The pre-pregnancy and pregnancy are often an opportunity for questions and even anxiety expressed by the woman in labor with Crohn's disease based on the history and experiences of their illness. We report the case of a primigeste of 27 years old, followed for Crohn's disease well controlled during the pre-pregnancy period by PENTASA no taking in early pregnancy had caused a relapse in the second trimester requiring hospitalization at Service of Hepatogastroenterology. On the obstetrical plan, the follow-up ultrasound objectified moderate growth restriction imposing a fetal extraction by caesarean section.
Sister Mary Joseph’s umbilical nodule designates an exceptional location umbilical metastatic of cancer, which is generally often pelvic adenocarcinoma. We report a case of this lesion due to adenocarcinoma of the ovary advanced in a patient, 58 years old who underwent surgery and chemotherapy. This nodule may indicate cancer or designates a recurrence. Adenocarcinoma is the most common histological type. Ovarian etiology is the leading cause in women. Faced with an umbilical metastasis, the prognosis is pejorative. Survival would be better however with combined surgery and chemotherapy treatment. So it must be known by the practitioner, because his recognition may allow early diagnosis and appropriate treatment.
Krukenberg's Tumors (TK) are defined as bilateral ovarian metastases from gastrointestinal cancer most often. They are rare and account 1 to 2% of ovarian tumors. We report a case of Krukenberg gastric original tumor in a female patient of 40 years old, G3P3, 3 living children, thyroidectomized with hormone replacement therapy, she was hospitalized for surgical exploration of two malignant abdominopelvic masses objectified in clinical examination and abdominopelvic ultrasound. Laparotomy had highlighted two ovarian tumors whose histology was in favor of ovarian metastases from carcinoma of digestive origin. Gastroesophageal Endoscopy showed a gastric adenocarcinoma with a signet-ring appearance of the pylorus and bulb gastric. Palliative chemotherapy was indicated. The patient died after four months. The treatment of this tumor remains palliative and is not codified. The progress of chemotherapy could improve the prognosis who is pejorative.
Granulosa tumors of the ovary are among the rare ovarian tumors, and included in the sex cord-stromal tumor category. They have a low degree of malignancy and have a good prognosis. Their clinical presentation is sometimes suggestive. Some biological markers (serum inhibin B and AMH) may be helpful for diagnosis, though their sensitivity is not perfect. Preoperative imaging diagnosis remains challenging due to the wide variability in morphology and lack of epidemiological data in the literature. These tumors are accompanied by high levels of estrogen. This state of hyperestrogenism is responsible for a broad spectrum of endometrial pathology from simple endometrial hyperplasia to the development of adenocarcinoma of the endometrium. Through this clinical observation of tumor of the adult type granulosa, we will discuss the main clinicopathological characteristics and histogenesis of this association to improve treatment of these tumors.
The fibrothecoma ovarian tumors are rare tumors representing less than 4% of all ovarian tumors. These tumors are observed in elderly and postmenopausal patients. The diagnosis is difficult because they are often mistakenly diagnosed as uterine fibromas or malignant ovarian tumors. Their diagnostic approach is guided by the clinical and Para clinical elements, but it is mainly based on histopathological evaluation. Conservative surgery is the treatment of choice in young women. Radical treatment is reserved for patients in perimenopause or postmenopausal period. We report two cases of this tumor, which were presented as advanced ovarian cancer, to identify diagnostic and therapeutic features. These are tumors with a good prognosis and a final recovery after surgery.
Pelvic tuberculosis accounts for 6% to 10% of tuberculosis cases. Tubal damage is the most frequent, followed by cervical and endometrial location. Ovarian tuberculosis is less common; presented as a clinical, biological and radiological form highly suggestive of ovarian tumor. Several factors contributed to the increase, mainly including related immunosuppression syndrome of acquired immunodeficiency. We report one case in a 24-year-old woman, single, followed for systemic lupus the initial interpretation of which, based on pleural and peritoneal exudate, showed suspected lateral uterine mass and significant elevated serum CA 125 level, mimicking disseminated ovarian carcinoma. Only after exploring laparotomy with biopsy was ovarian abscess tuberculosis identified, thus correcting the diagnosis. Its symptomatology was left after 2.5 months of antituberculosis multidrug. This is a rare disease whose diagnosis is histological and prognosis is dominated by the sequelae infertility.
Medical treatment of ectopic pregnancy (EP) is based on the administration of methotrexate (MTX). It concerns ectopic pregnancy with β-hCG <10000 without cardiac activity and applies to women informed, without history of ectopic pregnancy and who understand the predictive signs of break. These women should always be monitored until β-hCG negativity. The risk of tubal break persists throughout the treatment with MTX. The authors report three cases of ectopic pregnancy treated medically and whose evolution has been marked by a break. They talk through these cases about the indications and limitations of medical treatment and the risks of tubal break under medical treatment.
Trastuzumab is the first target molecule designed for breast cancer treatment. In first-line metastatic, trastuzumab in combination with chemotherapy significantly improved survival of patients bearing HER2-positive breast cancer. In adjuvant trastuzumab was tested in several randomized trials. In contemporary literature, many strong arguments confirm the clear survival benefit of trastuzumab in adjuvant administered concomitantly with taxane-based chemotherapy and concomitant with radiation therapy, and for a period of one year.
Peripartum cardiomyopathy (PPCM) is a rare cardiac disorder of unknown origin associated with a high risk of mortality (50%). Echocardiography confirms the diagnosis by showing a left ventricular dilatation and a decreased ejection fraction. Up to date, the treatment remains symptomatic. The authors report the case of a woman of 36 years old who presented a peripartum cardiomyopathy.
The authors report the case of a 26 years old woman with a medical history of three late fetal loss (between 20 to 22 weeks) who benefit in her actual pregnancy a recue cervical cerclage at 20 weeks of gestation. It allowed the continuation of the pregnancy until 38 weeks after elective suture removal at 36SA. The patient give birth by natural delivery to a baby girl in good condition. Prophylactic cerclage was recommended to the patient in later pregnancies. Through this case and based on recent literature reviews, the authors discuss the indications, contraindications, technical aspects and prognosis of rescue cervical cerclage.
Carcinosarcomas are rare uterine cancers and carry poor prognosis. Although these tumours usually arise de novo, some cases developed under tamoxifen therapy have been reported. We report a case of uterine carcinosarcoma occurring in a postmenopausal patient benefiting from tamoxifen therapy as adjuvant treatment of breast cancer.
A case of a malignant mesothelioma of clitoral location is reported in a 52 year-old woman.The microscopic and immunohistochemical exam of biopsy conﬁrmed the diagnosis of malignant mesothelioma of the clitoris. The computed tomography scan of thoraco abdominal pelvic was normal. The patient underwent surgical treatment followed by radiotherapy and chemotherapy. Most malignant mesotheliomas are pleural location; they rarely occur within the peritoneum and their clitoral location is exceptional. Our objective about this particular case is to discuss the diagnostic problems of exceptional tumour of the clitoris and clinical and pathologic aspects.
The authors report a case of hydrops fetalis discovered incidentally during a morphological ultrasound performed at 23 weeks of gestation in a 31 years old primigravida woman. The etiology was an infection by parvovirus B19. What is special about our observation is firstly that fetal infection by parvovirus B19 in pregnancy is rare and responsible of fetal anemia. Besides, thanks to a multidisciplinary care including obstetricians, neonatologists, anesthetists and after two transfusions, our patient was conducted pregnancy up to 34 weeks of gestation and give birth by caesarean section of a newborn female.