Primary umbilical endometriosis: Surgical case report.

Introduction: Endometriosis is a benign nevertheless a chronic condition which impacts greatly the quality of life through cyclic discomfort. We aim to report the case of umbilical endometriosis and a literature review of the different treatment modalities. Case Report: This was a case of a 43-year-old woman, with no history, who presented with a painful hemorrhagic umbilical swelling during the menstrual period associated with dysmenorrhea. Abdominal ultrasound revealed a subcutaneous umbilical mass of non-vascularized tissue nature confirmed on Doppler. Pelvic MRI which confirms the diagnosis of primary umbilical endometriosis. The patient underwent wide local excision of the endometriotic nodule with umbilical reconstruction. Histology confirmed the diagnosis of umbilical endometriosis. Resection margins were clear. Discussion: Extra-pelvic endometriosis sites are not common, especially the umbilicus. It usually occurs secondary to surgical scars, specifically after laparoscopy or open abdominal surgery. Surgical management is currently described as gold standard. Laparoscopic approach is recommended as it allows better visual inspection for secondary localization of endometriosis. Medical management corresponds to combined oral contraceptives (COCs) or progestins for management of endometriotic implants decreasing inflammatory effects, or Gonadotropin-releasing hormone for long-course treatment. Malignant transformation of the umbilical nodule has been described in literature with a reported risk of malignant transformation to be 3%. Conclusion: Current management of extragenital endometriosis suggest radical surgery with wide local excision. Due to the rarity, there is a paucity of data on umbilical endometriosis and mostly reported from case reports.

[Acute lower limb ischemia secondary to femoral osteochondroma]. / Ischémie aiguë du membre inférieur secondaire à un ostéochondrome fémoral.

Osteochondromas or bone exostoses are bone tumors commonly found in adolescents or young adults. These benign tumors are usually incidentally discovered, exceptionally by a vascular or nervous complication. We report the case of a 22-year-old patient presenting with left femoral exostosis revealed by an acute ischemia of the lower limb. Clinical examination of the contralateral limb was without abnormality. Computed tomography angiography revealed a thrombosed aneurysm of the supra articular popliteal artery associated to an exostosis of the lower extremity of the femur. Surgical treatment was recommended in this patient: resection of the popliteal aneurysm associated with a end-to-end suture of the popliteal artery and resection of bone exostosis.

Rare variant of metaplastic carcinoma of the breast: a case report and review of the literature.

BACKGROUND: Metaplastic carcinoma encompasses a group of neoplasms characterized by differentiation of the neoplastic epithelium into squamous cells and/or mesenchymal-looking elements. Spindle cell carcinoma is a rare variant of this special histological type. Its prognosis remains poor, with a high rate of local recurrence and distant metastasis. To date, only a small number of cases have been described. There is no clear agreement on this histological subtype. CASE PRESENTATION: We report a case of a 53-year-old Moroccan woman who consulted our institution following palpation of a nodule of the left breast. Mammography in combination with breast ultrasonography revealed a lesion classified as Breast Imaging Reporting and Data System 4 with microcalcification. The patient was diagnosed with spindle cell carcinoma of the breast. The diagnosis was based primarily on histological and immunohistochemical studies of the breast biopsy and secondarily on the surgical specimen. No local or distant metastasis was found. The treatment used was total surgical excision followed by radiotherapy. CONCLUSIONS: We describe the features (epidemiological, clinical, histological, immunohistochemical, and therapeutic outcomes) of our patient's case and compare them with literature data.

Systemic paraneoplastic vasculitis secondary to papillary carcinoma of the thyroid.

Systemic vasculitis secondary to thyroid carcinomas is exceptional. We report the case of a 55-year-old woman who presented with systemic vasculitis involving leucocytoclastic cutaneous vasculitis and renal disorders secondary to papillary thyroid carcinoma (PTC). Her symptoms resolved completely after total thyroidectomy. Other causes of vasculitis were excluded. To our knowledge, this is only the second case reported of systemic vasculitis associated with PTC in a paraneoplastic manner.

Compression of the peroneal nerve by a neurofibroma originating from collaterals of the peroneal nerve: a case report.

