Multidisciplinary Consultation Meetings Research Articles

Are multidisciplinary consultation meetings for prenatal diagnosis achievable in a low-income country? A descriptive cross-sectional survey in Benin

ObjectiveThe multidisciplinary antenatal diagnosis staff bring together practitioners who are involved in the management of the antenatal period at birth. This project was designed following the French experience to institute...

Assessment of enteral nutrition through feeding stomas or gastric tubes in digestive surgery

Ostomy feeding remains a reference approach for enteral nutritional assistance. In Madagascar, the techniques are still conventional surgical procedures due to the lack of adequate endoscopic equipment. This study aims to evaluate the benefits and risks of enteral nutrition with a two-week follow-up. Included patients who had benefited from enteral nutrition by tube feeding using nasogastric, gastrostomy, and jejunostomy tubes over six months in Joseph Ravoahangy Andrianavalona Hospital. Prevalence, age and gender, current body mass index (BMI), weight, nutritional grade, initial pathology, psychological status, comorbidities, type of feeding stoma, and the surgical technique (gastrostomy or jejunostomy) were studied. After 15 days, the effectiveness of enteral nutrition was assessed using BMI, serum albumin, C-Reactive Protein (CRP) level, as well as postoperative complications and quality of life. The patient's outcome on the 15th day has been determined. The Chi-square test analyzed the associations and Mann Whitney test compared the effects of enteral nutrition by ostomy and gastric tube use. Forty-two patients were included, aged 47(17-78). The sex ratio was 0.5. Initially, the body mass index was 17(12-23) kg/m², the serum albumin value 3.4 (2.5-4.7) gr/dl with a median CRP level of 16 (2-74.2) mg/l. Nutritional assistance resulted in a weight variation between baseline and 15th day. Comparing enteral nutrition by ostomy and gastric tube, only variation of C Reactive Protein on the 15th day has a significative difference. Mortality was 33% (gastrostomy), 31% (jejunostomy), 24% (nasogastric tube). Nutritional support and the choice of ostomy or gastric tube for enteral nutrition were not associated with mortality. The effectiveness of nutritional assistance is still questionable in this study if the results are more promising in the literature. The death rate linked to the initial pathology and the general state of the patients is still considerable, hence the interest in decision-making in multidisciplinary consultation meetings.

Addressing the impact of cancer on reproductive and erotic sexuality

The impact of oncological treatments on the sexual health of the individual is major. Reproductive and erotic sexuality may be altered. Prescriptions, of which the consequences are now well known, must be considered in the light of the patient's life plan. Multidisciplinary consultation meetings and individual or couple consultations are propticious places todiscuss and make balanced decisions.

Adapting patients' oncological treatment through remote participation of general practitioners in multi-disciplinary consultation meetings: A feasibility study

Background The general practitioner (GP) is central to managing patients with cancer, whose numbers are increasing worldwide. The GP’s involvement requires better coordination between involved partners, in particular oncologists and GPs. Objectives To conduct a feasibility study of remote participation of GPs in multi-disciplinary consultation meetings (MCMs). We analysed participation, participants’ satisfaction, and their impact on therapeutic decisions. Methods We conducted a feasibility study in the regional cancer centre of Toulouse, France. All patient cases discussed in the MCMs for myelodysplasia from 1 January to 31 March 2016 were included. Cases of patients aged over 18 years, with a diagnosis of myelodysplasia and registered with a GP were included if patients gave informed consent. One investigator collected the data provided by GPs during three telephone or video calls: before, during, and after the MCM, respectively. Results Of 86 patient cases discussed during three months of MCMs, 44 were eligible for GP participation; 27 GPs participated in discussions of 27 patient cases. The GP’s participation in the MCM led to a change in management in five cases, with four times treatment intensifications and once de-intensification. Medical, social, family-related, and psychological domains were discussed with input from the GPs. Overall, all participants were satisfied with the MCMs. Conclusion Remote participation of GPs in MCMs is feasible and may result in adapting oncological and haematological management for patients. This patient-centred approach requires a specific organisation that, when implemented, satisfies the needs of all participants.

