Novel Association of IGF2BP2 Gene Variants With Altered Risk of Breast Cancer and as Potential Molecular Biomarker of Triple Negative Breast Cancer

BACKGROUND

Several studies documented that insulin-like growth factor-2 mRNA-binding protein 2 (IGF2BP2) contributes to carcinogenesis, and 1 report documented the association of IGF2BP2 rs4402960 with increased risk of breast cancer (BC). This study investigated the association of rs4402960 and rs1470579 IGF2BP2 variants with BC and triple negative BC (TNBC).

MATERIALS AND METHODS

This case-control study included 488 BC patients comprising 130 TNBC and 358 non-TNBC patients, and 476 cancer-free controls. Genomic DNA was obtained from peripheral venous blood, and genotyping was done by allelic exclusion method on real-time PCR.

RESULTS

The rs440960, but not rs1470579, minor allele was significantly associated with BC, and significantly higher rs4402960 T/T genotype frequency was noted in BC patients than controls; the distribution of rs1470579 genotypes were comparable between BC patients and controls. In contrast, significantly lower rs1470579 minor allele frequency, and reduced rs1470579 A/C and C/C, and rs4402960 T/T genotype frequencies were seen in TNBC cases. Among TNBC cases, rs4402960 and rs1470579 correlated with menses pattern, histological type, breastfeeding, oral contraceptive use and hormonotherapy. Among non-TNBC patients, and rs1470579 correlated significantly with breast feeding, oral contraceptive use, hormonotherapy, and nodal status; rs4402960 also correlated with menses pattern. Two-locus (rs440960-rs1470579) haplotype analysis confirmed the positive association of TC, and negative association of GC and TA haplotypes with BC, while TC and GC haplotypes were negatively associated with TNBC.

CONCLUSION

Whereas rs440960 was positively associated with BC, both rs4402960 and rs1470579 were negatively associated with TNBC, suggesting potential diagnostic/prognostic role in BC and its complications.

Small bowel and lung histiocytic sarcoma revealed by acute peritonitis: A case report with review of literature

INTRODUCTION AND IMPORTANCE

Histiocytic sarcoma (HS) is a rare malignant neoplasm showing morphologic and immunohistochemical features of histiocytes. It is characterized typically by extranodal presentation and a poor clinical course, particularly in cases with disseminated disease.

CASE PRESENTATION

This report documents a case of bifocal and aggressive HS in small bowel and lung revealed by acute peritonitis in a 63-year-old man.

CLINICAL DISCUSSION

Despite its rarity, we believe that the correct diagnosis of HS is crucial for clinical treatment and prognostic prediction.

CONCLUSION

The collection of additional cases of HS are important to obtain further progress in prognosis and guide treatment decisions.

Burn-out of the Medical Oncology Health Care Professionals and Associated Factors in Tunisia

Introduction: Burn-out is defined as a syndrome of emotional exhaustion, depersonalization and diminished self-achievement that affects individuals exposed to chronic occupational stress. Physicians and caregivers faced with the death of their patients, such as oncology, are particularly vulnerable to this syndrome.

Objectives: To evaluate the burn-out of medical professionals in medical oncology, to research the predisposing factors and to analyze the functional complaints and the behavior of the staff associated with this syndrome.

Methods: A descriptive and analytical cross-sectional study among medical oncology professionals practicing in public hospitals in the Tunisian territory who exercise more than two years in oncology; with the Maslach Burnout Inventory (MBI).

Results: Our study population was predominantly female (81%). 53% are doctors and 47% are paramedical health care professionals. A high degree of emotional exhaustion, depersonalization and personal achievement were found in 63%, 53% and 59% in our population, respectively. With 21% global high burn-out. The female sex was associated with high emotional exhaustion and low personal accomplishment as well as global burn-out. This burn-out was attributed to factors associated with working conditions and professional climate, mainly: overwork, poor organization of service, lack of resources and time, lack of recognition, lack of communication, lack of respect, conflicts with colleagues, report unsatisfactory salary effort and aggressions by patients and their families. Functional complaints and health care professional’s behavior associated with burn-out were: feelings of sadness, blockage, and irritability, sleep disorders, unexplained pain, epigastralgia, addictive behaviors, psychotropic consumption, suicidal thoughts, decreased performance and desire for a job transfer.

