Paraneoplastic dermatoses are rare cutaneous manifestations that are secondary to an underlying neoplasm. They may precede the diagnosis of cancer by months or even years. Some clinical presentations are relatively specific, which allows for an early diagnosis and treatment of certain cancers. In this context, their recognition by both specialists and non-specialists is essential. The aim of this article is to highlight some of these clinical presentations.

Long considered mere degradative compartments, lysosomes are now recognized as key regulators of metabolism, signaling, and tumor invasion. Here, we discuss how their intracellular localization controls their function, signaling, and secretion. In melanoma, the peripheral distribution of lysosomes promotes aggressiveness and metastasis. Similar changes exist in other types of cancer, highlighting the role of lysosomal trafficking as a factor in malignancy and as a promising biomarker for diagnosis and treatment.

Meningiomas are the most common type of intracranial brain tumor and are usually benign. While histopathology is still considered the gold standard for diagnosing and classifying meningiomas, treatment in developing countries heavily relies on computed tomography (CT) and magnetic resonance imaging (MRI). Therefore, it is important to have imaging results that are as accurate as possible. The aim of this study was to determine the contribution of histopathology to the diagnosis of intracranial meningiomas in tertiary healthcare facilities (THFs) in Kinshasa, Democratic Republic of Congo.

Aggressiveness of end-of-life care refers to intensive medical interventions at an advanced disease stage, including the late initiation of chemotherapy. This study assesses its incidence among patients hospitalized at the Léon-Bérard Center.

A 79-year-old woman with a history of breast cancer was incidentally found to have a suspicious lung nodule. Though reluctant to accept treatments with disabling side effects, she was persuaded to undergo biopsy after oncologists stressed the low toxicity and potential benefit of EGFR inhibitors. The biopsy confirmed lung adenocarcinoma but caused complications, including pneumothorax and progressive dyspnea, without improving outcome. Her primary wish was to return home and limit hospital exposure, an expectation ultimately unmet. This case underlines the need to respect patient preferences, address cognitive biases like action bias, and reassess interventions through the lens of futility, particularly in geriatric oncology, where broader societal reflection and independent oversight are essential.

The management of cancers requires complete and accurate pathology reports. Recent literature refers to the importance of synoptic report in cancer pathologies. In Tunisia, we still adopt the narrative report.

Desmoplastic fibroma, also known as desmoid fibroma of bone, is a rare benign bone tumor, accounting for approximately 0.1 to 0.3% of all bone tumors. It was first described by Jaffe in 1958. This tumor has a slow progression with locally aggressive behavior, without metastasis or malignant transformation. For radiological diagnosis, magnetic resonance imaging (MRI) is the modality of choice to assess local extension within the bone and, when present, into the surrounding soft tissues. The definitive diagnosis is histological: the tumor is composed of tissue poor in fibroblasts and rich in collagen fibers, identical to the histology of desmoid fibromas of the soft tissues. Histological differential diagnosis can be challenging, particularly with low-grade fibrosarcomas. The treatment of choice is surgical, consisting of wide tumor resection whenever the location allows. A high rate of local recurrence characterises post-treatment evolution in cases of intralesional excision.

During decades, first-line treatment of advanced cervical cancer solely consisted of platinum-based chemotherapy, associated with bevacizumab whenever possible. Since 2022, immunotherapy is part of standard therapeutic strategy with pembrolizumab on the one hand, associated with chemotherapy and bevacizumab in patients with PD-L1 positive tumors (CPS≥1), and cemiplimab on the other hand, in patients who did not receive prior immunotherapy and progress after first line regardless of PD-L1 expression. Pretherapeutic work-up includes CT of the chest, abdomen and pelvis potentially associated with 18F-FDG PET-CT and MRI in case of relapse, as well as evaluation of PD-L1 status on tumor and immune cells to define the CPS score that will determine eligibility to pembrolizumab treatment (CPS≥1). Whenever possible, molecular screening and determination of HER2 status may allow orienting patients to clinical trials. Indeed, inclusion in investigational studies must be systematically considered and early supportive care is always recommended.

The evolution of serous high grade ovarian cancer management is characterized by a more regulated patients' journey on the one hand and the development of new therapeutic options on the other hand, the selection of which is guided by tumor molecular characteristics. Surgery remains the cornerstone of treatment. It can be performed only in authorized expert sites that can demonstrate sufficient experience from highly skilled surgical teams, and quality criteria including prehabilitation and rehabilitation programs. The diagnostic step is crucial; it comprises multiple biopsies that allow reliable pathological and molecular analyses, and a comprehensive surgical staging. Determination of BRCA1/2 mutation and homologous recombination deficiency statuses by validated methods guide maintenance therapy at advanced stages and referring to oncogenetic consultation if appropriate. For these advanced diseases, the two main questions for surgical strategy are the feasibility of complete resection (without residual disease, CC-0), assessed during surgical exploration of pelvis and abdomen, and the optimal timing of this surgery (upfront or after neoadjuvant chemotherapy). In recurrent diseases, surgery remains a main piece of treatment in case of late relapse and medical treatment depends on drugs used in the first line; in early platinum resistant relapse, a new therapeutic option is available with mirvétuximab soravtansine.

