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Background: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. GIST are rare during pregnancy. We report here the case of a patient who was admitted in our university hospital for GIST discovered during the second trimester of pregnancy. She was 42 years old, in the fifth months of pregnancy. She was admitted for biliary colic pain with vomiting. On abdominal examination, we objectified a distended abdomen with uterine height of 18 cm and epigastric mass of 10 cm. Abdominal ultrasound and magnetic resonance imaging (MRI) showed a hepatic, tissue and cystic mass, developing at the expense of the left liver. Endoscopy objectified an aspect of extrinsic compression at the front of the stomach. A cesarean was scheduled at the 35 th month of pregnancy for fetal extraction and rescue. Exploration of the peritoneal cavity during surgery has objectified a hepatic highly vascularised mass reaching up to the umbilicus. This mass was unresectable. A postoperative CT scan revealed a large bilobed epigastric mass adhering to the stomach and the left liver. Histological and immunohistochemical study of hepatic process showed a gastrointestinal stromal tumor of high risk of malignancy. Conclusion: few cases have been reported in the literature on GIST during pregnancy showing the rarity of the condition that requires multidisciplinary care.

Unlike primary pancreatic carcinoma, metastatic lesions of the pancreas are uncommon and account for approximately 2% of pancreatic malignancies. Small-cell lung carcinoma (SCLC) represents a group of highly malignant tumors giving rise to early and widespread metastasis at the time of diagnosis. However, the pancreas is a relatively infrequent site of metastasis by this neoplasm, and reports on metastatic small-cell carcinoma (SCC) in the pancreas, either of pulmonary or extrapulmonary origin, to be diagnosed by CT-scan-guided trucut biopsy (CT-TCB) are very rare. A 56-year-old man presented with a laterocervical lymphadenopathy associated to a mixed-density lung mass and a mass in the pancreatic body. CT-TCB slides from the pancreatic mass contained small, round tumor cells with extensive nuclear molding. The cytomorphological and histological diagnosis was metastatic SCC. Immunocytochemical staining showed that a variable number of neoplastic cells were positive for cytokeratin 7, TTF1, chromogranin A, and synaptophysin but negative for leukocyte common antigen and cytokeratin 20 with a very high expression of KI67. The transbronchial needle biopsy confirmed the diagnosis of an SCC. This case represents a rare metastatic lesion in the pancreas from SCLC, diagnosed by CT-TCB histological and immunohistochemical studies.

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e14725 Background: Signet ring cell carcinoma (SRC) of the stomach is a histological type based on microscopic characteristics, and its clinicopathologic characteristics and treatment are still controversial. Methods: In this retrospective study, we reviewed the records of 68 patients diagnosed with gastric SRC treated between January 2007 and July 2011. The aim of this study is to identify the epidemiological, clinical and therapeutic features of this type cancer in a Moroccan population Results: In our study, SRC of the stomach represents 39 % of the gastric cancer and 11 % of all the digestif tract cancer. The mean age at the diagnosis was 46 years ranged from 25 to 80 years, 68 % were female. The clinical symptoms were vomiting (72%), epigastric pain (70%) and deterioration of Performans Status (93%). 73% of the patients were metastatic at the diagnosis, sites of metastasis were: peritoneum (85 %), lymphatic nodes (43 %), liver (35%), lung (28 %), ovaries (7 %), adrenal glands (7 %), bone (4 %) and the kidney (2 %). 23% of the patients had a localized disease and locally advanced 8%. Among the 64 patients, 27% were treated with curative intent by total gastrectomy followed by adjuvant concomittant chemoradiotherapy (n=6), adjuvant chemotherapy (n = 4) or perioperative chemotherapy (n=7). For the metastatic patients, chemotherapy regimens were distributed as following: ECC (Epirubicine 50 mg/m2, Cisplatine 60 mg/m2, Capecitabine 625 mg/m2/12h) was administred to 45 % of the cases, cisplatine-5FU to 18 % of the cases, capecitabine as monotherapy for 16 %; FUFOL Mayo clinic regimen for 9 % and EOX (Epirubicine 50 mg/m2, oxaliplatine 130 mg/m2, capecitabine 625 mg/m2/12h) for 5%. 7% of the patients were oriented to supportive care. A second line of chemotherapy was administed to 4 patients based on XELIRI (irinotecan 250 mg/m2 and capecitabine 2000mg/d for 14 days) in 3 patients and XELOX (oxaliplatine 85 mg/m2 and capecitabine 2,000mg/d for 14 days) in one patient (n = 1). Conclusions: The gastric Signet ring cell carcinoma represents an entity with specific characteristics, which tends more toward tumor invasion depth, with nodal and peritoneal metastases. Our results are consistent with those of the literature concerning the epidemiological finding and diagnosis aspects.

