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2.  Is there any advantage to combined trastuzumab and chemotherapy in perioperative setting her 2neu positive localized gastric adenocarcinoma? 
We report here a 44-year-old Moroccan man with resectable gastric adenocarcinoma with overexpression of human epidermal growth factor receptor 2 (HER2) by immunohistochemistry who was treated with trastuzumab in combination with chemotherapy in perioperative setting. He received 3 cycles of neoadjuvant chemotherapy consisting of trastuzumab, oxaliplatin, and capecitabine. Afterwards, he received total gastrectomy with extended D2 lymphadenectomy without spleno-pancreatectomy. A pathologic complete response was obtained with a combination of trastuzumab and oxaliplatin and capecitabine. He received 3 more cycles of trastuzumab containing regimen postoperatively.
We conclude that resectable gastric carcinoma with overexpression of the c-erbB-2 protein should ideally be managed with perioperative combination of trastuzumab with chemotherapy. Further research to evaluate trastuzumab in combination with chemotherapy regimens in the perioperative and adjuvant setting is urgently needed.
doi:10.1186/1477-7819-9-112
PMCID: PMC3204255  PMID: 21955806
trastuzumab; chemotherapy; perioperative; gastric adenocarcinoma; resection
3.  Rare recurrence of a rare ovarian stromal tumor with luteinized cells: a case report 
Introduction
Sex cord-stromal tumors of the ovary are uncommon. They behave unpredictably and often have a late recurrence, making counseling, management, and prediction of prognosis challenging.
Case presentation
A 52-year-old Moroccan woman with an sex cord-stromal tumors underwent a bilateral oophorectomy. The histology was unusual but was likely to be a luteinized thecoma with suspicious features for invasion. Seven years later, after a gastrointestinal bleed, a metastasis within the small bowel mucosa was detected. This represents probable isolated hematogenous or lymphatic spread, which is highly unusual, especially in the absence of concurrent peritoneal disease.
Conclusions
To the best of our knowledge, this is the second reported case of an sex cord-stromal tumors recurring in small bowel mucosa and mimicking a primary colorectal tumor. This highlights the diverse nature and behavior of these tumors.
doi:10.1186/1752-1947-5-350
PMCID: PMC3163610  PMID: 21816048
4.  Metastatic collecting duct carcinoma of the kidney treated with sunitinib 
Collecting duct carcinoma (CDC) of the kidney is a rare and aggressive malignant tumor arising from the distal collecting tubules which has been shown to have a poor response to several kinds of systemic therapy. We present a case of metastatic CDC that responded favorably to a multiple tyrosine kinase inhibitor, sunitinib, achieving a partial response in both lung and skeletal metastases. To our knowledge, this is the first report showing therapeutic activity of sunitinib against CDC. Considering these findings, it would be worthwhile prospectively investigating the role of multiple tyrosine kinase inhibitors, particularly sunitinib, in the management of metastatic CDC.
doi:10.1186/1477-7819-9-73
PMCID: PMC3152528  PMID: 21752265
Collecting duct carcinoma; Sunitinib; Metastasis
5.  Diagnostic challenge for ovarian malignant melanoma in premenopausal women: Primary or metastatic? 
Background
In the ovary, metastatic malignant melanoma may be confused with primary malignant melanoma and presents a diagnosis challenge. Most cases are associated with disseminated diseases and poor prognosis. We present this case report of a metastatic ovarian malignant melanoma simulating primary ovarian cancer.
Case report
A 45-year-old premenopausal woman was incidentally found to have an abdominal mass, 3 years after removal of a cutaneous melanoma lesion. Ultrasound and CT scan revealed left two solid masses, which were found to be an ovarian tumor at laparotomy. Left oophorectomy was performed. Histopathology and immunohistochemistry showed melanoma metastasis to the ovary. Nine months later, the patient developed epilepsy and confusion. Magnetic Resonance Imaging showed unique Wright frontal lobe lesion. She underwent stereotactic radio surgery and dacarbazine monotherapy. For months later, the patient is died from disseminate disease progression.