Conclusions: By its impact on professionals, burn-out in medical oncology represents a major threat to the quality of health care. Its etiologies, although complex and intricate, are well known. Its prevention and its support are possible, but involve mobilization at all levels.

Burnout and predisposing factors in medical oncology in tunisia

Introduction

Health care professionals are particularly concerned with burnout

Objectives

This study aimed to evaluate the the factors predisposing to occupational burnout

Methods

This was a cross sectional study including health care professionals in medical oncology working in public hospitals in Tunisia. It was carried out from 15 January 2019 to 15 June 2019. Health profeessionals were asked to answer the Maslach –Burnout Inventory Test.

Results

The mean age was 34 ± 6.7 years [23 - 57]. The sex ratio was 0.22. Our study population included 37 doctors (53%) and 33 nurses (47%). The inappropriate working conditions mentioned by the participants were as follows: The requirementss of patients and their families (91.5%), the lack of resources (87%), overwork found (83%), unsatisfactory effort- salary ratio (83%) and the reduced number of staff (77%). Several Burn-out factors mentioned by the participants were significantly associated with a high emotional exhaustion syndrome: overwork, poor service organization, lack of resources, lack of time, lack of recognition, conflicts with colleagues, lack of communication, unsatisfactory salary - effort ratio, assaults by patients. Several factors were positively and significantly associated with a high depersonalization score: overwork, poor service organization, small number of staff, lack of resources, lack of respect, lack of recognition. The global burnout associating the achievement of the three dimensions was significantly associated with overwork, lack of recognition, conflicts with colleagues and assault by patients.

Conclusions

Burnout has become a major issue in Tunisian medicine. If left untreated, burnout epidemic may continue to worsen, to the detriment of patients and doctors

Burnout among health care professionals in medical oncology in tunisia

Introduction

Burnout syndrome concerns 27.8% of the general working population against 37% among doctors.

Objectives

This study aimed to report the prevalence of burnout among health care professionals in medical oncology in Tunisia.

Methods

This was a cross sectional study including health care professionals in medical oncology working in public hospitals in Tunisia. It was carried out from 15 January 2019 to 15 June 2019. Health profeessionals were asked to answer the Maslach –Burnout Inventory Test. Three scores allowing to locate the burn-out state of the person: the Score of emotional exhaustion (SEE), the Depersonalization score (SD) and the Score of personal achievement at work (SAP).

Results

Le taux de participation était de 58,3%. La combinaison d’un SEE élevé, d’un SD élevé et d’un SAP bas définit le syndrome de Burn-out. Le SEE était élevé chez 44 travailleurs (63%), indiquant un épuisement émotionnel sévère. Un SD élevé a été trouvé chez 37 répondants (53%). La majorité des participants (59%) avaient un PAS faible. Le burnout est défini par l’association chez la même personne d’un épuisement émotionnel élevé, d’une dépersonnalisation élevée et d’un faible rendement personnel. Cela a été trouvé chez 15 des participants (21%). Selon l’étude analytique, le sexe féminin était significativement associé à un SEE élevé, un SAP bas et un épuisement global. Le travail de nuit était significativement associé à un degré élevé de dépersonnalisation et à un degré élevé d’épuisement général.

Conclusions

Burnout is linked to an increasingly ergonomic load. Health care professionnel, particularly in oncology, are frequently faced to this syndrome.

Maternal cancer and autism spectrum disorder: Analytical cross-sectional study

Introduction

Autism spectrum disorder (ASD) and cancer are two pathologies that appear to be different, but whose multifactorial determinism involves shared genetic and environmental factors.

Objectives

This study aimed to find an association between maternal cancer and ASD in children by comparing the frequencies of ASD between children of mothers followed for cancer and children of mothers free from cancer

Methods

We recruited, between March and August 2018, women divided into 2 groups: G1; women followed for cancer at the oncology consultation of Monastir and Sousse (N1 = 100) and G2; women free from cancer (N2 = 101). We screened their offspring aged 18 months to 11 years for ASD using the C-AQ and the M-CHAT. We confirmed the diagnosis of ASD using ADI-R in children who tested positive.

