Publications by authors named "Khalid Mazaz"

68 Publications

Prognostic Impact of Tumor Budding on Moroccan Colon Cancer Patients.

Int J Surg Oncol 2022 21;2022:9334570. Epub 2022 Jan 21.

Laboratory of Anatomic and Molecular Pathology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco.

Background: Tumor budding is now emerging as one of the robust and promising histological factors that play an important role in colon cancer. In this study, we aimed to investigate the association between tumor budding and tumor clinicopathological factors, tumor molecular signature, and patient survival for the first time in a Moroccan population.

Methods: We collected data of 100 patients operated from colon adenocarcinoma. Tumor budding was assessed on HES slides, according to the International Tumor Budding Consensus Conference 2016 recommendations. The expression of MMR proteins was performed by immunohistochemistry. KRAS and NRAS mutations testing was performed by Sanger sequencing and pyrosequencing.

Results: High tumor budding grade (BUD 3) was found to be significantly associated with adverse clinicopathological features including older age (=0.03), presence of perineural invasion (=0.02), presence of vascular invasion (=0.05), distant metastases ( < 0.001), advanced TNM stage (=0.001), the occurrence of relapse (=0.04), and the high number of deceased cases (=0.02). Interestingly, we found that tumors with high-grade tumor budding were more likely to be microsatellite stable (MSS) (=0.005) and harbor more KRAS mutations (=0.02). Tumors with high-grade tumor budding were strongly associated with KRAS G12D mutation (=0.007). In all stages, high tumor budding was correlated with poorer overall survival (=0.04) and decreased relapse-free survival with a difference close to significance ((=0.09). We concluded that high tumor budding was strongly associated with unfavorable clinicopathological features and special molecular biomarkers and effectively affects the overall survival of CC patients.

Conclusions: Based on these findings and the ITBCC group recommendations, tumor budding should be taken into account along with other clinicopathologic factors in the risk assessment of colorectal cancer.
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http://dx.doi.org/10.1155/2022/9334570DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8799359PMC
February 2022

Impact of mental imagery on enhancing surgical skills learning in novice's surgeons: a pilot study.

BMC Med Educ 2021 Oct 28;21(1):545. Epub 2021 Oct 28.

Clinical Neurosciences Laboratory, Faculty of Medicine and Pharmacy of Fez, Sidi Mohammed Ben Abdellah University, BP. 1893; Km 2.200, Sidi Hrazem Road, 30000, Fez, Morocco.

Objective: Mental imagery (MI) has long been used in learning in both fields of sports and arts. However, it is restrictively applied in surgical training according to the medical literature. Few studies have evaluated its' feasibility and usefulness. The aim of this study is to assess the impact of mental imagery on surgical skills learning among novice's surgeons.

Material And Methods: In this pilot prospective randomized comparative study; we recruited 17 residents and interns of surgery education curriculum. They were all included in their first semester of the curricula. Two groups were randomly designed. Group (a) including "Mental Imagery" volunteers (n = 9) which benefited from a mental imagery rehearsal exercise prior to physical practice, while the control group (b) (n = 8) didn't underwent any MI process prior to surgery practice. Each participant of both groups was invited to perform an intestinal hand-sewn anastomosis on bovine intestine. Each procedure was evaluated and analyzed according to 14 qualitative criteria while each criterion was scored 0, 1 or 2 respectively assigned to the gesture was not acquired, gesture was performed with effort, or mastered gesture. The final score is 28 for those who master all 14 gestures. A non-parametric statistical comparison between the both studied groups was performed.

Results: Both groups of surgery students demonstrated equivalent age, sex ratio, laterality, and surgical experience. The mean overall score is significantly higher in the MI group (a) (17.78; SD = 2.42) compared to the control group (b) (10.63, SD = 2.85). However, advanced analysis of individual assessment items showed significant statistical difference between both groups only in 6 out of 14 assessed items.

Conclusion: Indeed, mental imagery will not be able to substitute the traditional learning of surgery for novice surgeons; it is an important approach for improving the technical skills acquisition and shortening the physical learning.
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http://dx.doi.org/10.1186/s12909-021-02987-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8555244PMC
October 2021

Comparative analysis of clinicopathologic features between adenoma and hyperplasia in surgically treated patients for hyperparathyroidism: A retrospective study.

