[Is there a place for stepped hormone assay in the development of hyperandrogenism?] / Comment j'explore Le dosage hormonal étagé a-t-il une place dans la mise au point des hyperandrogénies ?

Clinical hyperandrogenism is common in women. Nevertheless, it is important to identify the cause. As the hyperandrogenism may be ovarian or adrenal in origin, making the difference requires hormonal testing and ovarian and/or adrenal imaging. We present the case report of a patient explored in our clinic, that illustrates the difficulties to determine the origin of the endocrine disorder. The interest of employing selective ovarian and adrenal venous catheterization to aid in the diagnosis and the localization of the androgen-secreting tumor is discussed.

L'hyperandrogénie clinique est un motif de consultation fréquent. Le diagnostic différentiel permet d'établir l'étiologie parmi les causes ovariennes ou surrénaliennes. Outre le repérage de signes pathognomoniques cliniques, des examens complémentaires biologiques et iconographiques sont nécessaires pour la mise au point. Les difficultés diagnostiques sont illustrées à partir d'un cas clinique traité dans notre institution. L'intérêt du bilan hormonal étagé par cathétérisation des veines ovariennes et surrénaliennes afin de localiser l'origine de la sécrétion hormonale pathologique est discuté.

[An update in intrauterine contraception]. / Nouveautés en contraception intra-utérine.

Intrauterine devices (IUD) are the oldest of the modern contraceptives. There are currently two types of IUDs: copper IUD (Cu-IUD) and levonorgestrel IUD (LNG-IUD). Both offer high contraceptive effectiveness. Although they have been used for decades, the literature still brings its share of new information on IUDs: impact on oncological risk, non-contraceptive benefits, rare adverse effects, and impact on women's well-being. In addition, Cu-DIU is recognized as the most effective emergency contraceptive and can be inserted up to 5-7 days after the at-risk sexual intercourse. Research is now looking at the effectiveness of LNG-IUD in emergency contraception. Finally, new IUD concepts are also being evaluated: they should allow a reduction in the rate of expulsion, intermenstrual and heavy menstrual bleeding, an increase in comfort and in IUDs duration of use. This article makes an update on the latest developments in terms of intrauterine contraceptives.

Le dispositif intra-utérin (DIU) est le plus ancien des contraceptifs modernes. On distingue les DIU au cuivre (Cu-DIU) et les DIU au lévonorgestrel (LNG-DIU). Ils offrent une haute efficacité contraceptive. Bien qu'ils soient utilisés depuis des décennies, la littérature apporte encore aujourd'hui son lot de nouvelles informations sur les DIU: impact sur le risque oncologique, bénéfices non contraceptifs, effets indésirables rares et impact sur le bien-être des femmes. Par ailleurs, le Cu-DIU est reconnu comme étant le contraceptif d'urgence le plus efficace, pouvant être inséré jusqu'à 5-7 jours après le rapport à risque. La recherche se penche maintenant sur l'efficacité du LNG-DIU en contraception d'urgence. Enfin, de nouveaux concepts de DIU sont aussi à l'étude : ils devraient permettre une réduction du taux d'expulsion, une diminution des méno- et métrorragies, une augmentation du confort et une plus longue durée d'utilisation. Cet article fait le point sur les dernières nouveautés en termes de contraceptifs intra-utérins.

Recurrent or primary metastatic cervical cancer: current and future treatments.