Results

Nous avons examiné un total de 332 enfants. La fréquence des enfants atteints de TSA chez les mères G1 était de 5,4%, celle des enfants de mères G2 était de 1,2 avec une association significative entre cancer maternel et TSA (p = 0,035), qui est restée significative après analyse multivariée. (p = 0,001) D’autres facteurs que nous avons trouvés associés aux TSA dans notre population sont la présence d’une expérience stressante pendant la grossesse; exposition précoce avant l’âge de 2 ans à la télévision> 2 heures par jour; antécédents psychiatriques de la mère, du père et de la fratrie et dépression post-partum.

Conclusions

Le cancer maternel et les TSA semblent partager des mécanismes étiopathogènes communs

The repercussions of burnout among health care professionals in medical oncology in tunisia

Introduction

Freudenberger was the first to define burnout as a feeling of helplessness and guilt, as well as boredom and disinterest.

Objectives

Our study aimed to analyze functional complaints and the behavior of healthcare professionals in this area associated with this syndrome.

Methods

This was a cross sectional study including health care professionals in medical oncology working in public hospitals in Tunisia. It was carried out from 15 January 2019 to 15 June 2019. Health professionals were asked to answer the Maslach –Burnout Inventory Test.

Results

The average age was 34 years ± 6.7. Burn-out was found in 15 of the participants, (21%). In our population, a high emotional exhaustion score was significantly associated with its repercussions: Sadness, Blockage, sleep disturbances, unexplained pain, Epigastralgia / fatigue, Addictive behavior ; avoidance behavior, repercussions on the relationship with those around them, desire for a transfer, regret for choosing a profession, suicidal thoughts, absenteeism and smoking. A high depersonalization score was significantly associated with several functional and behavior complaints, in particular: irritability, anger, feeling of indifference, guilt, unexplained pain, decreased performance, suicidal thoughts. A low personal achievement score was significantly associated with psychotropic drug use. Global burn-out was significantly associated with feeling of blockage, guilt, unexplained pain, epigastralgia and fatigue, addictive behaviors and avoidance behaviors as well as suicidal thoughts, absenteeism and consumption of psychotropic drugs.

Conclusions

Through its impact on professionals, burnout in medical oncology represents a major threat to the quality of care and the survival of institutions.

[Pain management in cancer patients in a Tunisian hospital]

Pain is a common symptom in cancer patients. It is subjective and difficult to communicate. It continues to be outsourced and often overlooked despite the existence of multiple recommendations. The objective of this study is to describe pain management in cancer patients in a Tunisian hospital. This is a prospective study, conducted over one month at the maternity centre of Monastir by an intern in pharmacy using a questionnaire. Of 128 patients assessed, 50 were algic. Twenty-six percent of algic patients were not treated. The neuropathic component of pain was present in 30 % of cases but under treatment. Relief opioids were prescribed in 43 % of cases to relieve pain. Paracetamol was prescribed in 26 % of cases. Ten percent of patients use paracetamol self-medication. Sixteen percent of patients have tried non-pharmacological means, of which 62 % consume plants. To optimise the management of pain at our centre, the available analgesic sheets have been developed, validated by the medical staff and disseminated in the departments of carcinology and oncohematology. Therapeutic education sessions were also scheduled to warn patients about the risks of self-medication and misuse of medicinal plants. Pain management is complex. It requires respect for international recommendations, but especially for the efforts made by all stakeholders.

[Breast cancer and pregnancy: about 15 cases collected at the maternity center Monastir, Tunisia]

Le but de cette étude était de décrire les caractéristiques cliniques, radiologiques, histologiques et thérapeutiques du cancer du sein diagnostiqué au cours de la grossesse. Nous avons effectué la revue de tous les cancers du sein diagnostiqués au cours de la grossesse dans le centre Maternité et de Néonatologie de Monastir -Tunisie, sur une période allant de 2004 à 2019. Nous avons ainsi colligé 15 cas. L'âge moyen des patientes était de 34 ans. La plupart des cancers du sein associés à la grossesse (CSAG) était diagnostiquée en post-partum. Le carcinome canalaire infiltrant était le type histologique majeur (93% de cas), un cas rare de carcinome sécrétoire a été observé. Le stade clinique était dominé par les formes T2 et T4. Les récepteurs hormonaux étaient négatifs dans 40% des cas, le récepteur HER2 était positif dans 26,6% des cas. Le traitement incluait la chirurgie, radiothérapie, chimiothérapie et palliative. La moyenne de survie est de 32,2 mois. Le cancer du sein associé à la grossesse est une entité rare. Son pronostic est globalement mauvais en raison de l'âge jeune de survenue et d´un diagnostic souvent tardif. La décision thérapeutique constitue une contrainte difficile, par nécessité, multidisciplinaire à laquelle participera la patiente. La thérapie ciblée reste le grand espoir des nouvelles thérapies.

