Carcinomatous meningitis is a rare neuropathological entity in the routine oncology practice, with an estimated frequency of one case in ten metastatic cancers (10% or less). Lung cancer, breast cancer, melanoma, or primary brain tumors usually have the propensity to generate meningeal metastases according to the literature. We herein report unusual cases of Carcinomatous meningitis diagnosed in two young patients of 46 and 38 years old who were primarily followed up for metastatic ovarian cancer and metastatic gastric cancer respectively. Neurological symptoms were prominent at the time of diagnosis. The brain scan was non-contributory. The radiological diagnosis was made by injected brain magnetic resonance imaging (MRI) which showed metastatic meningeal lesions in both cases. Anatomopathological analysis of the cerebrospinal fluid (CSF) was decisive in revealing cancerous cells. The treatment consisted of a doublet of intrathecally (IT) Methotrexate-Depomedrol (patient with ovarian cancer) and a triplet of IT Methotrexate-cytarabine-Depomedrol (patient with gastric cancer). The evolution was marked by a clinical improvement without CSF sterilisation for the patient on the doublet treatment but died 5 months later on the occasion of a new progression. For the other patient on the triplet, the evolution was towards a rapid clinical deterioration with death within 2 months from diagnosis. Carcinomatous meningitis is therefore a serious complication that rapidly threatens the life of patients. Survival rarely exceeds 4 months.
The potential threat of COVID-19 pandemic on the continuity of care for cancer patients is thought to be significant. Oncologists are weighing up the balance of risks and benefits carefully when planning daily cancer care and making treatment decisions in the face of rapid change during this public health crisis. This report describes management strategies and care models that have been adopted by a single Medical Oncology department in a North Africa, Morocco.
The progress on cancer diagnosis and treatment has attained, in the last decade, enormous achievements by any estimate. Immunotherapy, new generations of targeted therapies, Chimeric antigen T-cells, cancer vaccines and the fascinating breakthroughs in translational research and cancer biology have changed the direction of cancer care. However, the fact that all patients worldwide cannot have access to these advances is dramatic. Alongside this, taking part in clinical research is one way to improve and invest in cancer care. Patients from African-and most low-resources countries-are rarely offered the chance of being included in clinical trials. This well-known fact paints a disheartening picture of what having cancer is like in the poorest settings. This situation will further decline with population aging, major changes in risk profile imported from developed countries and life expectancy increasing in most African countries. If no radical changes are made, this North-South contrast will become more critical and continue to grow. Yet, there is room for hope because only when we acknowledge the problem can we begin to address it. We need a better understanding of the reasons behind this gap and to advocate for more representation from African patients in clinical trials, with respect to the socio-economic, epidemiological and unique demands of each country across the continent.
Paraganglioma is a rare neuroendocrine tumor that arises outside of the adrenal gland, typically originating from the chromaffin tissue of the sympathetic or parasympathetic ganglia. It can manifest at any age, with a peak incidence occurring between 40 and 50 years old. When the tumor secretes catecholamines, it is referred to as "functional." Currently, there is no standardized therapeutic approach. However, the management of metastatic forms is based on a systemic treatment with tri-chemotherapy. Herein, we present the case of a young male patient with heavily metastatic functional malignant paraganglioma, which represents the first case managed in our department. After seven months of Somatuline treatment, our patient experienced disease progression. Subsequently, he received tri-chemotherapy comprising cyclophosphamide, vincristine, and dacarbazine, which proved to be suboptimal due to poor hematological tolerance and a progression-free survival of less than three months. In the third line of treatment, Sunitinib was administered, but the therapeutic response was poor, with clinical progression observed within two months, ultimately leading to the patient's demise at home. The overall survival was two years.
Neurofibromatosis type I is a complex, multisystem cancer predisposition syndrome of a number of tumors, which commonly arise in the central and peripheral nervous system, the gastrointestinal tract (GIT), and breast and soft tissues, yet the association with endometrial cancer is rare. Herein, we report the case of a 67-year-old female, never married, who had been followed since puberty for neurofibromatosis type I clinically manifested by pigmentary abnormalities such as café-au-lait macules, neurofibromas, and Lisch nodules with various comorbidities, such as diabetes type I, hypertension, renal failure, and ophthalmic disorders (poor vision). One year earlier, she developed a locally advanced endometrial cancer, for which chemotherapy would not have been optimal because of these comorbidities; due to the pathology of neurofibromatosis, the lifespan of such individuals is typically around fifteen years shorter than that of the general population and it negatively impacts their quality of life.
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