Despite screening programs for early detection and the approval of human papillomavirus vaccines, around 6% of women with cervical cancer (CC) are discovered with primary metastatic disease. Moreover, one-third of the patients receiving chemoradiation followed by brachytherapy for locally advanced disease will have a recurrence. At the end, the vast majority of recurrent or metastatic CC not amenable to locoregional treatments are considered incurable disease with very poor prognosis. Historically, cisplatin monotherapy, then a combination of cisplatin and paclitaxel were considered the standard of care. Ten years ago, the addition of bevacizumab to chemotherapy demonstrated favorable data in terms of response rate and overall survival. Even with this improvement, novel therapies are needed for the treatment of recurrent CC in first as well as later lines. In the last decades, a better understanding of the interactions between human papillomavirus infection and the host immune system response has focused interest on the use of immunotherapeutic drugs in CC patients. Indeed, immune checkpoint inhibitors (pembrolizumab, cemiplimab, and others) have recently emerged as novel therapeutic pillars that could provide durable responses with impact on overall survival in patients in the primary (in addition to chemotherapy) or recurrent (monotherapy) settings. Tisotumab vedotin, an antibody-drug conjugate targeting the tissue factor, is another emerging drug. Several trials in monotherapy or in combination with immunotherapy, chemotherapy, or bevacizumab showed very promising results. There is a high need for more potent biomarkers to better accurately determine which patients would receive the greatest benefit from all these aforementioned drugs, but also to identify patients with specific molecular characteristics that could benefit from other targeted therapies. The Cancer Genome Atlas Research Network identified several genes significantly mutated, potentially targetable. These molecular data have highlighted the molecular heterogeneity of CC.

[How to explore... hyperandrogenism associated with insulin resistance ? An example based on the HAIR-AN syndrome.] / Comment j'explore une hyperandrogénie dans un contexte d'insulinorésistance. Un exemple basé sur le syndrome HAIR-AN.

HAIR-AN, a syndrome associating hyperandrogenism, insulin resistance and acanthosis nigricans, is currently considered as a severe form of polycystic ovary syndrome. The physiopathology of this syndrome relies on the insulin resistance which is the basis of a vicious circle : the resulting hyperinsulinism leads to an excessive production of androgens. The latter increases abdominal fat deposition which in turn worsens the insulin resistance. Hyperinsulinism is also responsible for the acanthosis nigricans by stimulating the IGF-1 receptors on keratinocytes and fibroblasts. Hyperandrogenism is clinically translated into hirsutism that can be severe. Frequently, menstrual irregularity and obesity are part of the syndrome. HAIR-AN syndrome begins soon after puberty and is currently under-diagnosed. Treatment relies on an improvement in insulin-resistance by a loss of body weight and the use of insulin sensitizers. Moreover, anti-androgenic drugs will help improving hirsutism. Although more invasive, bariatric surgery has shown a great efficacy in this syndrome : by permitting a substantial loss of weight, it often normalizes insulin-sensitivity, allowing for improvements in hyperandrogenism and acanthosis nigricans.

Considéré comme une forme sévère du syndrome des ovaires micropolykystiques, le syndrome de HAIR-AN associe une hyperandrogénie, une résistance à l'insuline et un acanthosis nigricans. La base physiopathologique du syndrome HAIR-AN est un cercle vicieux ayant pour point de départ la résistance à l'insuline : l'hyperinsulinisme qui en résulte entraîne une production excessive d'androgènes. Ces derniers, en aggravant le dépôt de graisse abdominale, majorent la résistance à l'insuline. Il s'agit donc d'un phénomène auto-entretenu. En stimulant le récepteur à l'IGF-1 des kératinocytes et des fibroblastes, l'hyperinsulinisme est également responsable de l'acanthosis nigricans. L'hyperandrogénie se traduit cliniquement par un hirsutisme pouvant être sévère. On notera fréquemment aussi une irrégularité menstruelle et une obésité. Le syndrome HAIR-AN débute tôt après la puberté et est actuellement sous-diagnostiqué. Le traitement est, avant tout, celui de la résistance à l'insuline et nécessite donc une perte de poids associée à l'utilisation de molécules insulino-sensibilisatrices. De plus, des traitements hormonaux anti-androgéniques aideront également à diminuer le hirsutisme. Plus invasive, la chirurgie bariatrique a cependant démontré une grande efficacité chez ces patientes : en permettant une perte de poids conséquente, elle normalise souvent la sensibilité à l'insuline, ce qui améliore significativement l'hyperandrogénie et l'acanthosis nigricans.