[Cytogenic chorion sarcoma: clinical and radiological features]

Les sarcomes du stroma endométrial sont des tumeurs rares de la femme jeune. Le diagnostic est posé le plus souvent en post opératoire. Nous rapportons le cas d´une jeune fille de 22 ans admise dans un tableau de douleurs pelviennes avec métrorragies. L´imagerie a mis en évidence une masse utérine hétérogène. Le diagnostic de fibrome atypique était évoqué. Le diagnostic final est apporté par l´examen anatomopathologique de la pièce opératoire.

[Breast cancer treated with primary chemotherapy: predictive factors for radical treatment (retrospective study of 72 cases)]

La chimiothérapie néoadjuvante est devenue le traitement de première intention des cancers du sein localement avancés. Elle permet d’une part, une augmentation des chances de conservation mammaire sans pour autant une majoration du risque de récidive, et d’autre part un contrôle locorégional des formes inopérables d’emblée. Cependant, certains facteurs cliniques, radiologiques et histologiques sont associés à une augmentation du risque de mastectomie, tels que la présence de microcalcifications, la multifocalité, le grade SBR1 et 2, les stades cT3 et cT4 et la surexpression d’HER2. A partir de ce travail, nous avons cherché à déterminer les facteurs prédictifs de mastectomie après chimiothérapie néoadjuvante (CNA), si la mastectomie était justifiée ou non histologiquement et quels étaient les facteurs prédictifs de mastectomie non justifiée. Nous avons réalisé une étude rétrospective colligeant 72 patientes atteintes de cancer du sein et traité par CNA aux départements de gynécologie et d’oncologie médicale au CHU Fattouma Bourguiba de Monastir-Tunisie. Le taux du traitement conservateur était de 18,1%, il passe à 63,15% pour les tumeurs stade T2. La mastectomie n´était pas justifiée par l’histologie définitive dans 26,3% des cas. Les facteurs prédictifs de mastectomie non justifiée retrouvés dans notre étude étaient le statut RH négatif et le stade cT2. La réalisation de ce travail a conduit à une réflexion sur nos pratiques et leurs modifications. Le traitement chirurgical conservateur devra être considéré comme un standard thérapeutique et être systématiquement proposé à toutes les patientes traitées par CNA pour un cancer du sein y compris en cas de multifocalité, une taille clinique importante, des microcalcifications étendues, dans le but de diminuer de façon conséquente le nombre de mastectomies non justifiées.

[Diagnostic and therapeutic features of invasive lobular carcinoma of the breast: a study of 30 cases]

Le cancer lobulaire infiltrant (CLI) du sein représente 5 à 15% des cancers du sein, il est classé le deuxième type histologique le plus fréquent, après le cancer infiltrant de type non spécifique (CINS) et son incidence est en nette augmentation. Son diagnostic clinique et radiologique est difficile. Il est plus fréquemment bilatéral. C'est un cancer d'évolution plus lente que le CINS avec de meilleurs facteurs pronostiques notre étude vise à détailler les caractéristiques cliniques, radiologiques, thérapeutiques et pronostiques du CLI. Il s'agit d'une étude rétrospective descriptive de 30 cas de CLI du sein colligé au Centre de Maternité et Néonatologie Monastir sur une période de 10 ans. L'incidence du CLI était de 5,2%. L'âge moyen est de 53,43 ans. Dix pourcent avaient des antécédents personnels de mastopathies bénignes, 6,66% avaient des antécédents personnels du cancer du sein et 3,33% avaient des antécédents familiaux du cancer du sein. Le CLI était diagnostiqué à un stade tardif chez 18 cas. La masse était bifocale chez 5 patientes, multifocale chez 4 patientes et bilatérale chez 3 patientes. Une seule patiente avait présenté une métastase hépatique lors du diagnostic. La chirurgie radicale type Patey était réalisée d'emblée chez 63,33% des patientes. Des lésions multifocales étaient détectées dans 44,80% des cas lors de l'examen anatomopathologique. Le curage ganglionnaire était positif chez 21 patientes. Vingt-huit patientes soit 93,33% avaient bénéficié d'une radiothérapie et d'hormonothérapie adjuvante. La survie globale à 5 ans était estimée à 77,3%.