BACKGROUND: Paralysis of the external popliteal sciatic nerve is a frequent pathological condition that occurs after trauma. However, etiologies other than trauma, such as tumors, are also possible. The sensory collaterals of the external popliteal sciatic nerve have a small territory of innervation at the knee, and tumors involving these nerves become symptomatic after compression of the motor nerves. We here describe the first reported case of this phenomenon. CASE PRESENTATION: This case involved a lesion compressing the origin of the external popliteal sciatic nerve of a 13-year-old Moroccan boy diagnosed with a neurofibroma. He developed functional impairment of his left lower limb during a football game, and examination revealed a steppage gait. The initial diagnosis was stretching of the peroneal nerve. The definitive diagnosis of a neurofibroma was revealed by imaging and confirmed by surgery and pathology. Treatment involved total removal of the tumor; however, our patient's steppage gait persisted. CONCLUSIONS: Our patient developed compression of the external popliteal sciatic nerve from a tumor growing on a collateral nerve. Early diagnosis is an absolute necessity in such cases. Trauma and tumors of sensory nerves can distort the diagnosis, as in this case. Ultrasound and magnetic resonance imaging can contribute to an accurate diagnosis in patients with neuropathy in the absence trauma or tomacula.

A solitary fibrous tumor of the pleura revealed by hiccups.

Solitary fibrous tumors of the pleura are rare and benign primary localized tumors; they possess a malignant potential and thus should be excised. We report a case of a 43-year-old woman, who had suffered for 5 years from right basithoracic pain associated with progressive dyspnea and persistent hiccups during the last 6 months. We have not found any similar case in the literature. Further testing after excision by thoracotomy revealed a solitary fibrous pleural tumor. A brief discussion of the clinical presentation and incidence of these tumors is included.

[Multiple paragangliomas: about two cases]. / Paragangliomes multiples: à propos de deux cas.

The multiple paragangliomas are rare tumours, with slow evolution, posing diagnostic and therapeutic problems. The carotid and jugulo-tympanic localization are the most frequent, and the aortic localization is very infrequent. The association of two, three and four localization is possible in the multiple forms. These multiple localizations are more frequent in familial forms. Surgical removal is the first intention treatment of these tumours. In the multiple forms, the therapeutic strategy must be adapted to each case: usually, the intervention begins by the carotid localization. We report two cases of chemodectoma with multiple localizations. The first case is a 44 years-old woman, who presented a double localization: carotid (bilateral) and aortic (arch). The second case is a patient with a double aortic localization, carotid and aortic, associated to a tympano-jugular localization. Surgical treatment was performed for all these localization, except for the tympano-jugular localization, treated by embolization. The post-operative periods were uneventful. The first case had adjunctive radiotherapy.

[Cerebral revascularisation in Takayasu's arteritis]. / Revascularisation cérébrale dans la maladie de Takayasu.

SUBJECT: Supraaortic angioplasty is often not feasible in patients with Takayasu's arteritis because of involvement of long segment of arteries. Consequently, the role of surgical treatment in the management of cerebral ischemia is important in this disease. The objective of this work is to specify the indications and surgical techniques in lesions of arteries to the head in this disease and to report our experience. METHODS: Seven patients with cervical arterial lesions due to Takayasu's arteritis were treated by bypass surgery in the department of vascular surgery, Ibn-Sina hospital on one period of 11 years. RESULTS: It is about 6 women and one man of middle age at the time of the diagnosis of 33,8 years. The revealing signs were essentially of neurological and ocular order. Six of our patients were in inflammatory thrust at the time of the diagnosis, and required a medical treatment first to basis of corticosteroids. Bypasses from the ascending aorta to the carotid artery were performed in six cases. In one case, the bypass was performed between the brachiocephalic artery and common carotid artery. A death in relation with a cerebral hemorrhage occurred 2 days after the revascularisation. A clean improvement of the functional signs was noted among 3 patients, whereas the improvement was partial at two other. A secondary thrombosis of the bypass surgery occurred in 3 cases. CONCLUSION: The natural history of Takayasu's arteritis and its evolution is badly known. The operative indications must not rest solely on the only anatomical balance, but based on a bundle of arguments in which, the assessment of the cerebral blood flow would be useful. Cerebral hyperperfusion syndrom constitutes a major risk that can be reduced by staged revascularisations.

[Large ossifying fibroma of the jaws and hyperparathyroidism in a chronic hemodialyzed patient]. / Fibrome ossifiant géant des maxillaires et hyperparathyroïdisme chez un hémodialysé chronique.

OBJECTIVE: Describe the exceptional and fortuitous character of the association of ossifying fibroma and hyperparathyroidism in a chronic hemodialyzed patient. CASE REPORT: A twenty-year-old man who had undergone dialysis for ten years as the result of an indeterminate nephropathy was admitted for a functional disability in the standing position and a serious dysmorphic syndrome with swelling of the jaws that hindered proper closure of the mouth. RESULTS: Medical imagery revealed a polyostotic attack pleading in favor of renal osteodystrophy or a fibrous dysplasia. The surgical reduction of the tumor of the jaws shown, from the histological viewpoint, a large aggressive ossifying fibroma of the jaws. CONCLUSION: The association of ossifying fibroma and hyperparathyroidism in a chronic hemodialyzed patient is exceptional and fortuitous. The difficult treatment points out the need for early rigorous prevention of hyperparathyroidism in a chronic hemodialyzed patient.

