show a strong association between alcohol consumption and tobacco use and the risk of developing NPC. However, we did not find a statistically significant relationship with other food factors.
 
Colorectal cancer is the world’s third most common cancer, when both sexes are considered together. 400,000 deaths from colorectal cancer are recorded every year. This type of cancer is an increasingly significant problem for public health in Algeria. The aim of our work, which took the form of a retrospective study, was to determine the number of cases of colorectal cancer in western Algeria. The epidemiological study took place between 2000 and 2006. The sample included 501 patients with colon cancer (272 men or 54% and 229 women or 46%). The results obtained showed a slight masculine predominance with a sex ratio of 1.2, and a higher rate of malignancy in the left colon (61.8%) in comparison with the right colon (38.2%). According to Dukes classification, 58% of patients presented tumours in C and D stages. In conclusion, cancer of the left colon was more common in both sexes in comparison with localisation in the right colon, in all the various wilayas (Oran, Sidi-Bel-Abbes, Mascara, Ain-Temouchent and Relizane). The results of this study only tell us about the epidemiological situation concerning colon cancer in western Algeria. A study of nutrition in this part of Algeria might well give an interesting insight into the considerable effect of diet in the etiology of this type of cancer.
 
Le polymorphisme du système HLA est corrélé à la survenue de plusieurs types de tumeurs, du fait de son rôle clé dans la présentation des antigènes au système immunitaire. L’efficacité de cette présentation est définie par le type des molécules HLA impliquées ainsi que leur niveau d’expression à la surface cellulaire. Une combinaison des molécules HLA pourrait induire une bonne réponse ou un échappement de lȉantigène au système immunitaire, puisque ces molécules déclenchent la cytotoxicité spécifique, suite à la présentation des antigènes endogènes aux lymphocytes TCD8+. Dans la présente étude, nous nous proposons de rechercher d’éventuelles associations entre les allèles du gène HLA B et les paramètres histopronostiques du cancer du sein en Tunisie. Soixante-quatre femmes tunisiennes atteintes du cancer du sein et 74 femmes tunisiennes saines et non apparentées ont été typées par la technologie luminex pour le gène HLA B. La valeur de p et l’Odds Ratio (OR) ont été calculés pour définir les allèles de protection ou de risque à l’occurrence, l’évolution et la gravité du cancer du sein en Tunisie. Les résultats montrent un rôle protecteur de l’allèle B*40 contre l’occurrence du cancer du sein chez la femme tunisienne (OR = 0; IC 95 %: ]0–0,66[). Cette corrélation négative a été faiblement démontrée en relation avec la présentation la plus grave (EE III) et le stade le plus avancé de la pathologie (N+). Par ailleurs, une corrélation positive entre l’allèle B*18 et un bon pronostic EE I et II est démontrée (OR = 3,85; IC 95 %: ]1,09–13,82[). Cependant, l’association de cet allèle à l’envahissement ganglionnaire n’est pas confirmée.
 
Résumé Une enquête a été réalisée au sein d’une unité d’oncologie pédiatrique au Maroc dans le but d’étudier la fréquence de l’utilisation de la médecine alternative (MA), les facteurs à l’origine de son utilisation, son type, son coût et le bénéfice qui en est tiré. Patients et méthodes Nous avons inclus dans cette étude 79 patients suivis au sein du service d’oncologie pédiatrique de l’hôpital d’enfant de Rabat pour une pathologie cancéreuse et traités depuis au moins trois mois. Un questionnaire comprenant des données générales et des informations concernant l’utilisation de la MA a été rempli par les parents. Résultats Cinquante-quatre parents, soit 68 %, avaient utilisé un ou plusieurs types de MA. Le type de MA le plus utilisé était le miel naturel, suivi par les plantes, puis les moyens spirituels. Les parents avaient comme but de traiter le cancer dans 70 % des cas. Vingt-neuf pour cent des cas utilisaient la MA pour stimuler le système immunitaire. Quant aux bénéfices, 59 % des parents ont rapporté que les enfants se sentaient mieux. Ces remèdes ont fait disparaître la douleur chez 15 % des enfants. Des effets secondaires à l’utilisation de MA ont été rapportés dans 28 %des cas. Tous les patients ont reçu de la MA en complément aux traitements conventionnels, et 20 % seulement ont discuté avec leur médecin à propos de l’utilisation de MA. Le coût du traitement était de moins de 1 000 dirhams marocains (90 euros) dans 90 % des cas. Conclusion L’utilisation de MA en oncologie pédiatrique est une pratique courante au Maroc. Elle est fondée essentiellement sur l’utilisation de miel et de plantes, et le plus souvent les parents rapportent un bénéfice chez l’enfant, mais cette constatation reste subjective. Malheureusement, le plus souvent le médecin traitant n’est pas informé de cette pratique.
 