Histomolecular diagnosis of endometrial cancer systematically includes the evaluation of hormonal receptors, P53 and MMR statutes (determination of PD-L1 and HRD statutes is not required). Therapeutic progress in advanced endometrial cancer is mainly related to the first-line utilization of immunotherapy associated with chemotherapy, a strategy assessed in five randomized controlled trials, although at the moment, only dostarlimab is available in France. Immunotherapy administration requires specific pretherapeutic workup and monitoring. Hormone therapy remains an option in non-aggressive, low grade endometrioid cancer, expressing hormone receptors. Treatment choice is based on clinical situation (upfront metastatic disease or relapse after adjuvant therapy, and duration of platinum-free interval in case of adjuvant therapy), disease aggressivity, molecular status (in particular, MMR status) and patients' comorbidities. PARP inhibitors are not recommended as maintenance therapy. In second line, the combination of pembrolizumab and lenvatinib is the standard treatment if chemoimmunotherapy has not been used previously. If it has been, therapeutic strategy depends on the duration of platinum-free interval. Inclusion in a clinical trial should always be considered when the patient's performance status makes it possible. The choice of the trial is guided by HER2 status in immunohistochemistry and results of new generation sequencing when available. The current trend towards the development of personalized medicine highlights the importance of pathological and molecular characterization of the tumor.

Localized or locally advanced cervical cancer is treated with a curative intent. Its management requires multidisciplinary expertise and a rigorously structured approach to optimize the probability of success. Initial workup (clinical examination, imaging, pathology) allows precise characterization of the tumour and staging according to TNM and FIGO classifications. Surgical management of early stage cancers, ranging from conization for small tumour to hysterectomy, sometimes including sentinel lymph node biopsy, is based on therapeutic algorithms that take into account stage, pathological criteria (invasion, margins, node involvement) and risk category. Postoperative treatment, when required, includes radiochemotherapy, that can be followed by brachytherapy. In locally advanced cancers, treatment consists of radiochemotherapy followed by uterovaginal brachytherapy and immunotherapy that has recently demonstrated its benefits. Since cervical cancer often develops in young women, its management raises important questions related to fertility and sometimes, to the management of cancer during pregnancy. Finally, although it is not the topic of these recommendations, it is important to highlight the major role of vaccination to avoid the vast majority of these cancers.

Metastatic castration-sensitive prostate cancer (mCSPC) has undergone major therapeutic advances with the introduction of next-generation androgen receptor pathway inhibitors (ARPI). Two treatment strategies have demonstrated clinical benefit at this stage: doublet therapy, combining androgen deprivation therapy (ADT) with one of the four currently available ARPI, and triplet therapy, integrating abiraterone or darolutamide with docetaxel. The choice of therapeutic strategy is based on a personalized assessment that considers both tumor aggressiveness and the patient's overall profile, particularly cardiovascular and cognitive comorbidities, regardless of age, frailty, or level of activity. Optimal management of mCSPC requires a multidisciplinary approach, including a baseline cardiovascular workup, systematic geriatric assessment, non-pharmacological interventions (such as tailored physical activity and cognitive stimulation programs), calcium and vitamin D supplementation, structured sexual health support, and a comprehensive medication review conducted in collaboration with a pharmacist. Ongoing trials are exploring treatment de-escalation strategies, notably intermittent ADT, to preserve antitumor efficacy while improving quality of life. This review highlights the importance of a personalized, multidisciplinary approach, integrating therapeutic innovations with individualized supportive care, in a context marked by emerging differentiations of therapeutic options for mCSPC.

SURGERY OF SOFT TISSUE SARCOMA IN ADULTS. Medical strategy and surgery of soft tissue sarcoma are decided within the multidisciplinary tumor board with an appropriate imaging assessment, multiple percutaneous core needle biopsies to confirm diagnosis and a correct staging and risk assessment. Surgery must be carried out by a surgeon specifically trained in the treatment of this disease in an expert center. The standard surgical procedure is an one bloc excision with clear margins, which implies removing the tumour with a rim of normal tissue around it.