Ann Med Surg (Lond) 2021 Nov 9;71:102929. Epub 2021 Oct 9.

Department of Pathology, Hassan II University Hospital, Fès, Morocco.

Background: Hyperparathyroidism (HPT) is a common endocrine disorder resulting from overproduction of parathyroid hormone (PTH). Usually HPT is caused by parathyroid adenoma (PA) or parathyroid hyperplasia (PH). Our aim is to assess clinicopathologic features associated with PA and PH in patients with HPT.

Methods: We retrospectively collected 29 cases of HPT recorded at the Department of Pathology of Hassan II University Hospital of Fes, Morocco, from 2013 to 2016.

Results: The mean age was 52.14 ± 15.7 years (range of 22-76 years), 13 patients (44.8%) had primary HPT, 16 (55.2%) had secondary HPT. The largest size of the resected parathyroid specimens ranged from 1 to 3.6 cm (mean of 2.26 ± 0.66 cm). Seventeen patients (58.6%) had PA, the remaining cases were diagnosed as PH. There were no significant statistical differences between PA and PH in age, sex, clinical presentation, preoperative serum PTH, or in parathyroid gland size ( > 0.05). However compared to PH, PA is more often a single-gland disease, found in primary HPT with higher preoperative calcium level ( ˂ 0.05).

Conclusions: In patients surgically treated for HPT, PA is associated with some distinctive clinicopathologic features. These findings could be helpful to pathologists and clinicians for appropriate clinicopathologic management.
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http://dx.doi.org/10.1016/j.amsu.2021.102929DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8517285PMC
November 2021

Mutation status and prognostic value of KRAS and NRAS mutations in Moroccan colon cancer patients: A first report.

PLoS One 2021 30;16(3):e0248522. Epub 2021 Mar 30.

Faculty of Medicine and Pharmacy, Laboratory of Biomedical and Translational Research, Sidi Mohamed Ben Abdellah University, Fez, Morocco.

This study aimed to estimate the incidence of KRAS, NRAS, and BRAF mutations in the Moroccan population, and investigate the associations of KRAS and NRAS gene mutations with clinicopathological characteristics and their prognosis value. To achieve these objectives, we reviewed medical and pathology reports for 210 patients. RAS testing was investigated by Sanger sequencing and Pyrosequencing technology. BRAF (exon 15) status was analyzed by the Sanger method. The expression of MMR proteins was evaluated by Immunohistochemistry. KRAS and NRAS mutations were found in 36.7% and 2.9% of 210 patients, respectively. KRAS exon 2 mutations were identified in 76.5% of the cases. RAS-mutated colon cancers were significantly associated with female gender, presence of vascular invasion, classical adenocarcinoma, moderately differentiated tumors, advanced TNM stage III-IV, left colon site, higher incidence of distant metastases at the time of diagnostic, microsatellite stable phenotype, lower number of total lymph nodes, and higher means of positive lymph nodes and lymph node ratio. KRAS exon 2-mutated colon cancers, compared with KRAS wild-type colon cancers were associated with the same clinicopathological features of RAS-mutated colon cancers. NRAS-mutated patients were associated with lower total lymph node rate and the presence of positive lymph node. Rare RAS-mutated tumors, compared with wild-type tumors were more frequently moderately differentiated and associated with lower lymph node rate. We found that KRAS codon 13-mutated, tumors compared to codon 12-mutated tumors were significantly correlated with a higher death cases number, a lower rate of positive lymph, lower follow-up time, and poor overall survival. Our findings show that KRAS and NRAS mutations have distinct clinicopathological features. KRAS codon 13-mutated status was the worst predictor of prognosis at all stages in our population.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0248522PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8009361PMC
October 2021

The Effect of Lymph Nodes' Histologic Response on Survival Outcomes in Moroccan Patients with Rectal Cancer.

Int J Surg Oncol 2020 6;2020:8406045. Epub 2020 Jan 6.

Laboratory of Biomedical and Translational Research. University of Medicine and Pharmacy of Fez, University Sidi Mohammed Ben Abdellah of Fez, 30070 Fez, Morocco.

