Biomedicine & Healthcare Research

Epidemiological insights into occupational cancers: A five-year retrospective analysis at the Tunisian institute of occupational health and safety

2024-01-14T15:12:30+00:00

Cancer stands as the fourth leading cause of global mortality. Occupational exposures play a substantial role in the development of various types of cancer, including lung, colorectal, and breast cancer. The links between exposure to carcinogenic agents in the workplace and the subsequent development of various forms of cancer have been unequivocally established. This study aimed to analyze the epidemiological features of occupational cancers reported in the Tunisian Institute of Occupational Health and Safety during 2015−2020. This was a descriptive retrospective investigation, focusing on cases of reported occupational cancers that were documented during clinical consultations at the Institute of Occupational Health and Safety in Tunisia over the period from 2015 to 2020. Epidemiological features were analysed by year, region, industry, gender, age at diagnosis, and exposure duration to occupational hazards. A total of 7 patients sought consultation to evaluate the potential occupational origins of their cancers. The mean age of patients was 60.14 ± 10 years. All subjects had a history of smoking (7 cases), with an average of 22 pack-years. Alcohol consumption was reported in a solitary patient. In each case, a definitive occupational link was established. The patients held diverse occupational roles: miners (3 cases), construction workers (2 cases), machine operators (1 case), and maintenance agents (1 case). The average duration of occupational exposure was 27 years. Six patients had bronchopulmonary cancer. One patient had bladder cancer. Symptoms manifested, on average, 20 years after starting employment. Detailed occupational scrutiny unveiled exposure to distinct hazardous agents: silica particles (4 cases), asbestos (1 case), solvents (1 case), and nickel (1 case). Correspondingly, the reported cancer cases were classified under specific categories of the Tunisian list of compensable occupational diseases. The study underscores the significant but often overlooked role of occupational agents in the development of bronchial and bladder cancer. Urgent preventive actions, such as the implementation of protective equipment and automation of certain processes, are crucial to reducing the occurrence of occupational cancers.

Analysis of Infectious Risk in the Hemodialysis Unit at the University Hospital Center

2024-01-04T06:20:58+00:00

Hemodialysis, as an extra-renal purification technique, carries an inherent infectious risk. This study aimed to assess the infection risk associated with hygiene practices around hemodialysis patients in a hospital setting. This study employed Failure Modes and Effects Analysis (FMEA) to evaluate risks. A comprehensive visit was conducted at the hemodialysis unit of the nephrology department at Sahloul University Hospital of Sousse on a single day. The visit comprised a documentary inventory, premises observation, professional and patient interviews, and observation of professional practices to comprehensively understand infectious risk during patient care. The study identified seventeen failure modes during a hemodialysis session, categorized into six of level 1 criticality, four of level 2, and seven of level 3. The most critical failure modes included the improper handling and distribution of multi-dose heparin into single-dose injections in an unspecific area, as well as the absence of a 4-stage skin preparation for the puncture site. Proposed corrective measures to mitigate infectious risk were outlined. The FMEA approach effectively identified potential risks, necessitated a review of certain procedures, and proposed matrices to manage the most critical risks. This analysis, when conducted periodically, facilitates a genuine quality-focused approach, enhancing patient satisfaction and bolstering all stakeholders' confidence within the hemodialysis center.

Stage-specific treatment costs for cervical cancer in the Salah Azaiez Institute of cancer in Tunisia

2024-01-11T18:20:06+00:00

Cervical cancer (CC) is the fourth leading cause of cancer in women worldwide. The World Health Organization recommends performing country-specific economic assessments before the implementation of any national strategy. In Tunisia, studies about the cost of CC are rare. The latest study was in 2003, 20years prior to our study. Our objective was to estimate the stage-specific costs associated with CC in the Salah Azaiez Institute of cancer in Tunisia. This was a cost study conducted at Salah Azaiez Institute in March 2023 consisting of two parts; collecting data about needed check-ups in every cervical cancer stage and estimating the financial cost of each procedure from the hospital's finance unit. The cost of cervical cancer diagnosis and treatment at Salah Azaiez Institute ranged from 550 to 2603 US$ depending on the cancer stage and the treatment involved. The initial checkup of cervical cancer (including gynecological examination, biopsy, MRI, and laboratory checkups) cost 350$. The diagnosis and treatments cost 550$ for the IA stage and 585$ for IB1 and IB2 stages. These costs were significantly lower than stages IB3, II, IIIA, IIIB, and IVA (2603$). The diagnosis and treatment costs were of 1800$ for stage IIIC and 750$ for stage IVB. In conclusion, this study contributed in delivering essential data of the financial burdens associated to diagnosis and treatment of CC in Tunisia. This study would be an important tool to guide current strategy to fight against cervical cancer in Tunisia