Conclusion
Ovarian metastasis is an unusual presentation of cutaneous melanoma and the prognosis was dismal. As illustrated by this case report, a differential diagnosis of a metastatic malignant melanoma must be considered.
doi:10.1186/1477-7819-9-65
PMCID: PMC3157440  PMID: 21682901
melanoma; ovarian neoplasm; secondary; differential diagnosis
6.  Breast cancer treatment and sexual dysfunction: Moroccan women's perception 
BMC Women's Health  2011;11:29.
Background
This exploratory prospective study evaluated women's responses to questions that asked them to describe how their body image and sexual functioning had changed since their breast cancer diagnosis to treatment.
Methods
A questionnaire concerning body image scale and various sexual problems experienced after diagnosis and treatment was anonymously completed by 120 women in the outpatient clinic of our hospital's Division of medical Oncology. To be eligible, subjects had to be sexually active and had histology proven breast cancer. They also had to have received treatment for breast cancer.
Results
100% of participants have never spoken with their doctor about this subject. 84% of the participants continued sexual activity after treatment, but there was an increase in the incidence of sexual functioning problems which resulted in a slight reduction in the quality of their sex lives. 65% of the women experienced dyspareunia followed by lubrication difficulties (54%) and the absence or reduction of sexual desire (48% and 64%, respectively) while, 37% had lack of satisfaction (37%). Female orgasmic disorder and brief intercourse and arousal were reported respectively by 40% and 38% of the subjects. The sexual dysfunctions were absent before diagnosis and management of breast cancer in 91.5% subjects and of these 100% subjects complained of a deterioration of the symptomatology after the various treatments. 90% of the dysfunctions were observed after chemotherapy, 9% after surgery and 3% after radiotherapy; none of the subjects indicated the onset of dysfunctions to have been associated with hormonotherapy. 100% expressed not having received sufficient information about how the disease and treatment (including surgery) might affect their sexual life.
Conclusion
Breast cancer and its treatment may result in significant difficulties with sexual functioning and sexual life. Addressing these problems is essential to improve the quality of life of Moroccan women with breast cancer.
doi:10.1186/1472-6874-11-29
PMCID: PMC3143933  PMID: 21668971
7.  Thyroid carcinoma presenting as a dural metastasis mimicking a meningioma: A case report 
Context:
Follicular thyroid cancer rarely manifests itself as a distant metastatic lesion.
Case Report:
We report a case of a 41-year old man presented with a solid mass located in the left temporo-occipital region. The 3D computed tomography showed a large solid mass with high vascularity, skull erosion and supra-infratentorial epidural mass effect. After magnetic resonance imaging (MRI) a suspect diagnosis of meningioma was made. The patient underwent surgery where a soft mass with transverse sinus invasion was encountered; the tumour was successfully resected employing microsurgical techniques. Histological examination revealed a thyroid follicular neoplasm with positive staining for follicular carcinoma in immunohistochemical analysis. Postoperatively levels of thyroid hormones were normal. Treatment was planned for the thyroid gland, patient receiving 6 courses of chemotherapy including paclitaxel.
Conclusions:
The present case emphasizes that although they are uncommon, dural metastasis can be mistaken for meningiomas. The definitive diagnosis of a meningioma should be established only after the histopathological analysis. Thyroid follicular carcinoma should be included in the differential diagnosis in cases of extrinsic tumoral lesions.
doi:10.4297/najms.2011.339
PMCID: PMC3336932  PMID: 22540062
Metastasis; thyroid follicular carcinoma; meningioma
8.  Estimation of the cost of treatment by chemotherapy for early breast cancer in Morocco 
Background
Breast cancer is the first cancer in women both in incidence and mortality. The treatment of breast cancer benefited from the progress of chemotherapy and targeted therapies, but there was a parallel increase in treatment costs. Despite a relatively high incidence of many sites of cancer, so far, there is no national register for this disease in Morocco.
The main goal of this paper is to estimate the total cost of chemotherapy in the early stages of breast cancer due to its frequency and the chances of patients being cured. This study provides health decision-makers with a first estimate of costs and the opportunity to achieve the optimal use of available data to estimate the needs of antimitotics and trastuzumab in Morocco.