e14726 Background: Biliary tract cancers (BTC) are relatively rare (3% of digestive cancers), they mainly affect older women and are located in the gallbladder in about 70% of the cases. Methods: In this retrospective study, we reviewed 63 cases of BTC admitted in the medical oncology unit of HASSAN II university center between January 2007 and December 2011. The aim of this study is to define epidemiologic, diagnostic and therapeutic aspects of this disease in a Moroccan population. Results: In our study, BTC account for 4,9% of digestive cancers. The mean age of our patients was 58,2 years ranged from 32 to 81 years, female gender represent 69%. The tumors were located in the gallbladder (GB) in 70% of the cases divided into adenocarcinoma (79%) and squamous cell carcinoma (21%). The other locations were hilar cholangiocarcinoma (24%) and intrahepatic cholangiocarcinoma (6%). Magnetic resonance cholangiographic was performed (n=15) and suspected cancer in all cases. Incidental finding of GB cancer at surgery was recorded in 21 patients: intraoperatively in 8 cases or after pathological study in 13 cases. Staging of the disease was divided into localized stage (7%), locally advanced stage (13%) and metastatic stage (80%). A complete surgery in GB cancer was performed in 13 patients, a palliative surgery was done in 20 patients: cholecystectomy (n=7) and biliary drainage (n=13). For metastatic patients (n=44), a palliative chemotherapy was administred as following: combination of cisplatin and gemcitabin (n=18), gemcitabin (n=7), combination of cisplatin and 5 fluoro uracile (n=5), combination of oxaliplatin and gemcitabin (n=3), capecitabine (n=3), FUFOL Mayo clinic (n=2) and combination of capecitabine and oxaliplatin (n=2). While 9% of the patients received supportive care because of their comorbidities and the deterioration of the performans status and liver blood tests. Conclusions: Because of the silent evolution of BTC, the diagnosis is therefore delayed, the prognosis is poor and treatment is usually palliative. Our results are consistent with those of the literature concerning the epidemiological finding and diagnosis aspects.A multidisciplinary approach is recommended to improve the prognosis of patients with BTC.

e11502 Background: Few studies demonstrated that surgical resection of the primary tumor in patients with metastatic breast cancer at diagnosis is associated with significant improvement of survival. The aim of this study is to evaluate the correlation impact of local surgery in metastatic breast cancer at diagnosis with molecular subtypes. Methods: A retrospective study was conducted from 2007 to 2011 in our institution, of all stage IV breast cancer patients; who undergo breast surgery. Clinical , tumor characteristics, molecular subtypes, prognostic factors, therapeutic results data were analyzed. Results: We selected 59 cases. The mean age was 36 years (range: 22-44). 55 % women presented with locally advanced breast cancer with 13% T4 d . All patients underwent mastectomy except 4 who underwent conservative surgery .41 patients had axillary lymph node dissection. 63% were luminal A, 17% were luminal B, 7% were Her2-positive and 13% were basal-like . All patients received anthracycline based regimen and only 33% received taxanes. Loco regional radiotherapy (RT) was given to 6 women. Average follow-up was 13 months: - 20 patients represented partial response : 15 patients in luminal A , 3 patients in luminal B ,1 patients in basal-like and 1 patient in HER2-positive. - 11 patients (19%) were stable : 9 patients in luminal A and 2 patient in luminal B . -24 patients represented a progressive disease including 11 patients presented locoregional recurrence : 75 % in HER-positive, 40 % in basal-like, 50% in luminal B and 30% in luminal A (p=0.4). - 4 patients died in basal-like. The median local recurrence-free survival was 19 months and the median progression-free survival was 20 months. The local relapse is less observed in patients who: have a small tumor size (p = 0.003), had axillary lymph node dissection (p = 0.02) and loco regional radiotherapy (p = 0.03). The metastatic progression is less observed in patients with small tumor size (p = 0.01). Conclusions: Local Therapy of the primary tumor improves local control of disease, particularly in women with Small tumors. However, no significant correlation between impact of locale therapy and Molecular Subtypes was observed.