[Locally-advanced cervix cancer : multidisciplinary management]. / Cancer du col utérin localement avancé : approche multidisciplinaire.

Cervical cancer is the fourth most common cancer in women and is linked in over 95 % of cases to papillomavirus infection, the incidence of which has fallen in recent years due to screening and vaccination. Almost half of these cancers are diagnosed at a locally advanced stage with an overall 5-year survival of around 65 %. In recent decades, the management strategy of these locally advanced cancers has changed considerably and has allowed the improvement of survival but above all of local control as well as the reduction of toxicity, due to the implementation of imaging. Standard treatment consists of external beam radiation therapy combined with concomitant chemotherapy followed by intrauterine brachytherapy. The role of neo-adjuvant and adjuvant chemotherapy is still being evaluated. New therapeutic approaches (particularly immunotherapy) in addition to standard treatment are also being studied.

Le cancer du col de l'utérus est le quatrième cancer le plus fréquent chez la femme et est lié, dans sup�rieur a 95 % des cas, à une infection par le papillomavirus, dont l'incidence a chuté ces dernières années grâce au dépistage et à la vaccination. Près de la moitié de ces cancers sont diagnostiqués à un stade localement avancé avec une survie globale à 5 ans de l'ordre de 65 %. Ces dernières décennies, la stratégie de prise en charge de ces cancers localement avancés a considérablement changé. Elle a permis l'amélioration de la survie, mais surtout du contrôle local, ainsi que la réduction de la toxicité, grâce notamment à l'implémentation de l'imagerie. Le traitement standard consiste en une radiothérapie externe associée à une chimiothérapie concomitante, suivie d'une curiethérapie intra-utérine. La place de la chimiothérapie néo-adjuvante et adjuvante est toujours en cours d'évaluation. De nouvelles approches thérapeutiques (immunothérapie), en complément du traitement standard, sont aussi à l'étude.

[Spontaneous rupture of a splenic artery aneurysm during the third trimester of pregnancy]. / Rupture spontanée d'un anévrysme de l'artère splénique au cours du troisième trimestre de la grossesse.

We report the case of a 24-year-old female patient with spontaneous rupture of a splenic artery aneurysm in the third trimester of pregnancy. Pregnancy, throughout the physiological and hormonal changes it imposes, promotes the occurrence of aneurysm of the splenic artery and its rupture. Although this is a rare complication, its prognosis is severe and its typical clinical picture associating abdominal pain, hypotension and anemia is misleading for the clinician who likelier evokes a retroplacental hematoma or an uterine rupture. The maternal and foetal survival depends on rapid diagnosis and multidisciplinary management. Thus, it's important for the clinician to consider this differential diagnosis when abdominal pain or hemoperitoneum occurs in pregnant woman, particularly during the third trimester of pregnancy.

Nous rapportons l'histoire d'une patiente de 24 ans ayant présenté une rupture spontanée d'un anévrysme de l'artère splénique au cours du troisième trimestre de la grossesse. Celle-ci, de par les changements physiologiques et hormonaux qu'elle impose, favorise la survenue de l'anévrysme de l'artère splénique et sa rupture. Bien qu'il s'agisse d'une complication rare, son pronostic est redoutable et le tableau clinique typique associant douleur abdominale, hypotension et anémie est trompeur pour le clinicien qui évoque, plus volontiers, un hématome rétroplacentaire ou une rupture utérine. La survie materno-fœtale dépend de la rapidité diagnostique et d'une prise en charge multidisciplinaire, raisons pour lesquelles il est important que le clinicien considère ce diagnostic différentiel lors de la survenue d'une douleur abdominale ou d'un hémopéritoine chez la femme enceinte, particulièrement durant le 3ème trimestre de la grossesse.

Curative effect of second curettage for treatment of gestational trophoblastic disease - Results of the Belgian registry for gestational trophoblastic disease.

