Identification of G2607A mutation in EGFR gene with a significative rate in Moroccan patients with Bladder Cancer

The epidermal growth factor receptor (EGFR) is involved in the regulation of several cellular processes and in the development of many human cancers. Somatic mutations of EGFR at tyrosine kinase domain have been associated with clinical response to tyrosine kinase inhibitors (TKIs) in lung cancer patients. In this study, we evaluated the frequency of point mutations in EGFR for future use of TKI in clinical treatment of bladder cancer. A total, 50 Moroccan patient specimens with bladder cancer and 48 healthy controls were analysed for EGFR mutations in the region delimiting exons 18-21 by PCR amplification and direct sequencing. Our results showed the absence of mutations in the EGFR kinase domain in these exons in all analysed specimens. However, sequence analysis of the EGFR-TK domain, revealed the presence of (G2607A) polymorphism at exon 20. Statistical analysis showed significant difference in the frequencies of G2607A polymorphism between cancer cases and healthy controls (p=0.0001) and the frequencies of the GG and GA/AA genotypes among the cancer cases were 28% and 72%, respectively. Moreover, allelic frequencies of G2607A polymorphism showed significant difference between cancer cases and healthy controls (p=0.0025). Data analysis showed no significant association between G2607A polymorphism and patients' age, clinical stage and tumor grade (p > 0.05). However, a significant difference was found between this polymorphism and patients' sex that could be a sampling bias due to the very limited number of women with bladder cancer. Our findings highlight that, mutations in EGFR kinase domain is a rare event in bladder cancer, suggesting, that treatment of bladder cancer patients with TKI may not be effective. However, the EGFR G2607A polymorphism in exon 20 is frequent in bladder cancer cases and must be further explored for its relevance in the treatment of this disease.

[Infratemporal metastasis from a renal cell carcinoma]

INTRODUCTION

Kidney cancer, particularly clear cell carcinoma, has an unpredictable clinical course with a variable metastatic potential in time. Some metastatic sites are atypical, such as head and neck (6% of cases). We report an extremely rare case of clear cell renal carcinoma with a metastasis in the infratemporal fossa.

OBSERVATION

A 67 year old male patient, operated in 2007 for a Fuhrman grade I clear cell carcinoma of the left kidney (radical nephrectomy), consulted for swelling of the left temporo-zygomatic region. A local biopsy allowed diagnosing clear cell renal carcinoma metastases. The patient was inoperable and was treated by antiangiogenic drugs.

DISCUSSION

The recommended treatment is surgical exeresis when the metastasis is single and can be resected. Antiangiogenic therapy is an alternative in other cases.

[Temporomandibular joint primitive tumors and pseudo tumors]

The temporomandibular joint (TMJ) can be the site of bone, cartilaginous, or synovial tumors. There is no well-defined histological classification. We listed all benign tumors, malignant primitive tumors, and rare pseudo tumors of the TMJ. We provide a list to help for the diagnosis and the differential diagnosis of non-tumoral lesions by far the most frequent.

Bacteriological features of infectious spondylodiscitis at Mohammed V Military Teaching Hospital of Rabat

To review the bacteriological features of infectious spondylodiscitis and provide recommendations for the initial therapy which remains empirical in our context. Retrospective study including patients diagnosed with spondylodiscitis over a period of 4 years (2006–2009) at the Rabat Military Teaching Hospital. During the study period, we analysed 30 cases: the mean age was 49.9 years and 21 cases (70%) were male. The patients were predominantly hospitalized in neurosurgery department (15/30) followed by rheumatology department (10/30). The site of infection was lumbar in 21 cases (21/30), dorsal in 7 cases (7/30). 26 cultures were positive of which 19 (19/26) were monomicrobial. Tuberculosis (TB) was implicated in 10 cases (10/30) including 4 cases in association with common organisms (Propionibacterium acnes, Staphylococcus aureus, Staphylococcus epidermidis, Corynebacterium species). Brucella melitensis was isolated in 1 case. Infections caused by pyogenic bacteria were isolated in 15 cases of which 12 (12/15) revealed simple organisms including Gram-positive cocci in 9 cases (9/12) with 3 cases of S. aureus and Gram-negative bacilli in 3 cases (3/12) with 2 cases of P. aeruginosa. Blood cultures carried out for 16 patients were positive in 7 cases. The anatomopathologic exams carried out for 20 patients found in 6 cases epithelioid granulomata and giants cells with caseous necrosis in total concordance with TB culture. TB is the most frequent cause of spondylodiscitis in Morocco. Our study found the same frequency for non-specific and specific germs. Empirical treatment must take into account S. aureus and M. tuberculosis.

