Monocytes, circulating mononuclear phagocytes, play a fundamental role in innate immunity and the maintenance of tissue homeostasis. Using advanced technologies like flow cytometry, the characterization of monocytes has evolved from a simplistic view of a homogeneous population to a more complex understanding of a heterogeneous system comprising three main subtypes: classical monocytes (CD14++CD16-), intermediate monocytes (CD14++CD16+), and non-classical monocytes (CD14+CD16++). The identification of these subpopulations has enabled precise characterization of their functional profiles, enhancing the understanding of their roles in various pathological contexts, particularly in oncology. While anti-tumoral functions of monocytes have been clearly established in certain categories of cancers through tumor antigen presentation, induction of cytotoxic responses, and inhibition of metastatic progression, their role in promoting the development and progression of other cancers has also been highlighted during recent years. The utilization of monocytes in cancer immunotherapy presents promising opportunities, particularly by reprogramming their activity to enhance anti-tumoral responses or suppress their pro-tumoral functions. This review provides a comprehensive analysis of recent advances in the phenotypic and functional diversity of monocytes and their role in tumor progression, while highlighting emerging therapeutic strategies targeting these cells to optimize cancer treatment.

Over the past decade, targeted therapies have significantly improved the prognosis of metastatic breast cancer. CDK4/6 and PARP inhibitors are now gaining traction in the adjuvant setting, and their potential use in the neoadjuvant context is also being explored. This review presents an analysis of the current scientific evidence and associated clinical perspectives. CDK4/6 inhibitors act on cell cycle dysregulation, commonly observed in hormone receptor-positive breast cancers. In the adjuvant setting, abemaciclib and ribociclib have shown improvements in progression-free survival (PFS) in the monarchE and NATALEE trials, respectively, leading to their approval by the European Medicines Agency. In the neoadjuvant context, although these agents have demonstrated a reduction in proliferation markers such as Ki67, their impact on clinical practice remains limited to date. PARP inhibitors are based on the concept of synthetic lethality, specifically targeting cancers with germline BRCA1 or BRCA2 mutations. In the adjuvant setting, the OlympiA trial demonstrated a significant improvement in both PFS and overall survival (OS). In the neoadjuvant setting, these agents have also shown effects on pathological markers, though the clinical relevance of these findings has yet to be clearly established. Overall, these results underscore the growing role of targeted therapies in the adjuvant management of breast cancer. The identification and validation of predictive biomarkers will be crucial in optimizing their use, both in adjuvant and neoadjuvant settings.

Breast cancer is the second most common cause of brain metastases, after lung cancer. The risk of developing brain metastases varies according to the molecular subtype of breast cancer, with a higher incidence for triple-negative or HER2-positive cancers. The discovery of brain metastases, whether synchronous or metachronous, is a turning point in oncology management, and requires discussion at a neuro-oncology multidisciplinary consultation meeting to assess the value and modalities of local treatment by surgery and/or radiotherapy (stereotactic or total brain). Systemic treatments also play a major role in the control of breast cancer brain metastases. The most abundant literature on brain metastases concerns HER2-positive breast cancers, with robust data on the intracerebral efficacy of tyrosine kinase inhibitors (tucatinib, neratinib) and drug-conjugated antibodies (trastuzumab deruxtecan). The size of the brain metastases, whether they are stable or progressive, any previous irradiation, whether the brain involvement is symptomatic or not, the extracerebral evolution of the disease, the patient's general condition and the systemic options available must all be taken into account before deciding on a therapeutic strategy. This article does not deal with the specific management of leptomeningeal disease, which will be the subject of a separate article.

Hormone therapy is essential in the adjuvant management of early-stage HR+ breast cancer. Risk assessment for recurrence is a fundamental pillar in guiding therapeutic strategies and personalizing patient care. Tumors with a low risk of recurrence, eligible for treatment de-escalation, can be managed with standard hormone therapy. High-risk or intermediate-risk tumors warrant intensified approaches, including targeted therapies. This article reviews recent questions regarding the extension of hormone therapy to ovarian suppression and current strategies, with a focus on clinical studies such as OlympiA, monarchE, and NATALEE, which currently guide therapeutic decisions.

Adjuvant radiotherapy for breast cancer has demonstrated its benefit both in terms of local control and overall survival. However, it now appears possible to de-escalate both the indications and the technical modalities of treatment. Some of these new approaches are already validated, while others require further studies. Hypofractionation has been the subject of several trials, which have shown that shorter regimens (42.5Gy in 16 fractions, 41.6Gy in 13 fractions, or 40Gy in 15 fractions) are equivalent to longer schedules. It can be proposed for almost all patients and can be complemented, if necessary, by a boost to the original tumor volume. Accelerated partial breast irradiation, which can be used in patients with favourable local prognosis (tumor size≤3cm, unifocal, hormone receptor-positive, no HER2 overexpression), is ideally delivered via interstitial brachytherapy, as accelerated 3D radiotherapy has not yet shown benefit in this setting. However, partial breast irradiation can be delivered using moderate hypofractionation with 3D radiotherapy. Intraoperative radiotherapy, which has more restrictive indications, is an interesting alternative for elderly patients. Patient selection for these approaches must be rigorous and depends partly on the technique chosen. Patients should be fully informed about the potential side effects of each technique.

