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1.  Coexistence of Hodgkin's Lymphoma and Castleman's Disease: A Case Report with Successful Response to Chemotherapy and Radiotherapy 
Background. Castleman's disease is a rare clinicopathological entity of unknown origin. Coexistence of Hodgkin's lymphoma and Castleman's disease is rare. We report a case of Hodgkin's disease of cervical lymph nodes in a patient previously diagnosed with Castleman's disease. Case Presentation. A 43-year-old man admitted in July 2009 for a right cervical pain with lymph node at the physician examination. He underwent a right adenectomy and histological studies showed typical features of Castleman's disease. Three years after, the patient consulted for increasing the volume of cervical lymph node. Clinical examination showed a right cervical lymph node of 3 cm. The computed tomography scan of chest, abdominal and pelvic was normal. Histological and immunohistochemical studies of cervical lymph node biopsy specimen were in favor of Castleman's disease associated with Hodgkin's disease. Reed-Sternberg cells were positive for CD15 and CD30. The patient received chemotherapy based on anthracyclines, bleomycin, vinblastine, and dacarbazine (ABVD) and radiotherapy with complete response. Conclusion. Prevalence of Hodgkin's lymphoma in Castleman's disease is more difficult to establish because of the low number of cases reported in the literature.
PMCID: PMC3870129  PMID: 24381772
2.  Analysis of mutations in the E6 oncogene of human papillomavirus 16 in cervical cancer isolates from Moroccan women 
BMC Infectious Diseases  2013;13:378.
Worldwide, cervical cancer is the second most common cancer in women. High-risk human papillomavirus (HPV) play a crucial role in the etiology of cervical cancer and the most prevalent genotype is HPV16. HPV 16 intratypic variants have been reported to differ in their prevalence, biological and biochemical properties. The present study was designed to analyze and identify HPV type 16 E6 variants among patients with cervical cancer in Morocco.
A total of 103 HPV16 positive samples were isolated from 129 cervical cancer cases, and variant status was subsequently determined by DNA sequencing of the E6 gene.
Isolates from patients were grouped into the European (E), African (Af) and North-American (NA1) phylogenetic clusters with a high prevalence of E lineage (58.3%). The Af and NA1 variants were detected in 31.1% and 11.6% of the HPV16 positive specimens, respectively, whereas, only 3% of cases were prototype E350T. No European-Asian (EA), Asian (As) or Asian-American (AA) variants were observed in our HPV16-positive specimens. At the amino acid level, the most prevalent non-synonymous variants were L83V (T350G), H78Y (C335T), E113D (A442C), Q14D (C143G/G145T) and R10I (G132T), and were observed respectively in 65%, 41.8%, 38.8%, 30.1% and 23.3% of total samples.
Moreover, HPV16 European variants were mostly identified in younger women at early clinical diagnosis stages. Whereas, HPV16 Af variants were most likely associated with cervical cancer development in older women with pronounced aggressiveness.
This study suggests a predominance of E lineage strains among Moroccan HPV 16 isolates and raises the possibility that HPV16 variants have a preferential role in progression to malignancy and could be associated with the more aggressive nature of cervical cancer.
PMCID: PMC3751500  PMID: 23953248
Cervical cancer; Human papillomavirus 16; Variants; E6; Morocco
3.  Cancer incidence in Rabat, Morocco: 2006–2008 
ecancermedicalscience  2013;7:338.
No population-based data of cancer incidence from Morocco have been published before. This is the first report of cancer incidence in Rabat from a population-based cancer registry for the period 2006–2008.
Materials and methods
The cancer registry collects data on all new cases of cancer diagnosed in the resident population of the Rabat area. Data collection is an active process involving visits by registry staff to all data sources, essentially hospitals, pathological laboratories, and private clinics in Rabat.
