Rapports de cas cliniques et médicaux

The complex tumour microenvironment is a crucial regulator of anti-tumor immune responses in gynecologic cancers. How cancer cells interact with the diverse population of immune effector cells has a substantial impact on the efficacy of traditional chemotherapy and cutting-edge immunotherapy methods. In this study, we focus specifically on the role of macrophages in ovarian, endometrial, and cervical cancers. We discuss the evolution of macrophages and how their polarisation status is influenced by the stimuli in their surroundings. By fostering tumour growth and controlling immune-suppression, tumor-associated macrophages (TAMs) in the tumour microenvironment affect treatment outcomes. We outline clinical strategies that particularly target TAMs, such as limiting macrophage differentiation, blocking immunological checkpoints, reducing monocyte recruitment to the tumour, and preventing immune checkpoint blockade.

Buschke lowenstein tumor (BLT) or giant condylomas acuminata (GCA) is relatively rare. It is caused by papillomavirus, and in particular by HPV serotypes 6, 11. It most commonly occurs in immunocompromised males. It is characterized by the frequency of recurrence and the risk of malignant transformation and the treatment remains essentially surgical.

We report the case of twelve patients treated for anorectal TBL, eleven of whom were immunocompetent. Based on this study and a review of the literature, we will describe this condition's epidemiological, therapeutic and evolutionary aspects. The originality of this study lies in the fact that this pathology has been diagnosed in immunocompetent patients.

Primary synovial sarcoma of the lung is an extremely rare neoplasm and highly aggressive. The diagnosis is established after extra-thoracic sarcoma and other primary lung malignancies are excluded.

We report the case of a 73-year-old man who presented a well-defined mass. Immunohistochemically was positive for bcl-2, vimentin, S-100 but negative for CD34, cytokeratin, epithelial membrane antigen and calretinin.

Given the rarity of primary synovial sarcoma of the lung, there are no guidelines for its treatment and survival is low although new therapeutic possibilities are upcoming and should be considered in future management.

Background: Radical prostatectomy is among gold standard treatments for prostate cancer (PCa). As compared to other surgical approaches, robot-assisted radical prostatectomy (RARP) offers several advantages such as better intra-operative manipulation and lower peri-operative morbidity and as such, it is currently the preferred surgical option whenever available. In candidates to RARP, a large prostate is often a challenge as it may affect operative and functional outcomes, but can be safely performed according to current literature. However, studies of RARP involving a large prostate were often limited to a weight ranging from 50 to 150 grams, with only few cases of RARP performed on bigger prostate glands. For this reason, we want to describe a case of a patient with a prostate larger than 350 grams treated with RARP at our institution.

Case report: We presented a case of a 68-year-old patient that came for a second opinion following a diagnosis of prostate carcinoma after an elevated PSA of 21 ng/ml without the presence of lower urinary tract symptoms. Magnetic resonance imaging showed a PIRADS 5 lesion in the left apex with an estimated weight of 450 grams. Biopsy showed an International Society of Urological Pathology (ISUP) group-3 adenocarcinoma. RARP was performed using an anterior, trans-peritoneal approach. The operative time was 210 minutes, and the estimated blood loss was 1400 ml. Pathological examination showed a pT3b, ISUP group 3 invasive PCa, with negative surgical margins. After surgery, the patient was discharged after two days without postoperative complications, and the urethral catheter was removed after 5 days. At a follow-up visit 30 days after surgery, the patient had neither voiding problems nor urinary incontinence.

Conclusion: We described a case of a patient with an extremely large prostate who underwent robot-assisted radical prostatectomy for prostate cancer. Our findings suggest that a large prostate size is not an absolute contraindication for RARP, with optimal recovery of urinary continence early after surgery. Further research, especially larger studies with longer follow-up, is awaited in order to accurately evaluate outcomes of RARP in patients with large prostates.