Past decade was marked by development of several new drug for HR+/HER2- metastatic breast cancer leading to several major question in terms of strategy. We propose here to review state of art in terms of targeted therapy for advanced luminal breast cancer and how treatment strategy will be more and more personalized in a near future.

The diagnosis of B- and T-cell lymphomas relies on a multidisciplinary approach that combines morphological, immunological (via flow cytometry - FCM), and genetic analyses. The integration of cytological evaluation from tissue biopsy imprints with FCM enables rapid diagnostic orientation, which is valuable for guiding further complementary investigations. This atlas illustrates the main types of B- and T-cell lymphomas using cytology images, FCM data, and histological analyses derived from lymph node and splenic samples. The FCM profiles were established using routinely employed antibody panels. While results may show slight variations depending on the cytometer settings and fluorochromes used, they remain generally comparable across different instruments. An orientation panel consisting of 16 antibodies is used for the initial classification of lymphomas, with specific markers allowing for subsequent assessment of antigen expression according to cell type and pathological context. The combined study of cytological and histological features provides an integrated perspective of lymphoid pathology.

The treatment of rectal cancer has evolved dramatically in recent years. Today, specialists have more options to choose from, ranging from primary surgical resection with or without neoadjuvant treatment to an organ-preserving strategy (such as Watch-and-Wait) after total neoadjuvant treatment. The aim of this article is to review the advantages, limits, and risks of the Watch-and-Wait strategy for the treatment of rectal cancer.

Locoregional treatment of breast cancer is based on surgery of the breast and axilla, radiotherapy of the breast or chest wall and regional lymph node areas. A progressive therapeutic de-escalation was carried out in order to reduce the impact of the treatments. This de-escalation will be considered for breast treatment and for lymph node area during primary surgical treatment and for neo-adjuvant chemotherapy.

Oncoplasty techniques have been progressively and widely carried out in clinical practice after the description of the different procedures adapted to breast volumes and tumor locations. Surgery with oncoplasty makes it possible to reduce the rate of reoperation, for large tumors, with a local recurrence rate and overall survival rate at least equivalent to standard conservative surgeries. When surgery with oncoplasty is offered as an alternative to a mastectomy, the therapeutic implications must be the subject of informed and precise information so that the patient can make a choice between these two possibilities. Surgical expertise is necessary with the completion of initial and/or secondary, theoretical and practical training. If a total mastectomy is indicated for therapeutic or prophylactic purposes, it is more and more often possible to offer the patient immediate breast reconstruction if she wishes. Radiotherapy to the reconstructed breast and the need for adjuvant chemotherapy are no longer obstacles to this treatment proposal to the extent that the patient is requesting it and the risks of complications have been assessed and accepted. Reconstruction by breast implant remains the most used but autologous techniques and in particular lipomodeling make it possible to postpone the placement of foreign bodies.

Leptomeningeal disease (LMD) from breast cancer is defined by the invasion of the leptomeninges and cerebrospinal fluid (CSF) by tumor cells. Historically associated with a very poor prognosis and survival measured in weeks, their management has evolved considerably. Therapeutic advances, such as the introduction of targeted therapies, and a better understanding of the pathophysiology of LMD now enable earlier diagnosis through dedicated MRI sequences and optimized CSF analysis. The EANO-ESMO classification notably distinguishes type I LMD (cytology-positive), which carries a worse prognosis but is more sensitive to intrathecal (IT) treatments, from type II LMD (negative or uncertain cytology), often more responsive to local-regional approaches like radiotherapy. Data from large retrospective cohorts highlight the importance of combination therapies: systemic treatments, IT injections, radiotherapy, as well as early symptomatic and palliative care. This multidisciplinary approach improves median survival, now reaching several months, and can even surpass 10 months in HER2+ cases. Innovative clinical trials, such as ETIC-LM (NCT05800275) - a French phase II study evaluating the combination of IT trastuzumab, oral tucatinib, and oral capecitabine offer encouraging new strategies for patient care. Although the prognosis remains poor, recent advancements suggest a more hopeful future, providing better disease control and improved quality of life for patients with LMD from breast cancer.

