Issue No. 23 - Jan 2017

Multi-detector Computed Tomography (MDCT) Findings of Seven Cases with Spontaneous Regression of Hepatocellular Carcinoma

Adel El-Badrawy
Radiology Department, Mansoura Faculty of Medicine, Mansoura, Egypt


Purpose: To review Multi-detector CT findings of seven cases with spontaneous regression of hepatocellular carcinomas (HCC).

Materials and methods: This retrospective study included 7 patients confirmed with diagnosis of HCC. Triphasic CT scan using multi-detector CT scanner was done for all patients. They were 2 women and 5 men. 1st patient presented with metastatic HCC underwent fine needle aspiration cytology (FNAC) from vertebral metastasis. 2nd patient underwent only one session of trans-arterial chemo-lipidol. 3rd patient exposed to blunt trauma with rib fissure fracture. 4th patient presented with two HCCs underwent radio-frequency ablation of one lesion. 5th patient underwent FNAC from HCC and exposed to fracture acetabulum. 6th and 7th patients underwent FNAC from hepatic focal lesions.

Results: Complete regression of primary HCC and metastases occurred in 1st patient. 2nd patient showed partial lipidol uptakes of HCC with complete regression of HCC on follow up. Incomplete regression of HCC detected in 3rd, 6th and 7th patients. Partial regression of nonablated lesion detected in the 4th patient. Complete regression of HCC occurred on 5th patient.

Conclusion: Spontaneous regression of HCC is an interesting phenomenon. It has been hypothesized that invasive techniques and trauma may be linked. They may initiate immunologic mechanisms that may be involved in the regression. More reports and accumulation of such cases should help to clarify the mechanisms, contribute to a further understanding of this phenomenon and may lead to a new treatment strategy for HCC.

Keywords: computed tomography, spontaneous regression, hepatocellular carcinoma

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2 15-20

A Retrospective Study of Clinical Profile and Long Term Outcome to Imatinib Mesylate Alone in Childhood Chronic Myeloid Leukemia in Chronic Phase


Sonia K. Parikh, Asha Anand, Harsha Panchal, Apurva Patel, Sandip Shah, Kalpesh Prajapati, Gaurang Modi, Nitin Joshi
Department of Medical and Pediatric Oncology, The Gujarat Cancer and Research Institute, Ahmedabad, Gujarat. INDIA


Objective: Chronic myeloid leukemia (CML) is relatively rare malignancy in childhood. There are limited studies of use of Imatinib Mesylate (IM) alone in management of CML in this age group.

Method: We retrospectively analyzed the outcome of 30 consecutive children with CML chronic phase treated with IM alone.

Results: The median age at the time of diagnosis was 11 years with male preponderance. Asthenia and abdominal discomfort due to splenomegaly were the most common presenting features and splenomegaly a dominant sign. At time of starting IM, 19 children were in early CP while 11 were in late CP. Complete hematological remission was achieved in 90% with a median time to achieve CHR was 60 days. Among evaluable children, 83.3% achieved cytogenetic response (CyGR). Those who achieved complete CyGR were in major molecular remission at the time of last follow up. At 3 years, progression-free survival was 81.5% and overall survival was 100%. At 10 years, 12 (40%) children failed on IM therapy of which 3(10%) children developed primary IM resistance while 9 (30%) developed secondary IM resistance. IM was well tolerated and severe (grade III-IV) events were infrequent. Non-haematological toxicities were uncommon except hypopigmentation of skin which was seen in 60% of the cohort.

Conclusion: Presenting features of CML-CP in children is comparable to other Indian and international studies. IM is very effective and safe drug for the first line treatment of CML-CP in children. It is very effective in inducing CHR. Adherence to treatment is very important for achieving CyGR and long term survival. This data will be useful for financially deprived children in developing countries where allogeneic stem cell transplant (SCT) or second line tyrosine kinase inhibitors (TKIs) is not an affordable option.

