[Juvenile granulosa cell tumor of the ovary. A case report]. / Tumeur juvenile de la granulosa ovarienne. A propos d'une observation.

Juvenile granulosa cell tumors of the ovary (JGCTs) are a rare form of neoplasm that makes up less than 5% of ovarians tumors in childhood and adolescence. About 90% are diagnosed in stage I (FIGO) with a favorable prognosis, whereas those at higher stages have a less favorable outecome. The authors describe a juvenile granulosa cell tumor expressed by an early pseudopuberty occurring in a 6 year old child. Clinically, an endocrine syndrome was associated with a pelvic mass. Hyperoestrogenia and serum alphafoetoprotein level were biologically detected. Tumor was localized strictly to the ovary, so conservative surgery was applied and proved sufficient to remove all tumor tissue. Histological examination showed typical microscopic aspect of a juvenile granulosa cell tumor. The patient is well, 14 years after surgery with a normal growth and mental developpment.

[Antiphospholipid antibodies and pregnancy]. / Anticorps antiphospholipides et grossesse.

The presence of antiphospholipid antibodies is associated with a clinical syndrome characterised by thrombocytopenia, arterial and venous thromboses and recurrent fetal loss. Among theses antibodies currently detectable in laboratory are the lupus anticoagulant and anticardiolipin antibody. The antigens for theses antibodies are phospholipid-binding-proteins (prothrombin and beta 2 glycoprotein I). The exact mechanism of action of antiphospholipid antibodies remains controversal. The pathogenis of pregnancy loss seems related to the increased incidence of placental infraction. In spite of the improvement in our knowledge on the pathogenic mechanisms of the antiphospholipid syndrome, the standard therapy is still based on anti-platelet or anticoagulant drugs, both for vascular and obstetrical problems. Larger prospective clinical studies are needed to validate therapeutic implications.

[Epilepsy and pregnancy: necessity of a combined care]. / Epilepsie et grossesse: nécessité d'une prise en charge combinée.

Pregnant women with epilepsy are at risk for a variety of complications, that require an interdisciplinary cooperation between neurologists, pediatricians and obstetricians. We report a retrospective study of 50 pregnant women with epilepsy over a 5 year period. Phenobarbital is largely the most used (74%). During pregnancy, an increase in seizure frequency was noticed in 27 cases (54%). Baribituric were essentially maintained in 74% of cases. We have reported a relatively high intervention rate during the delivery. Forty eight babies (96%) were born at term. There were no cases of neonatal haemorrhage or perinatal death. Symptoms of drug impregnation were found in 7 cases (14%). Four children born to epileptic mothers treated during pregnancy had congenital malformations. Pregnancy doesn't have a catastrophic effect on the course of epilepsiy apart from the risk of an increase in the frequency of the fits. This risk must be reduced thanks to an optimal use of an anti-convulsive therapy before and during pregnancy. The major risk being foetal, mainly foetal malformations and hemorrhages.

[Breast myoepithelioma. Report of a new case and review of literature]. / Le myoepitheliome du sein. A propos d'un nouveau cas et revue de la littérature.

Breast myoepithelioma is rare. A case is reported of a 71 year old female. The tumor was clinically, radiologically and macroscopically demarcated. Diagnosis was based on histological and immunohistochemical studies. At the time of diagnosis the tumor was composed of myoepithelial cells with few cellular atypias and a low mitotic activity. Tumor cells expressed vimentin, actin, S100 protein and cytokeratin. No local or distant metastases were found. The patient had been treated initially with a large excision of tumor. Local recurrences detected 1 year after initial surgery and showed a similar morphology and immunoreactivity with higher mitotic activity. Mastectomy with axillary dissection was performed. No recurrences and no distant metastases detected 2 years later. Myoepithelial tumors generally considered as benign or low-grade lesion can give rise to a wide range of clinical evolution.

[Struma ovarii. Analysis of a series of 7 cases and review of the literature]. / Le goitre ovarien. Analyse d'une serie de 7 cas et revue de la litterature.

The authors report the result of a retrospective study of 7 cases of struma ovarii, four malignant and three benign cases, removed surgically at the Salah Azaiez Institute, Tunis, Tunisia, over a period of 20 years (1980-2000). Based on their personal experience and on a review of the literature, the authors discuss the diagnosis, management and outcome of struma ovarii, in particular with malignant transformation. Echography objectives pelvic tumor in all cases. The diagnosis is usually histological. Treatment is exclusively surgically, all patients with malignant struma ovarii were staged la (FIGO). Mean follow up was 4 years and 4 months (range: 1-7 years). No recurrences were reported and no distant metastases. Supervision was based on serum level thyroglobuline and scintigraphy with iodine 131. Histologic diagnosis of malignancy is difficult. Treatment is based on surgery and prognosis is relatively favorable even in malignant cases.

[Adult granulosa cell tumors of the ovary. Report of 32 cases]. / Les tumeurs de la granulosa adulte de l'ovaire: a propos de 32 cas.

The aim of this study is the analysis of different epidemiological, clinical, paraclinical and therapeutic aspects of adult granulosa cell tumors of the ovary (AGCT) GCT accounts for 5.7% of all ovarian malignancies. Echography objectives pelvic tumor in all cases. Diagnosis was histological. Primary treatment was exclusively surgically in 11 cases, followed by chemotherapy in 19 cases and radiotherapy in 2 cases. Patients with stage Ia who desire further childbearing can be treated with unilateral adnexectomy. For all other cases, radical surgery followed by chemotherapy for advanced stages and recurrences is the treatment of choice. Prognosis is tightly depending on stage and histologic finding.

[Pure dysgerminoma of the ovary. 12 case reports]. / Les dysgerminomes ovariens purs. A propos de 12 cas.

UNLABELLED: Data from the files of 12 patients with pur ovarian dysgerminoma managed between January 1970 and december 1990 were evaluated. Pur ovarian dysgerminoma accounts for 2% of all ovarian malignancies and 28% of malignant germ cell tumors. A palpable pelvic mass was detected in three-fourth of patients. Echography objective ovarian tumor in all cases. Diagnosis was histological. Primary treatment was surgery followed by radiotherapy in 8 cases and chemotherapy in 2 cases. 2 patients developed local recurrences were irradiated and 1 patient developed distant metastases was given chemotherapy in association to radiotherapy. The 5 years survival rate was 91.7%. CONCLUSION: Treatment of ovarian dysgerminoma remains controversial. However, patients with stage la who desire further childbearing can be safely treated with unilateral adnexectomy. For all other patients, radical surgery followed by radiation therapy or chemotherapy for the advanced stages and recurrents dysgerminoma is the treatment of choice. Prospective randomized clinical trials are needed for a well codified therapeutic strategy.

[Maternal-fetal transmission of HIV: preventive measures and prenatal care]. / La transmission materno-foetale du VIH: mesures préventives et prise en charge périnatale.

HIV can be transmitted to foetus during pregnancy, labour, and breastfeeding. An estimated 600,000 newborns acquired HIV each year through mother to fetus transmission. Without preventive interventions, approximately 25% of infants born to HIV positive mothers contract the virus. Elective delivery by caesarean section at 38th weeks, before labor and rupture of membrane, decreased the fetal risk. Anniotomy and long-standing rupture of the membranes should be avoided, as should breastfeeding. As well based on the review of literature the authors provide an overview of vertically acquired of HIV infection, preventive measures and perinatal car are discussed.