This is a 28-year-old woman nulligeste, followed for hypothyroidism under levothyrox consults for a primary infertility of 1 year. She did an infertility checkup: an ultrasound examination that showed a myomatous uterus and ovaries seat of a dermoid cyst. In hysterosalpingography, she has opacified tubes up to their isthmic portion without peritoneal diffusion. The husband's investigation is normal. She had a diagnostic laparoscopy that showed bilateral tubal agenesis with a negative methylene blue test. The patient is proposed for in vitro fertilization.
Cervical pregnancy is one of the few ectopic locations after abdominal pregnancy. It is characterized by the migration of the conceptus the cervical canal sometimes simulating an ongoing abortion. Her diagnosis should be suspected in any woman with risk factors who has suggestive clinical criteria. The ultrasonographic criteria that have been described for this diagnosis are: closed internal orifice of the cervix, peritrophoblastic vascular flow detected in infra-cervical. MRI can be helpful in confirming the diagnosis. The anatomopathological study comes to focus on the diagnosis in case of surgical treatment. The treatment of cervical pregnancy uses several local, systemic methods, endoscopic, and surgical. Until now, no standard treatment is available in the literature. The therapeutic indications are then variously appreciated in the literature, the medical treatment using the Methotrexate is currently the treatment of choice before 12 weeks of amenorrhea, with or without potassium chloride. As for surgical treatment is placed in second line after failure of methotrexate, however some experienced practitioners prefer hysteroscopic resection, and embolization of the uterine artery associated or not with medical treatment. The choice of the technique will depend on the evolution of the initial treatment.
Transient osteoporosis of pregnancy (TOP) is a rare and often misdiagnosed disease during pregnancy. The postpartum fatigue or stress fracture is a recognized cause of pain, the diagnosis of postpartum osteoporosis (PPO) should be considered in the differential diagnosis of disabling lumbalgia occurring either during pregnancy (especially in the third trimester) or immediately after delivery. We report here the case of a 31-year-old patient, primiparous with no particular history, who presented disabling radiating pubic pain on the fourth day of postpartum after her caesarean section, that pelvic MRI had shown a fracture of the left sacral fin, associated with osteopenia of the hip. Her phosphocalcic assessment had objectified a vitamin D deficiency.
Thrombocytopenia occurs in about 10% of pregnant women. This could be due to a normal variant of pregnancy (gestational thrombocytopenia), a pregnancy-specific condition (preeclampsia and HELLP syndrome) or a condition exacerbated by pregnancy (ITP, vasculitis, PTT). The prognosis and treatment vary enormously, based on the underlying cause. Gestational thrombocytopenia (accidental thrombocytopenia of pregnancy) is a mild, asymptomatic thrombocytopenia that usually occurs late in pregnancy. There is no association with fetal thrombocytopenia, and maternal thrombocytopenia disappears spontaneously after delivery.
The primum movens of pre-eclampsia is a systemic maternal endothelial dysfunction. Choroidal and retinal vessels are rarely affected or rarely explored, and their involvement is usually reversible in pre-eclampsia if the diagnosis is made in time to establish adequate surveillance and treatment for each situation. The underlying lesions to ocular disorders are retinal serous detachment (RSD), optic neuropathy and finally the most serious involvement is cortical blindness. The pathophysiological hypothesis is clearly proven by the various complementary examinations such as fundus examination, OCT (Optic Coherence Tomography), and fluorescein angiography. Clinically, there appears to be a parallelism between the clinical importance of edema and that of RSD.
We report the case of a patient who presented, during a severe pre-eclampsia (in an edematous form) on twin pregnancy, a favorable postpartum DSR with suspicion of optic neuropathy. A follow-up by internists was recommended.
This observation represents an unusual clinical aspect of a rare breast cancer, mucinous carcinoma which represents 1% of all breast cancers, with its two pure and mixed forms whose treatment and prognosis are not identical.
The pure form has a good prognosis despite the exceptional clinical presentation of this type of breast cancer hence the interest of this case study, Mrs. L, a 70 year-old without risk factors admitted for mastitis of the left breast with rapid installation over 2 months, suspected of malignancy, yet the couple mammography / ultrasound did not manifest this malignancy, it shows an aspect of opacity well circumscribed of sharp contours.
After the needle biopsy, the diagnosis of mucinous carcinoma was made which determined a suitable management is a neoadjuvant chemotherapy followed by a radical treatment, the hormonotherapy was continued in front of the expression of the hormonal receptors. Post-treatment surveillance did not report distant recurrence or metastasis.
