[Vulvar Darier-Ferrand dermatofibrosarcoma: Unusual localization of a rare tumour (about one case and a review of the literature)]. / Dermatofibrosarcome de Darier-Ferrand vulvaire : une localisation inhabituelle d'une tumeur rare (à propos d'un cas et revue de la littérature).

First described by Darier and Ferrand in 1984, the dermatofibrosarcoma is a fibrous tumour of the skin with high local malignancy, progressive evolution and great opportunity of recidivism. We report unusual case of Darier-Ferrand dermatofibrosarcoma relapsing of the vulva in a 76-year-old female patient. The clinical examination showed a big, rounded mass with fixed consistence. The surgical resection was complete, passing to 3 cm laterally with economy of healthy tissues that leaves the least of functional and esthetical sequelae. The histological examination of the operative piece confirmed the diagnosis. This case shows the huge nature of the mass, the local aggressiveness of the tumour and the possible difficulties of the complete exeresis of the lesion in significant anatomic region.

[Severe neonatal myasthenia with arthrogryposis]. / Myasthénie néonatale sévère avec arthrogrypose: à propos d'un cas et revue de la littérature.

Maternal myasthenia gravis has been associated with the presence of neonatal myasthania and sometimes fetal congenital anomalies. The purpose of this paper is to present an infant with multiple deformations born to a mother with myasthenia gravis. The infant presented with arthrogryposis multiplex and pulmonary hypoplasia. The new born died within the first day of life. Twenty-seven other cases of neonatal myasthenia with arthrogryposis have been reported. Twenty-two of them were stillborn or died. The surviving children needed ventilatory assistance for a long period.

[Krukenberg tumor: 9 cases report]. / Tumeur de Krukenberg: à propos de 9 cas.

INTRODUCTION: The Krukenberg tumor is a mysterious ovarian metastasis of digestive tract cancer accounting from 1 to 2% of all ovarian tumors. PATIENTS: and method. We report a series of 9 patients with Krukenberg tumors treated at the Casablanca University Hospital between 1982 and 1999. RESULTS: Mean age of the patients was 44 years. Pelvic signs predominated over digestive signs. Bilateral forms were more frequent. Surgical or medical treatment were given. The histological diagnosis is based on the presence of signet-ring cells associated with a pseudosarcoma stroma. The primary tumor was found in 50% of the cases. Prognosis is always unfavorable. All authors underline the gloomy prognosis of this tumor with fatal outcome in one year. Early diagnosis and complete resection is the only hope. CONCLUSION: Krukenberg tumor is an ovarian metastasis of digestive tract cancer. The only hope for improved prognosis is to search for ovarian metastasis in all cases and prophylactic ovariectomy in women over 40 with digestive tract cancer.

[Pelvic lymphocele: report of a case and review of the literature]. / Lymphocèle pelvienne: un diagnostic à ne pas méconnaître! A propas d'un cas et revue de la littérature

Lymphadenectomy for pelvic cancer can lead to complications, particularly lymphocele. We report a case of pelvic lymphocele, which occurred in a patient who underwent surgery for stage IIa cervical carcinoma after preoperative radiotherapy. The intervention consisted in colpohysterectomy, with lymphadenectomy without peritonisation. Five months later she developed dysuria and pelvic pain. Ultrasound and computed tomography showed a pelvic lymphocele complicated by renal insufficiency. Kidney function was re-established after intraperitoneal marsupialisation. One year later the patient was in good clinical condition with no disorder of kidney function.

[Heterotopic pregnancy: value of transabdominal sonography]. / Grossesse hétérotopique: intérêt de l'échographie sus pubienne (A propos d'un cas).

The authors report a case of an heterotopic pregnancy where the transabdominal US was more useful than endovaginal US. The embryon in this case was located in upper zone of the right iliac fossa, inaccessible to endovaginal US. Both methods are complementary.

[Mammary tuberculosis: a series of 14 cases]. / Tuberculose mammaire.

OBJECTIVES: We examined cases of mammary tuberculosis in order to determine the different modes of presentation and analyze diagnostic difficulties. METHODS: Retrospective analysis of 14 cases of mammary tuberculosis treated at the Ibn Rochd University Hospital in Casablanca over a 16 year period. RESULTS: Patient age ranged from 16 to 65 years. Contact with a contaminated person was recognized in 2 cases. The predominant clinical presentation was a tumor formation (12 cases) which sometimes simulated cancer. Axillary nodes were observed in 10 cases with 1 case of fistulization. Mammography suggested cancer in 3 cases. The diagnosis of mammary tuberculosis was based on pathology findings in 14 cases (2 biopsies, 12 peroperative specimens) and isolation of bacilli from pus in one case. Medical treatment was given. Surgery was associated as needed (abscess drainage, residual lesions). Except for one death due to tuberculous meningoencephalitis, clinical course was favorable with ad integrun breast recovery. DISCUSSION: Mammary tuberculosis is uncommon and often produces a pseudoneoplastic presentation. Pathology confirmation is required for diagnosis.