Prediction of Metastatic Relapse in Breast Cancer using Machine Learning Classifiers

The volume and amount of data in cancerology is continuously increasing, yet the vast majority of this data is not being used to uncover useful and hidden insights. As a result, one of the key goals of physicians for therapeutic decision-making during multidisciplinary consultation meetings is to combine prediction tools based on data and best practices (MCM). The current study looked into using CRISP-DM machine learning algorithms to predict metastatic recurrence in patients with early-stage (non-metastatic) breast cancer so that treatment-appropriate medicine may be given to lower the likelihood of metastatic relapse. From 2014 to 2021, data from patients with localized breast cancer were collected at the Regional Oncology Center in Meknes, Morocco. There were 449 records in the dataset, 13 predictor variables and one outcome variable. To create predictive models, we used machine learning techniques such as Support Vector Machine (SVM), Nave Bayes (NB), K-Nearest Neighbors (KNN) and Logistic Regression (LR). The main objective of this article is to compare the performance of these four algorithms on our data in terms of sensitivity, specificity and precision. According to our results, the accuracies of SVM, kNN, LR and NB are 0.906, 0.861, 0.806 and 0.517 respectively. With the fewest errors and maximum accuracy, the SVM classification model predicts metastatic breast cancer relapse. The unbiased prediction accuracy of each model is assessed using a 10-fold cross-validation method.

Should the management of radiation therapy for breast cancer be standardized? Results of a survey on current French practices in breast radiotherapy.

Breast cancer is the most frequent cancer in women in France. Its management has evolved considerably in recent years with a focus on reducing iatrogenic toxicity. The radiotherapy indications are validated in multidisciplinary consultation meetings; however, questions remain outstanding, particularly regarding hypofractionated radiotherapy, partial breast irradiation, and irradiation of the internal mammary chain and axillary lymph node area. An online survey was sent to 47 heads of radiotherapy departments in France. The survey consisted of 22 questions concerning indications for irradiation of the supraclavicular, internal mammary and axillary lymph node areas; irradiation techniques and modalities; prescribed doses; and fractionation. Twenty-four out of 47 centers responded (response rate of 51%). This survey demonstrated a wide variation in the prescribed dose regimen, monoisocentric radiotherapy, and indications of irradiation of the lymph node areas. This survey provides insight into the current radiotherapy practice for breast cancer in France. It shows the need to standardize practices.

Collaborative digital platform France \u2013 Cuba: oncorehabilitation in reproductive and sexual health

BackgroundIn the French West-Indies, few studies have been performed on fertility and sexual problems in cancer survivors, which are frequent and recurring issues reported by surveys on unmet needs. Additionally, mutualizing human and material resources and promoting cooperation through a collaborative platform are the most appropriate response to complex health pathways in the Caribbean territories. Implementation of such a collaborative platform will help to launch a strategic Caribbean partnership to transfer theoretical and technical skills and care standards in oncofertility and oncosexuality.MethodsWe propose to set up a collaborative digital platform to strengthen, from the French expertise, Cuban health professionals’ knowledge, know-how, and skills in oncofertility and oncosexuality. The project will be coordinated by a coordinating, scientific, and supervisory committee, and the main activities will include:Theoretical training in e-learning adapted to low-speed Internet.Practical training in fertility preservation and sexual rehabilitation.Digital multidisciplinary consultation meetings for medical decisions to be taken for complex clinical cases.The platform will benefit from a recurrent evaluation, by the two cancer registries of Martinique and Cuba, with the following performance indicators: number of Cuban professionals trained, number of professionals sensitized, hourly volumes (or number of training courses provided), satisfaction of trained professionals, number of e-RCPs carried out online and number of missionaries supported. These indicators will be set up and analyzed by the registers.This project meets the Cuban and French health policies (cancer plans and national sexual health strategies) and will be implemented in liaison with the Health Agencies of both countries and the Embassy of France in Cuba.DiscussionThis project aims to provide support through bilateral exchanges to improve reproductive and sexual health in Cuba’s cancer patients. This collaboration will be based on a long-lasting French expertise and a solid Cuban health system. Consequently, this collaborative digital platform will contribute to data collection for cancer surveillance, and the two participating countries will ultimately be identified in the Caribbean as having centers of competence and excellence in oncofertility and oncosexuality with care standards.