A total of 2,473 new cases of cancer were registered among residents in Rabat during the period 2006–2008. The overall world age-standardised rate (ASR) for all sites combined was 136.6/100,000 for men and 114.5/100,000 for women. The most frequently diagnosed malignancies in males were lung cancer (19.0%, ASR 24.8/105), followed by prostate cancer (15.5%, ASR 22.9/105), colorectal cancer (8.8%, ASR 12.0/105), bladder cancer (6.9%, ASR 9.7/105), and non-Hodgkin’s lymphoma (NHL) (6.0%, ASR 8.2/105). In females, the most frequently reported malignancies were breast cancer (39.9%, ASR 43.4/105), followed by cervix uteri cancer (11.4%, ASR 13.0/105), colorectal cancer (7.5%, ASR 9.0/105), NHL (3.4, ASR 4.2/105), and thyroid cancer (3.4%, ASR 3.9/105).
Of all cancers, 2% are observed in childhood (0–14 years), and ~43% of them are malignant haemopathies.
The data reported by Rabat Cancer Registry indicate that cancers of the breast, cervix, uteri, and colon and rectum in females and the lung, prostate, and colon and rectum in men are major cancers in the population of Rabat. The Incidences observed are sometimes different from those observed in the neighbouring North African countries.
PMCID: PMC3737118  PMID: 23940493
cancer; incidence; population-based registry; Rabat; Morocco
4.  Le lymphomes non hodgkinien primitif de la thyroïde: à propos de sept cas 
Les lymphomes non hodgkiniens primitifs de la thyroïde sont rares : ils représentent moins de 2 à 5 % des cancers de la thyroïde. L'objectif de ce travail est de revoir les stratégies diagnostiques et thérapeutiques actuelles des lymphomes non hodgkiniens primitifs de la thyroïde tout en présentant notre expérience à l'Institut national d'oncologie. Nous rapportons à travers une étude rétrospective, sept cas des lymphomes non hodgkiniens primitifs de la thyroïde colligés à l'Institut National d'Oncologie au Maroc entre 2004 et 2008. Sept patients ont été inclus dans notre étude, l’âge médian au moment du diagnostic était de 50 ans, avec sexe ratio de 2.5 à prédominance féminine. Le diagnostic histopathologique avec l'immunomarquage après chirurgie a conclu dans tous les cas à un lymphome malin non hodgkinien : 3 patientes avec un lymphome de type MALT, et les 4 autres avec un LMNH à grandes cellules de phénotype B. Une thyroïdite chronique lymphocytaire d'Hashimoto coexistante avec le lymphome malin primitif de la thyroïde était retrouvée chez une patiente. Concernant le traitement du lymphome, 5 patientes ont reçu une polychimiothérapie, et les 2 autres ont bénéficié d'un traitement combiné comportant la chimiothérapie et la radiothérapie. Une patiente est décédée 3 mois après la fin du traitement. Le suivi médian des autres patients était de 24 mois et on ne notait aucune récidive de lymphome. Les lymphomes non hodgkiniens primitifs de la thyroïde sont rares. Le traitement combiné par une chimiothérapie et radiothérapie a prouvé son efficacité. Le pronostic des stades localisés est généralement favorable.
PMCID: PMC3473965  PMID: 23077700
Lymphome primitif de la thyroïde; traitement; Primtive lymphoma; thyroid; treatment
5.  Extragonadal mixed germ cell tumor of the right arm: description of the first case in the literature 
Extragonadal localization of germ cell tumors (GCTs) is rare; to the best of our knowledge, a location in the soft tissue of the arm has never been previously reported in the literature.
Case presentation
We report the case of a 37-year-old man who presented with a primary malignant mixed non-seminomatous GCT (teratocarcinoma variety) in the right arm, treated by a combination of cisplatin-based chemotherapy and surgery. After 18 months of close follow-up, no locoregional recurrence or distant metastases have been detected.
A combination of chemotherapy and surgery is the most appropriate treatment strategy for extragonadal GCTs, to ensure both local and systemic control.
PMCID: PMC3356599  PMID: 22540884
Chemotherapy; Embryonic carcinoma; Extragonadal; Mixed germ cell tumors; Surgery; Teratoma
6.  Periductal stromal sarcoma in a child: a case report 
Periductal stromal sarcoma is an extremely rare malignant fibroepithelial tumor of the breast which is characterized by its biphasic histology with benign ductal elements and a sarcomatous stroma made of spindle cells and lacking phyllodes architecture. Its therapeutic management is based on wide surgery with free margins. Adjuvant therapies are not needed. Periductal stromal sarcoma may evolve into a phyllodes tumor with time, as well as a specific soft-tissue sarcoma. To the best of our knowledge, this tumor has never been described in a child.
