Primary clear cell adenocarcinoma of the vagina not associated with diethylstilbestrol: A case report.

Primary vaginal cancers are rare and clear cell adenocarcinoma is a malignant tumor that is all the more rare when the woman has not been exposed in utero to synthetic diethylstilboestrol (DES). We report the case of a 60-year-old woman with a history of balanced essential hypertension and partial mastectomy for neoplasia, who presented with a recurrent left inguinal adenopathy. Clinical examination revealed a 3 cm bulging lesion of the anterior vaginal wall in the lower third with indurated left inguinal adenopathy. Biopsy of the nodule showed an invasive clear cell adenocarcinoma. The extension bialn is negative and the multidisciplinary decision is to perform a partial colpectomy with bilateral inguinal curage. The patient is currently undergoing radiochemotherapy. This is a rare case with a poor prognosis. A poor response to adjuvant therapy with a high frequency of distant metastases is reported in the literature. Due to the rarity of this pathology, individual experience based on case reports is the main source of information. The most effective mode of treatment therefore remains unknown and depends on patient-specific factors such as tumor size, surgeon and oncologist team experiences.

[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.

[Vesico-uterine fistula of obstetrical origin. Report of 3 cases]. / Les fistules vésico-utérines d'origine obstétricale. A propos de 3 cas.

Vesico-uterine fistulae (VUF) lead to an abnormal breech between the bladder and the womb. They are responsible for urinary incontinence and/or cyclic hematuria. They are rare and, in most cases, lead to complications following caesarean deliveries. We report observations of 3 vesico-uterine fistulae treated over a 5 years period at university maternity based at Casablanca, Morocco; they all occurred following caesarean deliveries. These patients were consulted for urinary leakage occurring few weeks up to many years following surgical traumatism. Diagnosis was evoked clinically in all cases and confirmed by intravenous urography and/or hysterography. These VUF were successfully treated by simple breech suture at laparotomy. Treatment is very simple and efficient when the diagnosis is made early and fistula simple. Surgery is recommended after medical treatment failure aiming at fistula drainage.

[Delivery of large baby after cesarean section: role of trial of labor. Apropos of 355 cases]. / Accouchement du gros bébé sur utérus cicatriciel : la place de l'épreuve utérine.

OBJECTIVE: Our goal is to determine whether a trial of labor in women with suspected fetal macrosomia would be a valuable alternative to elective repeat cesarean. MATERIAL: and methods: Based on retrospective analysis of 355 women with previous cesarean section who delivered macrosomic infants (> or =4,000g), we tried to determine the impact of fetal weight on a trial of labor. The outcomes of trial of labor with fetal macrosomia were compared on the one hand to those of elective repeat cesarean and on the other hand to those of trial of labor with normal birth weight (<4,000g). RESULTS: The trial of labor was conducted in 297 cases (83,7%), and had led to vaginal birth in 189 cases (63,6%). There were 4 uterine ruptures (1,3%) and 8 uterine dehiscences (2,7%) among the women who underwent a trial of labor. In this group, there were 4 perinatal deaths (1,3%) related in one case to uterine rupture, and 2 brachial plexus injuries related to shoulder dystocia after vaginal birth. Perinatal and maternal outcomes of trial of labor were similar to those of elective repeat cesarean. A trial of labor was more associated with scar separations and lower success rate if the infant weighed 4,000g or more. CONCLUSIONS: It appears that the use of trial of labor for delivery of large baby with prior cesarean section was associated with lower success rate and the maternal and fetal risks could be increased. However, carefully others controlled studies are necessary to establish the appropriate management in this setting.

[Twin delivery after cesarean section: is a trial of labor warranted?]. / Accouchement gémellaire sur utérus cicatriciel: peut-on autoriser l'épreuve utérine?

OBJECTIVE: To determine whether a trial of labor in twin pregnancy is a valuable alternative to routine repeat cesarean section. MATERIAL AND METHODS: Based on retrospective analysis of 31 cases of twin gestation with previous cesarean section, we tried to assess the outcomes of 25 cases of trial of labor. The outcomes of trial of labor in twin pregnancy were compared to those of trial of labor in singleton pregnancy. RESULTS: The trial of labor was successful in 21 cases (84%). There was one case of scar dehiscence among the women who underwent a trial of labor, that occurred in the parturient with two previous cesarean sections after complete breech extraction. There were no significant differences in perinatal outcomes in any comparison of trial of labor versus no trial of labor. The outcomes of trial of labor in the twin pregnancy were similar to singleton pregnancy. CONCLUSIONS: Routine repeat cesarean section in the twin pregnancy is not necessarily warranted; a controlled trial of labor in selected cases would be a valuable alternative.

[Vaginal birth after cesarean delivery: can the trial of labor be extended]. / Accouchement des utérus cicatriciels: peut-on élargir l'épreuve utérine?

Based on a retrospective analysis of 1000 cases of scared uteri following cesarean section(s) (one cesarean, n = 857, 85.7%); two n = 129, 12.9%; three n = 14, 1.4%), we tried to answer two questions. Is trial of labor in case of low segment uterine-scar (excepting pelvic abnormalities, corporeal scar and more than two scars) free of risk for the mother and child? Can trial of labor be extended to cases of breech presentation, two previous cesarean sections, twin pregnancy and suspected macrosomia? In this series, the cesarean was indicated before labor in 138 cases (13.8%). Trial of labor was conducted in 862 cases (86.2%), and led to vaginal birth in 728 (84.5%). Successful trial of labor was observed in 75% of twin pregnancies, in 100% of breech presentations and in 69.6% of macrosomic infants. Uterine rupture occurred in 23 cases (2.7%), especially in cases with unknown corporeal scars (15 cases). No case of perinatal death related to uterine rupture was observed in this series.

[Trial of labor after 2 cesarean sections. Prospective study of 130 cases]. / Epreuve du travail sur utérus bicicatriciel. Etude prospective à propos de 130 cas.

The mode of delivery in the parturient women with two prior cesarean is controversial. Based on a prospective analysis of 130 cases, we tried to assess the outcome of trial of labor after two cesarean sections. Among 167 patients with two uterine scars, 130 (77.8%) were selected for a trial of labor that was successful in 65 cases (50%). The overall rate of vaginal birth and cesarean section was 39% and 61%, respectively. There were 4 scar dehiscences and 2 uterine ruptures among the women who underwent trial of labor, but no case of perinatal death or morbidity related to these complications was observed. In the majority of the cases, these scar separations were due to poor obstetrical conditions. Trial of vaginal delivery after two prior cesarean sections seems to us a reasonable attitude if it is well indicated and supervised correctly.