[Ovary teratoma_Report of 91 cases]

To analyse the clinical and anatomic aspects of cystic treatomas of the ovary, carcteristics of patients having cystic teratomas and the masnagement trends at our institution. Retrospective study of 91 cases of cystic teratomas of the ovary diagnosed and treated at Farhat-Hached Hospital [Sousse] between 1 january 1995 and 30 june 2003. Cystic teratomas constituted 12.13% of all ovarian tumors diagnosed and treated at our institutation during the study period. The median of age was 33.35 ans. Abdominal or pelvic pain was the most frequent symptoms for presentation in 67% of the cases. In addition; incidental finding was noted in 25.3% of the cases and swelling in 23% of the cases. The mean tumor diameter was 10 cm. The rate of bilateral cystic teratomas of the ovary was 14.3%. 19.8% of cystic teratomas has occurred in pregnancy. The operative video-laparoscopy was employed in 9 cases, laparotomy was employed in 82 cases. Histopathological evaluation has detected 96.7% cases of mature teratomas, and 3.3% cases of immature teratomas. Cystic teratomas are the most common ovarian neoplasm, that occurs most commonly during the reproduce years. The operative laporoscopy is the most common modiality of treatment of mature cystic teratomas. Immature teratomas must be treated by laparotomy associated if necessary to chimiotherapiy

[Lobular idiopathic granulomatos mastitis About 10 cases]

Our retrospective study was performed on 10 cases of granulo-matous mastitis registered in Obstetric Gynaecology Department and Pathology Department of CHU F. Hached Sousse, during 8 years period. The mean age was 36.4 years [range 32-59]. Among these 10 cases, 8 were observed in reproductive-age women and 2 were noted in menopausal women. Clinical findings showed unilateral breast nodule associated with inflammatory signis in 4 cases, mammelonary retraction in 2 cases and serous or sero-purulent mamelonnary flow in 4 cases. Mammographic examination suggested a malignant tumor in 5 patients. In all cases, the diagnosis is made by histopathology. Surgical treatment consisted in wide excision with drainage or radical mastectomy, eventually with combination with antibiotic therapy and non steroid anti-inflammatory drugs. Prognostic features showed a good cicatrisation in 4 cases, local recurrence and cutanonus fistulization in one patient. Granulomatous mastitis aetiology is still unclear, auto-immune aetio-pathologenesis appears more interesting and should be clarified

Local Regional Recurrance of Breast cancer in Tunisian Center

To evaluate locoregional recurrence rate of breast cancer, determine its anatomoclinical characteristics and discuss the available therapeutic alternatives. Patients and methods A retrospective study including 41 patients with LRR following modified radical mastectomy or conservative surgery of invasive breast carcinoma without metastasis, between January 1993 and December 2002. 38 cases of LRR occurred after mastectomy and 3 cases after conservative surgery. LRR rate was 4.84%. mean follow-up 44.7 months. Mean age of patients was 45 years and LRR mean occurrence time-interval 22.4 months. Recurrence was parietal in 25 cases, mammary in 2 cases, and nodal in 14 cases. 18 patients had to be operated on. Conclusion Prognosis of breast cancer depends on distant metastasis. LRR constitutes the second major risk liable to influence the overall prognosis

[Prevalence of high risk oncogen HPV by in situ hybridization and by PCR in condyloma acuminata in the region of the Tunisian center]

The aim of this study was to evaluate the frequency of "high-risk" HPV types in condyloma acuminata in patients from Tunisian Center. Thirty two paraffin-embedded biopsies were analyzed for the presence and type of HPV DNA by means of in situ hybridization [ISH] and polymerase chain reaction [PCR] techniques. ISH was done using a broad spectrum HPV biotinylated DNA probe for the detection of HPV DNA. HPV typing was carried out using specific probes for HPV types 6/11, 16/18 and 31/33. HPV DNA was amplified by PCR using the degenerate primers E1350L/E1547. HPV were typed by pU-1M/PU-2R primers for the oncogenic HPV types 16, 18, 31 and 33, and PU-31B/PU-2R for "low-risk" group [6 and 11]. Using ISH, HPV was detected in 27 out 32 cases [84.4%]. All were HPV 6/11 positive. Co-infection with oncogenic HPV was found in one case that reacted with 16/18 and 31/33 probes. Good quality DNA was obtained in 13 cases. HPV was detected by PCR in 11 of 13 specimens [80.6%] when E1350L/E1547 primers were used. HPV 6/11 were present in all cases. The results of this study provide specific confirmation of the predominance of HPV6/11 and low rate of co-infection in patient from Tunisian Center. Because of the difficulty of DNA extraction, risk of DNA degradation and contamination associated with PCR, the ISH remains more adapted to archival materiel especially in routine clinical practice

[Recurrent hydatidiform mole. About a case with 9 sucessive molar pregnancies]

The recurrent hydatiform mole is rare, its frequency is lower to 1%. We report the observation of a 28 years old women, without antecedents of molar pregnancy in the family and without considerable pathological antecedents. She had 9 successive molar pregnancies, without inset normal pregnancy and without living chilfren. The delay of at least 1 year between the gestations has been respected in 6 pregnancies. The etiologic balance in particular the caryotypes of parents is normal. The aurthors debate the etiopathogenic and prognostic factors of this pathology

[Pronostic factors in squamous cell carcinoma of the vulva. about 35 cases]

To evaluate the pronostic factors of the vulvar cancer. This is a retrospective study, of 35 cases of squamous cell carcinoma of the vulva diagnosed and treated at Farhat Hached Hospital [Sousse] between January 1991 and December 2002. The study of the pronostic factors is based on analysis of the following parameters obtained after a period varying from 6 months to 5 years: clinical data, pre-therapeutique and therapeutic evaluation, pathologic data, outcome and survival rate. The diagnostis was often late with a delay for consultation superior to 6 months in 60% of cases. 80% of the patient were in stages III and IV of FIGO with an average tumorous size of 3.8 cm and palpable lymph node in 74.2% of the cases. 22 patient underwent vulvectomy with bilateral inguinal node dissection. Adjuvant therapy was carried out in 8 cases. The rate of relapses was 22.7%. The global survival at 5 years of the operated patients was of 40%. The main prognostic factors were: the size tumorale, the degrees of stromal invasion and the lymph node invasion. Early detection fo vulvar cancer by regular gynecologic examinations and a biopsy of all suspect lesions, allows an early treatment consequenlly a better prognosis