Papillary fibroelastoma is a rare primary benign cardiac tumor which can cause severe embolic complications. We report the case of a 69-year old man presenting with dyspnea. The patient underwent transthoracic echocardiography that showed sessile mass on the mitral valve. Surgically excision of the mass was performed followed by histological examination. The diagnosis of papillary fibroelastoma was then confirmed.

Tumors of the small bowel account for 5% of all tumors of the gastrointestinal tract. Although important progress has been made from a radiological and endoscopic point of view, they have a poor prognosis due to delayed diagnosis. This occurs because of the absence of clinical manifestations and of the difficulties of exploration. This study aimed to highlight the endoscopic and histologic features of tumors of the small bowel. We conducted a retrospective descriptive study in the Department of Hepato-Gastroenterology at the University hospital Hassan II, Fez, over a period of 11 years (2002-2012). We analyzed the epidemiological, clinical, endoscopic and histologic features of tumors of the small bowel. Data were collected from the medical records of 27 patients. The average age was 48 years [21-80 years] with a male predominance (H/F:2.4). Melenas led to the discovery of tumor in 55% of cases, abdominal mass in 15% of cases and Koenig syndrome or occlusive syndrome in 11% of cases. One patient had a history of celiac disease. CT enteroclysis showed the seat of the tumor in 18 cases. Push enteroscopy for detection of proximal tumors and double-balloon enteroscopy for detection of distal tumor were performed in 8 patients (30%). Endoscopy showed ulcerated lesion in 37.5% of cases, ulcerated stenotic lesion in 50% of cases and ulcerobudding stenotic lesion in 25% of cases. Surgery with anatomopathological examination of the surgical specimen allowed the diagnosis in 18 cases. The histologic type was dominated by stromal tumors in 14 cases (51%), followed by adenocarcinomas in 5 cases (18.5%), B-cell non-Hodgkin lymphoma in 4 cases (15%), neuroendocrine carcinoma of the jejunum in 1 case. Tumors of the small bowel are rare but they are characterized by a poor prognosis. Current imaging techniques (CT enteroclysis and MR enterography) coupled with endoscopic examinations, in particular double-balloon enteroscopy, allow earlier diagnosis and mortality reduction.

We here report the case of a 54-year old woman presenting with a swelling in the left forearm occurred eight weeks before and rapidly increasing in volume. Clinical examination showed ulcero-budding painless purplish skin lesion measuring 2 cm along its longer axis (A). The patient underwent simple biopsy. Histological examination showed dyskeratosic, disorganized, hyperplastic epithelium with cytonuclear abnormalities, suggesting malignant transformation. Given the absence of infiltration in the chorion and the presence of hyperkeratosis, the diagnosis of keratoacanthoma was made. Resection of the tumor was indicated to confirm or deny this diagnosis. Histological examination revealed a protruding epithelial tumor-like lesion circumscribed by two species of lateral "bird beaks" delineating a crater filled with many layers of keratin. The crater was bordered by hyperplastic epithelium. The crater base was characterized by irregular papillomatous projections as well as by few cellular strands which seemed to shred in the underlying dermis. These were basophilic made up of cells displaying a certain degree of cytonuclear abnormalites arranged in one or two peripheral areas and, in their center, some eosinophilic, keratin, homogeneous cells, few mitoses as well as many horny globes, most often completely keratinized (B). The diagnosis of keratoacanthoma was retained. Keratoacanthoma is a well defined anatomo-clinical entity which can be very difficult to distinguish from squamous cell carcinoma, whose incidence is three times higher. A distinction between these two lesions is necessary due to their different management.

The development of immune checkpoint inhibitors in thoracic oncology has led to a reconsideration of the rules for radiological tumor assessment. The RECIST criteria are widely used for the assessment of conventional treatments but are not suitable for anti-tumoral immunotherapy. The mechanism of action of this new class of drugs may induce specific patterns of response, which are not fully assessed by the RECIST criteria. Several new criteria have been proposed to better detect these patterns of response. The changes usually include confirmation of progression, new ways of assessing new lesions, and a larger role for clinical assessment. Nevertheless, harmonization and validation of these criteria remains indispensable. In this review, we will detail the different criteria that are currently available, and discuss their strengths and weaknesses.