Radiotherapy is an essential part of the multidisciplinary management of cancer. We will review recent advances in breast cancer radiotherapy, highlighting how modern breast cancer radiotherapy is now an adapted-risk approach based on the individual patient's risk. We will also discuss how advances in technology and clinical research have made it possible to deliver radiotherapy in a less toxic and more comfortable manner for our patients.

Interpreting follicular helper T cell (Tfh) markers in the skin is challenging, raising the question of whether their expression is physiological or pathological. This review has two objectives: (1) to summarize current knowledge on Tfh lymphocytes, including circulating Tfh (cTfh) and peripheral helper T cells (Tph), and (2) to propose a practical approach for analyzing Tfh-rich skin infiltrates. Our method consists of two complementary entry points: histological and clinical. The histological approach classifies infiltrates into three patterns: (1) predominantly T-cell proliferation, suggesting a reactive infiltrate or hematodermia, (2) mixed B- and T-cell populations with a diffuse architecture, raising suspicion of a primary cutaneous CD4-positive small/medium T-cell lymphoproliferative disorder or Tfh lymphoma (primary or secondary), (3) B-cell nodules within a diffuse T-cell infiltrate, characteristic of reactive lymphoid hyperplasia, marginal zone B-cell lymphoproliferative disorders, or marginal zone lymphomas. In these cases, anti-IgM and anti-IgD immunolabeling is useful. Beyond Tfh-associated lymphocytes, the expression patterns and intensity of some Tfh markers (e.g., PD-1 in Sézary syndrome) help in reaching a diagnosis. The clinical algorithm categorizes presentations into three groups: (1) a solitary nodule or plaque, (2) multiple lesions (papules, plaques, or nodules/tumors), and (3) diffuse plaques or erythroderma. These histological and clinical algorithms are intertwined and complementary, providing a structured approach to evaluate Tfh-rich infiltrates in the skin.

Molecular imaging plays a crucial role in the diagnosis, staging, and monitoring of breast cancer. The most commonly used tracer at present is 18F-FDG, a marker of cellular metabolism, making 18F-FDG PET/CT a major imaging modality in the management of breast neoplasms. However, this tracer has limitations, particularly for low-grade ductal or lobular neoplasms, which exhibit low avidity for 18F-FDG. The 68Ga-FAPI tracer, which targets activated fibroblasts and whose uptake is independent of tumor aggressiveness, is currently under investigation and could serve as an excellent alternative to 18F-FDG in certain cases. Additionally, new tracers targeting novel biological pathways of the tumor, including hormonal receptors or HER2, are being developed. These tracers enable whole-body assessment of specific biomarker expressions on cancer cells, offering a more precise understanding of the disease. This approach could help tailor treatments to the molecular characteristics of each tumor, enabling personalized strategies that improve therapeutic efficacy and patient quality of life. Finally, inspired by the model of 177Lu-PSMA used in prostate cancer, researchers are exploring the potential to couple these tracers with therapeutic agents to develop targeted radionuclide therapy for breast neoplasms.

Female pelvic masses could be difficult to diagnose given the fact that there are so many structures within the pelvis that could be related to the mass. These benign or malignant neoplasms could be diagnosed through careful and systematic evaluation by history, biochemical, imaging, and surgical approaches. Although an ultrasound scan is often the first-line imaging modality for the evaluation of pelvic masses, it could be limited by poor acoustic windows and poor depth penetration. However, in low-resource settings, its usage is nonnegotiable. The case of a 26-year-old female with a 5-year history of lower abdominal swelling is hereby presented. The swelling was gradual in onset and associated with occasional dull lower abdominal cramps that radiate to the back, urinary retention, dysuria, and urinary frequency. An ultrasound scan diagnosed an ovarian mass and uterine fibroid with the suspicion of a bladder mass. She had a laparotomy, in which a left ovarian mass and a huge calcified pelvic mass extending from the region of the isthmus of the uterus through the posterior bladder wall and the anterior vaginal wall were discovered. Left ovariectomy and removal of the mass were done; a histologic diagnosis of mature ovarian teratoma and cervical fibroid was made. She had a smooth postoperative recovery on antibiotics and analgesics. The diagnostic challenge of pelvic masses even with the use of USS is demonstrated, and laparotomy has shown to be a diagnostic procedure here. Preoperative magnetic resonance imaging could be helpful when available and affordable.