[Usefulness and predictive value of PSA density, adjusted by transition zone volume, in men with PSA levels between 2 and 4 ng/ml]

OBJECTIVE

To assess the diagnostic significance of prostate-specific antigen (PSA), density (PSAD) accuracy, and PSAD adjusted by transition zone volume (PSATZD) in men with PSA levels between 2.0 and 4.0 ng/ml.

MATERIAL AND METHODS

Between 2000 and 2010, 138 men with PSA levels between 2 and 4.0 ng/ml underwent transrectal ultrasonography (TRUS) and 12-core prostate biopsy. Diagnostic accuracies for various cut-offs of PSAD and PSATZD were investigated according to subdivided PSA levels of 2.0 to 3.0 ng/ml and 3.1 to 4.0 ng/ml.

RESULTS

The detection rate of prostate cancer was 23,8% (32/134). The percentage of patients with extracapsular disease was 28.1% (10/32) and primary Gleason grade 4 or 5 was obtained in 8/32 (25%) patients. The transition zone volume and PSATZD in cancer cases were significantly different in comparison with those in non-cancer cases. The area under the receiver operating characteristic curve for PSATZD was significantly higher in comparison with that for PSAD in the same subdivided PSA ranges. The diagnostic efficiency for PSATZD was higher than that for PSAD. The diagnostic efficiency showed the highest value at the cut-off level for PSATZD of 0.23 and 0.28 in men with PSA levels of 2.0 to 3.0 ng/ml and 3.1 to 4.0 ng/ml, respectively.

CONCLUSIONS

The use of PSATZD cut-offs as a biopsy indication may reduce many unnecessary biopsies without missing most prostate cancer cases in the PSA range of 2.0 to 4.0 ng/ml.

[Heterotopic ossification on a midline laparotomy scar after digestive surgery: etiopathogenic discussion about two cases]

Heterotopic ossification (HO) is rarely seen after abdominal surgery and usually occurs after orthopedic surgery. It is a benign affection with an unknown mechanism and an unpredictable occurrence rate; but some etiopathogenic hypotheses have been put forward. Therapeutic attitudes were not assessed in this study. We report two observations of heterotopic ossification on mid-line laparotomy scar which could support the etiopathogenic hypothesis of osteoblastic cells migration in granulation tissue from the neighbouring bone tissue, particularly from the sternum or pubian structures. The etiopathogenic mechanism and treatment of this affection are discussed with regards to previously published literature.

[Bone scan findings in a North African ethnic group and relation to PSA level and Gleason score of the biopsy]

OBJECTIVE

A number of large-scaled studies carried out in western countries have proven a positive relationship between serum prostate specific antigen (PSA) level and prevalence of positive bone scan findings, in newly diagnosed prostate cancer patients. The aim of our study is to verify that the tendency occurs as well in north-african population, as well as to establish a possible correlation between PSA level, bone scan result, and Gleason score.

MATERIAL AND METHODS

Records of 348 patients diagnosed to have prostatic adenocarcinoma were reviewed retrospectively for bone scan results, PSA levels, and Gleason score. Statistical analyses were performed using the Fisher exact test, by a statistical software (statistical package for the social sciences "SPSS", version 11.5.1, Chicago, IL) with differences at P<0,05 considered significant.

RESULTS

Based on positive bone scintigraphy 102 patients were proven to have bone metastases. None of these patients had a PSA level of less than 10 ng/ml. Six metastatic patients had PSA level between 11 and 20 ng/ml. 45 metastatic cases had serum PSA between 21 and 100. Concerning PSA level over 101 ng/ml, 51 men had positive bone scan.

CONCLUSION

Based on the PSA level, the likelihood of positive bone scan result can be postulated. According to PSA levels, staging investigations can be more selective for our patients. The risk of positive bone scan is so low that it is not required for patients with PSA level less than 10 ng/ml. On the other hand, on studying the correlation between Gleason score and PSA level or bone scan results, no statistically significant relationship was established.

[Bone mineral density change: comparison between prostate cancer patients with or without metastases and healthy men (a North African ethnic group)]

AIM

To evaluate total body bone mineral density and regional bone mineral density in patients with prostate cancer with and without metastases, and to correlate them with bone scintigraphy findings.