Prognosis for patients with locally advanced rectal cancer remains controversial. The purpose of this study was to elucidate possible association between therapeutic effect on lymph nodes (LNs) and patient prognosis. Overall, 149 patients with rectal cancer received preoperative radiotherapy in concomitance with chemotherapy or exclusive radiotherapy before rectal excision. Microscopic examination of formalin-fixed lymph nodes was assessed for therapeutic effect. The establishment of groups combined reaction tissue types of fibrosis, colloid, and necrosis after neoadjuvant treatment was assigned. The average age was 56.38 years, ranged between 22 and 88 years, 53% were female, and 47% were men, with a sex ratio of 1 : 12. In the present study, we noticed that after a median follow-up time of 40.67 months (0-83; SD: 21.1), overall survival was statistically significant depending on age groups. Kaplan-Meier analysis showed significant differences in the rate of patients with an age under 65 years (70.64%) versus those with an age over 85 years (36.5%) ( < 0.001). Also, the OS was statistically significant depending on therapeutic effect groups composed of 0TE (No Therapeutic effect), C+ (presence of only colloidal effect), F+ (presence of only fibrosis tissue), and ME+ (mixture of 2 or 3 types of therapeutic effect) group. Indeed, we observed a significantly higher OS rate in the ME + group (86%) compared with the OS rate of LNs group with no therapeutic effect (57%) (=0.028). Additionally, there was a significant association between the presence of fibrosis on LNs and an extended delay of more than 8 weeks to neoadjuvant treatment completion and surgery. Our study indicates that the best patient prognosis could be predicted based on tumor presenting a best pathologic effect on lymph nodes, and that delaying surgery for more than 8 weeks to neoadjuvant treatment completion improves therapeutic response on LNs.
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http://dx.doi.org/10.1155/2020/8406045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7183526PMC
December 2020

Analysis of Molecular Pretreated Tumor Profiles as Predictive Biomarkers of Therapeutic Response and Survival Outcomes after Neoadjuvant Therapy for Rectal Cancer in Moroccan Population.

Dis Markers 2020 11;2020:8459303. Epub 2020 Jan 11.

Laboratory of Biomedical and Translational Research, University of Medicine and Pharmacy of Fez, Morocco.

Pathologic features depending on tumor response to preoperative chemoradiotherapy are important to determine the outcomes in patients with rectal cancer. Evaluating the potential predictive roles of biomarker expression and their prognostic impact is a promising challenge. We reported here the immunohistochemical staining of a panel marker of mismatch repair protein (MMR), Ki67, HER-2, and p53. Additionally, identification of somatic mutations of KRAS, NRAS, and BRAF genes were performed by direct sequencing and pyrosequencing in pretreated biopsy tissues from 57 patients diagnosed for rectal cancer. Clinical features and pathological criteria for postneoadjuvant treatment surgical resection specimen's data were collected. Immunohistochemical expression and mutational status were correlated with therapeutic response, overall survival, and disease progression. The mean age of patients was 56 years. Seven (12.3%) out of 57 patients had a complete therapeutic response. Our analysis showed that when using complete therapeutic response (Dworak 4) and incomplete therapeutic response (Dworak 3, 2, and 1) as grouping factor, high p53 expression at the pretreatment biopsy was significantly associated to an incomplete response ( = 0.002). For 20 and 2 out of 57, KRAS and NRAS mutations were detected, respectively. The majority of these mutations affected codon 12. KRAS mutations detected at codon 146 (A146T, A146V) was associated with the appearance of recurrence and distant metastasis ( = 0.019). A high expression of HER-2 corresponding to score 3+ was observed in 3 pretreatment biopsy specimens. This class was significantly associated with a short relapse-free survival ( = 0.002). Furthermore, the high expression of Ki67 was moderately correlated with an older age ( = 0.016, = 0.319). In addition, this shows that high p53 expression in the pretreatment biopsy was associated with an incomplete response in surgical resection specimens after neoadjuvant treatment, and a HER-2 score 3+ can be a predictive factor of distant metastasis and local recurrence. Larger, prospective, and more studies are needed.
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http://dx.doi.org/10.1155/2020/8459303DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6977322PMC
September 2020

Acute cecal volvulus: A diagnostic and therapeutic challenge in emergency: A case report.

Ann Med Surg (Lond) 2019 Dec 31;48:69-72. Epub 2019 Oct 31.

Department of General and Visceral Surgery, Hassan II University Hospital of Fez, 30050, Fez, Morocco.