[Kidney cancer and pregnancy]. / Cancer rénal et grossesse.

Renal cancer is rare in pregnant women. Through a study of two cases, the authors underline diagnostic, therapeutic and pathogenic aspects of this association. Two female patients, 26 and 34 years old, were admitted for renal tumor, discovered respectively at the first and the second trimester of pregnancy. Investigation's exams for tumor extension were negative. They were based on ultrasound exam (2 cases), CT scan (1 case) and chest X ray (2 cases). The histological examination concluded to a bright cell carcinoma. In the former case, evolution was marked by spontaneous abortion at the fifth post-operative day, and the absence of metastasis after 16 months. In the second case, the evolution was worse because of metastasis occurrence four months after normal delivery. Pregnancy represents a privileged period for the discovery of renal tumor. Exams of tumor extension must consider pregnancy age. The treatment is similar to that of usual renal cancer and is associated to a simultaneous supervision of the pregnancy.

[Granulomatous recurrent mastitis during pregnancy]. / Mastite granulomateuse récurrente et grossesse.

We report a case of granulomatous mastitis during pregnancy which raised important diagnostic and therapeutic problems. Several diagnoses were suspected and subsequently different therapeutic regimen were tried (antibiotic therapy associated with nonsteroidal antiinflammatory drugs, progestogens, vein tonicity drugs and bromocriptine). All were ineffective and the patients status worsened. Histology confirmed the diagnosis of granulomatous recurrent mastitis. Corticosteroid therapy and interruption of pregnancy successfully controlled the disease process.

[Inflammatory and/or locally advanced breast cancers. Difficulty evaluating the response to initial chemotherapy]. / Cancers du sein inflammatoires et/ou localement avancés. Difficulté de l'évaluation de la réponse à la chimiothérapie première.

At the Tenon Hospital (Paris), 48 inflammatory or locally advanced breast cancers were treated by neoadjuvant chemotherapy (three different protocols), followed by surgery (mastectomy or tumorectomy and axillary dissection). The histological data of the specimens are analyzed with regard to the clinical and radiologic evolution. Twenty complete clinical responses (41%), 22 partial clinical responses (45%), and no response in six cases (14%) were observed. Histology demonstrated residual tumors in 42 cases (87.5%), even in the case of complete clinical response (14 cases), without notable change of the grade (SBR). Lymph node clearance demonstrated positive nodes in 38 cases (79%). Despite its great agreement with clinical examination, mammography does not predict the existence of histological residual tumors after initial chemotherapy. Chemotherapy allowed local treatment, but can rarely sterilize the tumor completely.

[Subcapsular hematoma of the liver. Six cases and review of the literature]. / Hématome sous-capsulaire du foie. A propos de 6 cas et revue de la littérature.

Defined as a blood collection under the Glisson capsule, the subcapsular haematoma of liver is a rare complication of pre-eclampsia. We observed 6 cases of subcapsular haematoma of the liver in the Gynaecology-Obstetrics ward of the Ibnou Rochd University Hospital in Casablanca, Morocco. Age range was 18 to 39 years. Five of the patients were multiparous. All except one had at least one sign of pre-eclampsia. The diagnosis was made post-partum in 5 cases and was only confirmed intra-operatively in 6 cases. The treatment was tamponing-drainage of the peritoneal cavity in 3 cases, ligature of the hepatic artery in 2, and in one case with rupture of the liver, no therapy could be performed. There were 3 maternal deaths and 2 foetal deaths. These results were compared with those in the literature to determine the epidemiologic, diagnostic, therapeutic and prognostic characteristics of the subcapsular haematoma of the liver. The prognosis is poor and requires early diagnosis and treatment. Effective prevention of this severe complication should be based on correct screening and care for pregnant patients with hypertension.

[Acute hepatic steatosis in pregnancy can be cured without interrupting the pregnancy]. / La stéatose hépatique aiguë gravidique peut guérir malgré la poursuite de la grossesse.

Fatty liver during pregnancy is an acute hepatic disease of unknown origin. We report the case of a 24-year-old woman in whom the diagnosis was made on the basis of the histological examination. The disease did not disturb the normal course of the pregnancy and delivery. In the literature, it is generally suggested that pregnancy must be terminated in cases of acute fatty liver since no favourable outcome has been reported with continued pregnancy. We suggest that, in minor forms, close clinical observation and laboratory monitoring can provide the means of continuing the pregnancy to term.

[Jaundice and pregnancy. The role of viral hepatitis]. / Ictère et grossesse. La place de l'hépatite virale.

Through a series of 76 cases of jaundice observed in pregnant women, the authors emphasize on the biggest frequency of viral hepatitis among the all of etiology. In fact that one represents the 2/3 of cases. They insist on the graves forms of the diseases which are responsible of a high maternal mortality and big foetal complications.