Outcome comparison between radiochemotherapy and surgery in the management of locally advanced non-metastatic laryngeal cancer a single institution experience

he treatment of locally advanced non-metastatic laryngeal squamous cell carcinoma is very controversial. Total laryngectomy associated with lymph node dissection and adjuvant radiotherapy with or without chemotherapy is considered the gold standard treatment. The functional impairment on voice and breathing that result from this approach called for discussion of preservation of this organ. Since the publication of the Veterans' Study in 1991 on laryngeal cancer and the confirmation by subsequent randomized trials of an equivalent survival, treatment strategies for advanced laryngeal carcinoma have shown significant changes in favour of an organ-sparing approach by chemoradiotherapy. Purpose: We aim to assess the outcome of locally advanced non-metastatic laryngeal cancer classified as (T3NxM0 -T4NxM0) by comparing the carcinological results and the survival at one and three years between two cohorts of patients, one treated by surgery and the other by organ preservation protocols. Between the two series, we will analyze the carcinological outcomes, local control, local and lymph node recurrence, distant metastases, overall survival, and recurrence-free survival, lymph Node-free survival, and metastatic evolution. Results: 106 patients were treated for locally advanced squamous cell laryngeal carcinoma of the ENT department and radiation Oncology department of Mohamed VI University hospital between January 2014 and December 2018; Sixty-three patients in surgery group I and forty-three patients in group II went on organ sparing approach by radiochemotherapy. The two groups were compared according to local tumor control, local recurrence, lymph node recurrence, and distant metastasis. Early deaths and patients who were lost to follow-up were excluded from this analysis. The average age was 61 years in the surgery group versus 60 years in the RCC. The male predominance was marked in both treatment groups, 102 were male (96.23%) and only 4 female (3.77 %.).88.7% were smokers with an average consumption of 26.4 package-years. Only 15% of our smoking patients reported a withdrawal period estimated at two months on average. Alcohol-smoking synergy was observed in 19% of cases. In the surgery group, 47 patients or 83.9% had local tumor control compared to 12 patients or 41.4% in the radio-chemotherapy group with a statistically significant difference p<0.0001. Local recurrence was observed in 8 patients (14.5%) in the surgery group against 6 patients (46.2%) in the radio-chemotherapy cohort with a p= 0.02. We noted that there was a large number of missing data (30 patients) in the radio-chemotherapy group due to the large number of patients who were lost to follow-up, early deaths, and patients who did not progress well after treatment. There was no statistically significant difference between the two groups in terms of lymph node recurrence and metastatic progression. At 1 year, Overall survival was 87.9% of patients were alive (n=51 out of 58) in the surgery arm versus 60.6% (n=20 out of 33) in the radio-chemotherapy arm. At 3 years overall survival was 77.5% for surgery versus 48.4% for radiotherapy (p= 0.005).Lymph node free recurrence and metastatic free progression at 1 year was 94.5% in the surgery group compared with 84.6% for radio-chemotherapy. Survival at 3 years was 85.4% versus 53.8% respectively (p=0.05).In the chemoradiation therapy group, there were 30 missing data due to a large number of deaths and loss of the follow-up during the first year without any indication of the presence or absence of recurrence, compared to 8 missing data for the radio-chemotherapy group. Conclusion: The optimal treatment for advanced squamous cell carcinoma of the larynx is highly controversial. Total laryngectomy associated with cervical lymph node dissection remains the gold standard of treatment but organ-sparing protocols are as effective as surgical therapy. However, in our study, total laryngectomy plus lymph node dissection showed better survival outcomes in terms of locoregional control and significantly increased overall survival and recurrence-free survival. This makes surgery the treatment of choice in the management of locally advanced non-metastatic laryngeal cancer in our single institutional Moroccan setting. Possible reasons for these results may be poor patient selection, inadequate follow-up, incomplete treatment, and interrupted treatment sessions but also the long delay in consultation. Patients and professionals should be made aware of the small but significant disadvantage of the non-surgical therapy approach as part of the shared decision-making process when selecting treatment. Both surgery and radio-chemotherapy can be effective if the treatment indications are well directed. These indications depend on several many several parameters and should be considered at the multidisciplinary consultation meetings and adapted on a case-by-case basis.

Drug-drug interaction (DDI) with direct oral anticoagulant (DOAC) in patients with cancer