OBJECTIVE: We assessed the curative effect of a second curettage in patients with persistent hCG serum levels after first curettage for a gestational trophoblastic disease (GTD). STUDY DESIGN: This prospective observational study used the data of the Belgian register for GTD between July 2012 and January 2017. We analysed the data of patients who underwent a second curettage. We included 313 patients in the database. Primary endpoints were need for second curettage and chemotherapy. RESULTS: Thirty-seven patients of the study population (12 %) underwent a second curettage. 20 had persistent human chorionic gonadotropin hormone (hCG) elevation before second curettage. Of them, 9 patients (45 %) needed no further treatment afterwards. Eleven patients (55 %) needed further chemotherapy. Nine (82 %) were cured with single-agent chemotherapy and 2 patients (18 %) needed multi-agent chemotherapy. Of the 37 patients, patients with hCG levels below 5000 IU/L undergoing a second curettage were cured without chemotherapy in 65 % versus 45 % of patients with hCG level more than 5000 IU/L. Of the ten patients with a hCG level below 1000 IU/L, eight were cured without chemotherapy. CONCLUSIONS: Patients with post-mole gestational trophoblastic neoplasia can benefit from a second curettage to avoid chemotherapy, especially when the hCG level is lower than 5000 IU/L.

[Elective induction of labor in nulliparous women : should we stop ?] / L'induction élective du travail chez la patiente nullipare : stop ou encore ?

In Wallonia, almost one fourth of cesarean sections are performed on nulliparous women with vertex nonanomalous singleton gestations who underwent induction of labor. The purpose of this study is to compare maternal and neonatal outcomes with elective induction of labor versus spontaneous onset of labor. Data for all deliveries at CHU de Liège over a two-year period were obtained. Women with vertex nonanomalous singleton gestations who delivered from 3900 to 40+6 weeks were selected. We tested the association of elective induction and operative vaginal delivery, cesarean section, post-partum hemorrhage, episiotomy and perineal lacerations, length of labor, length of stay, 1-min and 5-min APGAR inferior to 7 and admission to neonatal intensive care unit. Length of stay was significantly longer in all induced women. In nulliparous women, there was a 45 % probability of operative vaginal delivery or cesarean section delivery in those who underwent elective induction of labor. In light of these results, it seems that our policy of elective induction of labor in nulliparous women is causing unnecessary and potentially avoidable interventions.

En Wallonie, l'induction du travail chez les patientes nullipares avec grossesse singleton en présentation céphalique recrute près d'un quart de l'ensemble des césariennes réalisées. L'objectif de cette étude est de comparer le travail spontané et l'induction élective du travail en termes d'issues obstétricales et de morbidités maternelles et néonatales. Entre janvier 2015 et décembre 2016, les femmes ayant accouché entre 390 et 40+6 semaines d'aménorrhée (SA) au CHU de Liège et ayant présenté une grossesse singleton avec présentation céphalique, sans pathologie maternelle, gravidique ou fœtale ont été sélectionnées. Les variables suivantes ont été retenues : taux d'extraction instrumentale, taux de césarienne, type d'hémorragie du post-partum, état du périnée, durée du travail, durée d'hospitalisation, APGAR (1-5 min) défavorable (inf�rieur a 7) et passage en néonatologie. La durée d'hospitalisation est augmentée chez toutes les femmes induites. Chez les patientes nullipares, l'induction élective se solde, dans 45 % des cas, par une extraction instrumentale ou une césarienne en cours de travail. Nos pratiques d'induction élective chez les patientes nullipares pourraient être responsables d'un certain nombre d'interventions non nécessaires et évitables.

[«I am not pregnant !¼ About denial of pregnancy ]. / «Je ne suis pas enceinte !¼ A propos du déni de grossesse .

The term «denial of pregnancy¼, although used in current medical practice since 1970, does not yet have a universal definition. The literature allows to define it as «the non-recognition of a pregnancy beyond the first trimester, which can last until delivery and cover it¼. The changes related to pregnancy are biologically reduced or incorrectly perceived or even ignored. Although often wrongly considered as a rare phenomenon, the literature describes it as having a prevalence of 2 to 3 cases per 1.000 viable deliveries. This case report associated with a short review of the literature aims to optimise the clinician awareness, leading to the diagnosis as well as the potential perinatal consequences linked to this phenomenon.

