[Adenosarcoma uterine]

This cancer is composed of a benign glandular component and sacromatous stroma. It is characterized by its rarity, difficulties in both diagnostic and therapeutic care. Patient aged 65 years old, complaining of a post-menopausal bleeding, the gynecological examination showed a collar - like benign polyp, both the ultrasound examination info showed an endometrial hypertrophy and the endometrial biopsy examination were negative. The positive diagnosis was based on the biopsy anatomopathological examination, after a subtotal hysterectomy with bilateral ovarian excision operation. This operation was ended by a neck -isthmectomy. Uretine adenosarcoma represents only 8% of all sarcomatous period. Its clinical symptoms are highly polymorphic dominated by the presence of metrorrhagia. Only the anatomo-pathological examination allows for the positive diagnosis by demonstrating the presence of malignant mesenchymal elements and benign epithelial components. Surgery is the main treatment the radio or chemotherapy were instituted in the advanced cases but their usefulness in terms of survival benefit remains controversial. The treatment involves a multidisciplinary team to establish a diagnostic and therapeutic proper conduct especially in advanced cases

[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

[Operative hysteroscopy]

It is essential and necessary therapeutic tool in the management of intrauterine pathologies. Indeed, it has facilitated the reach of these lesions and offers many advantages as a minimally invasive technique for either patients or physicians. Retrospective study on a series of 79 cases of operative hysteroscopy performed between January 2004 and December 2006. The mean age of patients was 43.7 years. Gestures made were: polypectomy in 27 cases [34.2%], myomectomy in 17 cases [21.5%], endometrial ablation in 14 cases [17.7%], septum resection in nine patients [11.4%], resection of trophoblastic tissue in two patients [2.5%]. Incidents and accidents during surgery accounted for 2.5%. This technique has now gained an important place in the field of gynecologic endoscopy, endo-uterine resection of intracavitary fibroids and endometrial polyps, the endometrectomy, cure of partition and synechiae are currently codified. Moreover, literature reports a net long-term improvement of clinical signs after hysteroscopic treatment, with improved pregnancy rates and embryo implantation. Hysteroscopy is currently the gold standard as a therapeutic technique for intrauterine lesions. However it has limits and not without complications

[Diagnostic hysteroscopy]

It is an essential and necessary tool in the management of intrauterine pathologies. Indeed, it allows a better diagnosis and better distribution of therapeutics, more precisely targeted. It is a quick, minimally invasive, reproducible and reliable. Retrospective study on a series of 174 cases of diagnostic hysteroscopy performed between January 2004 and December 2006. The mean age was 42,6 years; abnormal uterine bleeding is the main symptom in 110 patients [63%], followed by infertility in 30 patients [17.2%], the abortive disease [7.5%], removal of the intrauterine device [6.9%], and others [5.1%]. Nine patients [5%] had a normal examination; intrauterine abnormalities found were: polyps [31.6%], endometrial hypertrophy [32%], submucous adenomyomas [13.8%], synechiae [12%], endometrial atrophy [9.7%], the intrauterine device [6.9%], uterine septum [6.3%], trophoblast retention [3.5%], intraluminal neoplasms [1.7%], and adenomyosis [1.7%]. The hysteroscopy is accurate, safe, with a low failure rate in the diagnosis of intrauterine abnormalities. It has better sensitivity and specificity compared with sonography and hysterosalpingography. It involves certain risks, but generally remains rare. This examination is currently the gold standard as a diagnostic technique for intracavitary uterine lesions

[Granular cell tumor of vulva]

Benign tumor whose histogenesis is uncertain, although most of the immunohistochemical and ultrastructural evidences support its neurogenic origin of Schwann cell derivation. It is mostly in the craniocervical region, vulvar involvement is quite rare. A 23 year old woman noted the presence of a 1 cm sized mass on her right labium majus which subsequently increased in size to approximately 3 cm. the mass was totally resected. Her postoperative follow-up was uneventful. Histologic examination of the tumor showed tumor cells with morphologic features consistent with a granular cell tumor. Although benign and slow growing, it has a tendency for recurrence, hence the need for complete surgical excision. Malignant forms, which account for 1-2%, are often fatal with primary and multicentric lesions or metastatic lesions vital organs. While the efficacy of radiotherapy and chemotherapy is unproven. It is a rare entity often benign but may cause, in certain forms, morbidity and mortality. Therefore, clinicians and pathologists should be aware of the clinical and histologic features of these tumors