Keywords: Pediatric hematologic malignancies, Chronic Myeloid leukemia, Cytogenetics, Imatinib Mesylate

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3 21-25

Myeloid Sarcoma as the First Sign of Progression of Chronic Myeloid Leukemia in Medullary Chronic Phase: Experience from a Tertiary Cancer Centre in Southern India


Lokanatha Dasappa, Aditi Harsh Thanky, Lakshmaiah Chinnagiriyappa Kuntegowdanahalli, Govind Babu Kanakasetty, Linu Abraham Jacob, Suresh Babu Chikkadasappa Mallekavu, Rajeev Krishnappa Lakkavalli, Lokesh Nagendrappa Kadabur, Rudresha Haleshappa Antapura
Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, India


Introduction: Myeloid sarcoma (MS) in chronic myeloid leukemia (CML) is a rare entity which is suggestive of advanced phase of the disease and poorer outcomes. There is little data in literature available regarding its presentation in medullary chronic phase (CP) as well as outcomes in the era of tyrosine kinase inhibitors (TKI) and needs to be carefully evaluated as it can present the first sign of progressive disease before haematological progression.

Methods: We identified cases of MS presenting with medullary CML-CP from January 2002 to December 2015. We analyzed their clinical profile and outcomes with TKI.

Results: Only 8 out of 615 CML-CP cases developed MS. Median age of presentation was 43 years with male: female ratio of 1.7:1. Sites of presentation were soft tissue deposits (7 cases) and lymph nodes (2 cases). All the cases had myeloblastic morphology. With higher dose Imatinib/Nilotinib, median overall survival was 14 months with longest survival of 36 months in a case on Nilotinib while 4 patients progressed to medullary BP at a median duration of 9 months (2-10) and expired.

Conclusion: MS in medullary CML-CP carries better prognosis than medullary CML-BP. Due to rarity of presentation, MS presenting in soft tissues might be overlooked as an infection/hematoma unless proven otherwise. Our series emphasizes the need of meticulous examination and investigation of such presentations for earlier intervention to improve patient outcomes.

Keywords: myeloid sarcoma, chronic myeloid leukemia, chronic phase

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4 26-32

Postoperative Radiotherapy in Salivary Gland Carcinoma: A Single Institution Experience


Öztun Temelli1, Ersoy Kekilli2, Ahmet Kizilay3
1 Department of Radiation Oncology, 2 Department of Nuclear Medicine, 3 Department of Otolaryngology, School of Medicine, Inonu University, Malatya, Turkey


Background: Salivary gland carcinoma are rare tumors and the main treatment is surgical. The addition of radiotherapy to surgery decreases locoregional relapses in high risk patients. Aim of our study is to retrospectively evaluate local control and survival and the factors affecting them in patients who received postoperative radiotherapy.

Materials and methods: The medical records of 30 patients with salivary gland tumors operated on and referred to our clinic for adjuvant RT between January 2004 and June 2015 were retrospectively evaluated. RT was applied to the primary tumor or its lymphatics in a median dose of 60 Gy (48-66 Gy) in 1.8-2 Gy/fraction. The number of patients receiving concomitant chemotherapy was 8 (27%) and 22 (73%), respectively.

Results: The mean duration of follow-up was 47 months (range: 3-132 months). The mean duration between surgery and RT was 51 days and mean duration of RT was 43 days. Tumors were located in the parotid gland in 25 patients (83%), in the submandibular gland in four patients (14%), and in the sublingual gland in one patient (3%). Histopathologically, the most common tumor was adenoid cystic carcinoma (27%), followed by mucoepidermoid carcinoma (20%), and skin SCC metastatic to the parotid gland. Five-year overall survival (OS), five-year disease specific survival (DSS), and five-year disease free survival (DFS) were 50%, 50%, and 54%, respectively. Regional recurrence and distant organ metastasis developed in 5 (17%) and 9 (30%) patients, respectively. OS, DSS, and DFS were significantly decreased in patients with lymph node metastasis compared to the patients with no metastasis (p=0.002). DFS was better in Stage 1-2 patients compared to Stage 3-4 patients (p=0.019). OS and DFS were significantly in radiotherapy time in less than 45 days (p=0.01). A duration between surgery and radiotherapy of more than 42 days was associated with low DFS (p=0.042). No prognostic significance of age, gender, type of the salivary gland, T stage, tumor diameter, surgical margin, PNI, LVI, and extracapsular involvement was found among the other variables.

Conclusion: Adjuvant RT is an efficacious and safe method of treatment in high risk patients operated on for salivary gland tumor.

