Papillomavirus genotyping on formaldehyde fixed paraffin-embedded tissues in vulvar intraepithelial neoplasia.

PURPOSE: Few studies have described the epidemiology of human papillomavirus (HPV) in vulvar intraepithelial neoplasia (VIN). The aim of this study was to genotype HPV on formalin fixed paraffin-embedded tissues in VIN lesions. METHODS: A 5-year retrospective study was conducted by including all patients attending the teaching hospital of Nice with a diagnosis of VIN between 1st January 2010 and 31st December 2014. For all patients, HPV genotyping was performed with the PapilloCheck® microarray kit, routinely used on cervical cytology samples, and optimized for formaldehyde fixed paraffin-embedded tissues in VIN. RESULTS: Forty patients were included in the study: 39 patients had usual VIN and one presented with differentiated VIN. Among the 39 patients with usual VIN, the prevalence of HPV was 90% (35/39). Thirty-two patients had high grade VIN (82%) and seven low grade VIN (18%). In high grade VIN, the most represented HPV types were: HPV 16 (21/32 66%), HPV 56 (3/32 9%) and HPV 33 (2/32 6%). In low grade VIN, the most represented HPV types were: HPV 16 (4/7 57%) and HPV 6 (3/7 43%). Interestingly, 5/39 (13%) of patients diagnosed with usual VIN also had co-existing lichen sclerosus. CONCLUSIONS: We have optimized a HPV genotyping technique, routinely used on cervical cytology samples, and on paraffin fixed embedded tissue showing VIN. Moreover, we have identified five patients with lichen sclerosus co-existing with usual VIN. This association has rarely been reported and proves that these two entities can coexist.

Expression of the hypoxia-inducible monocarboxylate transporter MCT4 is increased in triple negative breast cancer and correlates independently with clinical outcome.

BACKGROUND: (18)Fluor-deoxy-glucose PET-scanning of glycolytic metabolism is being used for staging in many tumors however its impact on prognosis has never been studied in breast cancer. METHODS: Glycolytic and hypoxic markers: glucose transporter (GLUT1), carbonic anhydrase IX (CAIX), monocarboxylate transporter 1 and 4 (MCT1, 4), MCT accessory protein basigin and lactate-dehydrogenase A (LDH-A) were assessed by immunohistochemistry in two cohorts of breast cancer comprising 643 node-negative and 127 triple negative breast cancers (TNBC) respectively. RESULTS: In the 643 node-negative breast tumor cohort with a median follow-up of 124 months, TNBC were the most glycolytic (≈70%), followed by Her-2 (≈50%) and RH-positive cancers (≈30%). Tumoral MCT4 staining (without stromal staining) was a strong independent prognostic factor for metastasis-free survival (HR=0.47, P=0.02) and overall-survival (HR=0.38, P=0.002). These results were confirmed in the independent cohort of 127 cancer patients. CONCLUSION: Glycolytic markers are expressed in all breast tumors with highest expression occurring in TNBC. MCT4, the hypoxia-inducible lactate/H(+) symporter demonstrated the strongest deleterious impact on survival. We propose that MCT4 serves as a new prognostic factor in node-negative breast cancer and can perhaps act soon as a theranostic factor considering the current pharmacological development of MCT4 inhibitors.

[Anorexia nervosa during pregnancy: an unusual association]. / Grossesse et anorexie mentale évolutive : une observation inhabituelle.

We report the case of a pregnancy associated with severe restricting anorexia nervosa in a 33-year-old patient who weighed 41kg for 1.61m at conception. She continued to lose weight during pregnancy and she gave birth to an eutrophic child by cesarean section at 34 weeks of amenorrhea. Because of complications induced by the chronic food restriction, anorectic pregnant women should be viewed as being at high risk and also monitored closely both during and after pregnancy to optimize maternal and fetal outcomes.

[Delivery of emergency contraception to minors in French pharmacies]. / Délivrance de la contraception d'urgence aux mineures dans les pharmacies françaises.