Endometriosis is classically defined by the ectopic presence of tissues possessing the morphological and functional characteristics of the endometrium. Ovarian endometriosis is one of the most common locations. Its pathogenesis remains unclear, but a multifactorial origin has been proposed. The symptomatology is dominated by pain and infertility. The clinical examination is often poor. The suprapubic pelvic ultrasound, and especially the endovaginal ultrasound, remains the examination of first intension. Laparoscopy is the only test to affirm with certainty; biopsies, classify it into stages and choose the most appropriate therapeutic strategy. The treatment of the first intension remains surgical, the medical treatments being in the majority of the cases only palliatives. The therapeutic success depends on the radicality of the surgical excision.
We report the case of a postmenopausal patient with ovarian endometriosis simulating ovarian neoplastic pathology with review of the literature.
The paratubaires cysts are usually benign disease entities, frequently encountered in clinical practice, but rarely complicated twist; hence the importance of this work and we report the case of an adnexal torsion on paratubal 8cm cyst in a patient of 24 years.
Myasthenia gravis is a neurological disease that affects favorite with the young woman of childbearing age. The study of reciprocal interactions between gravis and pregnancy is essential to know for proper management of these patients whose follow-up should be done in close collaboration between obstetrician, neurologist, anesthesiologist and pediatrician.
Composing of less than 1% of all ovarian cancers, immature teratoma is a malignancy that mainly affects the young. Immature teratoma of the ovary together with pregnancy is rare. To our knowledge, this association was rarelly reported in the literature
The authors report the case of an immature teratoma found in the first trimester of pregnancy in a young primigravida.
Through the analysis of this observation and data in the literature, they discuss the different aspects of this association.
Ovaries are a frequent site of metastasis of the breast cancer. The annexielles metastases of breast cancer often present as a challenge for diagnosis and therapeutic.. Distinction between ovarian metastasis and primary ovarian cancer may sometimes be difficult. The surgical resection tends to increase survival a surgical option should consist of at least bilateral oophorectomy, even when the contralateral ovary appears to be normal. We presente cas of patient of 36years old female, followed by breast cancer since 2011 stade 1 initially (T1N1Mx), was underwent Patey (infiltrating ductal carcinoma) followed radiotherapy and chemotherapy, hormonotherapy, four years later the patient complaint of abdominal distention, abdominal ultrasound showed ovarian masse then open laparoscopy was done, left adnexectomy was realized and finally histological diagnosis revealed Ovarian metastasis of the breast cancer.
The obesity, factor of morbimortalite, is considered as a real health public problem. In gynecology, its consequences on the fertility and the contraception are sever and the obesity is at the origin of important obstetric complications that must make consider these pregnancies as at risk. Our practices have to take into account these complications by assuring an adapted and premature care to improve the maternal and neonatal outcomes.
Feto-maternal red cell alloimmunization is defined by the presence in a pregnant woman of alloantibodies directed against blood group antigens present on the red blood cells of the fetus and inherited by the father. It arises from the immune response to a first contact to these same antigens during a prior transfusion, transplant or pregnancy. The placental transfer and the fixation of the antibodies on the fetal red cells antigenic targets lead to a haemolysis in the fetus and the newborn. The resulting haemolytic disease can show different clinical forms, from a mild anaemia with neonatal hyperbilirubinemia to a major fetal damage with stillbirth caused by hydrops fetalis. The objective of management strategies of feto-maternal alloimmunization is to detect and monitor maternal alloimmunization and to appreciate the effects on the fetus or the newborn.
Endometrial stromal tumors are rare and are less than 5% of uterine tumors. They are composed of cells closely resembling endometrial stromal cells in the proliferative phase. They are classified into two categories: the stromal nodules, benign, and endometrial stromal sarcomas, including endometrial stromal sarcoma (low grade) and undifferentiated endometrial sarcoma (formerly high grade). The diagnosis is most often does retrospectively after histological analysis of the surgical specimen. The classical treatment is abdominal hysterectomy with bilateral oophorectomy. The adjuvant treatment are not yet established and the optimal treatment of this entity is still not clear. We report the case of a patient of 46 years, admitted for pelvic pain with abdomino-pelvic mass Ultrasound and MRI have found a polymyomatous uterus with interstitial body mass with a compression effect on the endometrium. The patient underwent total hysterectomy with bilateral oophorectomy, Histology with additional immunohistochemical concluded endometrial stromal sarcoma of low grade, stage IB, hormone receptor-negative. Through this rare case and with a literature review, we focus on the epidemiological, diagnostic, therapeutic and prognostic of that entity.
