Extrapulmonary small cell carcinomas are extremely rare, accounting for 0.1-0.4% of all malignancies and 2.5-4% of small cell carcinomas. In the head and neck region, the most common primary sites are the larynx, salivary gland, nasal cavity, paranasal sinus, tonsil, and oral cavity. Small cell carcinomas occurring in nasopharynx are exceedingly rare, to our best knowledge, only four cases of primary nasopharyngeal small cell carcinoma have been described in English literature. We report another case of nasopharyngeal small cell carcinoma arising in a 46-year-old woman. She accused, for five months, nasal blockage, right hypacusia, exophthalmos and reduced visual acuity. Cerebral and facial magnetic resonance imaging showed an extensive mass of the nasopharynx with the invasion of the sphenoidal body, the diagnosis of disseminated small cell carcinoma of nasopharynx was established. The patient received three courses of systemic chemotherapy; unfortunately, she died after the third course. The prognosis of such entity is poor and is similar to that for patients with extensive small cell lung cancer.
Multiple Myeloma is a blood cancer type B characterized by clonal proliferation of malignant plasma cells. The median age at diagnosis is 70 years. Cases among younger patients are rare, and less than 0,3% patients are younger than 30 years in most series. We report a case of a 25-year-old women. She was suffering from a sacred pain radiating towards the left lower limb and fatigue for three months. A magnetic resonance imaging for dorso-lumbar spine showed an extensive process and multiple osteolytic lesions in second, third and fourth sacred vertebras. She underwent a laparotomy that revealed a dense mass invading the sacrum and the rectum. The histological examination with immunocytochemistry analysis showed a plasmocytoma and the diagnosis of symptomatic multiple myeloma stages III established than she received two courses of chemotherapy. Despite the rarity of multiple myeloma among young patients, this diagnosis should be evoked when clinical, biological and radiological signs are in favor. It appears that there is no difference between younger and elderly patients on the presentation of the disease, although a longer survival reported among young patients.
Basal cell carcinoma is the most common skin cancer, characterised by a slow growing behavior, metastasis are extremely rare, and it occurs in less than 0, 1% of all cases. Giant basal cell carcinoma is a rare form of basal cell carcinoma, more aggressive and defined as a tumor measuring more than 5 cm at its largest diameter. Only 1% of all basal cell carcinoma develops to a giant basal cell carcinoma, resulting of patient's negligence. Giant basal cell carcinoma is associated with higher potential of metastasis and even death, compared to ordinary basal cell carcinoma. We report a case of giant basal cell carcinoma metastaticin lung occurring in a 79 years old male patient, with a fatal evolution after one course of systemic chemotherapy. Giant basal cell carcinoma is a very rare entity, early detection of these tumors could prevent metastasis occurrence and improve the prognosis of this malignancy.
We are reporting a case of multifocal reversible leucoencephalopathy syndrome induced by chemotherapy based on Folfox-Bevacizumab regimen. A 44-year-old female, with no history of hypertension, received a chemotherapy based on Folfox-Bevacizumab for her metastatic colon cancer (5 FU: 325 mg/m2 d1 by intravenous infusion, Oxaliplatin 80 mg/m2 d1, and Bevacizumab: 7.5 mg/Kg d1). During the fourth cure, she presented delirium, seizures, and visual disturbances. The computed tomography (CT) of the brain showed hypodense lesions of the white matter of frontal, parietal, and occipital lobes, which were bilateral and symmetrical. The clinical table was reversible under symptomatic treatment.
BackgroundEncephalopathy is a rare but serious central nervous system toxicity of ifosfamide. Its clinical symptoms are confusion, stupor, seizures, hallucinations and blurred vision.1 The methylene blue (MB) is administered as an antidote to the encephalopathy.PurposeDescription of MB formulation and control quality analysis of the preparation and safety case of encephalopathy associated with ifosfamide in the absence of MB injectable in the pharmaceutical market in the country.Material and methodsInitially the MB solution 10 mg/ml for intravenous administration was prepared. A disposable closed system transfer device with filter 0. 15 µm was used, so as to perform a sterile filtration. Next, an analytical control of drug substance and drug product was carried out in accordance with United States Pharmacopoeia. Finally, the preparation was administrated to the patient.ResultsA 60-year-old woman had a uterine leiomyosarcoma in February 2016. The patient received the first cure of doxorubicin (20 mg/m2), ifosfamide (2.5 g/m2) and mesna (2.5 g/m2). On the third day of treatment, the patient had obnubilation and awareness troubles. Ifosfamide-induced encephalopathy was suspected. A treatment with MB was proposed, but unfortunately the product is not marketed in the country. The MB was prepared at the pharmacy with serum glucose 5%: every 1 ml contains 10 mg of drug substance. It has the same visible absorption spectrum as the MB standard solution, contains less than 2.5 USP endotoxin unit per ml, has an osmolality of 308 mmol/Kg, a pH of 4.76 and the preparation was sterile. The drug substance was identified with infrared absorption, The patient received the MB solution in a dose of 6×50 mg day-1. The encephalopathy was resolved with recovery at the neurological level.ConclusionThe MB continues to be an effective antidote for encephalopathy associated with ifosfamide. As was seen in our patient, a dose of 6×50 mg day-1 was sufficient for the management of encephalopathy. Our result is consistent with a previous report.Reference and/or Acknowledgements1. Pelgrims J, De Vos F, Van den Brande J, Schrijvers D, Prové A, Vermorken JB. Methylene blue in the treatment and prevention of ifosfamide-induced encephalopathy: report of 12 cases and a review of the literature. Brit J Cancer2000;82(2):291–294.No conflict of interest
Le leiomyosarcome représente une tumeur rare de la vessie. Sa présentation clinique est non spécifique et dominée par l'hématurie. La résection endoscopique de la vessie avec un examen anathomopathologique permet de poser le diagnostic. La rareté de cette localisation ne permet pas d’établir une stratégie thérapeutique standard, néanmoins la chirurgie reste le traitement le plus utilisé. Nous rapportons le cas d'une patiente âgée de 64 ans, ayant présenté une hématurie. L'examen anatomopathologique d'une résection endoscopique de la vessie a posé le diagnostic d'un leiomyosarcome.
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