OBJECTIVE: The goal of this work was to evaluate the application in French pharmacies of the decree n 2002-39 relating to the delivery of the emergency contraception to minors. PATIENTS AND METHODS: Four selected minors carried out an anonymous investigation in 53 randomised pharmacies in the town of Nice (south of France). RESULTS: The cost-free delivery of the emergency oral contraception was refused to minors by 37.7% of pharmacies. DISCUSSION AND CONCLUSION: Our article highlights the remaining problems, five years after the decree, with the delivery of the emergency contraception. It seems necessary to explain to all the professionals of information, drugs delivery and treatments relating to the contraception or abortive methods the importance of their roles and the respect of their legal obligations.

[Influence of mode of delivery in term breech presentation on the Apgar score and transfer in neonatal care unit. Results of the management of 568 singleton pregnancies in a level III French maternity]. / Influence de la voie d'accouchement dans la présentation du siège à terme sur le score d'Apgar et les transferts en néonatologie. Résultats de la prise en charge de 568 grossesses singleton dans une maternité française de niveau III.

OBJECTIVES: The aim of our study was to define the influence of mode of delivery in term breech presentation on the Apgar score and transfert in neonatal care unit using our university hospital protocol. MATERIAL AND METHOD: We conducted a retrospective study. The study included 568 singleton term pregnancies during the period January 1996 to December 2005. The main selection criteria were Apgar score and transfert in neonatal care unit. RESULTS: Analysis of the Apgar scores at 1.5 and 10min and transfer in neonatal care unit do not show any statistical difference. CONCLUSION: The absence of a difference in neonatal prognosis is to allow vaginal delivery to be carried out. To carry on with the teaching of obstetrical manoeuvres makes it possible to avoid pointless surgical intervention and a bad maternofoetal prognosis in the event of an unexpected breech presentation.

[Feasibility and preliminary experiment of a routine use of Da-VinciS in fertility surgery]. / Faisabilité et expérience préliminaire de l'utilisation du robot Da-VinciS dans la chirurgie de l'infertilité féminine.

OBJECTIVES: The goal of our study is to evaluate the use of Da-Vinci S in the field of fertility laparoscopic surgery. MATERIALS AND METHODS: Ten successive patients were included for a laparoscopic fertility surgery using the Da-Vinci S. Surgical feasibility, operating time, length of hospital stay and postoperative complications have been analyzed. RESULTS: All procedures have been completed using Da-Vinci S. CONCLUSION: In our preliminary surgical experience, the Da-Vinci S can be technically used in the field of fertility surgery.

[Sternalis muscle in breast surgery]. / Le muscle sternalis: derrière quel sein se cache-t-il?

The sternalis muscle is a normal anatomic variant, which exists in about 5 to 8% of people. It runs longitudinally superficial to pectoralis major, alongside the sternum. Although the sternalis seems common in cadaveric studies, physicians are not familiar with it, which may lead to confusion in diagnosis. Occasionally, the sternalis may be misinterpreted as a breast mass on mammogramm. In that case, computed tomography and magnetic resonance imaging are useful. We report herein two cases of sternalis muscles encountered during mastectomy.

[A surprising reason for consulting: wires projecting from the anus, a rare complication of intra uterine device insertion]. / Un motif de consultation surprenant: la perception de fils sortant par l'anus. à propos d'une complication rare de la pose de DIU.

Rectal perforation by migration of an intrauterine device is a rare complication which gynecologists must be aware of. Treatment can associate endoscopic examinations and a surgical procedure.

[Bening enterogenital fistulas arising from the digestive tract: three cases]. / Fistules entérogénitales d'origine digestive bénigne: à propos de trois cas.