Cancer-associated thrombosis (CAT) is the second leading cause of death in cancer patients after tumor progression. The treatment of CAT is challenging because of a high risk of VTE recurrence, a high risk of bleeding, common presence of comorbidities, poly-medication, and potential drug-drug interactions (DDI). Since 2018, direct oral anticoagulants (DOACs) represent a promising therapeutic alternative and have been recently included into the 2019 update of the International Initiative on Thrombosis and Cancer (ITAC-CME) clinical practice guidelines for management of CAT. However, pharmacokinetic studies suggest that concomitant treatment with P-gp or CYP3A4 inhibitors will result in an increased exposure to rivaroxaban and apixaban, but the clinical relevance of these studies is unknown. In addition, there is an important inter-individual variability in drug absorption, distribution, metabolism and elimination, even more in cancer patients. Overall, the risk of pharmacokinetic DDI should be estimated based on several individual (patient age, renal and liver function, number of comedications) and diseases-related factors, including inflammation, sarcopenia, and low body weight. In this context, DDI with clinical implications could be expected with anti-neoplastic agents or supportive care treatments, especially with drugs known to be moderate or strong inhibitors/inducers of CYP3A4 and P-gp. Consequently, in the presence of potential DDIs through CYP3A4, and/or P-gp, LMWHs remain the first-line anticoagulant of choice for the long-term treatment of CAT. Multidisciplinary consultation meetings and therapeutic patient education should be emphasized in the complex management of CAT.

Rôle de l’IDE en urologie fonctionnelle

The management of patients in functional urology is complex and requires the expertise of the medical team but also of the nurse team. The aim of this article is to detail the roles of the nurses in functional urology. Exchanges with the nurses of our unit, analysis of the literature using the terms "nurse", "urology", "urodynamics" in the PubMed search engine, and a search for regulatory texts relating to the practice of nurses in urology units were conducted. Since the creation of the Inter-University Diploma of Nurse Expert in Urology in 2002and the inter-professional cooperation protocols in 2009, the urologist can rely on the specific skills of nurses to optimise the patient's management: from endoscopic or urodynamic explorations, to stomatherapy or sexology, from therapeutic education to specialised treatments such as posterior tibial nerve stimulation, sacral neuromodulation or botulinum toxin injections. Their expertise is an undeniable asset in the patient support and for the quality of care. The cooperation protocols respond to the current problems of the healthcare system: attractiveness for paramedical professionals, medical demographics and ambulatory care. The increasingly frequent practice of multidisciplinary consultation meetings also gives them a coordinating role. Nurses in functional urology plays a major role in diagnostic and therapeutic management as the patient's privileged contact and collaborator with the referring urologist.

Strategic plan for management of COVID-19 in paediatric haematology and oncology departments

Strategic plan for management of COVID-19 in paediatric haematology and oncology departments

Complications obstétricales du lupus érythémateux systémique et du SAPL : une prise en charge multidisciplinaire

The main autoimmune diseases responsible for obstetric complications are systemic lupus erythematosus and antiphospholipid syndrome. They are particularly associated with an increased risk of miscarriage, stillbirth, intrauterine growth restriction, prematurity and pre-eclampsia. Therapeutics to prevent its complications are mainly low dose aspirin and low molecular weight heparins. However, the introduction of these therapies will have to consider the benefit/risk ratio to manage pregnancy and especially delivery. Consistency of care provided by autoimmunity specialists and gynaecologist-obstetricians is extremely important and must be promoted through regular exchanges, fuelled by a mutual culture, through multidisciplinary consultation meetings.

English

While multidisciplinary consultation meetings on therapeutic protocols, psychological management, treatment of pain for patients living with cancer are setting up, their nutritional status in Cote-d'Ivoire is almost absent in oncology units. This study aimed to assess the nutritional profile of adult patients with cancer, followed at the oncology service of the University Hospital of Treichville. A descriptive and analytical cross-sectional study was conducted over a 40-day period, from an anonymous questionnaire and involving fifty-three (53) cancer patients. sociodemographic, clinical and biological data as well as qualitative parameters on food consumption (24-hour recall) were collected. The results revealed that the mean age was 51 years with a female predominance (87.5%). The nutritional status of patients was evaluated according to several parameters: The Body Mass Index (BMI) accounted for 8.33% of malnourished patients with 37.5% of patients being obese or overweight. Weight loss in the 6 months preceding the survey concerned 77.55% patients, 30.61% of whom were severely malnourished. Albuminemia and the Nutritional Risk Index (NRI) showed that respectively 13.5% of the patients were malnourished and 22.5% of patients were at risk of complications related to undernutrition. In 18.87% of cases, surveyed patients had taken less than three meals a day. Therefore, prevalence of undernutrition/malnutrition was high in the study population. No single parameter was sufficiently sensitive and specific. Based on this, the combination of several parameters is necessary for an objective assessment for intervention. Nutritional management of patients living with cancer deserves to be integrated into the overall therapeutic project. Key words: Nutrition, cancer, undernutrition, nutritional assessment, food intake.