Common matrix metalloproteinase-2 gene variants and altered susceptibility to breast cancer and associated features in Tunisian women

A role for matrix metalloproteinase polymorphisms in breast cancer development and progression was proposed, but with inconclusive results. We assessed the relation of matrix metalloproteinase-2 variants with breast cancer and related phenotypes in Tunisians. This case-control retrospective study involved 430 women with breast cancer and 498 healthy controls. Genotyping of matrix metalloproteinase-2 rs243866, rs243865, rs243864, and rs2285053 was analyzed by allelic exclusion. The minor allele frequency of rs2285053 was significantly lower in women with breast cancer cases as compared to control women; minor allele frequencies of the remaining single-nucleotide polymorphisms were similar between cases and control women. The distribution of rs243865 and rs2285053 genotypes was significantly different between breast cancer patients and control subjects. This persisted when key covariates were controlled for. None of the matrix metalloproteinase-2 variants were associated with estrogen receptor positivity, progesterone receptor positivity, or with double estrogen receptor–progesterone receptor positivity in breast cancer patients. Matrix metalloproteinase-2 rs243866, rs243865, and rs243864 were positively associated with menstrual irregularity and histological type, while rs243866 and rs2285053 were negatively associated with menarche and nodal status. In addition, rs2285053 was negatively associated with triple negativity, tumor size, distance metastasis, molecular type, and chemotherapy. Haploview analysis revealed high linkage disequilibrium between matrix metalloproteinase-2 variants. Four-locus Haploview analysis identified haplotypes GCTT and GTTC to be negatively associated with breast cancer, which remained statistically after controlling for key covariates. Matrix metalloproteinase-2 alleles and genotypes, along with four-locus haplotypes, are related to reduced susceptibility to breast cancer in Tunisian women, suggesting a protective effect.

Breast diseases in women over the age of 65 in Monastir, Tunisia

As life expectancy is on the rise, it is predicted that a growing number of people will live beyond the age of 65 and therefore a higher number of elderly women will have breast diseases requiring significant health care and services. This study is aimed at investigating the characteristics, the treatment and outcomes of women older than 65 years old treated for breast diseases at our institution. This was a retrospective study covering the period from January 2003 to December 2011. It involved 92 patients aged over 65 and treated for breast disease in the Maternity Center of Monastir, Tunisia. The data included characteristics of patients and tumors, treatment and outcomes that were obtained through data extraction sheets. We reported a study of 92 women over the age of 65 of whom 77 women had malignant breast disease (83.6%) and 15 benign breast diseases (16.4%). Breast cancer was discovered at a mean age of 72.5 ± 6.6 years. Distant metastases were found in 5.3% of cases and infiltrative ductal carcinoma was detected in 85.7% of patients. Hormonal receptors were positive for estrogens in 64.7% of cases. Surgical treatment was performed in 73 patients and adjuvant treatment was prescribed for 67 women (86%). The complication rate was 16.6% among the 73 patients who underwent surgery. Benign breast diseases represented 16.3% of the mammary pathologies. Abscesses and fibrocystic mastopathy were the most frequent histological diagnoses. Despite great interest in geriatric gynecological pathology worldwide, many questions related to how optimally treat this patient population remain unanswered. In this study, a surgical treatment was performed in 94.8% of breast cancer patients and the complication rate was 16.6%.