Fistulas between the female genital tract and the digestive tract occur after obstetrical, oncological, or post-operative complications. We report herein 3 rare cases of enterogenital fistulas: one colouterine fistula and one colotubal fistula in a patient with diverticulitis, and one ileovaginal fistula in a patient with Crohn's disease. Vaginal discharge was frequent and incited patients to consult a gynecologist. Better knowledge of enterogenital fistulas is necessary to enable earlier diagnosis and apply specific treatment. The incidence of colovaginal fistulas is increasing in diverticular disease because of increased prevalences of hysterectomies and diverticular disease.

[Evaluation of the TVT technique according to age]. / Evaluation selon l'âge de la technique TVT.

OBJECTIVE: To compare efficacy and long-term morbidity of the TVT between patients younger than 70 years and patients older than 70 years. METHOD: Retrospective monocentric study from January 2000 to May 2001. A postal questionnaire was sent to patients to evaluate their satisfaction and their functional status after surgery. RESULTS: The study included 154 patients, and 137 (89%) answered the questionnaire. Seventy-two were less than 70 years old (52.5%) and 65 were more than 70 years old (47.5%). The satisfaction rate in the total population was 88.3%. Amongst the patients younger than 70 years, 97.5% were cured or improved, versus 78.5% of the oldest patients (p=0.001). The study within age groups showed that the satisfaction rate between 70-74 years was higher (92.6%) than in the total population and lower after 75 years (66.7%). This difference is linked to the rates of de novo and persistent urge incontinence, which increase after 75 years. CONCLUSION: The TVT seems to be a good treatment for urinary incontinence in women younger than 75 years. Patients should be warned that preoperative urge incontinence may persist after surgery.

[Bowel perforation as late complication of tension-free vaginal tape]. / Perforation intestinale tardive après une opération de TVT.

Tension-free vaginal tape (TVT) is considered as the treatment of choice for female stress urinary incontinence. Bowel erosion is a rare complication of TVT that generally occurs a few days after surgery with a clinical picture of peritonitis and/or intestinal obstruction. Herein is reported a case of a bowel erosion with a late clinical manifestation 3 months after hysterectomy and TVT placement for genital prolapse and urinary incontinence. Bowel erosion may complicate TVT operation several months after surgery and should be considered as differential diagnosis in patients presenting with a clinical picture of peritonitis and/or intestinal obstruction.

[Diagnosis of postpartum abdominal pain: about a rare case of portal vein thrombosis]. / Orientation diagnostique devant des douleurs abdominales du post-partum: à propos d'un cas rare de thrombose portale.

We report the management of patient with acute abdominal pain in the immediate post-partum caesarean section performed in the context of preeclampsia. Acute portal vein thrombosis is diagnosed, in a patient with no personal or family history of venous thrombosis. Blood tests showed a protein C and S deficiencies. Portal vein thrombosis is an extremely rare occurrence in pregnancy and postpartum.

[Role of imaging in cases of bleeding after spontaneous or induced abortion]. / Rôle de l'imagerie en cas de métrorragies après fausse couche spontanée ou interruption volontaire de grossesse.

Post-abortum hemorrhage is a common clinical situation and etiological diagnosis has to be made early to avoid further complications such as persistent bleeding, infection or adhesions that may compromise fertility. Retained products of conception are the most common cause of bleeding. The diagnosis is based on endovaginal color doppler ultrasound showing a thickened and hypervascular endometrial echo-complex extending partly to the myometrium. The main differential diagnosis is uterine arteriovenous malformation, mostly iatrogenic. Diagnosis is based on the presence of myometrial confluent cystic lesions filled with turbulent and high velocity arterial flow on endovaginal color doppler ultrasound. The distinction between these two etiologies of post-abortion bleeding is mandatory because of totally different treatment: typically medical and/or surgical in case of retained products of conception and by selective arterial embolization in case of vascular malformation.

[Pregnancy after embolization of a uterine leiomyomata]. / Grossesse évolutive après embolisation d'un utérus fibromyomateux.