Keywords: Radiotherapy, salivary gland carcinoma

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5 33-36

Study of Serum Carcinoembryonic Antigen’s Profile for Breast Cancer in Western Algeria: 100 cases


Zineb Tahari1,2, Asmahane Medjdoub1,2, Tewfik. Sahraoui1, Leila Belhabri3, Fatima Zohra El Kebir1
1 Laboratory of Developmental Biology and Differentiation, Faculty of Natural Sciences and Life, University of Oran1, Ahmed Ben Bella, Oran, Algeria.
2 Faculty of Natural Sciences and Life, University of Sciences and Technology Mohamed Boudiaf, Oran, Algeria
3 Pasteur Institute of Oran, Gambetta Sylvain Parent Cave Gay Street, Oran, Algeria


Background: Breast cancer is the most common cancer in women worldwide. Biology contributes to the early diagnosis and monitoring of breast cancer with several categories of markers such as prognostic markers (ER, PR, HER2), proliferative markers (Ki67), and tumor markers such as CEA and CA 15-3. CEA can be detected at a high concentration in serum of patients with malignant tumors. Aim: The aim of our study was to evaluate the concentrations of CEA in serum of women with breast cancer and to verify the existence of a possible link between the average rates of CEA and SBR grade.

Methods: Serum samples from 100 patients with breast cancer and 100 controls was recovered and examined with an AxSYM analyzer (Abbott Laboratories, USA) to measure CEA using Microparticle Enzyme Immunoassay (MEIA) technology.

Results: In our clinical study, the mean age of patients and controls were 52.7 and 50.3 years respectively. The results revealed an elevation in the CEA levels from patients with an average value of 16.61 ± 0.2 ng/ml. Positive correlation was found between CEA concentrations and SBR grade, it has found with 45,7 ± 1 ng/ml in grade III.

Conclusion: CEA represents an excellent marker for breast cancer development. Changes in its concentration reflect the effectiveness or ineffectiveness of treatment.

Keywords: Breast cancer, tumor markers, CEA, SBR grading, prognosis

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6 37-43

Symptom Prevalence of Patients with Cancer in a Tertiary Cancer Center in Jordan


Alia Alawneh, Huda Anshasi, Ghaleb Khirfan, Hesham Yaseen, Anood Quran
King Hussein Cancer Center, Jordan


Background: Prevalence of symptoms experienced by patients with cancer was studied in different parts of the world. In Jordan, to the best of our knowledge, there is no published data on the prevalence of symptoms among patients with cancer. The aim of this study is to estimate the prevalence of symptoms among patients with cancer in Jordan.

Method: This was a secondary analysis of cross-sectional survey that evaluate the psychometric properties of the Arabic version of the European Organization for Research and Treatment of Cancer Quality of Life 15 items Questionnaire for Palliative Care (EORTC QLQ-C15-PAL) among patients admitted to a tertiary cancer center in Jordan.

Results: A total of 175 patients with cancer participated in the study; 51.4% were males, 48.6 % were females, mean age of patients was 50 years. Median number of symptoms per patient was 6, interquartile range was 5-7. The majority of patients (143; 81%) had more than 3 non-pain symptoms each. The most frequently reported symptom was tiredness (82%), whereas the least prevalent symptom was depression (55%). Pain was prevalent in 71% of patients, median severity score was 50%.

Conclusion: Patients with cancer suffer from a large constellation of symptoms, frequent assessment with a designated tool can help early identification of these symptoms and subsequent management. This highlights the need for integrated palliative services along with other health care provision.

Keywords: Cancer, symptom, prevalence, Jordan, Arabic EORTC

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7 44-51

The Possible Role of Diabetes in the Etiology of Laryngeal Cancer


Roberto Menicagli1, Gianni Bolla2, Laura Menicagli2, Anastassia Esseridou3
1 RomaBiomed Research Lab, Mediglia, Italy.
2 University of Milan, Faculty of Medicine, Dept. Of Clinical Sciences, Italy.
3 IRSS Policlinico San Donato, University of Milan, Italy


Background: Laryngeal cancer and oral cancer are not always correlated with genetic mutations, HPV infection, smoking, and alcohol abuse. In the absence of these risk factors, there is an increase on these cancers with a parallel increase of diabetes. The aim of this study is to verify if diabetes could be a risk factor for the laryngeal cancer.

