5-Fluorouracil-Induced Hyperammonemia Encephalopathy in a Patient with Gastric Cancer

Chemotherapy with 5-fluorouracil (5 FU) has been widely used to treat advanced gastric cancer. Knowing the side effects is therefore important in order to better prevent them. Fluoropyrimidine-induced hyperammonemic encephalopathy is a rare complication and characterized neurological status with elevated ammonia level without radiological abnormalities. We report the first case of 5 FU-induced hyperammonemic encephalopathy in women patients on induction chemotherapy for gastric cancer in Madagascar. His ammonia level (NH3) was 102 μmol/l. The patient recovered from his confusional state after two days of treatment with hyperhydration and vitamin therapy.

Colorectal Cancer in the Oncology Department at the Joseph Ravoahangy Andrianavalona, Antananarivo, Madagascar: Retrospective Study

Introduction: Colorectal cancer is one of the most common causes of cancer morbidity. The epidemiological and therapeutic data available are very limited in Antananarivo. The aim of this study was to provide an updated report on the management of colorectal cancer and know the survival of patients. Patients and Methods: A descriptive retrospective study during 2018 and 2019 carried out in the oncology department of Joseph Ravoahangy Andrianavalona Antananarivo Hospital. Newly diagnosed patients with histological evidence were included in the study. Results: Sixty-five cases of cancer were collected, including 39 colon cancers and 26 rectal cancers. The average age was 53 years with extremes of 18 and 83 years. In 41.53%, the patients were young people under 50 years old. The sex ratio was 0.95. Four patients (6.15%) had a family history of first degree cancer. The left colon was the most common location in 43.06% of cases. Only 39% of patients were diagnosed within 6 months of the first symptoms. The most common histological type was lieberkuhnian adenocarcinoma (87.69%). None of the patients underwent an immunohistochemistry examination. Stage IV and III accounted for 41.53% and 35.38% respectively. The majority (55.38%) of patients had benefited from surgery. Chemotherapy was performed in 56.89% of cases. One metastatic patient had received targeted therapy. Nine patients (34.61%) among the 26 with rectal cancers had benefited from concomitant radiochemotherapy. Survival at 30 months was 20%. Conclusion: The survival rate of patients at 30 months is very low. Improving the management of colorectal cancer requires awareness-raising and early detection.

Breast Carcinoma Arising in Fibroadenoma in a 15-Year-Old Girl;Diagnosis and Treatment Challenge

Breast cancer in adolescents occurring in fibroadenomas is extremely rare. We report a case of right breast cancer in a 15-year-old female student diagnosed in 2020. This is the youngest reported case of breast cancer arising within fibroadenomas in the literature. The teenager has no personal or family history of cancer or known hereditary disease. Currently, there is no consensus on the management of breast cancer arising from adenofibromas in adolescents. Clinically, the tumor was inflammatory with axillary lymph node involvement (T4dN1M0). The fine-needle aspiration cytologic was suspicious of malignancy. The patient received four courses of neoadjuvant chemotherapy with 5-fluorouracil®, doxorubicin® and cyclosphosphamide®, followed by radical right mastectomy. The histological result of the surgical specimen is a non-specific carcinoma with a therapeutic effect greater than fifty percent. The patient received three courses of adjuvant chemotherapy with paclitaxel®. The adolescent underwent radiation therapy at her chest wall of 50 Gy and regional lymph node of 46 Gy. After radiotherapy, hormone therapy with Tamoxifene® at 20 mg per day was started. At 16 months from radiotherapy, there is no recurrence. The reconstruction of the right breast is planned in a few months.

Gestational Trophoblastic Neoplasia: Clinical and Therapeutic Profile in Madagascar

Gestational trophoblastic disease (GTD) develops from abnormal cellular proliferation of trophoblasts following fertilization. This includes complete and partial hydatidiform mole (HM) and gestational trophoblastic neoplasia (GTN). The aim of this study was to report the epidemiological, clinical and therapeutic profile of gestational trophoblastic neoplasia (GTN) over period of ten years in the department of Oncology Radiotherapy at the University Hospital Joseph Ravoahangy Andrianavalona (HJRA) Antananarivo Madagascar. Medical records of women diagnosed with GTD in the department of Oncology Radiotherapy at HJRA from January 1st, 2007 to September 2017 were retrospectively reviewed. Only patients with the FIGO diagnosis GTN were included, while those with the histological diagnosis of hydatidiform mole (HM), also sometimes classified as GTD, were not included in this study. Also excluded were all cases with incomplete or missing data. Twenty four patients were included. Median age of patients at the time of diagnosis was 37 years (range 18 - 60). Most patients developed GTN following molar pregnancy (75%), had disease duration from antecedent pregnancy of less than 6 months (58.20%), and had the pre-treatment hCG level more than 10,000 IU/L (58.27%). At diagnosis, 14 patients (58.33%) had localized disease (M0). Most common metastatic sites at initial diagnosis were the liver and brain (20.83%). After a median follow-up from initial diagnosis of six months (range 1 - 24), 58.33% were lost to follow up. This represented an increase in the percentage of patients lost to follow up prior to completion of therapy, when compared with our previous results for an earlier time period. GTN in Malagasy woman displays an aggressive clinic profile. Finding ways to increase treatment compliance provides the best way to minimize recurrences of this potentially deadly disease.