Role of FDG-PET/CT in the diagnosis of recurrent breast cancer

2023-12-29T14:04:39+00:00

In patients with recurrent breast cancer, FDG PET/CT has demonstrated superior efficacy compared to conventional imaging (CI) in identifying loco-regional or distant recurrence. This holds true regardless of whether recurrence is suspected based on clinical examination, CI, or an increase in tumor markers (TM) such as CA 15.3 or CEA, and even if tumor markers are within normal ranges. PET/CT is also a powerful imaging modality for conducting a whole-body workup of a known recurrence aiding in the determination of whether the recurrence is isolated. To investigate our experience with the concordance of FDG-PET/CT and CI, we studied cases of breast carcinoma retrospectively collected between 2022 and 2023 from our institution's archive. PET images were analyzed by at least two nuclear medicine specialists. We then compared them with the findings of CI and analyzed their accuracy based on patients' follow-up. A total of 25 patients was selected. PET-CT was effective in clarifying uncertain findings from CT scans. It ruled out bone metastasis in two out of nine equivocal cases and confirmed seven out of nine. It excluded three out of seven pulmonary lesions while confirming three. It also confirmed other uncertain lesions in CT, such as muscular and parietal ones. Moreover, PET/CT detected additional lesions not seen in CT [bone (n=4) and liver (n=1)]. In conclusion, this study supported the findings of prior studies, highlighting the valuable contribution of PET/CT in the detection of recurrent breast cancer and its superiority to CI.

Review Histopathological-molecular classifications of papillary thyroid cancers: Challenges in genetic practice settings

2023-12-11T16:50:52+00:00

Thyroid cancer is a relatively rare disease. A literature review concerning frequencies and successive histopathological and molecular classifications of thyroid cancer was conducted to highlight new guidelines for molecular diagnostics to be implemented in practice for managing the most prevalent form of differentiated thyroid carcinomas, namely papillary thyroid cancer. Our study has shown that the frequency of thyroid cancer varies among countries, with its incidence rising faster than any other malignancy in recent decades, mainly owing to the increasing rate of detection of small cancers. Furthermore, the histopathological types of thyroid cancer have been redefined along successive WHO classifications. Indeed, to better stratify the prognosis and patient management, continuous improvements have been made to the classifications based on increasingly relevant criteria, ranging from histological structure to genetic signatures, and including cellular criteria of malignancy. In 1974, during the first edition of the WHO classifications, papillary thyroid cancer was defined as a malignant epithelial tumor containing a papillary structure. Faced with numerous issues of plethoric diagnosis and unnecessary treatments resulting from the binary distinction of thyroid proliferations into benign or malignant (in subsequent editions in 1988 and 2004), the fourth edition in 2017 added a third category, that of borderline thyroid tumors (uncertain malignant potential), with the introduction of nuclear features as major classification criteria. In the fifth edition (WHO 2022 classification), nuclear features and molecular signatures have become essential criteria, distinguishing thyroid neoplasms based on the signaling pathways involved. Thus, three groups of thyroid cancers have been separated based on mutational profiles and gene expression: 1/ the BRAFV600E-like cancer group involving BRAF V600E mutation and gene fusions involving BRAF, RET, NTRK1/3,ALK and MET; 2/ the RAS-like cancer group including NRAS, HRAS, KRAS, EIF1AX, DICER1, BRAF K601E mutations, and gene fusions involving PPARG and THADA; and 3/ the no-BRAF V600E/no-RAS-like neoplasms group involving PAX8/PPARG gene fusion and mutations in EZH1, IDH1, SOS1, SPOP, DICER1, and PTEN.

Familial medullary thyroid carcinoma: A rare germline mutation in the RET proto-oncogene

2023-12-28T08:55:56+00:00

Medullary thyroid carcinoma (MTC) is an aggressive thyroid cancer that generally accounts for more than 10% of thyroid malignancies. Approximately 25% of MTC cases exhibit up hereditary traits. Dominantly inherited syndromes of MTC such as multiple endocrine neoplasia type 2A (MEN 2A), multiple endocrine neoplasia type 2B (MEN 2B) and familial medullary thyroid carcinoma (FMTC) are linked to gain-of-function alterations in the RET proto-oncogene. This latter encodes a receptor tyrosine kinase involved in several signal transduction pathways in neural precursor cells. Therefore, genetic screening for RET mutations facilitates early disease diagnosis and the possibility of prophylactic thyroidectomy for at-risk relatives. This study underscores the relevance of RET genetic analysis by describing a familial case of MTC with c.1597G>T (p.Gly533Cys) mutation in the RET gene.