Introduction: Cecal volvulus is an uncommon cause of intestinal obstruction due to an axial twist of the caecum, ascending colon and terminal ileum around the mesenteric pedicle. It is responsible for 1%-1.5 of all intestinal obstructions in adult. The clinical signs may be highly variables and can be responsible of delays in diagnostic and treatment. The delay in diagnosis leads to intestinal necrosis or perforation. The mortality ranges from 10 to 40% depending on the presence of a viable or gangrenous intestine.

Presentation Of Case: A 64 year old woman admitted the emergency department for acute bowel obstruction. Clinical examination found typically acute bowel obstruction signs. Plain radiography showed dilated gas-filled segment of the colon in the left side of abdomen and volvulus of cecum was suspected. Enhanced abdominal CT scan confirmed the diagnosis. Emergency exploratory laparotomy was performed and confirmed the cecal volvulus. A manual untwisting of volvulus and a Caecopexy were performed. The patient subsequently recovered uneventfully and was discharged on postoperative day 3.

Discussion: The management of cecal volvulus requires prompt (emergency) diagnosis and prompt surgical intervention. Any delay in diagnosis may lead to intestinal necrosis or perforation and worsening the prognosis in patients who are generally elderly. Several authors reported a high mortality rate of cecal volvulus due to delay to diagnosis and surgical intervention.

Conclusion: The low incidence of this condition needs a high index of suspicion and emergency surgical management. Despite significant progress in medical imaging, the preoperative diagnosis of cecal volvulus is very difficult. As a result, the treatment is often delayed.
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http://dx.doi.org/10.1016/j.amsu.2019.10.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6849140PMC
December 2019

[Total small bowel volvulus complicating common incomplete mesentery, an exceptional complication in adults: about a case].

Pan Afr Med J 2019 17;33:220. Epub 2019 Jul 17.

Service de Chirurgie Viscérale B, CHU Hassan 2, Fes, Maroc.

Total small bowel volvulus complicating common incomplete mesentery is an arrest of rotation of the primary intestinal loop at 180°. The root of the mesentery is very short and the whole small intestine is located on the superior mesenteric artery axis. Patients are at very high risk of small bowel volvulus and enteromesenteric infarction. Acute volvulus requires emergency surgery; imaging must not delay surgery. Surgery is based on the untwisting of the volvulus (counterclockwise) after the assessment of intestinal viability. The intestine placed in the complete common mesentery position: the cœcum is situated in the right iliac region. We report the case of a 60-year old patient admitted with total small bowel volvulus on an incomplete common mesentery who underwent emergency surgery with favorable postoperative outcome.
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http://dx.doi.org/10.11604/pamj.2019.33.220.18159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6814366PMC
November 2019

Predictive factors of disease-free survival after complete pathological response to neoadjuvant radiotherapy for rectal adenocarcinoma: retrospective case series.

BMC Cancer 2019 Oct 28;19(1):1008. Epub 2019 Oct 28.

Surgical Oncology Department, National Institute of Oncology, Mohammed V University Medical School, Rabat, Morocco.

Background: Many data suggest that patients with low rectal adenocarcinoma who achieved ypT0N0 status have improved survival and disease-free survival (DFS) compared to all other stages however only few data are available regarding the specific prognosis factors of this subgroup. This study aimed to evaluate predictive factors for disease free survival after complete pathological response (CPR) in cases of low rectal adenocarcinoma.

Materials And Methods: From January 2005 to December 2013, all patients with low rectal adenocarcinoma who underwent neoadjuvant chemoradiotherapy followed by total mesorectal excision and achieved CPR were included at 7 Moroccan and 1 Algerian centres. Predictive factors for disease-free survival were analysed by uni and multivariate analysis.

Results: Eigthy-four (12.1%) patients achieved a CPR (ypT0N0). Multivariate analysis revealed that both poorly differentiated tumors (OR, 9.23; 95 CI 1.35-62.82; P = 0.023) and the occurrence of perineal sepsis (OR, 13.51; 95 CI 1.96-93.12; P = 0.008) were independently associated with impaired DFS.

Conclusions: Patients with low rectal cancer who exhibited a CPR after neoadjuvant therapy have good prognoses; however, the occurrence of perineal sepsis and/or poor initial differentiation may be associated with impaired DFS in these patients.

Trial Registration: The study was retrospectively registered the 28th July 2018 in ClinicalTrials.gov register with the reference NCT03601689.
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http://dx.doi.org/10.1186/s12885-019-6239-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6816192PMC
October 2019

Applicability and outcome of laparoscopic adrenalectomy for large tumours.

