Background: The clinical reasoning is expressed daily in the ability to solve clinical problems of patients. Its supervision is essential to establish an individualized educational plan that encourages its development. Objective: To analyze the impact of clinical reasoning learning sessions as remediation strategy of clinical reasoning difficulties. Method: exploratory retrospective study of medical students analyzing the difficulties of clinical reasoning and pedagogic practice of supervision promoting its development through the introduction of clinical reasoning learning sessions guided by a course book and grids evaluation as remediation strategy. Results: After the application of our supervision model of the clinical reasoning, 94.6 % of students were satisfied. They thus suggested the introduction of clinical reasoning evaluation before clinical examinations 7th year. Conclusion: the introduction of clinical reasoning learning sessions both in diagnosis and remediation of difficulties reasoning proves a real need. It would be appropriate to propose models applicable in other disciplines and to integer its evaluation in university program of internship

Juvenile granulosa tumor is a sex cord stromal tumor extremely rare, with usually estrogenic effects, while virilizing form is exceptional, often discovered at a stage confined to the ovary, justifying therefore a conservative treatment. Its prognosis appears favorable, depending on early management. However, its evolvement may be hampered by early and aggressive recurrence.
We report a new case compiled in Obstetrics Gynecology Service (HMIMV) of virilizing form of juvenile granulosa cell tumors, discovered during a recent exacerbation of a preexisting androgen syndrome in a girl of 24 years. It's extreme rarity prompted us to report it highlighting, through a literature review, its diagnostic features, therapeutic and evolutionary.

The neurofibromatosis type 1 (NF1) or von Recklinghausen's disease is an autosomal dominant disease. The association of NF1 to breast cancer is unusual and rarely r eported in literature. We report a case of this rare association. The discovery of breast cancer at a 51 years old patient in an advanced stage (T3N1M0), occasioned the appearance of dermatological lesions which are pathognomonic of neurofibromatosis1. Monitoring of patients with neurofibromatosis type1 seems justified to detect Early a possible association to breast cancer.

Bowen vulvar disease is defined as squamous cell carcinoma strictly intraepithelial, it's a viral infection which mostly affects postmenopausal women. It can be associated to other lesions specially gynecological cancers. The diagnosis is essentially histological. The evolution can go to invasion. Its treatment is based on surgery. We report the case of a female patient of 46 years, who consulted for a vulvar ulceration range of 5 cm in diameter, treated with wide excision, the histological examination is in favor of Bowen's disease. Through a review of litterature, we focus on the clinical, evolutionary and therapeutic features of this pathology.

Pseudo tumoral peritoneal tuberculosis is a rare clinical form witch clinical and para clinical aspects can mimic advanced ovarian cancer leading to unjustified radical surgery, with high risk of morbidities, often in a young woman. We report a new case of pseudo tumoral peritoneal tuberculosis in a girl of 21 years old in which diagnosis of ovarian cancer with ascitis and peritoneal carcinomatosis was suspected clinically, radiologically and biologically by rising CA125. Exploratory laparotomy with extemporaneous histological examination has confirmed tuberculosis diagnosis.