Method
We start by evaluating the individual cost according to the therapeutic sub-groups, namely:
1. Patients needing chemotherapy with only anthracycline-based therapy.
2. Patients needing chemotherapy with both anthracycline and taxane but without trastuzumab.
3. Patients needing trastuzumab in addition to chemotherapy.
For each sub-group, the protocol of treatment is described, and the individual costs per unit, and for the whole cycle, are evaluated.
Then we estimate the number of women suffering from breast cancer on the basis of two data bases available in Morocco.
Finally, we calculate the total annual cost of treatment of breast cancer in Morocco.
Results
The total cost of breast cancer in Morocco is given in Moroccan dirhams (MAD), the US dollar at the current exchange rate (MAD 10 = USD 1.30) and in international dollars or purchasing power parity (MAD 10 = PPP 1.95).
The cost of a therapy with trastuzumab is 8.4 times the cost of a sequential chemotherapy combining anthracycline and taxane, and nearly 60 times the cost of chemotherapy based on anthracycline alone.
Globally, between USD 13.3 million and USD 28.6 million need to be devoted every year by the Moroccan health authorities to treat women with localized breast cancer in keeping with international recommendations.
Discussion
According to our estimation methods, the complete cost of adjuvant chemotherapy including trastuzumab will range from 1.3 to 2.4% of the global budget of the Moroccan Health Department (MAD 9.8 billion or USD 1.274 billion). Unfortunately, only one-third of the Moroccan population has healthcare insurance whereas for each patient the treatment with chemotherapy alone costs 1.15 times the annual minimum income (MAD 23,710 or USD 3,082), and treatment requiring both chemotherapy and trastuzumab costs 9.76 times the annual minimum income. For the tumour over expressing HER2Neu, we need to treat 25 women in order to save (cure) one woman: the calculated cost for one life saved is USD 663,000. The question is, is it cost-effective for an emerging country?
Conclusion
In this paper we aimed at evaluating the total cost of chemotherapy in the early stages of breast cancer in order to provide health decision-makers with a first estimation and a good opportunity for the optimal use of available data for the needs of antimitotics and trastuzumab in Morocco. Different protocols were considered and the individual cost of the whole treatment was given according to therapies using anthracycline alone, sequential chemotherapy combining anthracycline and taxane, and sequential chemotherapy with trastuzumab. According to our estimations, Moroccan health authorities need to devote between USD 13.3 million and USD 28.6 million every year in order to treat women suffering from localized breast cancer in ways consistent with international recommended standards.
doi:10.1186/1478-7547-8-16
PMCID: PMC2942794  PMID: 20828417
9.  Primary lymphoma of the head and neck: two case reports and review of the literature 
Cases Journal  2008;1:426.
Background
The head and neck is the second most common region for the extra-nodal lymphomas after that of gastrointestinal tract. Approximately 2.5% of malignant lymphoma arises in the oral and para-oral region. In this paper we report two cases of early stage head and neck lymphoma which were managed successfully with chemotherapy and a review of the related literature.
Cases presentation
The first case concerns a 48 years male patient having a diffuse large B-Cell lymphoma of the oropharynx at early bulky stage. This patient was managed successfully with 7 of Rituximab 375 mg/m2, Cyclophosphamide 750 mg/m2 d1, Doxorubicine 50 mg/m2 d1, Vincristine 1.4 mg/m2 d1, and prednisone 50 mg/m2 d1-5 (RCHOP) regimen. The second case concerns a 50 years female patient having the nasal natural killer (NK)/T-cell lymphoma of the left nasal pit at early stage. This case was managed successfully with 6 of Cyclophosphamide 750 mg/m2 d1, Doxorubicine 50 mg/m2 d1, Vincristine 1.4 mg/m2 d1, and prednisone 50 mg/m2 d1-5 (CHOP) regimen.
Conclusion
These two cases highlight the important role of CHOP based chemotherapy for achieving successful treatment cure for patients having an early stage head and neck lymphoma.
doi:10.1186/1757-1626-1-426
PMCID: PMC2639388  PMID: 19116013

Results 1-9 (9)