Case presentation
A 14-year-old Arabic boy was presented to our hospital one year ago with a nodule of the right breast that was gradually increasing in size without signs of inflammation. The histological examination after lumpectomy revealed a periductal stromal sarcoma with free surgical margins. No adjuvant treatment was given. At 50 months of close follow-up, no recurrence was observed.
Periductal stromal sarcoma in a child is a very rare disease which has the same indolent behavior as it does in adults. Therefore, close follow-up is required.
PMCID: PMC3141703  PMID: 21714873
7.  Lymphome malin non Hodgkinien primitif du larynx: à propos d'un cas 
Le lymphome malin non hodgkinien (LMNH) primitif laryngé est une entité rare qui représente moins de 1% des cancers du larynx. Nous rapportons un nouveau cas, chez un homme de 24 ans qui avait présenté une dysphonie et une dysphagie d'installations progressives. La laryngoscopie a révélé une lésion bourgeonnante de la bande ventriculaire gauche. L'histologie a objectivé un lymphome T, CD3 positif, qui a bien évolué après traitement par quatre cures de CHOP (cyclophosphamide, doxorubicine, vincristine, et prednisone), suivies d'une radiothérapie sur le larynx et le médiastin supérieur à la dose totale de 40Gy. Malgré sa rareté relative, cette pathologie de diagnostic difficile, nécessite une vigilance particulière et devrait être gérée selon les tendances actuelles du traitement pour les LMNH ganglionnaires.
PMCID: PMC3215539  PMID: 22355427
Cancer; larynx; lymphome non-hodgkinien; primitif
8.  Successful management of primary non Hodgkins lymphoma of the cranial vault 
Primary bone lymphoma (PBL) is a relatively uncommon entity. However, involvement of the cranial vault is an unusual manifestation of aggressive non-Hodgkin’s lymphoma. We report the case of a 42-year old immunocompetent woman who presented with an enlarging mass involving the right parietal bone. Magnetic resonance imaging (MRI) of the brain revealed an expansive tumor that affects the right parietal bone. Computed tomographic (CT) scans of the abdomen, chest and pelvis were negative for lymphadenopathy or organomegaly. Biopsy of the mass showed diffuse large B-cell non-Hodgkin’s lymphoma confirmed by immunohistochemical study. The patient had a complete response after 4 cycles of chemotherapy followed by external beam radiotherapy. After a follow-up of more than 9 months the patient is still in good local control without distant metastasis. The aim of our work is to report a case of Primary bone lymphoma of the cranial vault with good response to treatment combining sequential chemotherapy and radiotherapy.
PMCID: PMC3201612  PMID: 22121457
B-Cell lymphoma; primary bone lymphoma; extranodal lymphoma; cranial vault
9.  Excellente réponse à la radiothérapie externe d’un synovialosarcome primitif de la glande parotide 
Le synovialosarcome de la parotide est rare, peu de cas ont été rapportés dans la littérature. Nous rapportons l’observation d’une patiente âgée de 40 ans qui a présenté d’un synovialosarcome primitif de la parotide, dont le traitement a associé une chirurgie suivie d’une radiothérapie adjuvante. L’évolution a été marquée par un bon contrôle locorégional avec un recul de 6 ans. Le but de notre travail est de rapporter un excellent contrôle locorégional d’un synovialosarcome primitif de la parotide par un traitement multimodal combinant l’exérèse chirurgicale large à une radiothérapie externe.
PMCID: PMC3221404  PMID: 22121442
Synovialosarcome; parotide; chirurgie; radiothérapie
10.  Genetic testing and first presymptomatic diagnosis in Moroccan families at high risk for breast/ovarian cancer 
Oncology Letters  2011;2(2):389-393.