The Uterine fibroma pathology is common and the relationships between fibroids and pregnancy are triple: Fibroids can prevent conception and implantation; the fibroid may complicate the course of pregnancy, at delivery and postpartum period 'and pregnancy-induced condition can facilitate the development of fibroids to complications. We report the case of a patient who was followed in our department from 17 weeks+2days of pregnancy whose ultrasound revealed fibroid located in the uterine isthmus .Through our case and with the support of the literature, We will insist the complications that can occur and understand the importance of diagnosis and early management of this entity.
The malignant germinal tumors of the ovary are rare, but a rest curable whatever is the stage. We report the observation of 24 years old patient, married, never get pregnant , who was sent in our hospital for pelvic pains, the gynecological examination revealed an abdominal mass in the umbilical level . The pelvic ultrasound and the abdominal CT scan showed a heterogeneous solid mass in depends on the ovary. A laparotomy was indicated, allowed a right adnexectomy. The anatomopathologique examination is returned in favor of a dysgerminoma. The germinal tumors of the ovary are rare tumors which affect the girls and the young women, they have a good prognosis whether his stage with an optimal treatment and the majority of the patients keep their reproduction functions.
Aplasia cutis congenital is a rare congenital absence of skin, exceptionally involves extremities. Most cases are sporadic but familial autosomal dominant pattern can be found. The etiology remains unclear, both genetic and environmental causes have been implicated. This lesion has primarily a clinical diagnosis. Imaging studies may be used to evaluate underlying tissues and investigate other comorbid abnormalities. Treatment modalities depend upon the extent defect and involvement of underlying tissues. Genetic counseling is useful in cases of hereditary form. We report a new case of extensive bilateral aplasia cutis congenital of extremities in a new born, occurred as an isolated sporadic case without family history, no teratogenic medication and no evidence for an amniotic band or infection in pregnancy.
Kasabach Merritt syndrome is defined by clinical and biological association of a purplish-red vascular tumor rapidly extensive, thrombocytopenia, a variable degree of disseminated intravascular coagulation and sometimes anemia. It usually occurs in neonates and infants less than 6 months, sometimes in utero. The imaging can confirm the diagnosis and search for deep locations. This syndrome can be life-threatening by the risk of bleeding, coagulopathy, thrombosis, compression and heart failure. The therapeutic management should be early, multidisciplinary adapting therapeutic benefits to risks in order to improve the prognosis. We report a case of Kasabach Merritt syndrome, we insist through a literature review of diagnostic, therapeutic and evolutionary difficulties.
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.
Neuroendocrine tumors with small cell cervical represent less than 2% of cervical cancers, and if their evolution depends on the volume and tumor stage, prognosis is generally dark Morphological characteristics and clinical features of these tumors are comparable with neuroendocrine tumors of the lung. This tumor can also be found in other sites such as the skin, gastrointestinal tract, pancreas and cervical region. We report two new cases of neuroendocrine carcinoma of the cervix small cell and through the literature data we review the different aspects of this rare entity.
Maternal benefits of fetal extraction have been clearly demonstrated in the case of hemodynamic failure. However, in case of respiratory failure very little data are available. The aim of our study is to discuss the management of patients with respiratory distress during pregnancy secondary to a pleuropulmonary disease.
Vaginal Angioleiomyoma is a rare entity. We report a case of vaginal Angioleiomyoma with literature review. Our case was about a 48 years old woman who consulted for a nodule in the posterior wall of the vagina. The surgery allowed removal of a tissue-like structure of 2 cm. The final histologic diagnosis was a vaginal Angioleiomyoma.
Endometrial adenocarcinoma usually occurs after menopause. This tumor is extremely rare in women younger than 30 years. Its treatment includes hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy and in same cases, radiotherapy. We report a case of endometrial Adenocarcinoma in a 26-year-old patient. Through this case the authors emphasize the need of endometrial evaluation in young females with abnormal bleeding before starting any medical treatment. Specific problems of endometrial cancer at young age include delay in diagnosis, difficulty in pathologic interpretation of the curetting tissues and the motivation of most patients to preserve their fertility.
Tuberculosis of the breast is a very rare infection, it occurs chiefly in women of childbearing potential, usually as an apparently primary infection and constitute a diagnosis and therapeutic challenge. Administration of antituberculosis agents is the mainstay of therapy. Surgery is required in some cases. We report one case of breast tuberculosis. The diagnosis was put on histology with good outcome under anti bacillary treatment. Through the literature data we recall the epidemiological, clinical, diagnostic and treatment of this pathology.