The patient is a 36 year old female who presented breast cancer with leptomeningeal involvement. A systematic lumbar puncture was performed and sent to the laboratory for CSF analysis. CSF examination using wet mount preparation showed a large number of round spherules. After discussion with the ordering physician, we learnt that the patient had received intrathecal liposomal cytarabine injection 19 days earlier. Cytarabine liposomes are spherules with a granular interior and range in size from 10-30 μm. It can be confused with leukocytes and lead to spurious elevation of CSF leukocytes count. Care needs to be taken in interpreting CSF results in patients who have received intrathecal liposomal cytarabine.

CA 125 assay is sometimes combined in practice with the one of CA 15-3 and CEA in the extension assessment of breast cancers. The purpose of this work is to evaluate the contribution of the initial CA 125 as an indicator of distant metastases (DM) or of serous inflammation (SI). This retrospective study concerns a population of 620 patients with breast cancer without metastatic extension (n=325) or metastatic breast cancer (n=295) diagnosed at the Georges-François Leclerc center from 1998 to 2014. Seventy-four patients had SI. We showed that initial CA 125 level is linked to the TNM clinic status, the HER2 status, the nature and the number of metastatic locations, the inflammation of the tumor or serous. The ROC curves and logistic regression analyses show that CA 125 is an independent predictive criterion of DM presence (threshold of 55 kU/L): this is the only positive marker in 7% of patients with DM. At the threshold of 110 kU/L, the CA 125 is the only predictive biologic factor for SI. In conclusion, these data present the independent predictive value of CA 125 on the presence of DM or SI on condition of usinga specific threshold for each of these uses.

Standard of care in breast cancer management is well-defined. However, some gray zones still exist, in particular adjuvant radiotherapy indications in case of pN1mi breast cancer. Here we propose to define their prognosis, to underpin the benefit of adjuvant treatments in such patients' management and to define lymphedema risk, which is the most common late side effect of locoregional treatments.

Adjuvant radiotherapy is the pillar of breast conserving surgery. Its omission is related with a higher risk of local recurrence and of breast cancer related or non-related mortality. It is of paramount importance to guarantee this treatment is fully administered to all patients after breast conserving surgery, including the elderly. In the last three decades several hypofractionated treatment schemes have shown their non-inferiority, allowing for treatment time reduction facilitating adhesion to treatment and reducing radiotherapy burden. This review focuses on the schemes and indications which have been validated by large phase 3 trials and those which are still under evaluation.

Recent therapeutic advances in non-small cell lung cancer allow a better understanding of the interactions between the tumour and its direct immune environment. The identification of new immune biomarkers integrating both cell subpopulations and their interactions is a real issue in oncology. New techniques of tissue analysis, particularly multiplex immunohistochemistry, consisting of a labelling of several antigens of interest by immunofluorescence on the same slide, provide a better understanding of the tumour environment. Integration of these modalities of analysis to the therapeutic decision is promising, because it allows an increased characterization of each tumour, particularly interesting with radiotherapy and immunotherapy. This article describes the potential of these assays in locally advanced non-small cell lung cancer.

Paraneoplastic pemphigus (PNP) is a rare condition associated with poor prognosis. It associates polymorphic mucocutaneous manifestations with neoplasia. Diagnosis is difficult because of the various clinical and histological features involved and the lack of specificity of immunological examinations.

Breast cancer is the most common cancer among women. Prognosis depends, in large part, on the presence of metastases. Liver, skeleton and lungs are the most frequent metastatic sites, whereas genital metastases are more rare and less known. The detection of an ovarian mass in a woman with a history of breast cancer raises the question of its primary or secondary origin. The frequency of ovarian metastases reported in the literature is approximately 20-30%. However, when an ovarian mass is detected in a woman with breast cancer, primary ovarian tumor is diagnosed three times more often than a metastasis. Cervical, uterine or corporeal metastases are even more rare. They are often diagnosed late, due to their clinical latency; transvaginal ultrasound coupled with Color Doppler and Pap smear must be performed as first-line examinations knowing that their screening performance in patients with ovarian masses is deemed low. An increase in CA 15-3 and CEA tumor markers must lead clinicians to investigate for metastases, but it doesn't provide diagnostic orientation toward a specific metastatic site. Finally, only anatomo-athological examination allows certain diagnosis. We here report 3 cases of genital metastases from primary breast cancer (two patients with ovarian metastases and one patient with cervico-uterine metastasis) in order to highlight the role of accurate and regular genital examination in the monitoring of patients with breast cancer and to discuss the predictive factors for their occurrence.