Le chondrosarcome myxoïde extrasquelettique (CME) est une entité rare, distincte sur le plan clinique, histologique, immunohistochimique, cytogénétique et évolutive. C’est un sarcome classé par l’OMS comme un sarcome de bas grade et qui représente 2,5 % des sarcomes des tissus mous. Son individualisation est importante, car elle est caractérisée par une agressivité essentiellement locale et une survie prolongée. La clé diagnostique est morphologique, aidée par l’immunohistochimie et l’étude génétique qui permettent de la différencier des autres tumeurs à stroma myxoïde et des chordomes. Nous en rapporterons un cas localisé au niveau du genou. The extraskeletal myxoid chondrosarcoma (CME) is a rare malignant soft tissue tumour described as a distinct clinical, histological, immunohistochemical, genetical and evolutive entity. It represents only 2.5% of soft tissue sarcomas, and is considered by WHO as a low grade sarcoma. Its individualization is important because it has a long and indolent clinical course, and tumour-related death often occurs after a long survival period. The diagnostic key is morphological supported by immunohistochemistry and genetics t(9;22) that allow to differentiate it from other tumours with myxoid stroma and from chordoma. A new case of soft tissue myxoid chondrosarcoma (chordoid sarcoma) of the knee is reported. Mots clésChondrosarcome myxoïde extrasquelettique-Genou-Tumeur maligne KeywordsExtraskeletal myxoid chondrosarcoma-Knee-Malignant tumour
 
L’adénocarcinome duodénal est une tumeur exceptionnelle. Les manifestations cliniques sont non spécifiques et posent un problème diagnostique, d’où l’intérêt des explorations endoscopiques et radiologiques. La duodénopancréatectomie céphalique est le traitement de choix, surtout chez des patients sans métastases ganglionnaires. Nous rapportons l’observation d’une patiente de 52 ans en montrant l’aspect anatomoradiologique de cette localisation rare dans la littérature. Le recul de cette observation est d’une année. A duodenal adenocarcinoma is a very rare type of tumour. The clinical signs are not specific, and they pose a diagnosis problem; hence the usefulness of endoscopic and radiological explorations. Cephalic duodenopancreatectomy is the first-choice treatment, especially in patients without ganglionic metastases. We report on the observation of a female patient, aged 52, showing the anatomical and radiological aspect of this location, which is rare in the literature. The follow-up period for this observation is one year. Mots clésAdénocarcinome-Tumeur duodénale-Tomodensitométrie-Pronostic KeywordsAdenocarcinoma-Duodenal tumour-Computed tomography-Prognosis
 
L’angiosarcome du sein est une tumeur conjonctive très rare, elle est de diagnostic difficile et de très mauvais pronostic. Sa définition est anatomopathologique; il s’agit d’une prolifération maligne primitive des cellules endothéliales du tissu vasculaire de la glande mammaire. Notre étude a porté sur deux cas d’angiosarcome du sein pris en charge à la maternité des Orangers puis à l’Institut national d’oncologie. Le diagnostic préopératoire a été soulevé sur les données cliniques et anatomopathologiques. Le traitement était essentiellement chirurgical. L’évolution a été marquée par la rémission complète dans les deux cas. À la lumière de ces deux observations ainsi qu’à la revue de la littérature, nous avons essayé de faire une mise au point sur les différents aspects de cette maladie. Angiosarcoma is a rare type of breast cancer; it has the worst prognosis of all breast malignancies and it is difficult to diagnose. Its definition is pathological; it is a primary malignant proliferation of endothelial cells of vascular tissue of the mammary gland. We report two cases of breast angiosarcoma observed at the Maternity of Oranges and at the National Institute of Oncology. The preoperative diagnosis was raised on the clinical and pathological data. The treatment was essentially surgical. The evolution was marked by complete remission in both cases. In light of these two observations and the literature review, we tried to update on the various aspects of this disease. Mots clésAngiosarcome–Sein–Traitement KeywordsAngiosarcoma–Breast–Treatment
 