Le terme de «déni de grossesse¼, bien qu'utilisé dans la pratique médicale courante depuis 1970, n'a, à ce jour, pas encore de définition universelle. La littérature permet de le définir comme la «non-reconnaissance d'une grossesse au-delà du premier trimestre, qui peut se prolonger jusqu'à l'accouchement et recouvrir ce dernier¼. Les changements liés à la grossesse sont biologiquement réduits et incorrectement perçus par la femme, ce qui fait passer son évolution sous silence. Bien que souvent considéré à tort comme un phénomène rare, la littérature le décrit, cependant, avec une prévalence de 2 à 3 cas pour 1.000 accouchements viables. Le cas clinique rapporté ici, accompagné d'une revue succincte de la littérature, vise à conscientiser les cliniciens quant aux circonstances de diagnostic d'un déni de grossesse et la morbi-mortalité périnatale qui y est, potentiellement, associée.

Lomboaortic Lymphadenectomy in Gynecological Oncology: Laparotomy, Laparoscopy or Robot-Assisted Laparoscopy?

BACKGROUND: The outcomes of paraaortic lymphadenectomy were compared for the treatment of gynecological malignancies to identify the most appropriate surgical approach. METHODS: Our retrospective, multicentric study included 1304 patients who underwent paraaortic lymphadenectomy for gynecological malignancies. The patients were categorized into the following five groups based on treatment type: transperitoneal laparoscopy (group A, n = 198), extraperitoneal laparoscopy (group B, n = 681), robot-assisted transperitoneal laparoscopy (group C, n = 135), robot-assisted extraperitoneal laparoscopy (group D, n = 44), and laparotomy (group E, n = 246). RESULTS: The prevalence of cancer types differed according to the surgical approach: there were more ovarian cancers in group E and more cervical cancers in groups B and D (p < 0.001). Estimated blood loss was higher in group E (844.2 mL) than in groups treated with minimally invasive interventions (115.8-141.5 mL, p < 0.005). For infrarenal dissection, fewer nodes were removed in group C compared with the other approaches (16 vs. 21 nodes, respectively, p < 0.05). The average operative time ranged from 169 min for group A to 247 min for group E (p < 0.001). Length of hospital stay was 14 days for group E versus 3.5 days for minimally invasive procedures (p < 0.05). The early postoperative grade 3 and superior Dindo-Clavien complications occurred in 9-10% of the patients in groups B-D, 15% of the patients in group E, and only 3% and 4% for groups A and C, respectively. The most common complication was lymphocele. CONCLUSIONS: Laparotomy increases preoperative and postoperative morbidity. The robot-assisted transperitoneal approach demonstrated a poorer lymph node yield than laparotomy and extraperitoneal approaches.

[Guidelines for surgical management of gynaecological cancer during pandemic COVID-19 period - FRANCOGYN group for the CNGOF]. / Prise en charge chirurgicale des cancers gynécologiques en période de pandémie COVID-19 ­ Recommandations du Groupe FRANCOGYN pour le CNGOF.