Pan Afr Med J 2018 11;31:23. Epub 2018 Sep 11.

Department of Visceral and Endocrine Surgery, Hassan II University Hospital, Fez, Morocco.

Laparoscopic adrenalectomy has been shown to be as safe and effective as conventional open surgery for small and benign adrenal lesions. With increasing experience with laparoscopic adrenalectomy, this approach has become the procedure of choice for the majority of patients requiring adrenalectomy. In our department, from 2011 to 2016, a total of 28 patients with 31 adrenal tumours underwent laparoscopic adrenalectomy regardless of tumour size. Our policy in the department is to exclude adrenal tumours that are potentially malignant or metastatic adrenal tumours for laparoscopic resection. In this a retrospective study, we divided patients into two groups according to tumour size: < 5 or ≥ 5 cm, which was considered as the definition of large adrenal tumours. We compared demographic data and per- and postoperative outcomes. There was no statistical difference between the two groups for per-operative complications (16,6% vs 18,75% , P = 0.71), postoperative complications (16,6% vs 18,75% , P = 0.71), postoperative length of hospital stay (5 vs 8 days P = 0.40), mortality (0% vs 0%) or oncologic outcomes: recurrence and metastasis (8.3% vs 6.25% P = 0.70). The only statistical difference was the operating time, at a mean (SD) 194 (60) vs 237 (71) min (P = 0.039) and the conversion rate (0% vs 12.5% P < 0.01). Laparoscopic adrenalectomy can be done for all patients with adrenal tumours regardless of tumour size, even it needs more time for large tumour but appears to be safe and feasible when performed by experienced surgeons.
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http://dx.doi.org/10.11604/pamj.2018.31.23.15153DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6430842PMC
April 2019

Isolated splenic lymphangioma presenting as a huge mass causing anemia and abdominal distension in an adult patient: a case report.

J Med Case Rep 2018 Apr 16;12(1):97. Epub 2018 Apr 16.

Department of Pathology, Hassan II University Hospital, Fez, Morocco.

Background: Lymphangiomas are uncommon benign lesions of lymphatic vessels very rarely affecting the spleen. Isolated involvement of the spleen in adult patients is rarely reported.

Case Presentation: We report a case of a 40-year-old Arabic woman who presented with a 25-cm abdominal mass, fatigue, and anemia evolving for 6 months. Her physical examination revealed anemic syndrome and an enormous splenomegaly extending beyond the umbilical area. An abdominal computed tomographic scan showed a 25-cm splenic mass with multiple hypodense nodules without enhancement after contrast injection. A surgical total splenectomy was performed. Histopathological analysis led to the diagnosis of cystic splenic lymphangioma. The patient's postoperative course was uneventful, and she was discharged from the hospital.

Conclusions: Isolated splenic lymphangioma in adult patients is very rare. The preoperative diagnosis is challenging because imaging techniques are not specific. Pathological analysis of the resected specimen is the only effective way to render the definitive diagnosis. Splenic lymphangiomas have a benign course after complete surgical resection.
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http://dx.doi.org/10.1186/s13256-018-1664-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5901864PMC
April 2018

The expression of MDM2 in gastrointestinal stromal tumors: immunohistochemical analysis of 35 cases.

BMC Clin Pathol 2018 24;18. Epub 2018 Jan 24.

1Department of pathology, Hassan II university hospital, Fès, Morocco.

Background: Gastrointestinal stromal tumors (GIST) are the most common primary mesenchymal tumors of the digestive system. The assessment of their biological behavior still remains a scientific challenge. To date, there are no well-established biological prognostic markers of GIST. Our aim is to study the expression of the MDM2 oncoprotein in GIST through an immunohistochemical analysis.

Methods: It was a retrospective study of 35 cases of GIST diagnosed from 2009 to 2012 in the department of pathology of Hassan II university hospital, Fès, Morocco. MDM2 immunohistochemical staining was performed on archival paraffin-embedded and formalin-fixed specimens (with a threshold of nuclear positivity > 10%). Analysis of correlations between MDM2 immunoexpression and clinicopathological features of GIST has been performed.