[Two cases of malignant tumors of the inferior vena cava]. / Deux cas de tumeurs malignes de la veine cave inférieure.

The malignant tumors of the inferior vena cava are rare. Their prognosis is bad. We report two cases of a 17-year-old and 46-year-old woman presenting the one an intimal sarcoma of the inferior vena cava and the other a metastatic of adenocarcinoma whose primary tumor was not identified. The aortic wall was invaded in both patients. The ureter repulsed in first case, was invaded in second case. The treatment consisted on resection of the tumor including the aortic wall with vein closure in both patients, with right nephrectomy in second patient. In the two cases, a prosthetic reconstruction of the arterial integrity was attempted with aortobiiliac bypass. The two patients died after relapse tumorous to the 6th month in first patient and by multisystem organ failure 5th day post-operative in second. Through these two personal cases, we try to point out the difficult problem of diagnosis that put these tumors and their bad prognosis despite an improvement of treatment.

[Treatment of ovarian cysts by laparoscopic surgery: a retrospective study of 40 cases]. / Le traitement coeliochirurgical des kystes de l'ovaire. Etude retrospective a propos de 40 cas.

The ovarian cysts treatment has taken advantage of the improvement made on the operating laparoscopy, that gives progressively better results than those of the laparotomy. On the one hand, laparoscopic surgery reduces the traditional surgery constraints by giving an exact histologic diagnosis and a radical cyst treatment. On the other hand, it prevents against inherent recurrence related to a sample puncture, and en the same time diminish adhesion risks. The laparoscopy can treat all kind of histologic benign ovarian cysts. We report the first experience of the Maternité Universitaire des Orangers in treating ovarian cysts by laparoscopic surgery.

[Breast angiosarcomas: three case reports]. / Les angiosarcomes du sein: à propos de 3 observations.

Angiosarcoma is a rare type of breast cancer, it has the worst prognosis of all breast malignancies. We report three cases of breast angiosarcoma observed at the National Oncology Institute and the Maternity of Orangers. A preoperative diagnosis was evoked in one case only, after a local recurrence in the second one and histological in the last one. Mastectomy is the reference treatment. The development is distinguished by general metastasis. Based on review of literature, we analysed the different aspects of this disease.

[Abdominal aortic aneurysm and Behçet's disease: four cases]. / Anévrisme de l'aorte abdominale au cours de la maladie de Behçet. A propos de 4 cas.

Behçet's disease is an uncommon systemic process generally developing during the third or fourth decade of life. Recurrent inflammatory lesions are characteristic. Cardiovascular involvement, which may be arterial or venous, is rare but with particularly severe prognosis. Four cases of abdominal aortic aneurysm are reported. One patient underwent emergency surgery for acute rupture. All patients were male, age range 29-45 years, mean age 36.5 years. Three patients were followed for Behçet's disease. Surgical revascularization was performed in all four patients, mainly with prosthetic grafts, one with patch aortoplasty. The postoperative period was complicated by paraplegia and thrombosis of the prosthetic graft in the patient who underwent emergency surgery. On the basis of these cases and cases reported in the literature, it can be concluded that morbidity and mortality are high because of the etiology underlying vascular involvement in Behçet's disease.

[Synovial hemangioma of the knee joint. A case report]. / L'hémangiome synovial du genou. A propos d'une observation]

Synovial hemangioma of the knee joint was diagnosed in a young woman 15 years after the first signs. The principal clinical manifestation involved repeated episodes of hemorrhagic joint effusion. MRI is the exploration of choice for this vascular tumor of the synovial membrane, although a pathology study is needed to confirm the diagnosis. Cure is achieved with surgical resection.

[Inflammatory pseudotumor of the spleen]. / Pseudotumeur inflammatoire de la rate.

Inflammatory pseudotumor of the spleen is a very rare benign lesion of unknown etiology. Splenectomy is recommended to obtain histological diagnosis and to eliminate a malignant tumor.

[Uterine leiomyoma in a patient with Rokitansky-Kuster-Hauser syndrome. Report of a case]. / Léiomyome utérin sur syndrome de Rokitansky-Kuster-Hauser. A propos d'un cas.

We report the discovery of a leiomyoma which developed from a fibrous myometrial band in a woman with Rokitansky-Kuster-Hauser syndrome. This localization is exceptional. The diagnosis was suspected at physical examination and pelvic ultrasonography and laparoscopy. Histology confirmed leiomyoma.