Traitements systémiques du carcinome adénoïde kystique de la sphère ORL localement avancé ou métastatique, une revue systématique

Adenoid Cystic Carcinoma is a rare tumor of the head and neck sphere. The purpose of this review is a state of the art of systemic treatments (chemotherapies, targeted therapies, immunotherapies) for locally recurrent or metastatic disease. Our inclusion criteria included head and neck adult patient, metastatic or locally advanced, treated by a systemic therapy, and with at least 10 or more patients. Forty articles have been selected in this review. The objective response rate under chemotherapy was predominantly<10% (0-70%) with objective responses in monotherapy with cisplatin, mitoxantrone, vinorelbine and eribuline, and with cisplatin-vinorelbine combination. EGFR inhibitors provided 40% objective responses only in combination. Inhibitors of VEGF and histone deacetylase have allowed disease stabilization in progressive patients, with about 10% of objective response. Inhibitors of c-KIT monotherapy yield objective response rates of<5%. Direct inhibitors of the PI3K/AKT/mTOR pathway display 0% objective response rate. The best objective response rates were obtained with cisplatin-vinorelbine combination. Many targetable molecular abnormalities have been identified and studies have shown prolonged stabilization with EGFR, VEGF and HDAC inhibitors. Multi-disciplinary collaborative consultation (MCC) meetings such as French network of experts in rare head and neck tumors (REFCOR) or Molecular MCC should be proposed and may allow referral to centers proposing specific therapeutic trials.

Decision-making in gender reassignment surgery

The prescribing of hormones and theperforming of gender reassignment surgery on a healthy body are dangerous and irreversible acts. To ensure patients' safety, endocrinologists and surgeons must use the skills of experienced psychiatrists to create a differential diagnosis, evaluate any frailties and weigh up the risk-benefit ratio. Therapeutic decisions are made as part of multidisciplinary consultation meetings. A minimumtwo-year observation period must be respected for the treatment to be covered by social security.

1083. Long-Term Prognosis of 448 Infectious Endocarditis Followed by an Endocarditis Team

BackgroundThe management of infective endocarditis (IE) by an expert medico-surgical team through multidisciplinary consultation meetings is now recommended. While it seems clear that it can improve the short-term prognosis of patients, long-term data are still scarce.MethodsAll patients hospitalized between 2013 and 2017 in the three teaching hospitals of our center with an IE treated by the multidisciplinary team were followed prospectively at 1, 3, 6, and 12 months. The main objective was to determine the 1-year mortality of the entire cohort treated by the team.ResultsDuring the study, 493 patients had a certain or possible IE and the outcome at 1 year was known for 448 of them (4 lost to follow-up and 41 followed for less than 1 year): 254 had native valve IE (57%) and 194 had prosthetic valve IE (43%). The median age of IE patients was 69.3 years (155 patients were over 75 years old) and 329 (73%) were men. Healthcare-associated IE (HAIE) accounted for 47% of cases. A microorganism was isolated in 92% of cases (S. aureus = 24%), 252 patients (56%) had an embolic events and 68 (15%) had heart failure. The Charlson Median Comorbidity Index (ICC) was 5.0. Two hundred sixteen patients (48%) underwent surgery. The mortality rates at 1 month, 3 months, 6 months, and 1 year were, respectively, 14.1%, 19.0%, 23.2%, and 27.7%. The ICC at inclusion of patients who died at 1 year was 6.0 vs. 4.0 for survivors. Mortality at 1 year was significantly higher in case of HAIE (33% vs. 23%), documented S. aureus IE (39% vs. 24%), exclusive medical treatment (40% vs. 15%), and heart failure (43% vs. 25%).ConclusionWhile the management of IE by an endocarditis team seems to improve the short-term prognosis of IE, 1-year mortality remains high as patients are increasingly older and have severe comorbidities. Our study confirms that early prognostic factors remain in the long term and that the prognosis is better in community-acquired IE with surgery.Disclosures All authors: No reported disclosures.