INTRODUCTION: Recommendations for the management of patients with gynecological cancer during the COVID-19 pandemic period. MATERIAL AND METHOD: Recommendations based on the consensus conference model. RESULTS: In the case of a COVID-19 positive patient, surgical management should be postponed for at least 15 days. For cervical cancer, the place of surgery must be re-evaluated in relation to radiotherapy and Radio-Chemotherapy-Concomitant and the value of lymph node staging surgeries must be reviewed on a case-by-case basis. For advanced ovarian cancers, neo-adjuvant chemotherapy should be favored even if primary cytoreduction surgery could be envisaged. It is lawful not to offer hyperthermic intraperitoneal chemotherapy during a COVID-19 pandemic. In the case of patients who must undergo interval surgery, it is possible to continue the chemotherapy and to offer surgery after 6 cycles of chemotherapy. For early stage endometrial cancer, in case of low and intermediate preoperative ESMO risk, hysterectomy with bilateral annexectomy associated with a sentinel lymph node procedure should be favored. It is possible to consider postponing surgery for 1 to 2 months in low-risk endometrial cancers (FIGO Ia stage on MRI and grade 1-2 endometrioid cancer on endometrial biopsy). For high ESMO risk, it ispossible to favor the MSKCC algorithm (combining PET-CT and sentinel lymph node biopsy) in order to omit pelvic and lumbar-aortic lymphadenectomies. CONCLUSION: During COVID-19 pandemic, patients suffering from cancer should not lose life chance, while limiting the risks associated with the virus.

Variation of the maximum velocity along the umbilical vein supports the Reynolds pulsometer model.

OBJECTIVE: To challenge, with a modern sonographic approach and a numerical model, the Reynolds's concept which suggests that the vascular structure of the umbilical cord could act as a pulsometer facilitating the venous return to the foetus. METHOD: Forty-five patients between 20 and 28 weeks of gestation were included in the study. The blood maximum velocity in the umbilical vein, measured at both foetal and placental ends, was assessed. Several sonographic parameters of the cord, including the diameter of the umbilical vein at both extremities, cord cross-sectional area and Wharton's jelly section surface were measured. We compare our data with those of a numerical model. RESULTS: A difference in maximum velocity between the two extremities of the umbilical vein (ΔUVVmax) was noted. The maximum velocity was significantly higher at the foetal umbilical end (14.12 +/-3.18 cm/s) than at the placental end (11.93 +/-2.55 cm/s; p < 0.0001). The mean difference is 2.2 +/- 2.3 cm/s. No difference in the umbilical vein diameter was measured at both cord ends (umbilical 4.85 +/-0.9 mm, placental 4.86 +/-0.87 mm, p < 0.0001). There is no significant relationship between ΔUVVmax and the cord cross-sectional area or Wharton's jelly index. CONCLUSION: Modifications of the spatial velocity profile together with the pulsometer model could explain the maximum velocity changes that is measured in the umbilical vein along the cord. This numerical model consolidates the sonographic observations.

Ulcer of Lipschutz, a rare and unknown cause of genital ulceration.

Acute genital ulcers are painful and distressing to women. Lipchutz Ulcer is an uncommon disease that typically occurs in sexually inactive young women. The main differential diagnosis are sexually-transmitted or non-infectious diseases which cause genital or oro-genital ulcerations. This article aims to review the diagnosis of acute genital ulcers and, through a rare case of acute genital ulcerations, to discuss diagnostic procedures.

[Role of metformin in gynaecology and obstetrics]. / Comment je traite Place de la metformine en gynécologie-obstétrique.

Metformin raises much interest in the fields of gynaecology and obstetrics. This article discusses both the efficacy and safety of metformin in the management of polycystic ovary syndrome as well as in the prevention, treatment and follow-up of gestational diabetes. Recent observational data suggest that metformin may also exert positive effects as adjuvant therapy in some cancers, among which endometrial cancer and breast cancer.

La metformine suscite un réel intérêt dans le domaine de la gynécologie et de l'obstétrique. Cet article discute l'efficacité et la sécurité de la metformine dans la prise en charge des femmes avec un syndrome des ovaires micropolykystiques ainsi que dans la prévention, le traitement et le suivi d'un diabète gestationnel. Des données observationnelles récentes suggèrent également que la metformine pourrait jouer un rôle favorable comme traitement adjuvant dans certains cancers, dont ceux de l'endomètre et du sein.

[Delivery site for fœtus with congenital heart disease : CHU of Liège experience and international recommandations]. / Choix du lieu de naissance du fœtus cardiopathe. Expérience liégeoise et recommandations internationales.

