[Uterine sarcomas: clinical and therapeutic aspects (10 cases)]. / Sarcomes utérins: aspects cliniques et thérapeutiques. A propos de 10 cas.

PURPOSE: Uterine sarcomas are rare tumours characterized by clinical and histopathological diversity and poor prognosis. We analyzed diagnostic, prognostic and therapeutic difficulties encountered with these tumors by insisting on the importance of early diagnosis. PATIENTS AND METHODS: From 1997 to 2004 ten patients with uterine sarcoma who underwent surgery in the obstetrics and gynecology unit at the Tunis maternity center were included in this retrospective study. The tumors were classified at the time of diagnosis using the FIGO staging system. The histological diagnosis was based on the WHO classification. RESULTS: There were 5 cases of leiomyosarcoma, 2 cases of carcinosarcoma, 2 cases of endometrial stromal sarcoma and 1 adenosarcoma. There were four cases of stage I, two cases of stage II, two cases of stage III and two of stage IV tumors. The diagnosis of uterine sarcoma was strongly suspected and proved before the initial operation in 20% of cases and during this operation in 60% of cases. Diagnosis was only established at the histological exam in two cases. Total hysterectomy with bilateral salpingo-oophorectomy was performed in 90% of patients. Radiation therapy was performed in four. Chemotherapy was delivered in two patients. After an average of four years five patients were in remission, three had died and two were lost to follow-up. CONCLUSION: Early preoperative or intra-operative diagnosis is essential while awaiting for more effective chemotherapy protocols or therapeutic strategies.

The Rapunzel syndrome: case report and review of the literature.

We report a case of a gastric trichobezoar (TB) extending throughout the small bowel in a child. The possibility of a TB causing an epigastric mass should be borne in mind, and ultrasonography could be used to support such a diagnosis. These bezoars should be considered to possibly have extensions for which there may be no preoperative or endoscopic evidence. Their complete operative removal is required. A psychiatric consultation and long-term follow-up are necessary, as recurrence of trichophagia and eventually the TB could occur.

[Imaging of cerebral thrombophlebitis]. / Imagerie des thrombophlébites cérébrales.

Because of the polymorphic nature of the clinical presentations observed, the diagnosis of cerebral vein thrombosis (CVT) is often difficult and based on the findings of various imaging techniques. Routine CT scan constitutes a guiding examination allowing exclusion of other diseases responsible for the clinical symptoms and signs. MRI, a noninvasive technique allowing analysis of perfusion and thrombosis would appear to be the first-line examination for diagnosis as well as follow-up. The development of MR angiography techniques now allows confirmation of the diagnosis of dural sinus occlusion. However, certain false-negatives may be observed with MRI, especially in the case of cortical vein thrombosis. When doubt persists concerning the diagnosis, cerebral angiography remains the reference examination.