Uterine artery embolization could be useful in the treatment of myoma, either before surgery to facilitate dissection, or totally in place of surgery. Nowadays, this technique seems attractive, considering the development of a conservative and non-invasive medicine. However the question of fertility in women of childbearing-age remains. The case of a pregnancy following uterine artery embolization is here described. All pregnancies from the literature have been reviewed and the discussion includes benefits and drawbacks of this method.

[Unexpected discovery of a bladder tumor during a TVT operation]. / Découverte fortuite d'une tumeur vésicale au cours d'une opération de TVT.

With the common use of the tension-free vaginal tape (TVT) procedure, we will probably be facing more and more pathologies that will require a transurethral treatment. We report an intra-operative discovery of a bladder tumor during a cystoscopic TVT procedure. The tumor was easily treated by several transurethral resections without any consequences on the result of the TVT procedure.

[Pregnancy with Implanon: a report on three cases]. / Grossesse sous Implanon : une « enquête ¼ à propos de trois cas.

We explored the potential causes associated with pregnancies occurring in patients using an etonogestrel contraceptive implant (Implanon). Three cases of treatment failure were reported where no predisposing factors were found (i.e. Body Mass Index, hepatic inducing therapy). Etonogestrel plasmatic detection was positive in two cases whereas in the third case with negative endocrinological makers, neither palpation nor ultrasonography identified the device. Therefore, true contraceptive failure can be considered in two of the reported cases. Furthermore, pregnancies associated with Implanon use warrant additional attention including notification to drug monitoring centers and Organon SA.

[The gynecologist and the melanoma: breast and endometrial metastases]. / Le gynécologue face au mélanome: métastases mammaires et utérines, à propos de trois cas.

Melanoma has an important metastatic potential and its incidence is greatly increasing. Even after many years of negative follow-up, gynecologists should be aware that a gynecological tumor might be a secondary location for a woman with a medical history of melanoma. Because of a poor prognosis and a reduced life expectancy, it is necessary to make a disease staging in order to offer a prompt diagnosis and a personalized strategy of treatment. Considering the increasing incidence of melanoma, gynecologists will face more frequently with this situation.

[Management of delivery after previous caesarean section in France]. / État des lieux en France de la prise en charge des utérus cicatriciels.

UNLABELLED: Since many years, caesarean section rate has increased in France. The purpose of the study was to compare the different French obstetrical attitudes after a prior caesarean section. METHODS: This retrospective study was performed between March 2008 and February 2010. We collected the answers of a majority of maternity centres contacted with an anonymous questionnaire sent by postal, electronic, fax mails. RESULTS: Of the 194 maternity centres which have responded, there were 37 university hospitals and 312 obstetricians: 75.6% of them worked in public sector and 19.2% in private one. The use of a protocol is registered for 29.6% of questioned obstetricians (only 14% in private sector, P=0.002). Pelvimetry is consistently proposed by 44.4% of them. A trial of labour in case of breech presentation is proposed by 20% of questioned obstetricians, with twin pregnancies by 23.7%, with two prior low-transverse caesarean delivery by 12%, most in university hospitals, level III, with more than 1500 births per year. Induction of labour is allowed by 73.9% of questioned obstetricians, by ocytocics as a majority. Induction by Prostine(®) is underwent by 14.5% of them (24.6% in academic centres, P=0.01), by Propess(®) by 19.2% of them (30% in university hospitals, P=0.008). CONCLUSION: These findings showed that the management of delivery after caesarean section is associated with statistically significant differences in France. These informations are relevant for counselling French obstetrical practices.

[Surprising vaginal polyps]. / Surprenants polypes vaginaux !

We present herein a particular case of surprising vaginal polyps, associated with nodular lesions (epidermal cysts). Fibroepithelial polyps are rare and benign but pathological aspect may be similar to malignant lesions. Vaginal polyps usually appear after genito-urinary surgery, during pregnancy, or with hormonal treatment. These lesions are effectively treated by local resection, with rare recurrence.