L’angiosarcome primitif de la rate est une tumeur maligne rare avec un pronostic fâcheux. Les hémorragies digestives constituent un mode de révélation inhabituelle. On rapporte le cas d’un patient de 71 ans présentant un angiosarcome primitif de la rate révélé par des hématémèses. Le diagnostic était fait en préopératoire grâce à l’imagerie et à la biopsie. La chirurgie et la chimiothérapie constituent les principaux traitements. Avec une revue de la littérature, quelques concepts cliniques radiologiques et thérapeutiques de ces rares tumeurs seront discutés. Primary angiosarcoma of the spleen is a rare neoplasm with a very poor prognosis. Gastrointestinal bleeding is unusual presentation. We report the case of a 71-year-old man with primary splenic angiosarcoma revealed by hematemesis. Surgery and chemotherapy are the principal treatments. The literature on primary splenic angiosarcoma is reviewed. Clinical, radiological and therapeutic aspects of this rare tumor are discussed. Mots clésAngiosarcome-Rate-Hématémèse-Chirurgie-Chimiothérapie KeywordsAngiosarcoma-Spleen-Hematemesis-Surgery-Chemotherapy
 
Les tumeurs stromales du tube digestif ou GIST sont des tumeurs indifférenciées rares: 1–3 % des tumeurs malignes gastro-intestinales. La localisation anorectale est très rare. Du fait d’un potentiel de récidive très important, les tumeurs stromales de haut grade de malignité doivent bénéficier d’une chirurgie agressive encadrée d’une chimiothérapie néoadjuvante ou adjuvante pour améliorer la résécabilité et diminuer le risque de récidive. Nous rapportons une observation de tumeur stromale anorectale et nous en discutons les particularités diagnostique, thérapeutique et pronostique à la lumière des données de la littérature. Gastrointestinal stromal tumours (GIST) are uncommon, undifferentiated lesions, representing 1–3% of gastrointestinal malignancy. Localisation in the anorectal area is very rare. The chances of recurrence are substantial, so high-grade stromal tumours require aggressive surgery accompanied by neoadjuvant or adjuvant chemotherapy, so as to improve resectability and reduce the risk of relapse.We report a case of anorectal stromal tumour and discuss the diagnostic, therapeutic and prognostic features in the light of information available in the literature. Mots clésAnorectale-Stromale-Tumeur-Chirurgie-Imatinib KeywordsAnorectal-Stromal-Tumour-Surgery-Imatinib
 
Hepatitis B virus is a major public health issue worldwide and particularly in the African Sub-Saharan region. The aim of this study was to determine the frequency of HBsAg carriage in the reference laboratory located at the NIPHR over a ten-year period (1997–2006). Screening for HBsAg was carried out by VIDAS® PC (BioMérieux® France) using the ELFA method. The prevalence of HBsAg was estimated at 24.9% in a population of 4,466 patients, consisting of more men than women at a ration of 1.30. High frequency was observed in the 25–34 age-range, with a rate of 29.7%. Drivers and members of the armed forces had the highest prevalence, with 32.3 and 30.1% respectively. In 35.8% of cases, candidates taking the HBsAg test were in apparent good health. In 64.2% of cases, HBsAg screening had been requested because of hepatitis B related symptoms. To reduce hepatitis B related morbidity in Mali, the vaccination and public awareness campaigns must be intensified and focused on younger members of the population.
 
Top-cited authors
Abdelhalim Trabelsi
  • Centre Hospitalier Universitaire de Sahloul
Wafa Jomaa
  • Institut Salah-Azaïz de Cancerologie
Faten Hammedi
  • Centre Hôpital Universitaire Farhat Hached
Mourad Mokni
  • Medical Faculty
Essobozou Plaodezina Pegbessou
  • centre hospitalier universitaire de Lomé