がんの科学と治療

Introduction: Non-Hodgkin’s primary lymphoma of the breast is a rare entity. These tumors represent 0.04% to 0.52% of malignant breast pathology, 2.2% of extranodal lymphoma and 0.4% of all non-Hodgkin lymphoma. Clinical and radiological aspects show no special characteristics. The diagnosis is based on the presence of a lymphomatous proliferation strongly associated to the breast tissue and the diagnosis of an extra-mammary lymphoma must be removed except the presence of ipsilateral axillary lymphadenopathy.

Patients and methods: This is a retrospective study of 9 patients treated for non-Hodgkin’s primary lymphoma of the breast. They were collected over a period of 14 years (2000-2013). They interested 1 case of follicular lymphoma, 1 case of large T-cell lymphoma and 7 cases of large B-cell lymphoma. The average age was 50 years, ranging from 30 to 76 years. The sex ratio was 0.11 (1 man/8 women). The median follow-up was 43 months (4-192). Six patients were older than 60 years. All the tumors were architecturally diffuse. The overall survival was 100% at one year 60% at 3 years. Seven patients achieved a complete remission after initial treatment; one had relapsed after 2 months. Among the 7 cases of large B cell lymphoma, two cases result from follicular lymphoma’s transformation. The average processing time was 17 months.

Conclusion: The primary breast lymphoma is often diagnosed late. Treatment should be rapidly implemented. Indeed, the 5-year survival of stage I of the Ann Arbor classification is better than for stage II.

Abstract

Objective: Multiple myeloma (MM) accounts for approximately 15% of hematological cancers. Although still incurable, the prognosis of MM has much improved within the past two decades due to the use of high-dose chemotherapy (HDT) supported by autologous stem-cell transplantation (ASCT) for eligible patients and a variety of novel agents. How to use and sequence these new potent treatments is a growing challenge. While focus is on efficiency and tolerability, the ultimate goal is the reestablishment and preservation of patients’ quality of life (QoL). This has increased the relevance of examining MM patient’s QoL and experiences as long-term survivors. This qualitative study therefore aimed to gain in-depth knowledge about health related QoL in patients with relapsingremitting MM (RRMM).

Methods: A literature study identified topics for individual in-depth qualitative interviews with eight Danish myeloma patients, four women and four men. Semi-structured interview guides were applied exploring the participants’ experiences with the course of disease and treatment, its impact on their physical, cognitive and psychosocial QoL and functioning, and if they had unmet care needs. The interviews were transcribed verbatim and analysed using a narrative medical anthropological approach aiming to elicit significant patterns in the patients’ perspectives on the impact of MM on their QoL.

Results: The participants had ambiguous perceptions of MM that was simultaneously seen as life menacing and manageable. Their physical and cognitive functioning was reduced from disease symptoms and treatmentrelated toxicity. Persistent peripheral neuropathy was considered particularly burdensome. The initial shock of receiving a cancer diagnosis was reduced by reassurance of the high manageability of MM. In the long run, the participants were able to lead ‘fairly normal’ lives but said their QoL was reduced by concerns about underlying disease, relapse and disability. Being able to uphold a social role and meaningful activities was crucial to their QoL. Overall, the participants did not discuss HRQoL issues with their oncologist, however, because the main focus in consultations is on cancer control.

Conclusion: Long-term QoL in patients with MM may be over-estimated. Their disease perspectives and priorities should be explored and taken into account when making treatment decisions. Newly diagnosed patients may have particular needs for emotional support and information about the improved manageability of MM.

This study systematically reviewed the incidence of cancer and the challenges to its treatment in Nigeria. Critical and in depth review of the studies available on the condition was done with the aim of identifying the status of cancer in Nigeria and challenges to treatment. The basic finding was that Nigeria has been under the bondage of cancer with little or nothing being done by both Nigerian government and international agencies to alleviate the suffering. The most current data on cancer was in 2012 and revealed that newly diagnosed cases of cancer in Nigeria per year was at 102000 people while 71,000 died from cancers. This presented Nigeria at the fore front of African countries with cancer cases. Since 2012 till date no data is available on the status of cancer in Nigeria. The studies further revealed the challenges facing cancer care to include the following: poor health system, lack of human resource, lack of screening centers, cost of drug. In conclusion, cancer cases are in a pandemic level in Nigeria evidenced by uncountable people who died of it daily. Nigeria health system is ill equipped to withstand the situation coupled with her current dilapidated economic state. Further studies should be carried out in the different geopolitical zones as to obtain a comprehensive data on the status of cancer in Nigeria.

Background: Calcifying fibrous tumor (CFT) is a rare benign mesenchymal tumor; with a predilection for children and young adults that usually arises in the subcutaneous and deep soft tissues, pleura, or peritoneum. CFT of the gastrointestinal tract is exceedingly rare.

Discussion: We describe here a patient with an unusual presentation-intestinal calcifying fibrous tumor. This 26-year-old man came to our emergency department with abdominal distension and intermittent epigastric cramping pain. The physical examination was negative. Colonoscopy showed an intestinal polyp, measuring 3 cm in greatest axe. The macroscopic examination showed a segmental resection of jejunum with pedunculated polyp. The polyp had a smooth, shiny and gray surface, it measured 3 cm. Histologically, it was consisting of hyalinized, hypocellular lamellar collagen, bland spindle cells, chronic inflammatory cell infiltrates, and psammomatous or dystrophic calcifications.

Conclusion: CFT of the gastrointestinal tract is exceedingly rare. We describe a case arising in the small intestine, and discuss the differential diagnosis with other common and uncommon spindle cell lesions.