[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

Association of chemokine and chemokine receptor polymorphisms with activity degree of IBD in Tunisian patients

Crohn's disease [CD] and ulcerative colitis [UC] have complex genetic background that is characterised by more than one susceptibility locus. To detect a possible association between the functional polymorphisms of the chemokine receptors CCR5, CCR2 and MCP-1 genes and susceptibility to CD and UC in Tunisian population, polymorphisms of CCR5-delta 32, CCR5-59029-A/G, CCR2-V64I and MCP-1-2518- G/A were analysed in 194 Inflammatory bowel disease [IBD] patients and 169 healthy blood donors using PCR-RFLP and PCR-SSP methods. The patients were classified in 126 patients with CD and 68 patients with UC. The genotypic and allelic frequencies of all polymorphisms studied, did not reveal significant differences between patients and controls, and among CD and UC patients. However, analysis of CD patients revealed that those without homozygosous G/G genotype are more frequently in remission compared to those with this genotype [OR: 0.4; 95%CI: [0.174-0.928]; p=0.03]. Also, the frequency of the CCR2-64I muted allele was statistically higher in CD patients in remission disease than those in active form [OR: 0.267; 95%CI: [0.09-0.78]; p=0.01]. Adjustment for known covariates factors [age, gender and immunosuppressive regimen] confirmed these univariate findings and revealed that the CCR5-59029-A/G and CCR2-V64I genotype were associated to remission form of CD [OR: 2.63; 95%CI: [1.01-6.80]; p=0.047 and OR: 4.64; 95%CI: [1.01-21.31]; p=0.049 respectively]. In conclusion, the present study supports the involvement of chemokine receptor [CCR2 and CCR5] polymorphisms in activity degree of the IBD disease in Tunisian patients

[Prophylactic caesarean deliveries]

The rate of caesarean deliveries has increased in recent years. Among the major problems of the practitioners in this regard we find the choice of indications. The overall objective of this study is to profile information and compare with the practices of some teams described in the literature, while assessing the value of the programming of these cesarean vis- a- vis the maternal and fetal prognosis. This study aims to profile the indications of prophylactic caesarean deliveries and to assess the value of their programming in terms of maternal-foetal morbidity. 290 prophylactic cesareans were performed at the teaching maternity between January, 1[st] and December 31[st] 2007, divided into programmed prophylactic caesarean and prophylactic caesareans carried out urgently. The rate of caesarean sections was 17%. 26% of these caesarean sections were prophylactic, and were spread in 55% of programmed ones and 45% of urgent ones. The scarreduterus and the foetal-pelvic disproportion were two thirds of the indications in our series. The average gestational age of achievement of the prophylactic caesareans was 39 weeks. When the type of anaesthesia used, 2/3 o the programmed ones were done under spinal anaesthesia, while 86% of the urgent ones were under general anaesthesia. Wound infection was the prophylactic caesareans in two thirds of cases. The best conditions for programmed prophylactic caesareans compared to the prophylactic caesareans carried out urgently show the interest of programming, and justify the need for proper monitoring of all pregnanciesintensive care unit

[Abdominal pain in case of uni-cornuate uterus]

Thinking of the diagnosis of complicated uterine malformation in case of acute abdominal pain. In our case, the patient was holding a unicornuate uterus and was admitted for abdominal pain. The etiological diagnosis was performed during laparotomy leading to hemi-hysterectomy. The unicornuate uterus with rudimentary horn results of a failure of the mullerian ducts. This malformation is discovered during examinations for infertility or after acute complication. The diagnosis is established by imaging [ultrasonography and magnetic resonance imaging] and laparoscopy. Although rare, these malformations should be evocated when patient present abdominal pain and justify the surgical excision of the rudimentary horn to prevent complications [endometriosis, sever dysmenorrhea, rupture of ectopic pregnancy in a rudimentary uterine horn]

[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

[Overlap syndrome autoimmune hepatitis=primary biliary cirrhosis. Comparative study with isolated autoimmune hepatitis results of a multicentric Tunisian]

Autoimmune hepatitis [AIR] and primary biliary cirrhosis [PBC] are two autoimmune diseases affecting the liver. Suggestive signs of the two diseases can however occur simultaneously or consecutively in the same patient leading to an overlap syndrome. The aim of our multicentric retrospective study was to study clinical, biological, immunological and histological features of 17 patients with overlap syndrome and to compare them with those of 62 patients with isolated autoimmune hepatitis. Overlap syndrome "AIH-PBC" accounts for 20,5%of patients with autoimmune hepatitis in our series. Our two groups were similar in age and gender. Clinically, in overlap syndrome group, a significantly higher prevalence of pruritus arid significantly lower prevalence of ascites were observed as compared to isolated AIH group. No significant differences were observed between the two groups of patients with regard to frequency of concurrent immune diseases. Biologically, serum alkaline phosphatase and garnma-glutamyl-transpeptidase were significantly higher in overlap syndrome than in patients with isolated AIH. Significantly more overlap syndrome patients were positive for anti-mitochondrial antibodies than isolated AIR patients. The patients with isolated AIR had a higher frequency of cirrhosis at presentation that the patients with overlap syndrome. The histologic profile was not different between isolated AIR and Overlap syndrome. Overlap syndrome "AIR-PBC" is not rare. Compared with isolated AIH, it is characterised by a higher frequency of clinical and biological signs of cholestasis, a higher frequency of antimitochondrial antibodies and the rarity of cirrhosis at the diagnosis of the disease

[Inflammatory bowel disease and psoriasis about two cases]

Cutaneous manifestations of inflammatory bowel disease are relatively common. An association with psoriasis has been rarely observed. Case reports: We report the cases of two patients, 60 and 48 years old, suffering respectively from ulcerative colitis and Crohn's disease. The first patient had a 6 years history of plaque psoriasis. In the second case, skin lesions appeard simultaneously to the flare of inflammatory bowel disease. The association of inflammatory bowel disease and psoriasis may be explained by the similarity of genetic and immunological factors in both disorders

[Detection of human papilloma virus in screening of cervical cancer]

During the last decade a numerous studies consacrated to study of the HUMAN PAPILLOMA VIRUS [HPV] have allowed to conclude that this infection is strongly related to genesis of the cervical cancerous. The detection of the highly oncogenic virus allowed to institute a treatment at the early stage. The advantage of the detection is limited in the developing countries due to the shortage for screening. The instauration of an organized national protocol for mass screening is a good solution