Paraneoplastic syndromes revealing ovarian teratoma in young and menopausal women: report of two cases

Paraneoplastic syndromes are a heterogeneous group of clinical and biological manifestations caused by underling neoplasms. They can reveal ovarian teratoma which express neuroendocrine proteins, or contain mature or immature neural tissue inducing an autoimmune response. The etiological investigation is then crucial to early identification of the tumor in order to optimize the prognosis and to limit neurological sequelae. In case of ovarian teratoma, management is essentially based on surgical resection sometimes associated with immunotherapie. We report two new cases of ovarian teratoma revealed by paraneoplastic syndromes in young and menopausal woman.

[Squamous cell carcinoma of the breast: report of a case and review of the literature]

Squamous cell carcinoma of the breast is a rare tumour of metaplasic origin; etiopathogeny is controversial; diagnosis is based on histological examination after eliminating the primary tumor; clinical and radiological examination is not specific; treatment is the same as for invasive ductal carcinoma; prognisis is poor due to tumor size and lymph node involvement. We report a case of breast squamous cell carcinoma in a 39 years old patient who was examined in the obstetrics and gynecology department of the military hospital in Rabat. Patient observation allowed us to specify the clinical characteristics of this entity which remains rare.

Large twisted ovarian fibroma in menopausal women: a case report

Ovarian fibroma is the most common benign solid tumors of the ovary, commonly misdiagnosed as uterine fibromaor as malignant ovarian tumors. It occurs generally in older perimenopausal and postmenopausal women. Occasionally large fibromas may undergo torsion causing acute abdominal pain. Doppler Ultrasonographyimaging is the choice study. CT and MRI are often needed for further characterization and differentiation from other solid ovarian masses. The choice treatment is surgical removal with intraoperative frozensection. Immunohistochemicalanalysis is recommended to rule out the differential diagnosis. Here we present a case of a postmenopausal woman with a large twisted ovarian fibroma reflecting diagnostic and management difficulties including potential misdiagnosis of the tumor as a malignant ovarian neoplasm that may influence the surgical approach.

[Massive vulval edema during pregnancy: report of a case]

L’œdème vulvaire massif est rare pendant la grossesse, mais requiert une attention particulière car il peut se greffer de complications maternelles et fœtales. Il peut être associé à plusieurs pathologies spécifiques ou non spécifiques à la grossesse dont le diagnostic fait appel obligatoirement à un interrogatoire et un examen clinique minutieux, puis à un bilan biologique standard. Le traitement doit être étiologique chaque fois que possible à coté du traitement symptomatique. Cette situation peut nécessiter un accouchement par césarienne. En dehors du risque potentiel de nécrose tissulaire et du risque exceptionnel de décès maternel associé à l’œdème vulvaire massif du post-partum l’évolution est favorable sous traitement bien conduit.

Léiomyosarcome utérin récidivant: à propos d’un cas

Les léiomyosarcomes utérins sont des tumeurs malignes, rares, de mauvais pronostic. Nous rapportons un cas de léiomyosarcome diagnostiqué initialement à l'examen anapath d'une pièce d'hystérectomie réalisée pour myome utérin chez une femme de 45 ans. Il s'agit d'une observation particulière. La plupart des auteurs soulignent le mauvais pronostic précoce du léiomyosarcome avec récidive tumorale; Le principal facteur pronostique étant l'activité mitotique. La tumeur de notre patiente a une activité mitotique élevée, elle a récidivé trois fois en cinq ans et opérée à trois reprises.

[Severe sickle cell disease and pregnancy. Systematic prophylactic transfusions in 16 cases]

Sickle cell disease is a major cause of maternal and neonatal mortality in tropical regions. Treatment consists of regular blood transfusion during pregnancy and delivery. Transfusion may be performed selectively (in function of the clinical status of the mother, fetus, and pregnancy) or prophylactically. Both management strategies result in a significant improvement in the obstetric outcome. However systematic prophylactic transfusion has been shunned due to the risk of transmitting infections and allo-immunization. The16-case series reported here demonstrates a real benefit for prophylactic blood transfusion during pregnancy complicated by sickle cell disease in tropical zones. Improvements in our transfusion curves resulting from better donor selection, follow-up, and phenotyping support arguments previously made over one decade ago in favor of the prophylactic approach especially in countries with high transfusional risks. In our experience the risks associated with more transfusions was offset by the greater safety margin and better efficacy of the prophylactic approach.

[Heterotopic pregnancy: report of three cases]

The association of intra-uterine and extra-uterine pregnancy has increased steadily with the widespread use of infertility treatment. Diagnosis of extra-uterine pregnancy may be delayed as a result of visualization of an intrauterine gestation sac, leading to a less favorable diagnosis than for simple extrauterine pregnancy. The purpose of this report is to described three heterotopic pregnancies observed in a series of 25 simple extrauterine pregnancies managed in the Gynecology Department of the El Rapha Clinic in Libreville Gabon over an 18 months period. A review of the literature is included to provide more background on this association.

[Breast angiosarcomas: three case reports]

Angiosarcoma is a rare type of breast cancer, it has the worst prognosis of all breast malignancies. We report three cases of breast angiosarcoma observed at the National Oncology Institute and the Maternity of Orangers. A preoperative diagnosis was evoked in one case only, after a local recurrence in the second one and histological in the last one. Mastectomy is the reference treatment. The development is distinguished by general metastasis. Based on review of literature, we analysed the different aspects of this disease.