THE DIAGNOSIS OF SARCOMA REQUIRES TEAM EXPERTISE. Sarcoma is the prototype of the "rare cancer" which suff ers from a sometimes complicated diagnostic pathway. This is all the truer for soft tissue sarcomas for which the clinical signs are not very specific or even falsely reassuring. The key message is that any patient with a suspected sarcoma must be referred as soon as possible to an expert "sarcoma" center belonging to the NetSarc+ network to benefit from the expertise both diagnostically and therapeutically. In the centers of this expert network, the diagnostic phase begins with radiological expertise both on the analysis of tumor semiology and on the taking of specific samples for diagnostic purposes. This precious sample allows the expert pathologist to apply the most accurate techniques to off er a precise diagnosis and determine the grade of malignancy, paving the way for personalized treatment.

A PLURAL ENTITY. Sarcoma are a heterogeneous group of 150 different histopathological entities, developed from soft tissues or bone of any anatomical location.Their estimated incidence is around 70 cases for 100 000 people. They can occur in patients of any age, including children, the median age of onset being around 60 years. Most sarcomas are sporadic, since predisposing factors are rare. In France, the treatment of patiens with sarcomas must be carried out, within a center belonging to Netsarc+ networt as soon as a diagnosis is suspected, to offer them a better prognosis, mostly explained by the quality of the surgery, a major prognostic factor in these diseases.

CYSTIC LESIONS OF THE PANCREAS. The practice of every gastroenterologist is daily punctuated by the management of patients with pancreatic cystic lesions (PCL). The discovery is usually fortuitous and the lesions in majority are small (less than 10mm). The prevalence of PCL in the general population of adults is very high and probably greater than 40% if we consider lesions of 2 mm. Some PCL are precancerous lesions, (as intraductal papillary mucinous neoplasm [IPMN]) with a real risk of pancreatic adenocarcinoma and others cystic lesions have a risk of metastases such as pseudopapillary and solid tumors or cystic neuroendocrine tumors. The follow-up protocol, recommended by international experts, is highly debated because it is expensive, potentially invasive (in case of repeated use of endoscopic ultrasound) and not perfect. Only a few patients will develop aggressive and potentially invasive lesions. However, the lack of specific diagnostic tools for the grade of dysplasia and the mortality rate of pancreatic cancer leads European experts to recommend regular monitoring.

Ewing sarcoma (ES) is an aggressive sarcoma with a peak incidence in adolescents and young adults. Current therapy involves multiagent chemotherapy and local therapy but despite intensification of treatment patients with metastases at diagnosis and recurrent disease have poor prognosis. Improved understanding of ES biology has identified novel targets with promising activity in ES patients. Tyrosine kinase inhibitors are currently being evaluated as combination and maintenance therapy. Other emerging therapies include those that target the EWSR1:FLI1 fusion oncoprotein, cell cycle, apoptotic and DNA-repair pathways. Immunotherapeutic approaches are also being investigated, particularly CAR-T and CAR-NK cell therapy. Close collaboration between clinicians and biologists has also highlighted the importance of biomarkers that are still being validated prospectively and might be incorporated into standard of care in the future.

Secretory carcinoma is a histological type mostly found in salivary gland tumors, but also in breast and skin tumors. These tumors share pathological characteristics and the presence of an ETV6-NTRK3 gene fusion. Secretory lacrimal gland carcinoma is even rarer. Our case is a middle-aged man who presented with a left orbital tumor with proptosis, diplopia and mass effect on the globe. Multimodal imaging revealed a heterogeneous tumor enhanced with gadolinium. There were no granulomatous foci. Total excision was preferred over diagnostic biopsy because of the intense vascularization of the tumor. Histopathology revealed a secretory carcinoma of the lacrimal gland. The FISH study showed ETV6 gene fission in 90% of enumerated cells. After consultation, it was decided not to irradiate because of the risk of xerophthalmia, cataract and meningioma. After eighteen months, follow-up imaging showed local recurrence, treated then by surgery and stereotactic radiation therapy. During follow-up, chemotherapy was added when a second recurrence at the orbital site occurred. To support our diagnostic approach, we found only two other cases of secretory carcinoma of the lacrimal gland in the medical literature, both treated by isolated excision. The characterization of histological subtypes of carcinomas has direct implication in the therapeutic approach with the use of targeted therapies. Thus, tyrosine kinase inhibitors can provide valuable options in the treatment of secretory carcinomas.

Pediatric-type follicular lymphoma is a rare entity, predominantly involving lymph nodes in the head and neck of children and young adults. Ocular adnexal involvement, particularly of the conjunctiva, is exceptionally uncommon in this age group.

Squamous cell carcinomas of the external auditory canal are rare, with limited data available in the literature on patient survival in Europe. The low incidence of this condition complicates the development of a standard surgical management procedure, particularly given the lack of consensus regarding the value of neck dissection. The aim of this study was to evaluate the benefit of parotidectomy and neck dissection combined with tumor resection, and to assess the survival outcomes of patients treated for squamous cell carcinoma of the external auditory canal.