We report the case of Conn adenoma revealed by tetraparesis in a 33-year old pregnant woman at the 16thweek of amenorrhea. The patient had a blood pressure of 147/87 mmHg, which was considered high-normal, hypokalemia at 1.1 mmol/l. The diagnosis was confirmed by hormone dosage which showed elevated plasma aldosterone levels and decreased plasma renin activity. MRI showed a left adrenal nodule, 1.5 cm in diameter, compatible with adrenal adenoma. Left adrenalectomy was performed with simple postoperative course and normalization of kalemia and blood pressure.

Phyllodes tumors of the breast are very rare and are exceptional in children and adolescents; their treatment is based on surgery and radiotherapy, with a good prognosis. We report the case of a 12-year old teenage girl presenting with a mass in the left breast. The diagnosis of a phyllodes tumor was confirmed on the basis of clinical, imaging and histological examinations. Treatment consisted of a large tumorectomy without adjuvant therapy, with good evolution during a 2-year follow-up.

At a time when innovative therapies in breast cancer multiply, poorer countries such as Senegal are still lag far behind in the overall management of this type of cancer. In Senegal, although the treatment of advanced breast cancer is now well codified, survival and morbidity outcomes are still mediocre in view of diagnostic delays and of sometimes expensive and poorly tolerated mutilating treatments become necessary. With respect to advanced cancers, the challenges will lie in building of palliative care centres and in developing multidisciplinary approaches to improve quality of life and to support patients. On the other hand, with respect to preclinical or potentially curable cancers, the challenges are immense given the importance of early detection, localisation and diagnosis (stereotactic or ultrasound guided biopsy) but also of precision surgery and of complete resection (indexing - excision ensuring a margin of healthy tissue and specimen radiograph) while minimizing complications such as those of classic dissection (sentinel lymph node biopsy). Our health structures are not always prepared to achieve these goals. This is a situational analysis of the contextual obstacles that still exist and add a burden on the overall management of breast cancer in Senegal.

The gastric metastasis of breast cancer are rare, and their discovery is difficult, because the symptoms is often unspecific or even absent. We report an original case of ductal carcinoma of the breast revealed by a gastric metastasis discovered incidentally.

Sarcoidosis is a multisystem granulomatous disease that can affect all organs, thoracic involvement often predominates representing its most evocative manifestation. Atypical manifestations, such as the presence of multiple scattered pulmonary nodules may indicate malignancy. Our study reports the case of a 56-year-old patient investigated for asthenia associated with paresthesia of the lower limbs evolving since 6 months. Chest CT scan showed multiple scattered pulmonary nodules. Histological examination of specimens obtained by bronchial biopsy allowed to exclude neoplastic origin and confirmed the diagnosis of sarcoidosis. On the basis of normal pulmonary function tests and the absence of extrapulmonary visceral involvement, simple patient monitoring was recommended. Radiologically sarcoidosis can exceptionally present as multiple scattered pulmonary nodules. Histological evidence is necessary to exclude other etiologies including tumors. Corticosteroids are indicated only in the presence of severe respiratory functional impairment and/or associated visceral involvement.

Hamartochondroma is a benign tumor of the tracheobronchial tree, often found incidentally and rarely symptomatic. It is more common in men than in women. Its radiological aspect is often evocative. Surgery is indicated for large and/or symptomatic tumors. Histological diagnosis usually poses no difficulty We report the case of a 30-year-old young patient with no particular past medical history and with spontaneous pneumothorax revealing a large sized hamartochondroma. This rare association could be explained by the fact that tumors of fairly anarchic composition may contain cyst formations that may rupture into the pleura causing effusions.

We here report the case of a 32-year old female patient with a 5-year history of recurrent purulent bronchial syndrome. Radiological assessment showed a left basithoracic finely ringed bright areas related to cylindrical bronchiectasis located in the left lower lobe. Flexible bronchoscopy showed smooth surface, reddish tumor obstructing the entrance of the left basal pyramid. The patient underwent left lower lobectomy associated with mediastinal lymph node dissection. Histological examination of the surgical specimen was in favor of typical carcinoid tumor. Postoperative outcome was uncomplicated and clinical and radiological evolution was good.

Dysregulation of cellular cycle is a key component of carcinogenesis and its targeting represents an interesting approach. Recently, the development of selective inhibitors of the cycle targeting the cyclin-dependent kinases (CDK) 4 and 6 revived interest in this therapeutic class after the failure of pan-inhibitors. Palbociclib, ribociclib, and abemaciclib are the 3 drugs with the most advanced development. They demonstrated preclinical activity in luminal breast cancer models and are under clinical evaluation. The first available studies demonstrate the value of these compounds with an improved prognosis of metastatic patients in combination with endocrine therapy (palbociclib, ribociclib) or in monotherapy (abemaciclib). The results of ongoing studies will clarify the role of these agents in our new strategies and the individualisation of biomarkers will help to define patients who benefit most from this approach.