Synchronous and metachronous of multiple primary malignancies in the same patient: A rare case report

2024-01-06T08:22:20+00:00

The synchronous and metachronous occurrence of multiple primary cancers in a single patient is an exceptionally uncommon phenomenon. However, owing to the continual advancements in diagnostic techniques, these instances are systematically classified based on the timing of their manifestation. Synchronous cases manifest within six months of the diagnosis of the preceding neoplasm, while metachronous cases emerge with an interval of more than six months between occurrences. We report the case of a 52-year-old woman who was being treated for infiltrating ductal carcinoma. The patient underwent a right mastectomy and lymph node dissection. Two months later, the patient complained of heavy menstrual bleeding, which revealed endometrial adenocarcinoma. However, a total hysterectomy with bilateral salpingo-oophorectomy was performed, along with chemotherapy. Seven months later, the patient presented with a right axillary mass. Histopathological analysis revealed to be small lymphocytic lymphoma, positive for CD5 and CD23, negative for CD3 and cyclin D1, with no evidence of breast cancer. She received chemotherapy and was treated with rituximab for 2 years. After 18 months, she developed chronic lymphocytic leukemia. She received chemotherapy with bendamustine and rituximab for 6 cycles. Currently, the last PET scan, after completing her treatment, showed no metabolic activity. The management of this condition represents an interesting clinical scenario. The choice of which tumor to treat initially and how to schedule additional treatments based on each patient's tumor risk are also essential considerations. This process must involve multidisciplinary physician team to ensure favorable outcomes.

Management of colo-adnexal fistula in serous adenocarcinoma of the ovary: a case report

2023-12-28T08:25:12+00:00

Ovarian cancer is the leading cause of death from gynecological cancer. Fistulization of ovarian cancer into digestive tract with a fistula tract is a rare phenomenon. This complication worsens the prognosis, the fistulous communication in the digestive lumen leads to the leakage of its contents. The tumor therefore becomes superinfected and may result in pelvic peritonitis in case of secondary rupture. On the other hand, the patient is deprived of the benefit of undergoing neoadjuvant chemotherapy, which will decrease the chances of a complete macroscopic cytoreduction. This case presents a 53-year-old patient operated on for a presumed ovarian abscess. Upon exploration, an ovarian tumor fistulized into the sigmoid was discovered. The treatment consisted of sigmoidectomy, creation of an end-loop colostomy, total hysterectomy, bilateral oopohorectomy, peritonectomy of 2 pelvic parietal nodules, infra-gastric omentectomy and lombo-aortic curage. The current case highlighted the encountered difficulty on diagnostic and therapeutic levels: the ovarian tumor was misdiagnosed as an abscess and the need of extensive extirpative surgery to comply with “oncological surgery of the ovary” in a hostile environment. Through a literature review, we aim to sensitize the medical community of this rare entity in order to clarify its pathophysiological consequences and make the adequate therapeutic measures.

Fused PET/MRI images in the therapeutic follow-up of recurrent chordoma: A case report

2023-12-29T08:35:09+00:00

Chordoma is an uncommon and malignant bone tumor that mainly occurs in the sacrum. Despite successful radical resection followed by radiotherapy, this tumor is still associated with a high rate of recurrence. As far as we know, this is the first reported case of recurrent chordoma where the integrated PET/MRI was used to ensure accuracy for staging and treatment management. We present a case of a 76-year-old man with a history of sacrococcygeal chordoma treated surgically 2 years earlier. Recently, a local recurrence has been suspected following the appearance of a subcutaneous nodule on the surgical scar. Therefore, a pelvic MRI scan was done showing hypointense and hyperintense nodules in weighted T1 and T2 images, respectively. The fused PET/MRI images revealed the presence of abnormal foci of 18F-FDG uptake not only in the multiple lesions identified in the MRI but also in the adjacent soft tissue, suggestive of extensive sites of recurrence. In conclusion, fused PET/MRI acquisitions hold the potential for a significant contribution to managing recurrent chordomas and refining therapeutic follow-up.

Chest wall Desmoid tumor…A multidisciplinary care

2024-01-09T17:21:48+00:00

Desmoid tumors, though rare, can present challenges, especially when occurring in the chest. This case involves a 44-year-old woman with a parietal swelling, initially painless but progressively growing. “Café au lait” spots were noted, along with a left paraspinal mass. Imaging revealed an infiltrating parasternal mass extending to adjacent structures. An ultrasound-guided biopsy confirmed the diagnosis of desmoid type fibromatosis. After initial monitoring, surgery became indicated due to tumor growth. The patient had a total en bloc resection of the tumor process taking out the anterior arches of the 3^rd to the 5^th left rib with their intercostal spaces, the lower and left part of the sternal body as well as the xiphoid appendage. A polypropylene plate was used to construct the parietal defect. In order to cover the loss of soft tissue, a myoplasty with a pure and pedicle left pectoralis major muscle flap was performed. The final anatomo-pathological examination of the specimen concluded to a complete resection of the tumor with healthy margins. The patient’s postoperative course was uncomplicated with no local recurrence after 12 months. Despite the benignity of desmoid tumors, they do represent a real local danger considering their aggressiveness. The tumor resection must be complete with adequate margins in order to decrease the risk of local recurrence.