PATIENTS AND METHODS

135 patients with prostatic carcinoma and 50 healthy subjects were investigated with bone scintigraphy and dual-energy X-ray absorptiometry. The bone scintigraphic findings were classified as normal (score 0: n=55), abnormal but not typical for metastases (score 1: n=45), and typical pattern of metastases (score 2: n=35).

RESULTS

: The patients with bone metastases prostate cancer had significantly higher total bone mineral density and regional bone mineral density of trunk and pelvis than healthy controls and prostate cancer patients without bone metastases. There was a significant positive correlation between bone scan score and total bone mineral density and regional bone mineral density of trunk and pelvis (r=0.328; P<0.05; r=0.60; P<0.001; r=0.480; P<0.001, respectively).

CONCLUSION

Bone metastasis is a major cause of morbidity in prostatic cancer, bone loss during hormonal treatment is currently effective. Our results show that patients of prostate cancer with bone metastases have increased bone mineral density (BMD) in the pelvis and trunk, possibly because of a predominance of osteoblastic over osteolytic metastases demonstrated by (99m)Tc MDP bone scan.

Acral myxoinflammatory fibroblastic sarcoma

Acral myxoinflammatory fibroblastic sarcoma is a rare low-grade malignant soft tissue tumor, usually observed in the extremities of middle-aged patients. We report a case involving the third finger of the left hand of a middle-aged man. The tumor showed a nodular architecture, with cellular areas, occasional foci of hyalinized fibrosis, and hypocellular areas with a myxoid background. Various neoplastic cells were identified including spindled or rounded epithelioid cells and occasional bizarre giant cells, morphologically mimicking ganglion cells. Tumor cells were strongly immunoreactive for vimentin and variably positive for CD68 and CD34. The tumor was completely removed, without further treatment.

[Papillary carcinoma in a thyroglossal duct cyst, a case report: Which management]

Cysts of the thyroglossal duct are common but malignant degeneration is rare, occurring only in 1% of the cases. The most frequent histological type is papillary carcinoma. The clinical presentation of these cancers is generally nonspecific, diagnosis being established postoperatively using the Sistrunk method. Debate remains open concerning appropriate management strategies and post-therapeutic follow-up for this type of neoplasia. We report the case of a 45-year-old patient who underwent surgery for an anterior neck mass that had developed over three years. Histology favored multifocal papillary carcinoma in a thyroglossal duct remant. Total thyroidectomy was performed. The postoperative protocol, established empirically due to the absence of consensus, included radioactive iodine and hormone suppression even though the thyroid was intact. After one year of follow-up, outcome has remained favorable.

Cystic schwannoma of the cauda equina mimicking hemangioblastoma

Cystic schwannoma is highly unusual and intraspinal involvement seems to be even more rare. We report a case of intradural lumbar-cystic schwannoma in a 50-year-old man who presented with chronic low-back pain and sciatalgia, which were initially related to a bulging disc. Diagnosis of a tumor origin was suspected two years later on MRI as a hemangioblastoma. The lesion was histologically confirmed to be a schwannoma. Only eight cases of spinal schwannoma with large cyst have been previously reported. Cystic schwannoma should be considered in the differential diagnosis of lumbar intradural-cystic lesion.

[Alveolar rhabdomyosarcoma of the parotid gland]

INTRODUCTION

Alveolar rhabdomyosarcoma of salivary glands is a rare malignant neoplasm, presenting a striated muscular differentiation. It is typically observed in children, adolescents, and young adults but can sometimes be diagnosed in older people.

OBSERVATION

We report the case of a 57 year-old man presenting with a primary alveolar rhabdomyosarcoma of the parotid gland. The patient was treated by surgery and radiotherapy.

DISCUSSION

According to literature data, alveolar rhabdomyosarcoma of the parotid gland is exceptionally described after 40 years of age. In that case it has the worst prognosis and its lethality is due mainly to its very early metastasis.

