[Glassy cell carcinoma: a rare cervical neoplasm. Case report of two patients and review of the literature]. / Glassy cell carcinoma : un cancer rare du col de l'utérus. À propos de deux cas et revue de la littérature.

The main histological types of cervix cancer are squamous cell carcinoma and adenocarcinoma. The glassy cell carcinoma is a rare form found in less than 2% of cases and it is an entity, aggressive and unknown, of worse prognosis, whose current treatment is not distinguished from other histological types. We report the cases of two patients with glassy cell carcinoma of the cervix with a review of the literature.

[Heterotopic ovarian hydatidiform mole. A case report]. / Môle hydatiforme hétérotopique ovarienne. A propos d'un cas.

We report a case of ruptured ovarian molar pregnancy, diagnosed in the context of haemorragic shock 19 days following evacuation of an intrauterine hydatiform mole. To our knowledge, this is the first reported case of heterotopic molar pregnancy.

[Hysterectomies performed for presumed leiomyomas: should the fear of leiomyosarcoma make us apprehend non laparotomic surgical routes?]. / Hystérectomies pour léiomyomes présumés : la crainte du léiomyosarcome doit-elle faire appréhender la voie d'abord chirurgicale autre que laparotomique ?

OBJECTIVES: The presenting symptoms of leiomyosarcoma (LMS) are the same as those of leiomyoma. The diagnosis of LMS is usually achieved retrospectively after pathological analysis of hysterectomy specimens. The aim of surgery in uterine sarcomas being resection without tumor morcellation, LMS poses the problem of the choice of surgical route because it is more likely to occur in relatively young women. This study was undertaken to determine, firstly, the frequency of LMS in a series of hysterectomies performed for presumed leiomyomas, secondly, if there exist any particular context in which LMS should be considered and how this may modify the choice of surgical route, thirdly, to discuss about the therapeutical aspects of those cases of LMS diagnosed incidentally after uterine morcellation. PATIENTS AND METHODS: A retrospective review, from 1996 to 2005, of cases of LMS diagnosed retrospectively in patients having benefited from hysterectomy for presumed leiomyomas, at the department of Obstetrics-Gynaecology, Belfort Hospital. RESULTS: From 1996 to 2005, 1297 hysterectomies have been performed for presumed leiomyomas in our department. Patients' mean age was 48 years (34 to 77 years). Menometrorraghia was the most common symptom having motivated surgery (57%), followed by pelvic pain (31%) and the notion of a rapidly growing uterine mass (12%). The distribution of surgical route was as follows: laparotomic route, n=393 (30%); vaginal route, n=855 (66%) and laparoscopic assisted vaginal route, n=49 (4%). Pathological analysis had revealed LMS in three patients (0.23%). DISCUSSION AND CONCLUSION: LMS is usually diagnosed incidentally on hysterectomy specimen analysis. Indeed, the surgeon may find himself in a therapeutic dilemma in cases where vaginal extraction has required tumour morcellation with an increased risk of peritoneal and/or vaginal dissemination. However, given the extremely low incidence of LMS in series of hysterectomies performed for presumed leiomyomas and the lack of specific preoperative context to clearly evoke this diagnosis, the fear of leiomyosarcoma should not make us apprehend nonlaparotomic surgical routes.

[Pure rhabdomyosarcoma of the uterine corpus: an exceptional tumor in postmenopausal women. Report on two cases]. / Rhabdomyosarcome pur du corps utérin: une tumeur exceptionnelle chez la femme ménopausée. A propos de deux cas.

Rhabdomyosarcoma (RMS) of the uterine corpus is rare in adult females. This tumor can be encountered in two distinct histopathological contexts: usually as a component of a malignant mixed mullerian tumor and exceptionally as a pure heterologous sarcoma. We report two cases of pure RMS of the uterine corpus occurring in postmenopausal women. The two patients suffered from vaginal bleeding and preoperative diagnosis was achieved in both cases. Both patients benefited from exploratory laparotomy, total hysterectomy and bilateral salpingo-oophorectomy. Both of them were free from the disease 15 months and 1 year respectively, after initial surgery. These two observations are worthy of publication because pure RMS of the uterine corpus is exceptional in postmenopausal women.

[Uterine sarcomas: clinical and histopathological aspects. Report on 15 cases]. / Sarcomes utérins: aspects cliniques et histopathologiques. A propos de 15 cas.