Germline mutations in the BRCA1 and BRCA2 genes highly predispose to breast and ovarian cancers and are responsible for a substantial proportion of familial breast and ovarian cancers. No female individuals from families from Morocco affected by breast cancer with mutations of these genes have previously been reported, and clinicians in Morocco are unaccustomed to dealing with healthy female individuals carrying mutations in the BRCA genes. This study aimed to report the initial experience of a group of Moroccan investigators carrying out predictive genetic testing to detect a known familial mutation in healthy Moroccan females with a high risk of developing breast cancer and to introduce supervision of these asymptomatic female carriers as a new approach in the prevention and early diagnosis of breast and ovarian cancers in Morocco. Presymptomatic diagnosis was carried out using DNA genetic testing in 5 healthy Moroccan female individuals from three families with an elevated risk of developing breast cancer. These are the first Moroccan families reported to be affected by breast cancers associated with BRCA mutations. Presymptomatic diagnosis was carried out for breast cancer in 5 female individuals from three Moroccan families with BRCA mutations. Two of the families are the first reported incidence of the founder mutation Ashkenazi BRCA1-185_186delAG in Moroccan patients. The third family carried the known BRCA2 mutation c.5073dupA/p.trp1692metfsX3. We tested the presence of these mutations in 5 asymptomatic healthy females from the three families. Two sisters from family 1 carried the BRCA1-185_186delAG mutation, whereas the third female individual from family 2 carried the c.5073dupA/p.trp1692metfsX3 mutation. However, one healthy female individual and her mother from family 3 did not carry the familial mutation of the BRCA1 gene. This study found BRCA mutations in three asymptomatic subjects, suggesting that this is the first step towards the development of persistent medical monitoring of females from families with a history of breast and ovarian cancers. Consequently, it is crucial for oncologists in Morocco to initiate the supervision of healthy female individuals with genetic defects which may lead to hereditary cancers.
PMCID: PMC3410606  PMID: 22866093
BRCA1/2 genes; hereditary breast-ovarian cancer; presymptomatic DNA testing
11.  Radiotherapy on hidradenocarcinoma 
Clear cell Hidradenocarcinoma is a rare carcinoma arising from sweat glands. It is an aggressive tumor that most metastasizes to regional lymph nodes and distant viscera; surgery with safe margins is the mainstay of treatment.
Case Report:
We report a case of 68-year-old woman who presented with an invasive clear cell hidradenocarcinoma situated in the left parotid area which recurred 5 months after surgery, this recurrence was managed successfully by high-dose irradiation of the tumor bed (66 Gy) and regional lymphatic chains (50 Gy), after a follow-up of more than 15 months, the patient is in good local control without significant toxicity.
Post operative radiotherapy allows better local control and should be mandatory when histological features predictive of recurrence are present: positive margins, histology poorly differentiated, perineural invasion, vascular and lymphatic invasion, lymph node involvement, and extracapsular spread.
PMCID: PMC3336933  PMID: 22540063
Hidradenocarcinoma; sweat-gland; rare; surgery; recurrence; megavoltage external beam radiotherapy
12.  Anthracycline and concurrent radiotherapy as adjuvant treatment of operable breast cancer: a retrospective cohort study in a single institution 
BMC Research Notes  2010;3:247.
Concurrent chemoradiotherapy (CCRT) after breast surgery was investigated by few authors and remains controversial, because of concerns of toxicity with taxanes/anthracyclines and radiation. This treatment is not standard and is more commonly used for locally advanced breast cancer. The aim of our study was to evaluate the efficacy and safety of the concomitant use of anthracycline with radiotherapy (RT).
Four hundred women having operable breast cancer, treated by adjuvant chemotherapy (CT) and RT in concomitant way between January 2001 and December 2003, were included in this retrospective cohort study. The study compares 2 adjuvant treatments using CCRT, the first with anthracycline (group A) and the second with CMF (group B). The CT treatment was repeated every 21 days for 6 courses and the total delivered dose of RT was 50 Gy, divided as 2 Gy daily fractions. Locoregional recurrence free (LRFS), event free (EFS), and overall survivals (OS) were estimated by the Kaplan-Meier method. The log-rank test was used to compare survival events. Multivariate Cox-regression was used to evaluate the relationship between patient characteristics, treatment and survival.
