[Sertoli-Leydig tumor of UC]

It represents 1% only of all malignancies that mostly affects young women. Its histological diagnosis is difficult and unpredictable. Trough this observation and literature review, we will outline the difficulties of management of this tumour. Mrs. I.R 28 years old had a secondary amenorrhea of 4 months with a huge abdominopelvic mass. CT examination described a mars occupying the right adnexa of 23 cm diameter orienting suspected teratoma or other tumours of ovarian origin. During surgery, we discovered an enormous fibrocyotic necrotic and friable mass, at the expense of the right ovary, so a right ophorectomy was done. The pathological examination confirmed the diagnosis. The patient was clinically manifested by an abdominal distension, with signs of hyperandrogenism and or hyperestrogenism. So a hormonal examination was essential in case of virilization to eliminate abnormal adrenal anomaly. The imaging and macroscopie study showed a solid avarian mass with some well-demarcated intra mural cysts of varying size. Histological examination defines the tumour grade. There are six sub-types that are valued by the degree of tubular differentiation of the Sertoli cell component and the abundance of primitive gonadal stroma. Recurrences are early. The reported prognostic factors are: histologic grade, tumor rupture and the presence of a heterologous mesenchymal elements. The differential diagnosis poses a problem with other ovarian tumours. Treatment consists of a lumpectomy or unilateral oophorectomy for the benign forms than a bilateral oophorectomy and hysterectomy if the tumour is poorly differentiated or greater than the stage of IFGO. This tumour is characterized by its rarity and difficulty of diagnosis. It occurs in a nulliparous or paucipare, young women. The unpredictable evolution causes a radical problem in the management of this entity

Haemobilia after blunt hepatic traumatism: interest of the arteriography and the embolisation

The hemobilia is the result of a pathological communication between bile ducts and vessels the intra or extra hepatic. We reported a case of a 48 year old patient who was admitted to emergency service for an accident of the public highway with a central hepatic-hematome, detected by scanner. The treatment consisted of a simple monitoring. Three weeks after the hepatic contusion, the patient developed a hemobilia by cracking of intra hepatic a pseudoaneurism in the bile ducts, the diagnosis had been evoked by the presence of hematemess, directed by Doppler echo, and confirmed by the coeliace arteriography. The haemostasis was successfully treated by precutneous arteriographic embolisation. Without recurrence for two years. The post traumatic hemobilia is a rare complication of the hepatic contusions, observed in 0.5 to 2 percent of the cases. Traditional symptomatology gathers three signs or triad of Sandbloom, which biliary colics, ictere and diagestive haemorrhage. Pulsated the Doppler echo is an effective examination in the tracking of the hepatic aneurisms. The surgery which was formerly the treatment of choice of the hemobilies currently left place to the percutaneous embolisation