Endometriosis of a wall scar is a rare clinical entity, and in the perineum is exceptional occurring after gynaecological or obstetrical surgery. The origin remains vague. The clinical characteristic of these lesions implies an inconstant painful swelling during menstruation; however only the histological examination of the specimen will be able to confirm the diagnosis. The treatment is primarily surgical and relies on the complete surgical excision of the lesion.
Collision tumor means the coexistence of two adjacent tumors, but histologically distinct without mixture into the fabric. These tumors involving the ovaries are rare. Benign cystic teratomas are often present at the same time as other abnormalities of the ovary. The most common histological combination in the ovary is the coexistence of cystic mature teratoma with mucinous tumors, its association with serous tumors is rare and the incidence is unknown. Ovarian mature cystic teratomas are benign often diagnosed in young girls. We present a rare case of a triple coexistence of a large tumor collision (consisting of a serous cystadenoma, mucinous cystadenoma and a mature cystic teratoma Benin) in the same ovary in a girl of 16 years.
Lactating adenoma is a benign tumor of pregnancy and lactation, found most often in the third trimester of pregnancy and less frequently during lactation. Clinically, it presents itself as a unique and discrete mobile mass. It is a rare benign tumor which the diagnosis requires pathological confirmation. Usually it disappears spontaneously. Chirurgical treatment is offered for aesthetic problems related to the size of the adenoma. The authors report a case of lactating adenoma discovered at eight months of the post partum. Through this case, they discuss the clinical, radiological, histopathological aspects and various therapeutic modalities of this tumor.
Genital tuberculosis of women is part of extra pulmonary forms of tuberculosis. It is an uncommon disease in developed countries, but remains endemic in developing countries. The causative agent is, in most cases, Mycobacterium tuberculosis. Genital tuberculosis is a cause of infertility. The definitive diagnosis is made by biology or histology. Because this affection is paucibacillary, these tests may be falsely negative; In fact, diagnosis can then be focused on radiological, endoscopic and nosological arguments.
Granulosa cell tumors of the ovary are rare, and included in the sex cord-stromal tumor category. They have a low malignancy potential and generally have a good prognosis. They are the most frequent hormone-secreting tumors of the ovary and may lead to suggestive clinical symptoms. 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 (small patient populations). From a review of the clinical of one case of granulosa cell tumor of the adult and a review of the literature, we will describe its clinical, paraclinical, therapeutic and prognostic.
Isolated massive vulval edema in pregnancy is rare. The causative mechanisms remains poorly understood but it is probably related to mechanical, osmotic and hormonal factors. The differential diagnosis of vulval edema includes infections, tumors, lymph birth defects, trauma, inflammatory and metabolic diseases. The authors report a case of a 27 year-old primigravida woman with twin pregnancy who was admitted to the obstetrical emergency at 37 weeks of gestation for a severe anemic syndrom associated to a massive vulval edema with no sign of pre-eclampsia. Biological examination showed a severe microcytic hypochromic anemia associated to a hypoproteinemia. Other causes of vulval edema were excluded. After blood transfusion, the patient gave birth by Caesarean section. In the post partum period, the vulval edema resolved progressively. By the fourteenth day post cesarean section, the vulval edema had completely regressed. Three weeks later, a spontaneous regression of the vulval edema was observed. The aim of this report this case is to discuss the clinical aspects, differential diagnosis, causes and evolution of vulval edema in pregnancy.
As a consequence of breast imaging development and development of screening, benign epithelial breast diseases (BEBD) represent a growing percentage of breast pathology diagnoses. Some BEBD have to be individualized (radial scars, papillomas, complex sclerosing adenosis, lobular intraepithelial neoplasia, flat epithelial atypia, atypical hyperplasia), being preinvasive lesions or markers of increased breast cancer risk, or being associated with suspect radiological aspect. BEBD should be managed in a pluridisciplinar way and correctly diagnosed by percutaneous biopsies or surgical specimens. The goals of surgery vary according to lesions. It always allows a complete surgical specimen analysis and therefore a search for atypical or cancerous cells. Surgery can also have a preventive role by reducing the risk of potential malignant transformation. Finally, it enables in some cases the excision of a radiologically suspect mass. So the aim of this review is to give a clinical and morphological description of most common BEBD, underlying their cancer risk, specific diagnosis, therapeutic, follow-up and psychological repercussions.