Methods: A questionnaire was given to a group of ninety laryngectomees to verify if these patients have presented diabetes and xerostomia before surgery. In two groups, diabetics and healthy persons, the values of the salivary mucins and the pH were evaluated. The results were statistically analysed using Fisher Exact Test and Chisquare Test

Results: Diabetes is a risk factor: p= 0.0445 for laryngectomees male vs control group. Xerostomia inlaryngectomees male is a risk factor: p= 0.050. The values of mucins and pH in diabetic group show significant difference: p=0.05 vs control group

Discussion: In all autoimmune diseases, a decrease in the value of pH and salivary flow consequently decreases the value of spinnbarkeit which measures the capacity of the mucous layer to adhere to the epithelium and alter the protective oral mucin layer. We find that diabetes is epidemiologically correlated with laryngeal cancer. In fact, only diabetes increases the concentration of salivary mucins with a formation of mucin layer even more reduced, and so completely ineffective in protecting the mucosa. Conclusions: The increase of mucin secretion in diabetes alters much the protective layer allowing the risk factors to promote cancer growth.

Keywords: Laryngeal cancer, epidemiology, mucous, spinnbarkeit, flow rate, pH, glycosylation, SIgA, oral cancer

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8 52-56

Assessment of Tumor Cell Cannibalism as a Predictor of Oral Squamous Cell Carcinoma - A Histopathologic Correlation


Megha Jain1, Swati Saawarn1, Anish Gupta1, Sahana Ashok1, Shubhangi Mhaske1, Samar Khan2, Manish Jain3
1 Department of Oral Pathology and Microbiology, Peoples Dental Academy, Bhopal, India
2 Department of Oral and Maxillofacial Pathology, College of Dentistry, Jazan University, Jazan KSA
3 Department Public Health Dentistry, Peoples Dental Academy, Bhopal, India


Aim: Cellular cannibalism is defined as the ability of a cell to engulf another cell of its own type or any other. It has been recognized in various malignancies and is linked well with the aggressiveness, degree of anaplasia, invasiveness and metastatic potential. Literature search fetched up very few studies related to the presence and significance of cannibalism with respect to Oral squamous cell carcinoma [OSCC]. The present study was aimed to detect tumor cell cannibalism in OSCC and to validate its role as a prognosticator of OSCC in relation to metastasis and degree of differentiation.

Method: 30 histopathologically proven cases, 15 cases each of metastatic OSCC (7 well differentiated OSCC and 8 moderately differentiated OSCC) and non-metastatic OSCC (8 well differentiated OSCC and 7 moderately differentiated OSCC) were included in the study. Quantitative assessment of tumor cell cannibalism was done. The data was analyzed using Mann Whitney test.

Result: Metastatic OSCC showed higher frequency of cannibalistic cells compared to non-metastatic OSCC. More number of cannibalistic cells were found in moderately differentiated OSCC than well differentiated OSCC in both groups. Moreover, Grade III cannibalism and complex cannibalism was also found to be associated with metastatic, moderately differentiated OSCC exclusively.

Conclusion: It has been found that higher number of cannibalistic cells were associated with OSCC showing metastasis indicating their aggressive behavior. So, we recommend that quantitative assessment of tumor cell cannibalism should become a part of the routine histopathological examination of OSCC to screen its hostile behavior.

Keywords: Oral squamous cell carcinoma, Cannibalism, Metastasis, Histopathology

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9 57-62

Surgical Outcomes Post Neoadjuvant Chemotherapy in Stage IV cancers of Oral Cavity


Tarun Kumar, Kiran Kothari, Mahesh H. Patel, K. Ravi, Vijay Yadav
Gujarat Cancer Research Institute, Ahmedabad, India


Aim: To know the effect of neoadjuvant chemotherapy on surgical outcomes (R1 resections, post-operative complications, recurrence and follow up) in Stage IV borderline operable cancers of oral cavity.