Results: The mean age was 55.23 years (range 25-84 years) with a male predominance (sex ratio = 1.5). The stomach was the main site of GIST, with 17 cases (48.57%) followed by the small bowel (9 cases, 25.71%). The spindle cell type GIST was the most frequent morphological variant (29 cases, 82.85%). Tumor necrosis was present in 8 cases (22.85%). Two patients (5.71%) had very low risk GIST, 5 (14.28%) had low risk GIST, 7 patients (20%) had intermediate risk tumors. The remaining 21 cases (60%) had high risk GIST. At the time of diagnosis, 9 patients (25.71%) had metastatic tumors. At immunohistochemical analysis, 40% of cases (14 patients) stained positive for MDM2. Of these MDMD2-positive tumors, 11/14 (78.57%) had high risk tumors and 8/14 cases (57.14%) presented with metastatic GIST. MDM2 positivity was significantly associated with the metastatic status ( = 0.001).

Conclusion: The current study suggests that MDM2 immunohistochemical expression is a negative histoprognostic factor in GIST with a statistically significant correlation with metastasis.
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http://dx.doi.org/10.1186/s12907-018-0069-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5781285PMC
January 2018

Bilateral pheochromocytoma with ganglioneuroma component associated with multiple neuroendocrine neoplasia type 2A: a case report.

J Med Case Rep 2017 Aug 1;11(1):208. Epub 2017 Aug 1.

Department of Pathology, Hassan II University Hospital, Fès, Morocco.

Background: Composite pheochromocytoma/paragangliomas are very rare tumors composed of ordinary pheochromocytoma paragangliomas associated with neurogenic tumors. Several hereditary susceptibility disorders are known to be associated with pheochromocytoma/paragangliomas such as multiple endocrine neoplasia type 2 (2A or B). To the best of our knowledge, only four cases of composite pheochromocytoma/paragangliomas associated with multiple endocrine neoplasia type 2 have been reported.

Case Presentation: A 40-year-old Arabic woman presented with headache, palpitations, paroxysmal hypertension, and weight loss, which she had had for the last 3 years. She had a familial history of diabetes and multiple endocrine neoplasia type 2. A radiological examination revealed thyroid lesions and bilateral adrenal medulla tumors. Our patient had undergone bilateral adrenalectomy, total thyroidectomy with cervical lymphadenectomy, and parathyroidectomy. A pathological examination confirmed the multiple endocrine neoplasia type 2A consisting of left medullary pheochromocytoma, right medullary composite pheochromocytoma-ganglioneuroma, medullary carcinoma of the thyroid with lymph node metastasis and parathyroid hyperplasia. A genetic analysis also revealed that our patient had a RET germline mutation.

Conclusion: Composite pheochromocytoma/paraganglioma associated with multiple endocrine neoplasia type 2 is a very rare occurrence, as the current literature provides only a few cases. Further reported cases are needed in order to understand the behavior and the pathogenesis of this uncommon entity.
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http://dx.doi.org/10.1186/s13256-017-1364-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5537993PMC
August 2017

Fournier gangrene: rare complication of rectal cancer.

Pan Afr Med J 2015 24;20:288. Epub 2015 Mar 24.

Urology Department, Hassan II University Hospital, Fez, Morocco.

Fournier's Gangrene is a rare complication of rectal cancer. Its discovery is often delayed. It's incidence is about 0.3/100,000 populations in Western countries. We report a patient with peritoneal perforation of rectal cancer revealed by scrotal and perineal necrotizing fasciitis.
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http://dx.doi.org/10.11604/pamj.2015.20.288.5506DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4483353PMC
April 2016

[Primitive omental appendagitis: a rare cause of abdominal pain].

Pan Afr Med J 2015 24;20:170. Epub 2015 Feb 24.

Faculté de Médecine et de Pharmacie de Fès, Université Sidi Mohammed Ben Abdellah, Département de Chirurgie, CHU Hassan II, Fès, Maroc.

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http://dx.doi.org/10.11604/pamj.2015.20.170.5638DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4469451PMC
March 2016

Epigenetics could explain some Moroccan population colorectal cancers peculiarities: microsatellite instability pathway exploration.

Diagn Pathol 2015 Jun 24;10:77. Epub 2015 Jun 24.

Department of pathology, University hospital Hassan II of Fez, Fez, Morocco.