[Genital metastases from breast cancer: study of 3 cases and literature review]

Le cancer du sein est le cancer le plus fréquent chez la femme, et son pronostic dépend en grande partie de l'existence de métastases. Le foie, le squelette et les poumons en sont les sites les plus fréquents, alors que les métastases génitales semblent plus rares et moins connues. La découverte d'une masse ovarienne chez une femme présentant un antécédent de cancer du sein pose le problème de son origine primitive ou secondaire. La fréquence rapportée dans la littérature des métastases ovariennes est d'environ 20 à 30 %. Cependant, lorsque l'on découvre une masse ovarienne chez une femme atteinte de cancer du sein, il s'agit trois fois plus souvent d'une tumeur ovarienne primitive que d'une métastase. La localisation utérine cervicale ou corporéale est encore plus rare. Leur diagnostic est souvent tardif, en raison de leur latence clinique; l'échographie, notamment par voie endovaginale et couplée au Doppler couleur, et le Frottis cervico-utérin doivent être réalisés de première intention sachant que leur rendement pour leur dépistage des masses ovariennes semble très faible. L'augmentation des marqueurs tumoraux CA 15-3 et ACE doit conduire à la recherche de métastases, mais ne fournit pas d'orientation diagnostique vers un site métastatique précis. Enfin, c'est l'examen anatomopathologique qui permettra de poser le diagnostic avec certitude. Les auteurs rapportent 3 observations de métastases génitales de cancer primitif mammaire (deux ovariennes et une cervicale utérine) soulignent l'intérêt de l'examen génital précis et régulier dans la surveillance des cancers du sein et discutent les facteurs prédictifs de leur survenue.

Adenosquamous carcinoma of the right colon: A case report and review of the literature

•

Adenosquamous carcinoma is a rare colorectal tumor with both glandular and squamous histologic component.

•

To the best of our knowledge only few cases have been reported in the literature till date.

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Adenosquamous carcinoma is a rare colorectal neoplasm with non-specific complaints.

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Its clinicopathologic behavior is not understood.

•

Preoperative diagnosis is often difficult. Surgical resection remains the mainstay of treatment.

Introduction

Adenosquamous carcinoma is a rare colorectal tumor with both an adenocarcinoma and a squamous cell carcinoma component. To the best of our knowledge, only few cases have been reported in the literature.

Case presentation

We report a case of a 46-year-old woman, hospitalized for large bowel obstruction syndrome. Computed tomography scan showed an irregular mass of the right colic angle, responsible for an occlusive syndrome with distension of the right colon, the appendix and the terminal ileum. The patient underwent right hemicolectomy with D2 lymphadenectomy. Histopathological examination revealed mixed adenocarcinoma and squamous carcinoma. Adjuvant chemotherapy was prescribed for the patient.

Discussion

Adenosquamous carcinoma is a rare colorectal neoplasm revealed by non-specific complaints. Its clinicopathology is not yet understood. Preoperative diagnosis is often difficult. Surgical resection remains the mainstay of treatment.

Conclusion

Adenosquamous carcinoma is a malignant tumor with poorer prognosis than adenocacinomas.

Factors Predictive of Quality of Life among Breast Cancer Patients

Background: Due to progress in medical care, the number of survivors from cancer has increased significantly during recent years and this raises the question of the quality of life (QoL), especially of the many women treated for a breast cancer. This paper focuses on correlations of QoL with anxiety and depression on the one hand and with socio demographic, anatomo-clinical and therapeutic parameters on the other. Methods: In this cross-sectional study, seventy patients were enrolled and filled in two auto-questionnaires, both in validated Arabic versions: The SF-36 for assessment of QoL and the Hospital Anxiety and Depression Scale (HAD-S) for evaluation of anxiety and depression. The statistical approaches used to determine predictive factors were bivariate correlations to determine relationships between quantitative variables, and T-tests and one-way Anova to analyze links between qualitative and quantitative variables. Results: The QoL of patients was altered with an SF-36 mean total score of 54.0 ± 22.7, and the alteration affects the different aspects. The mean scores for anxiety and depression in patients were 6.91 ± 4.72 and 6.24 ± 3.88, respectively. The results of this study suggested an association between the QoL and chemotherapy (p= 0.014) and its adverse effects (p=0.01), as well as anxiety (p= 0.0001) and depressive symptoms (p= 0.0001). Socio-demographic factors, the stage of the cancer, and surgery, radiotherapy or hormone therapy did not appear to have significant effects. Conclusion: The management of breast cancer patients needs a collaborative approach between oncologists, gynecologists, psychologist and psychiatrists.