The CRIOAc healthcare network in France: A nationwide Health Ministry program to improve the management of bone and joint infection

BackgroundBone and joint infections (BJIs) have a major clinical and economic impact in industrialized countries. Its management requires a multidisciplinary approach, and a great experience for the most complicated cases to limit treatment failure, motor disability and amputation risk. To our best knowledge there is not currently national specific organization dedicated to manage BJI. Is it possible to build at a national level, a network involving orthopaedic surgeons, infectiologists and microbiologists performing locally multidisciplinary meetings to facilitate the recruitment and the management of patients with complex bone and joint infection in regional centers? HypothesisA national healthcare network with regional labeled centers creates a dynamic that improves the recruitment, the management, the education, and the clinical research in the field of complex BJI. Patients and methodsWe describe the history of this unique national healthcare network and how it works, specify the missions confided to the CRIOAcs, evaluate the activity of the network over the first decade, and finally discuss perspectives. ResultsThe labelling of 24 centers in the CRIOAc network allowed for a meshing of the territory, with the possibility of management of complex BJI in each region of France. A dedicated secure national online information system was designed and used to facilitate decision-making during multidisciplinary consultation meetings. Since October 2012 to June 2017, 4553 multidisciplinary consultation meetings have been performed in the structures belonging to the network, with 34,607 cases discussed in 19,961 individual. Prosthetic joint infections represented 38% (7585/19,961) of all BJIs. Among all the cases discussed, the rate of complexity was of 61% (21,110/34,607) (related to antibiotic resistance, infection recurrence, patient co morbidities). A national scientific meeting was created and a national postgraduate diploma in the field of BJI was launched in 2014. The promotion of education, clinical research and interactivity between each academic discipline and between each labeled centers across the country has synergized the strengths and have greatly facilitated the management of patients with BJI. DiscussionThe setting up of the CRIOAc network in France took time, and has a cost for the French Ministry of Health. However, this network has greatly facilitated the management of BJI in France, and allowed to concentrate the management of complex BJI in centers that have significantly gained skills. There is, to our knowledge, no other exemple of such nationwide network in the field of BJI. Level of evidenceIV, case series without control group.

Palliatieve zorg in beeld?!

Palliative care in the picture?! This article describes a video-based observation research method to investigate the approach of healthcare professionals in a Dutch hospital when identifying palliative patients. We analyzed video recordings of eight multidisciplinary consultation meetings of four medical disciplines: cardiology, oncology, urology and geriatric care. The method of video-based observation suited the aim of this research. The most valuable aspects were the subtleties (e.g. non-verbal information) in interdisciplinary communication about palliative patients.

Gynaecologic cancer surgery and preservation of fertility

For gynecological cancers, even at an early stage, the standard treatment is "radical excision" involving hysterectomy (radical or not) with bilateral salpingo-oophorectomy. But for young patients with early stage disease, many recent studies have focused on preservation of subsequent fertility by keeping at least one ovary and the uterus. The main objective of this fertility-sparing surgery is to preserve fertility, if this can be accomplished without increasing the oncological risks. Whether the initial site of the cancer is the cervix, uterine fundus or ovary, the oncologic validation of fertility-sparing treatment requires several evaluation criteria: a rigorous clinical, radiological and surgical staging to verify that the pathology is truly at an early initial stage; expert pathologic interpretation of biopsy specimens to validate the histological criteria of "good prognosis"; provision of complete and understandable patient education verifying the true objectives for this fertility-sparing treatment (whose intent is to retain a potential for subsequent fertility without guaranteeing it) and provision of an explanation of the oncological constraints and implications of fertility-sparing surgery in the event of a possible pregnancy. As always in oncology, this strategy demands teamwork requiring successive discussions with the patient and spouse and thorough discussion of the oncological safety of this fertility-sparing strategy in multidisciplinary consultation meetings before "giving a green light".

The Primary Squamous Cell Carcinoma of The Endometrium: A Case Report and Literature Review

Introduction: The primary squamous cell carcinoma of the endometrium is a rare tumor. The incidence of these tumors is extremely low. Case Presentation: We report the case of an old patient of 67 years old, married with 5 children, 9 years since menopause. She consults for spontaneous postmenopausal bleeding with alteration of general state. The patient underwent hysteroscopy with biopsy endometrial curettage. Histology showed an adenocarcinoma endometroide grade 2. Then a total hysterectomy with bilateral adnexectomyand pelvic node dissection and multiple biopsies were realized. The anatomopathological examination showed a moderately differentiated non keratinizing squamous cell carcinoma without cervical location. The decision of the multidisciplinary consultation meetings was to complete the surgery by adjuvant radiotherapy. The patient presented a large retroperitoneal later aortic mass of 105mm and deceased one year later Conclusion: The primary endometrial carcinoma, squamous cell (PESCC) is an extremely rare tumor and its pathogenesis remains unclear. There are no guidelines for how it should be treated: a first surgery with or without adjuvant therapy are offered