Background: Colorectal Cancers (CRC) are one of the most common malignancies in the world. Their incidence in Morocco, between 2005 and 2007, was 5.6 for 100000 inhabitants, which is very low compared to what found in developed countries. In addition, CRCs show a high frequency of rectal localizations, and occurs in a younger population in Morocco compared to what found in developed countries. The purpose of this study is to confirm these CRC peculiarities in Morocco and try to explain them by exploring the microsatellite instability molecular pathway.

Methods: This is a prospective observational study conducted since January 2010, including 385 patients admitted in Hassan II University Hospital of Fez. We collected clinical, radiological and pathological data. We investigated the expression of mismatch repair (MMR) proteins in 214 patients and BRAF gene mutations in 159 patients.

Results: Mean age was 55.08 +/- 15.16 years. 36.5% of patients were less than 50 years old and 49.3% of tumors were localized in the rectum. Loss of MMR protein expression was observed in 11.2% of cases. It was independently associated with individual or family history of cancer belonging to Hereditary Non-Polyposis Colorectal Cancer (HNPCC) spectrum (p = 0.01) and proximal localization (p = 0.02). No BRAF mutation was detected in all cases.

Conclusions: These results confirm the high occurrence of CRCs to young patients and the high frequency of rectal localizations in Moroccan population. They mostly show an absence of BRAF mutation, supposing a rarity of MLH1 promoter hypermethylation pathway, which may even partially explain the CRC peculiarities in our context.

Virtual Slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/5868184711716884.
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http://dx.doi.org/10.1186/s13000-015-0326-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4477595PMC
June 2015

A rare cause of intestinal obstruction: ileosigmoid knot.

Pan Afr Med J 2014 9;19:21. Epub 2014 Sep 9.

Department of Surgery, Faculty of Medecine and Pharmacy in Fez, Univerity Sidi Mohammed Ben Abdellah, CHU Hassan II, Fez, Morocco.

Intestinal obstruction is common surgical emergency; ileosigmoid knot is a rare cause of intestinal obstruction (a loop ileum and sigmoid colon twisted around each other in a knot). We recorded a three cases in HASSAN II hospital in the last 3 years.
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http://dx.doi.org/10.11604/pamj.2014.19.21.3902DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4286229PMC
September 2015

[Intestinal cystic pneumatosis secondary to a peptic ulcer: report of three cases].

Pan Afr Med J 2015 17;20:150. Epub 2015 Feb 17.

Faculté de Médecine et de Pharmacie de Fès, Université Sidi Mohammed Ben Abdellah, Département de Chirurgie, CHU Hassan II, Fès, Maroc.

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http://dx.doi.org/10.11604/pamj.2015.20.150.3017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4919673PMC
December 2016

[Large intra-rectal foreign body : a case report].

Pan Afr Med J 2014 4;18:273. Epub 2014 Aug 4.

Service de Chirurgie Viscérale, CHU Hassan II - Fès, Université Sidi Mohamed Ben Abdellah, Faculté de Médecine et de Pharmacie de Fès, Fès, Maroc.

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http://dx.doi.org/10.11604/pamj.2014.18.273.4226DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4258213PMC
July 2015

[Small bowel volvulus on peritoneal hydatid disease: a rare cause of obstruction].

Pan Afr Med J 2014 24;18:79. Epub 2014 May 24.

Service de Chirurgie Viscérale, CHU Hassan II - Fès, Université Sidi Mohamed Ben Abdellah, Faculté de Médecine et de Pharmacie de Fès, Maroc.

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http://dx.doi.org/10.11604/pamj.2014.18.79.4205DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4231250PMC
July 2015

[Intrarectal foreign body: traditional medicine or behavioral disorder?].

Pan Afr Med J 2014 8;17:254. Epub 2014 Apr 8.

Service de Chirurgie Viscérale B, CHU Hassan II, Fès, Maroc.

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http://dx.doi.org/10.11604/pamj.2014.17.254.4199DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4189873PMC
May 2015

Catastrophic hemorrhage of adrenal pheochromocytoma following thrombolysis for acute myocardial infarction: case report and literature review.

World J Emerg Surg 2014 20;9(1):50. Epub 2014 Sep 20.

School of medicine and pharmacy of Fez, Sidi Mohammed Ben Abdellah University, BP: 1893, km 2.200, route de Sidi Hrazem, Fez, 30000 Morocco ; Department of surgery, University Hospital Hassan II, BP: 1893, km 2.200, route de Sidi Hrazem, Fez, 30000 Morocco.