Materials & Methods: Patients in group A (n=45) were those who were referred for neoadjuvant chemotherapy (NACT) with an intention to operate at a later date. These were compared with 45 patients of group B who were operated upfront. All 90 patients have stage IV squamous cell carcinoma of oral cavity. Details of patients were studied retrospectively from hospital records of surgical, medical, radiotherapy and pathology departments. All patients referred for NACT were wet lesions with perilesional edema and diffuse margins of lesions where the demarcation from normal tissue was not clear. Treatment response was assessed clinically and radiologically. Any reduction in tumor size on CT scan, MRI or clinically was considered response to chemotherapy. Various chemotherapy regimens were given in different patients - TPF (Taxol- Docetaxel or Paclitaxel, Cisplatin, 5 Fluoro Uracil), PMF (Cisplatin, Mitomycin C, 5 Fluoro Uracil), Cisplatin + Methotrexate and Cisplatin with 5 Fluoro Uracil. Inoperability was defined as involvement of the upper infratemporal fossa where R0 resection was difficult. Patients were followed up monthly after completion of treatment for one year and three monthly thereafter. Survival was calculated from the day of surgery to the death of the patient or last patient contact. The time of recurrence was also calculated from the day of surgery. Statistical methods used in the study were simple frequencies and proportion. Test of significance was Z test. Z = 2 was considered significant. Kaplan Meir survival analysis was used through SPSS software for disease free survival

Results: Total 39 patients were operated in group A as remaining six progressed to inoperability while on chemotherapy. There were 3 R1 resections in group A and 9 R1 resections in group B (Z= 1.67). Eleven and three postoperative complications in group A and B respectively (Z= 2.67). There were nine and 16 recurrences so far in group A & B respectively (Z=1.27). DFS at one year was 90% and 55% respectively (p= 0.017).

Conclusion: Though the study shows a trend in favor of NACT when R1 resections, recurrences and survival at one year are considered but this was at the cost of those six patients who progressed on NACT and could have been operated initially. Such patients were present in each and every subset of chemotherapy used.

Keywords: neoadjuvant chemotherapy, stage IV, surgical outcomes

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10 63-66 Bilateral Breast Cancer After Prophylactic Bilateral Pulmonary Irradiation

El Meddeb Hamrouni A¹ ², Chehata Jebsi M¹, Kanoun S¹, Rancoule C², Guy JB², Magne N², Bouaouina N¹.
1 Department of Radiation Oncology, Hospital of Farhat Hached, Susah, Tunisia.
2 Institut de Cancérologie Lucien-Neuwirth, Department of Radiation Oncology, 108 bis, Avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez, France


The purpose of this article is to report a new case of a probably radio-induced bilateral breast cancer occurred after prophylactic bilateral pulmonary irradiation in the treatment of osteosarcoma. A 42-year-old woman, treated at the age of 12 years for osteosarcoma at the right lower limb with chemotherapy (methotrexate, adriamycin and cisplatin) followed by non- conservative surgery and adjuvant radiotherapy. Eighteen years after, she developed her first breast cancer, and five years later, her second contralateral breast cancer. The patient was treated for her two non-metastatic cancers and is currently in complete remission. This publication adds to several previous publications the very probable effect of ionizing radiation in the occurrence of secondary cancers.

Keywords: Breast Cancer; Bilateral; Radiotherapy; radio-induced; pulmonary irradiation.

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11 67-71

Solitary Metastasis of Clear Renal Cell Carcinoma to Thyroid Gland: Three reported cases with review of the literature


J. Astl1,6, A. A. Bahannan,2*, J. Dušková,3, Z. Novák4, P. Vlcek 5, J. Betka1
1 Dept. of Otolaryngology and Head and Neck Surgery 1st Faculty of Medicine, Charles University & Motol University Hospital, Prague, Czech Republic.
2 Dept. of Surgery and Surgical Specialities, Division of Otorhinolaryngology, College of Medicine & Health Sciences, Hadhramout University, Mukalla, Hadhramout, Republic of Yemen.
3 2nd Dept. of Pathology & Institute of Postgraduate Studies, 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
4 Endocrinological Institute, 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
5 Dept. of Nuclear Medicine, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic.
6 Dept. of Otolaryngology 3rd Faculty of Medicine, Charles University & Military University Hospital, Prague, Czech Republic.