[Spheno-orbital mesenchymal chondrosarcoma. A case report]

Mesenchymal chondrosarcoma is a highly malignant and extremely rare tumor of the orbit: only 18 cases have been reported to date. We report a case of spheno-orbital mesenchymal chondrosarcoma in a 36-year-old woman presented with a 4-month history of progressive left exophthalmia and temporal mass. A CT-scan of the orbit and MRI showed a spheno-orbital mass, with temporal fossa extension, fed by the internal maxillary artery visible on cerebral angiography. Surgery via a transcranial, left frontotemporozygomatic approach after selective embolization enabled subtotal removal. Definitive histologic examination revealed mesenchymal chondrosarcoma. Postoperatively, exophthalmia spectacularly regressed. We report our clinical findings and present a review of the literature.

[Ganglioneuroma of the zygoma]

INTRODUCTION

Ganglioneuroma is an uncommon benign tumor that arises from the sympathetic nervous system accounting for less than 1% of all soft-tissue neoplasms.

CASE REPORT

We report the case of a 22 year-old man who presented a ganglioneuroma localized in the zygoma.

DISCUSSION

Ganglioneuroma generally develop in the abdomen or thorax soft tissue. The occurrence of ganglioneuroma in the bone is exceptional. To date less than ten cases have been reported, six of which involved the mandible. We discuss the possible causes of tumor development at this site.

[Orbital location of Kaposi's sarcoma]

Kaposi's sarcoma is a proliferative disease, probably induced by human herpes virus type 8 (HHV8). Its expression is cutaneous and visceral, with four clinical forms. An orbital location of Kaposi's sarcoma remains exceptional. In order to evaluate the epidemiological, clinical, and therapeutic objectives of this tumor location, we report a case of a 58-year-old patient hospitalized in the ophthalmology department for a surgically treated right orbital tumor.

[A rare cause of posterior mediastinal tumors: extramedullary hematopoiesis]

We report a case of a patient with intrathoracic extramedullary hematopoiesis presenting as a posterior mediastinal tumor, without associated myelofibrosis. Pathophysiology and the options for diagnosis and treatment in this condition are discussed.

[Small cell neuroendocrine carcinoma of the bladder. A new case report]

This rare but aggressive bladder tumour presents the morphological and immunohistochemical characteristic common to all neuro-endocrine tumours observed in other organs. The authors report a case of primarymalignant neuro-endocrine bladder tumour. Combined surgery-cisplatin-based adjuvant chematherapy is recommended.

[Neuroendocrine tumor of the prostate. A case report]

We report one case of neuroendocrine tumour of the prostate in a 74 years old patient. The clinical symptomatology was dominated by pollakuria, dysuria. Digital rectal examination showed a bulky prostate, hard and irregular. The rate of PSA was high (23 ng/mL). The endorectal ultrasonography revealed a pelvic heterogeneous mass depending of prostate. The biopsy showed an adenocarcinoma of prostate. The patient underwent a transuretral resection of the prostate (TURP) and pulpectomy. Histology and immunohistochemistry through antibody anti NES and antibody antisynaptophysin of shavings of resection revealed a neuroendocrine tumour of the prostate. Twelve months after, the lung X-ray, abdominal ultrasonography and bone scintigram was normal. The rate of PSA was 2.1 ng/mL.

[Gorlin-Goltz phacomatosis: ophthalmological aspects in one case]

We report the case of a 21-year-old girl who presented an eyelid tumor with retinal hamartoma. General examination revealed a basal cell nevus on the face, jaw cysts, skeletal malformations and brain calcifications. Histological examination of the eyelid lesion and of the skin nevus showed basal cell carcinoma. Familial investigation evidenced the hereditary nature of this disease. We review Gorlin-Goltz phakomatosis, an uncommon disease often unrecognized by ophthalmologists, and discuss nosological considerations.

[Degenerated Buschke Loewenstein tumor of the scrotum]

The Buschke-Loewenstein tumour (BLT) is a sexually transmissible benign tumour of viral origin. It is characterized by a large tumour volume, the possibility of local recurrence and especially its potential for malignant transformation. We report a case of scrotal BLT in a 49-year-old patient with a history of recurrent scrotal fistula, with negative HIV serology, but in whom the search for Human Papilloma Virus (HPV) was not performed. The tumour arising from the scrotal skin was resected and the testis was found to be normal. Histology confirmed transformation of the tumour into a squamous cell carcinoma. The clinical course was favourable, after a follow-up of 8 months with no local recurrence. In the light of this case of rare tumour, especially in its malignant form and its unusual scrotal site, the authors review the problems related to clinical classification, histology (differential diagnosis with primary squamous cell carcinoma), clinical course and treatment raised by this tumour.