We describe here the case of a 62-year-old man with acute abdominal syndrome and severe hemorrhagic shock following successful thrombolysis for acute cardiac infarction. Emergency surgical exploration revealed extensive intraperitoneal and retroperitoneal hemorrhage resulting from the rupture of a large adrenal tumor. The diagnosis of pheochromocytoma was confirmed by histological findings. The patient died a few hours after surgery from multiorgan failure despite resuscitation attempts. This report discusses the diagnosis difficulties, treatment approach, and relevant literature.
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http://dx.doi.org/10.1186/1749-7922-9-50DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4177258PMC
October 2014

Stromal tumor of the lesser omentum : a case report.

Pan Afr Med J 2014 28;17:236. Epub 2014 Mar 28.

Département de Chirurgie, Faculté de médecine et de pharmacie de Fès, Université Sidi Mohammed Ben Abdellah, CHU Hassan II, Fès, Maroc.

Gastrointestinal stromal tumors (GISTs) represent the majority of primary non-epithelial neoplasms of the digestive tract, most frequently expressing the KIT protein detected by immunohistochemical staining for the CD117 antigen. Extragastrointestinal stromal tumors (EGISTs), neoplasms with immunohistological features overlapping those of GISTs, are found in the abdomen outside of the gastrointestinal tract with no connection to the gastric or intestinal wall. We report the clinical, macroscopic and immunohistological features of an EGIST arising in the lesser omentum of a 58-year-old woman. This is a very rare location of intra abdominal stromal tumors.
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http://dx.doi.org/10.11604/pamj.2014.17.236.3133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145276PMC
May 2015

Left paraduodenal hernia: A rare cause of acute abdomen.

Pan Afr Med J 2014 27;17:230. Epub 2014 Mar 27.

Faculté de Médecine et de Pharmacie de Fès, Université Sidi Mohammed Ben Abdellah, Département de Chirurgie, CHU Hassan II, Fès, Maroc.

Paraduodenal hernia is a rare congenital anomaly that arises from an error of rotation of the midgut. The duodenum and the small intestine become trapped in a sac which is lined by the peritoneum, behind the mesentery of the colon, either to the right or left of the midline. It is therfore a rare and potentially life-threatening condition that can cause intestinal obstruction progressing to strangulation and perforation. We report a case of a 55-year-old patient presenting a left paraduodenal hernia diagnosed intraoperatively after being operated on in the emergency setting for acute abdomen. The small bowel was twisted upon its mesentery and was entrapped in a large left paraduodenal space. Fortunately, once the bowel was reduced from the paraduodenal space, the blood flow was reestablished and the small bowel resumed a proper functioning. The mouth of the sac was obliterated by suture opposition to the posterior wall. The patient's subsequent hospital course was uneventful, and he was discharged in satisfactory condition 4 days postoperatively.
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http://dx.doi.org/10.11604/pamj.2014.17.230.3546DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145264PMC
May 2015

[Cancer patient satisfaction survey in a Moroccan university hospital].

Sante Publique 2013 Sep-Oct;25(5):627-32

Objectives: Assessment of patient satisfaction helps to guide hospital strategies concerning optimal patient management. The objective of this study was to evaluate the satisfaction of cancer patients hospitalised at Fez university hospital, to study the various components of satisfaction and to integrate the patient in quality of care improvement policies.

Methods: A prospective study was conducted in two voluntary wards of the hospital. An anonymous standardized questionnaire was administered to patients hospitalised for cancer surgery or treatment.

Results: 87.1% of patients reported that they were very satisfied with their hospitalisation, while 12.9% rated their stay as acceptable. 98.4% would recommend the hospital to their relatives. In contrast, 67.2% of patients surveyed considered that the cost of their stay was too expensive.

Conclusion: The majority of items were declared as "Very satisfactory" by the patients. They represent a challenge to be maintained in the future: ward reception, comfortable accommodation, the behaviour and availability of staff, the doctor-patient relationship, respect for patient, the explanations provided concerning the health problem and treatment, psychological support and pain management. For items reported to be less satisfactory, recommendations should be implemented concerning the admissions office, administrative formalities on admission, the information provided at the time of discharge, quality of meals, development of nursing skills and dietary advice.
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February 2014
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