OBJECTIVE: Sarcoma of the uterus are rare uterine cancers with poor prognosis. They are characterised by pathological diversity and their symptomatology is not specific. The aim of this study was to review our experience with uterine sarcomas, to analyze their clinical and histopathological features, to discuss about diagnostic and therapeutic difficulties associated with these tumours and to compare our findings with previously published data. PATIENTS AND METHODS: A retrospective review, from 1996 to 2005, of cases of uterine sarcomas diagnosed and treated at the department of obstetrics-gynaecology, Belfort Hospital. Clinical and pathological features, types of treatment, tumoral stage according to the FIGO histological classification and patients' outcome were recorded. RESULTS: From 1996 to 2005, 15 cases of uterine sarcomas have been diagnosed in our department. Our study included six histological types: carcinosarcoma (n=5), leiomyosarcoma (n=3), rhabdomyosarcoma (n=2), adenosarcoma (n=2), stromal sarcoma (n=2), and undifferentiated sarcoma (n=1). Patients' mean age at the time of diagnosis was 67.6 years (range: 48-91 years). Vaginal bleeding was the most common presenting symptom, being present in 10 patients (67%). The mean time from onset of symptomatology and pathological diagnosis of sarcoma was 17.1 weeks (range: one to 60 weeks). In 10 patients (67%), definitive diagnosis of sarcoma was achieved only after surgical specimen analysis and in only three of them (30%), physical examination combined with pelvic ultrasonography had suspected malignancy. Dilation and curettage was performed in nine patients and failed to rule out neoplasia in three cases (33.5%). Fourteen patients (93%) underwent surgery: total hysterectomy with bilateral salpingo-oophorectomy in all of them and pelvic lymphadenectomy in four of them. Eight patients were in FIGO stage I, one patient in stage II, three patients in stage III and two patients in stage IV. Six patients benefited from adjuvant treatment: external beam radiotherapy and brachytherapy in three cases, brachytherapy in one case and chemotherapy in two cases. At the time of analysis, four patients were lost to follow-up, four patients were dead and with an average follow-up of 25 months, seven patients had a favourable outcome. DISCUSSION AND CONCLUSION: Uterine sarcomas are rare cancers with poor prognosis. Their symptomatology is non-specific and they are characterized by histopathological diversity. Early diagnosis is essential because patients' survival is correlated to tumour stage. However, preoperative diagnosis is often difficult and definitive diagnosis is frequently achieved after pathological analysis of hysterectomies specimens.

Genital human papillomavirus infection among women recruited for routine cervical cancer screening or for colposcopy determined by Hybrid Capture II and polymerase chain reaction.

The purpose of this study was to evaluate the clinical use of the Hybrid Capture (HC)-II system for the detection of human papillomavirus (HPV) DNA to identify women at risk of progression to high grade squamous intraepithelial lesions (HGSIL) and carcinomas by differentiating low risk (LR) HPV types (6, 11, 42, 43, 44) and high/intermediate risk (HR) HPV types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68). Five hundred and ninety-six women were enrolled in the study. Among them, 466 attended the hospital for routine cytologic screening and 130 were referred for colposcopy because of an abnormal Pap smear. The presence of HPV DNA was tested in cervical samples collected with the Digene Cervical Sampler in Digene Specimen Transport Medium (Digene Corporation, Silver Spring, MD, U.S.A.) using the HC-II assay. Results were compared with those obtained by polymerase chain reaction (PCR) using the MY09-MY11 primers followed by several hybridizations with specific probes. The overall HPV positivity was 32.9% by HC-II and 37.8% by PCR. Among cytologically normal smears, 19.5% were positive by HC-II (14.3% HR) and 25.1% by PCR. Of the atypical squamous cells of undetermined significance samples, 52.9% were positive by HC-II (41.1% HR) and 55.9% by PCR. Of the low grade SIL, 64.5% were positive by HC-II (59.4% HR) and 68.7% by PCR. The HPV positivity rate was found identical by both techniques in high grade smears (81.6%) and squamous cervical carcinomas (100%). By using PCR as the reference method, the sensitivity of HC-II was higher among women with abnormal cytology than with normal cytology (87.3% vs. 70%). Specificity was 80.8% and 97.5%, respectively. In summary, these results indicate that the HC-II method and MY-PCR identified nearly equivalent prevalences of HPV in cervical smear specimens.

[Menstrual pneumothorax and pelvic endometriosis. Discussion of pathogenesis]. / Pneumothorax cataménial et endométriose pelvienne. Discussion pathogénique.

The authors report a new case of menstrual pneumothorax and pelvic endometriosis which was discovered at this time. In this case (because of the presence of lesions suggesting the condition on thoracotomy) the probable mechanism thought to cause this pneumothorax would be the cyclical shedding of pleural endometriotic lesions. The authors review the characteristics of this unusual syndrome and base their review on an analysis of the hundred cases reported in the literature. They show that there are two theories of pathogenicity classically held. The first is the existence of congenital gaps in the diaphragm which allow air to pass into the pleura during the periods, the other is the possibility of endometriotic pleural lesions damaging the cortex of the lung as they shed their cells during the period.