The definition of borderline ovarian tumors is pathological. It is based on the combination of several histological criteria established by Hart and Norris and reviewed by Scully et al. : pluristratification and epithelial budding, increased mitotic activity which can be very variable, cytonuclear atypia (differential diagnosis with benign tumors), absence of stromal invasion (differential diagnosis of malignant tumors). Serous tumors represent approximately 55% of borderline tumors. They are bilateral in 28-50% of cases. This histological type is, however, more often associated with extra-ovarian locations, as found in 30% of cases on average peritoneal implants whose detection is fundamental because the class tumor stage III. These can be invasive or non-invasive, the prognostic value of invasiveness is controversial. Pre and intraoperative diagnosis of borderline ovarian tumors is difficult and requires a multidisciplinary approach, involving surgeons, pathologists, radiologists and medical oncologists trained as much as possible with this type of lesion border. Staging should be as complete as possible and should be as far as possible during the initial surgical resection. A restaging should be made when the initial staging is incomplete. Restaging does not affect patient survival but used to evaluate the prognosis of the initial tumor. Its indication still remains controversial: it is recommended for early-stage tumors, for which the treatment is now well codified. The authors discuss the issue of keeping the ovaries during hysterectomy for benign lesions throught the case of a patient of 50 years who benefited 9 years ago a subtotal hysterectomy for polymyomatous uterus and presented a bilateral serous tumor borderline on remaining ovary.
Ogilvie's syndrome is a rare postsurgical complication. The high mortality rate after caecal perforation explains the seriousness of this clinical situation. The early diagnosis is made by plain abdominal X-ray and abdominal scanner. Conservative treatment is usually effective and surgery should be reserved for complicated cases or refractory to conservative treatment. We report a case of Ogilvie's syndrome after cesarean section. A case is reported clinical evolution of a chronic colonic obstruction disease after cesarean section which has been treated by conservative methods as Prostigmine
Design hemodialysis is a rare event, maternal-fetal high risk because of the frequency of complications. However, improved technology and quality hemodialysis improves fertility in chronic hemodialysis patients of childbearing age with increasing number of pregnancies and decreased rates of premature and others complications. Indeed, treatment of anemia, and improved figures uremia by intensive dialysis in women on hemodialysis, and treatment of other complications, may improve outcomes. In chronic kidney disease and pregnancy exert on each other interaction: CKD sounds on fetal prognosis, while pregnancy can alter the course of the CKD. This pregnancy should be planned and benefit from joint monitoring by a nephrologist, obstetrician, especially when the patient is hypertensive, This pregnancy should be planned and benefit from joint monitoring by a nephrologist and obstetrician, especially when the patient is hypertensive, and effective contraception, reversible, safe and reliable, must be chosen in these patients and as well as those which have been grafted and of childbearing. But currently, the majority of patients suffering from this disease are likely to have a pregnancy, like other moms, no worsening of their kidney, thanks to recent advances in obstetrics and neonatology. We report a case of pregnancy led to 36SA in chronic hemodialysis patient from the age of 13, and we will consider successively the general factors of maternal and fetal prognosis in patients with CKD, complications that this pregnancy and the impact of pregnancy on chronic renal dialysis stage, to finally define the optimal treatment of hemodialysis pregnant women and confront the literature data rules.
The Retro Placental Hematoma (RPH) or placental abruption untimely normally inserted paroxysmal is an accident that threatens maternal and fetal prognosis. It is a major emergency obstetric pathology and remains the second leading cause of maternal mortality after postpartum haemorrhage. It is actually very difficult to have an accurate evaluation the frequency of the HRP because it requires a complete table including Pathologists; or simple macroscopic or microscopic findings; or purely clinical diagnosis for some. Its occurrence requires appropriate resuscitation and adapted care to improve the prognosis. We report our study of 49 cases the HRP hospitalized in Obstetrics and Gynecology of Instruction Military Hospital Mohamed V in Rabat, diagnosed on a suggestive clinical picture and the presence of hematoma after examining the issue. This is a descriptive and comparative retrospective study over a period of one year. This study compared two groups: with HRP feotale death in utero and HRP without fetal death in utero. This study aims to evaluate neonatal mortality and maternal morbidity related to RPH and therapeutic modalities. This pathology formerly known pathology multiparous tends to reach more and more heifer. The important blood loss and delay the expulsion worse prognosis causing severe maternal morbidity hence the need to expand the indications for cesarean of retro placental hematoma regardless of the fetal state. Our study aims to contribute to reduce mortality and morbidity Fetomaternal by improving our work is stepping up efforts for a rapid decision-making, and we must educate what especially pregnant women of the risk factors to see from the beginning of symptoms. The pregnancy monitoring, early diagnosis of RPH, an obstetrical treatment adequate, and a resuscitation well driving can improve the prognosis of this disease.
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