Marginal zone lymphoma (MZL) is the third most frequent lymphoma in Western countries with an increasing incidence with age. There are different histologic subtypes: Splenic MZL (SMZL), Nodal MZL (NZML), Extranodal MZL (EMZL) or MALT lymphoma and more recently, a novel entity called splenic diffuse red pulp small B-cell lymphoma. The accurate diagnosis relies on morphologic, phenotypic, cytogenetic and molecular features in order to rule out other indolent non-Hodgkin lymphomas. First line treatment depends on MZL subtypes: depending on localized or disseminated disease, MALT lymphoma are managed with radiotherapy on immunochemotherapy. SMZL, when requiring therapy, are treated with splenectomy ore more frequently monotherapy Rituximab or immunochemotherapy depending on age, comorbidities and tumor burden. Management of NMZL is often similar to Follicular lymphoma treatment. Treatment of refractory or relapsed MZL takes into account the time between the diagnosis and the progression, the nature and outcomes of previous therapies and the general condition of the patient. Conventional treatments may be a suitable option but novel therapies are more frequently used. In this review, we focus on the role of Bruton Tyrosine Kinases (where only Zanubrutinib has marketing authorization in France), PI3Kinases, Syk and BCL-2 inhibitors as well as on the results of immunomodulatory drugs and more recently the use of bispecific antibodies and T-cell chimeric antigen receptor (CAR-T cell).

The concept of oligometastatic disease in lung cancer has been the subject of much publication and speculation. Indeed, beyond its definition, which is still a matter of debate, it is a rather broad concept considering synchronous oligometastatic disease but also oligoprogression and oligopersistence concepts. These questions are increasingly common considering the improvement of systemic treatments in recent years. Although no prospective randomized trial has been conducted to date, it would seem appropriate to offer patients local ablative treatment of oligoprogression, especially if symptomatic or in cases of oncogenic addiction. On the other hand, the most recent data do not defend the closure treatment approach for patients who benefit from immunotherapy. All in all, it is important to remember that systemic therapy remains the cornerstone of treatment for metastatic lung cancer, and that further robust randomized studies will be needed to determine the place of local therapy.

The discovery of ALK gene rearrangement in 3 to 5% of non-small cell lung carcinomas has revolutionized our understanding and therapeutic approach of these cancers. This oncogenic driver is associated with specific clinical and biological features is associated with specific clinical and biological features, mainly affecting young and never-smoker patients, with a particular tropism for brain metastases. The development of ALK tyrosine kinase inhibitors has transformed patient outcomes, with remarkable efficacy of latest-generation molecules, particularly in controlling brain metastases. However, the emergence of complex resistance mechanisms, whether ALK-dependent or ALK-independent, remains a major challenge. The comprehensive understanding of these resistance mechanisms now guides the development of next-generation inhibitors and innovative therapeutic strategies, paving the way for increasingly personalized precision medicine.

Among the oncogenic alterations of non-small cell lung cancer (NSCLC), the EGFR gene mutation is observed in 15% of patients in France, particularly among non-smokers and women. Treatment mainly relies on tyrosine kinase inhibitors (TKIs) targeting EGFR. In first-line metastatic treatment, osimertinib, a third-generation TKI, has become the standard, improving progression-free survival (PFS) and overall survival (OS) compared to first- or second-generation TKIs. The combination of TKI/chemotherapy (osimertinib/carboplatine-pemetrexed) and TKI/bispecific antibodies (e.g., amivantamab/lazertinib) are alternatives under evaluation, with benefits in PFS but increased toxicity. In case of progression under first- or second-generation TKIs, the most common resistance is the T790M mutation, which can be targeted by osimertinib. For other resistances, platinum-based chemotherapy remains an option. Amivantamab combined with chemotherapy has shown an improvement in PFS in the second line and has early access in France. Other emerging approaches include conjugated antibodies (patritumab deruxtecan, datopotamab deruxtecan) and next-generation TKIs. In the future, personalized treatment based on the molecular profile and early response to TKIs could optimize management, particularly by integrating predictive markers such as EGFR clearance under treatment.

Since 2017, anti-PD-(L)1 immunotherapy has been the cornerstone of first-line treatment for stage IV non-oncogene-addicted non-small cell lung cancer. Its phase I development has established that the level of PD-L1 expression by tumor cells is predictive of response rate and progression-free survival. Above 50%, it makes chemotherapy not mandatory, with a median survival for pembrolizumab monotherapy of around 26 months and five-year survival of 32%. Large phase III studies have also validated the combination of anti-PD-(L)1 immunotherapy and platinum-based chemotherapy regardless of PD-L1 level of expression, increasing five-year survival from 10% to 18%. Dual immunotherapy combining anti-CTLA-4 and anti-PD-(L)1 might be interesting, especially in PD-L1 negative tumors, but is not available in France. Treatment personalization, particularly in the case of PD-L 1 expression >50%, should be based on response and non-response factors to immunotherapy, including patient-related factors such as performans status, age, smoking status, as well as tumor-related factors such as disease aggressiveness, tumor volume, mutational profile, along with concomitant medications. The optimal duration of immunotherapy is uncertain and arbitrarily set at two years. Many options are currently being explored to improve first-line treatment outcomes, as the majority of patients experience resistance to immunotherapy.