Optimal choice of delivery site after a diagnosis of congenital heart disease (CHD) improves neonatal mortality and morbidity. We report the CHU of Liège experience and review the international recommendations. Between 2011 and 2016, 54 fetuses were diagnosed with CHD in our service. Retrospectively we estimated the appropriateness of the site of delivery considering the postnatal outcome. We confronted our experience with the recent international recommendations for in utero transfer to a tertiary center. The latter are based on the risk of hemodynamic instability at birth but differ for the ductal-dependent cardiopathy. The postanatal evolution and the low emergency transfer rate (4 %) in our series demonstrate the quality of our policy. We propose to validate the French transfer in utero recommendations for our obstetrical department, especially for ductal-dependent cardiopathy.

Le choix d'une structure de naissance adaptée au foetus cardiopathe permet de diminuer la morbi-mortalité néonatale. Nous rapportons l'expérience du CHU de Liège en matière d'orientation obstétricale des foetus cardiopathes et la confrontons aux données internationales. De 2011 à 2016, 54 fœtus cardiopathes ont été examinés dans notre unité de diagnostic anténatal. Cette série fait l'objet d'une analyse rétrospective en termes de pertinence du choix du lieu de naissance au vu de l'évolution postnatale et d'une confrontation aux recommandations internationales récentes de transfert in utero. Ces dernières reposent sur le risque d'instabilité néonatale et diffèrent pour les cardiopathies ducto-dépendantes. L'évolution néonatale et le faible taux de transfert postnatal urgent (4 %) dans notre série témoignent d'une orientation obstétricale adaptée. Nous proposons d'implémenter, au sein du département obstétrical universitaire liégeois, les recommandations françaises de transfert in utero en centre tertiaire, notamment le transfert des cardiopathies ducto-dépendantes.

[Hematocolpos : an unappreciated diagnosis of hymen imperforation]. / Le cas clinique du mois. Hématocolpos : un diagnostic méconnu d'imperforation hyménéale.

The imperforation of the hymen is a relatively rare congenital malformation. It usually manifests itself in adolescence by a hematocolpos. Hematocolpos is the vaginal retention of menstrual blood at puberty. It results clinically in painful amenorrhea and more rarely in a pelvic mass syndrome. The diagnosis is easy, it is primarily clinical. Pelvic ultrasound and nuclear magnetic resonance are the complementary examinations to be performed as a preoperative assessment and to detect any associated genito-urinary malformations.

L'imperforation de l'hymen est une malformation congénitale relativement rare. L'hématocolpos, qui désigne l'accumulation progressive de sang menstruel dans la cavité vaginale, en est la manifestation la plus fréquente à l'adolescence. Il se traduit cliniquement par une cryptoménorrhée douloureuse et, plus rarement, par un syndrome de masse pelvien. Le diagnostic est facile et, avant tout, clinique. L'échographie et la résonance magnétique nucléaire sont les examens complémentaires de choix pour déceler d'éventuelles malformations génito-urinaires associées. Le traitement consiste en une hyménéotomie.

[Pseudotumoral pelvic actinomycosis : one should think of it]. / Le cas clinique du mois - Actinomycose pelvienne pseudo-tumorale : il fallait y penser.

Actinomycosis is a rare chronic disease caused by a group of anaerobic Gram positive bacteria. It may mimic a neoplasia at various anatomical levels. A pelvic localization is exceptional but has an increasing incidence since the use of intrauterine devices. In such cases, pelvic actinomycosis may present as a gynecological or a lower colonic malignancy. For all atypical clinical, with a prominent infectious or inflammatory context, the diagnosis of actinomycosis must be suggested and discussed with the pathologist to whom the biopsy will be submitted. In the absence of a preoperative diagnosis, an inadequately aggressive pelvic surgery might be performed and rendered particularly complex due to the adherent and diffusely inflammatory pattern of the disease. The treatment of choice remains a long-term therapy with antibiotics that leads to a complete clinical and radiological response in the majority of cases. We report the case of a 27-year-old woman with a clinical and radiological diagnosis of rectal carcinoma but with limited preoperative biopsy that revealed a pelvic actinomycosis and allowed a conservative and successful antibacterial treatment.