Rhabdomyosarcoma is the more frequent mesenchymal tumor in children and in adolescents. It accounts for 60 -70% of mesenchymal tumors and approximately 5% of all solid tumors occurring at these ages. Almost half of rhabdomyosarcomas occur in the head and the neck. We report the case of a 20-year old patient with a new histological, aggressive temporo-parietal rhabdomyosarcoma.

We report the case of a Caucasian 73-year-old woman, without medical history, who is operated of two lesions of the forehead and the scalp measuring 0.4 and 1cm. There is no adenopathy. Histopathological examination revealed a diffuse vascular proliferation of the dermis and the hypodermis composed of small vessels bordered of plump "epthelioid" endothelial cells. There is no mitotic figure. The stroma is slightly fibrous accompanied by a polymorphic inflammatory infiltrate rich in lymphocytes, sometimes arranged in lymphoid follicles, plasma cells and eosinophils. The proposed diagnosis is angiolymphoid hyperplasia with eosinophilia. This is a rare vascular tumor, benign according with the OMS classification and preferentially observed in the skin. We report a cutaneous case, clinical and histopathological data of the reported cases and present the main differential diagnoses.

Brain metastases occur in 1 to 4 % of patients with colorectal cancer and are unique in 0.5 % of them. Because of their infrequent nature, brain imaging is not recommended in the systematic follow-up of these patients. We report here an exceptional case of a unique brain metastasis in a very unusual position. An 82-year-old patient with a colorectal cancer of the splenic angle that was treated with surgery and adjuvant chemotherapy, developed a series of neurological symptoms over four to six weeks: difficulty swallowing, loss of strength in the four limbs and balance disorders. These symptoms urged the performance of a nuclear magnetic resonance to exclude a central neurological lesion. MRI revealed a nodular tumor of 20 millimeters in the major transverse axis and 17 millimeters in the cerebro-caudal axis, located on the ventral portion of the protuberance. Because of its localization, surgery was not possible and the lesion was treated with Cyberknife radiosurgery. Thanks to the treatment, the lesion decreased in size and the symptoms improved significantly. Despite an initially very poor prognosis in view of the localization of the metastasis, the patient is alive and in excellent general condition more than eight months after the diagnosis of recurrence.

The primary vaginal melanoma is a rare aggressive tumour with a poor prognosis. The average age at diagnosis is 60, and there are no known risk factors. The establishment of a classification system and treatment protocols are made difficult because there are so few cases. The 5-year survival rate is estimated at no more than ten per cent. We report a case of an inoperable primary vaginal melanoma in a 58-year old woman. There were metastatic lymph nodes in the lumbo-aortic region, but no extension to bone or viscera. She was treated with nivolumab as monotherapy. Clinical and radiological evolution were both favourable, and the treatment was well tolerated.

Mature ovarian teratoma is the most frequent benign tumor in premenopausal women. It is usually asymptomatic but complications are possible such as adnexal torsion, infection, malignant transformation or cystic rupture. The latter can be spontaneous or more often occurs during surgery of excision of dermoid cyst. It can rarely result in chemical peritonitis, which is due to the irritation of the peritoneal serosa by the aseptic content of the tumour. We report the case of a patient who undrewent an emergency laparotomy for a chemical peritonitis following a spontaneous rupture of a dermoid cyst. Afterwards, she developed an acute respiratory distress syndrome that required an admission in the intensive care unit and subsequent surgery.

Adrenal cysts are a rare entity which makes their treatment somewhat tough. Discovered in a fortuitous way or in the course of explorations for very aspecific symptoms, it is necessary to decide on a case-by-case basis, and after a careful clinical examination, whether the lesion is to be treated through surgery or if a follow-up iconography is sufficient. Three main parameters will influence this choice: the functional status of the cyst, its malignant potential and the potential complications related to the cyst. Current recommendations suggest a surgical treatment for all symptomatic cysts, for functional cysts, for cysts with a diameter exceeding 5 cm, for hemorrhagic cysts and for cysts with malignant imaging potential. The progress and surgical advantages brought by the development of laparoscopy make it the first technique to be chosen.