In the 2 groups (A+B) (n = 400; 249 in group A and 151 in group B), the median follow-up period was 74.5 months. At 5 years, the isolated LRFS was significantly higher in group A compared to group B (98.7% vs 95.3%; hazard ratio [HR] = 0.258; 95% CI, 0.067 to 0.997; log-rank P = .034). In addition, the use of anthracycline regimens was associated with a higher rate of 5 years EFS (80.4% vs 75.1%; HR = 0.665; 95% CI, 0.455 to 1.016; log-rank P = .057). The 5 years OS was 83.2% and 79.2% in the anthracycline and CMF groups, respectively (HR = 0.708; 95% CI, 0.455 to 1.128; log-rank P = .143). Multivariate analysis confirmed the positive effect of anthracycline regimens on LRFS (HR = 0.347; 95% CI, 0.114 to 1.053; log-rank P = .062), EFS (HR = 0.539; 95% CI, 0.344 to 0.846; P = 0.012), and OS (HR = 0.63; 95% CI, 0.401 to 0.991; P = .046). LRFS, EFS and OS were significantly higher in the anthracycline group where the patients (n = 288) received more than 1 cycle of concurrent CT (P = .038, P = .026 and P = .038, respectively). LRFS and EFS were significantly higher in the anthracycline group within the BCT subgroup (P = .049 and P = .04, respectively). There were more hematologic, and more grade 2/3/4 skin toxicity in the anthracycline group.
After mastectomy or BCT, the adjuvant treatment based on anthracycline and concurrent RT reduced breast cancer relapse rate, and significantly improved LRFS, EFS and OS in the patients receiving more than 1 cycle of concurrent CT. There were more hematologic and non hematologic toxicities in the anthracycline group.
PMCID: PMC2958885  PMID: 20920323
13.  Concurrent chemoradiotherapy in adjuvant treatment of breast cancer 
The optimal sequencing of chemotherapy and radiotherapy after breast surgery was largely studied but remains controversial. Concurrent chemo-radiotherapy is a valuable method for adjuvant treatment of breast cancer which is under ongoing research program in our hospital. We are evaluating the feasibility of the concomitant use of chemotherapy retrospectively.
Two hundred forty four women having breast cancer were investigated in a retrospective study. All patients were either treated by radical surgery or breast conservative surgery. The study compares two adjuvant treatments associating concomitant chemotherapy and radiotherapy. In the first group (group A) the patients were treated by chemotherapy and radiotherapy in concomitant way using anthracycline (n = 110). In the second group (group B) the patients were treated by chemotherapy and radiotherapy in concomitant way using CMF treatment (n = 134). Chemotherapy was administered in six cycles, one each 3 weeks. Radiotherapy delivered a radiation dose of 50 Gy on the whole breast (or on the external wall) and/or on the lymphatic region. The Kaplan-Meier method was used to estimate the rates of disease free survival, loco-regional recurrence-free survival and overall survival. The Pearson Khi2 test was used to analyse the homogeneity between the two groups. The log-rank test was used to evaluate the differences between the two groups A and B.
After 76.4 months median follow-up (65.3 months mean follow up), only one patient relapsed to loco-regional breast cancer when the treatment was based on anthracycline. However, 8 patients relapsed to loco-regional breast cancer when the treatment was based on CMF. In the anthracycline group, the disease free survival after 5 years, was 80.4% compared to 76.4% in the CMF group (Log-rank test: p = 0.136). The overall survival after 5 years was 82.5% and 81.1% in the anthracycline and CMF groups respectively (Log-rank test: p = 0.428). The loco-regional free survival at 5 years was equal to 98.6% in group A and 94% in group B (Log-rank test: p = 0,033). The rate of grade II and grade III anaemia was 13.9% and 6.7% in anthracycline group and CMF group respectively (Khi2-test: p = 0.009). The rate of grade II and grade III skin dermatitis toxicity was 4.5% in the group A and 0% in the group B (Khi2-test: p = 0.013).
From the 5 years retrospective investigation we showed similar disease free survival and overall survival in the two concurrent chemo-radiotherapy treatments based on anthracycline and CMF. However in the loco-regional breast cancer the treatment based on anthracycline was significantly better than that of the treatment based on CMF. There was more haematological and skin dermatitis toxicity in the anthracycline group.
PMCID: PMC2679760  PMID: 19351405

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