L'actinomycose est une pathologie bactérienne rare pouvant prendre un aspect pseudo-tumoral. La localisation pelvienne est exceptionnelle, mais d'incidence croissante depuis l'utilisation des dispositifs intra-utérins. La présentation peut alors évoquer une néoplasie gynécologique ou colique basse. Devant tout tableau clinique atypique suggérant une malignité pelvienne mais dominé par un contexte infectieux et/ou inflammatoire, le diagnostic d'actinomycose doit être évoqué et discuté avec le collègue anatomo-athologiste auquel les prélèvements histologiques seront soumis. En l'absence de diagnostic pré-opératoire, une chirurgie radicale peut être pratiquée de manière inadéquate et se révéler particulièrement délabrante en raison du caractère adhérent et diffusément inflammatoire de la lésion. Le traitement de choix est une antibiothérapie au long cours amenant à une résolution clinique et radiologique complète dans la majorité des cas. Nous rapportons le cas d'une patiente de 27 ans chez laquelle un diagnostic de néoplasie rectale primitive est suggéré cliniquement et radiologiquement, mais chez qui les biopsies pré-opératoires limitées ont permis un diagnostic d'actinomycose pelvienne et un traitement conservateur.

Fifth Ovarian Cancer Consensus Conference: individualized therapy and patient factors.

This manuscript reports the consensus statements regarding the design and conduct of clinical trials in patients with newly diagnosed and recurrent epithelial ovarian cancer (EOC), following deliberation at the Fifth Ovarian Cancer Consensus Conference (OCCC), held in Tokyo in November 2015. Three important questions were identified for discussion prior to the meeting and achieved consensus during the meeting: (i) What are the most important factors to be evaluated prior to initial therapy? (ii) What are the most important factors to be evaluated specifically in recurrent disease? (iii) Are there specific considerations for special patient subpopulations? In addition, we report a list of important unmet needs compiled during the consensus process, which is intended to guide future research initiatives.

Prenatal diagnosis of a terminal chromosome 1 (q42-q44) deletion: original case report and review of the literature.

Terminal chromosome 1q deletion is rarely reported but causes typical malformations that have been well described in childhood. Clinical features include facial dysmorphy, growth and/or psychomotor retardation, brain agenesis or hypoplasia of the corpus callosum, epilepsy and occasional urogenital or cardiac malformations. The diagnosis of this condition is usually made at birth. The rare cases of antenatal diagnosis were based on microcephaly and growth retardation. In the present case, the foetus presented with an hypoplasia of the corpus callosum, a dysmorphic profile and a single umbilical artery. The foetal echocardiography suggested a non- compaction of the left ventricular myocardium. No microcephaly or growth retardation were noted. We compare our antenatal findings to those described in the literature with the aim to better define the antenatal phenotype of the terminal chromosome 1 deletion syndrome.

A reversible posterior leucoencephalopathy syndrome including blindness caused by preeclampsia.

Complications of (pre)eclampsia may involve multiple systems and organs. Neurological symptoms may occur. Visual symptoms concern up to 25% the of patients with severe preeclampsia and 50% of the patients with eclampsia. An uncommon effect of severe preeclampsia is sudden blindness. Blindness may be part of a clinical and radiological presentation named Posterior Reversible Encephalopathy Syndrome (PRES). PRES may lead to permanent neurological deficit, recurrences or death. We report the case of a 24-year-old Caucasian patient, gravida 5 para 2 who developed preeclampsia and PRES complicated with blindness at 32 weeks of gestation. Optimal care allowed visual symptoms to resolve within 24 hours and a favourable maternal outcome and no long- term sequelae. We describe different causes and manifestations of PRES and highlight the need for immediate care in order to optimize the chance of symptoms reversibility.