Metastasis to the head and neck and more specifically to the thyroid gland from distant primary tumors is less common in comparison to the local regional metastasis of squamous cell carcinomas of the upper aero-digestive tract. Preoperative diagnosis of these cases can be difficult. The authors present three cases with distant solitary metastases of clear renal cell carcinoma to the thyroid gland with ambiguous mechanism of tumor spread to the thyroid. Solitary metastases of clear renal cell carcinomas are an uncommon variant of metastasis of this tumor and may imitate thyroid well differentiated carcinoma which most commonly affects the thyroid gland. Therefore, thorough endocrinological investigation of the thyroid gland is necessary. The recommended therapy of renal cell carcinoma metastasis includes surgical removal of all cancerous tissues - i.e. of the gland with the possibly infiltrated adjacent tissues, as well as removal of the affected lymph nodes - selective radical neck dissection. In our study, we discuss the clinical picture, pathology, diagnosis, differential diagnosis and prognosis together with literature review.

Keywords: distant metastases, clear renal cell carcinoma, thyroid gland, histopathology, therapy

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12 72-76 Management of Hard Palatine Fistula Caused by Granulocytic Sarcoma: Case Report

Rasha Aboelhassan1, Howayda Abdel All1, Asmaa Mohammed1, Ahmed Mousa1, Mohamed Elsayed Hassan2, Mohamed Abdel Moaty Samra1, Raafat Abdel Fattah1
1 Nasser Institute Cancer Center, Egypt.
2 Nasser Institute Hospital, Egypt


Granulocytic Sarcoma (GS) is a rare condition with a wide list of differential diagnosis and debatable guidelines of treatment in different cancer centers. Most of literature recommended systemic chemotherapy with or without radiation therapy and small role of surgery. One of the rarest sites for myeloid sarcoma is hard palate, which usually worsen the quality of life of the patient due to difficulty in feeding, drinking and speaking. We are reporting a case of hard palatine fistula caused by granulocytic sarcoma, in which we tried to get local control of disease with 3 dimension conformal radiation therapy 3DCRT and surgery with systemic control with chemotherapy using recommendation of multidisciplinary team and targeting mainly patient quality of life

Keywords: granulocytic sarcoma, myeloid sarcoma, palatine fistula, 3DCRT, head and neck, hard palate

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13 77-81

An Expansile Well-defined Radiolucency in Anterior Mandible: Case Presentation with Treatment Approach and Literature Update

Shelly Arora1, Aadithya B. Urs2, Zainab Choudhary3
1 Faculty of Dentistry, SEGi University, Kotadamansara, Selangor, Malaysia.
2 Department of Oral Pathology, Maulana Azad Institute of Dental Sciences, New Delhi, India.
3 Department of Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, New Delhi, India


A 15-year-old Indian male patient presented with a history of pain and swelling in left mandible. Imaging studies revealed a well-defined unilocular radiolucency in the body of the mandible. Patient also gave the past history of the surgery of the jaws, which was histopathologically diagnosed as dentigerous cyst. Following this patient underwent incisional biopsy and later excisional biopsy. The histopathologic diagnosis for incisional biopsy was unicystic ameloblastoma but final diagnosis was dentinogenic ghost cell tumor for the excised tissue. To the best of our knowledge, this appears o be the first case of dentigerous cyst transforming into dentinogenic ghost cell tumor. The clinical presentation of the case, differential diagnosis and treatment modalities are being discussed.

Keywords: dentigerous cyst, dentinogenic ghost cell tumour, mandible, unicystic amelobalstoma

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14 82-85

Neoadjuvant Chemotherapy: A New Standard for Muscle Invasive Bladder Cancer?


Nabil Ismaili
Department of Medical Oncology, Sheikh Khalifa Hospital and Mohammed VI University of Health Sciences, Casablanca, Morocco


Bladder cancer is the seventh most common cancer and the ninth most common cause of cancer deaths for men worldwide. Cystectomy with pelvic lymph nodes dissection is the standard local treatment of muscle invasive bladder cancer (MIBC) (T2-T4). In the last decade, the management of MIBC had become multidisciplinary involving peri-operative chemotherapy (neo- or adjuvant chemotherapy). Randomized trials and meta-analyses confirmed the survival benefit of neoadjuvant chemotherapy before local treatment (surgery and/or radiotherapy). Consequently, this sequence should be considered as standard treatment of choice, for patients with good performance status (0-1) and good renal function. The benefit of adjuvant chemotherapy is not clear for patients treated with primary surgery.

Keywords: Bladder cancer, Chemotherapy, Neoadjuvant, Adjuvant

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