Prognosis and treatment of advanced melanoma have been transformed by the success of immunotherapies, in particular agents targeting PD-1. PD-L1 expression assessed by immunohistochemistry in not an effective predictive biomarker to select patients in this tumor type, since significant clinical benefit was observed in the group of patients with negative tumors. The predictive value of PD-L1 testing to select patients for combination of anti-PD-1 and anti-CTLA-4 agents is under evaluation. Other tissue biomarkers are emerging to identify sensitive tumors to anti-PD-1 agents. In particular, assessment of immune infiltrates in tumor tissue, mutational load and tumor neoantigens seem promising in melanoma.

The aim of this article is to emphasize the impact of the immune response in digestive cancers, especially from colorectal (CRC) origin. In this setting, an adaptive lymphocytic infiltrate underlines the prognostic impact of the immune response, because it is associated to a favorable outcome. The next challenge will be to validate, in a prospective therapeutic trial, the integration of the immune response as decisional parameter for adjuvant therapy. The immune response is also a predictive parameter in microsatellite instable metastatic CRC, characterized by an adaptive lymphocytic infiltrate, leading to a very high response rate to immune therapies. However, prognostic and predictive biomarkers still need to be optimized in order to better select patients. These data are also valuable for digestive non-colorectal cancers, which are briefly analyzed. The methodology for the assessment of these prognostic and predictive biomarkers, which represents an important issue in precision medicine, is also discussed.

The International Agency for Research on Cancer (IARC) has classified two liver flukes as carcinogenic to humans (Group 1): Opisthorchis viverrini in 1994 and Clonorchis sinensis in 2009. This review is focused on O. viverrini, the most studied of these two trematodes, which infects nearly 10 million people in Southeast Asia. The life cycle involves two intermediate hosts living in fresh water: a snail of the genus Bithynia and a ciprinid fish. The definitive hosts (human, cat, dog) become infected by ingesting raw fish containing metacercariae, the infective stage of the parasite. Adult flukes attach to the epithelium of the bile ducts where they feed for as long as 10 to 30 years, resulting in chronic inflammation, epithelial hyperplasia, periductal fibrosis and formation of granuloma. For a long asymptomatic, the distomatosis is revealed by a chronic cholangitis when the parasite load becomes high. Complications can occur with time: gallstones, cholangitis, liver abscess, pancreatitis and, after a few decades, cholangiocarcinoma (CCA). The epidemiological correlation between the prevalence of O. viverrini infection and the incidence of CCA has been demonstrated in the northeast of Thailand. Specifically, the Khon Kaen province has the highest incidence rate in the world. The CCA can develop asymptomatically for a long time, especially in intrahepatic locations. It is often discovered at a late stage, unresectable. Its prognosis is dreadful with a survival rate less than 5% at 5 years. The phenomenon of carcinogenesis induced by O. viverrini is multifactorial. It has been specially studied using experimental infection on the Syrian golden hamster. Three intricated mechanisms are involved: (i) the direct damage caused by adult worms on the bile duct epithelium, (ii) the immunopathologic processes related to chronic inflammation (oxidative stress) and (iii) the mitogenic and anti-apoptotic effects of the proteins secreted by the parasite. Exogenous cofactors are also involved, such as nitrosamines in fish-based dishes undercoocked or fermented, very popular in these endemic regions. Despite the effectiveness of praziquantel to successfully cure this distomatose, opisthorchiasis persists endemic in areas where the incidence of CCA tends to progress. Mass deworming campaigns are ineffective due to the frequency of reinfection in the exposed population. Repeating alternatively cures and reinfections may promote carcinogenesis. The failure of prevention programs reflects the difficulty of changing the traditional habits of consuming raw or fermented fish. Pending a vaccine prophylaxis, control strategies are based on integrated measures involving the treatment of reservoir hosts, sanitation and efforts of continuing information and education to deter the consumption of uncooked fish and to improve the sanitation in rural areas.

Mid gut neuroendocrine tumors (NET) are rare tumors whose incidence is increasing. Curative surgery remains the gold standard for the treatment of NETs of the small intestine. Surgery should be considered as soon as possible even if a metastatic stage is diagnosed. The management of unresectable well-differentiated metastatic NETs of the small intestine recently changed with the publication of trials demonstrating the benefit of targeted therapies and metabolic radiotherapy, leading to a change of practices and update of French and international recommendations.

Classical Hodgkin lymphoma (HL) is a curable disease in 80% of advanced and 90% of localized stages. An improvement of the HL curability is still possible with the emergence of first-line therapy with a better balance between efficacy and toxicity and early identification patients with high risk of failure requiring specific treatment. 18FDG PET-CT gained a major role in the baseline staging and response assessment to HL treatment. The prognostic value of early PET-CT allowed to develop PET-CT guided therapies able to optimize the balance between efficacy and toxicity including the modulation of the chemotherapy intensity or the omission of radiotherapy for some localized diseases. New drugs emerged in the treatment of relapse or refractory HL (brentuximab vedotine [BV], immunological checkpoint inhibitor anti-PD1). Although their place in the strategies of salvage therapy is still debated several trials have reported relevant efficacy in some unmet medical need: refractory patients or relapses after auto/allograft. This review addresses the questions of PET-CT-based therapeutic strategies in first-line and the impact of new drugs targeting the micro-environment (anti-PD1) or the Hodgkin Reed Sternberg cells (BV).