[Idiopathic granulomatous mastitis associated with erythema nodosum: a case report]. / Mastite granulomateuse idiopathique associant un érythème noueux: à propos d'un cas.

Idiopathic granulomatous mastitis (IMD) is a chronic benign inflammatory disease of the breast which can mimic breast cancer. It is more common in young women of childbearing age and poses a challenge in diagnosis of inflammatory breast tumor. We report the case of a 26-year-old female patient who presented with inflammatory breast. Clinical examination showed apyretic patient with edematized and painless irregular smooth mass in the left breast measuring 4 cm surmounted by crusts and multiples fistulizing scars discharging pus by applying pressure, with mobile ipsilateral axillary adenopathy. The remainder of the physical examination showed inflammatory erythematous patches on both legs. A mammogram plus breast ultrasound was performed followed by biopsy that objectified fibrous mastopathy. Lumpectomy was performed due to the persistence of symptoms. Anatomopathological examination objectified granulomatous mastitis. Etiological research didn't identify a clear cause. Corticotherapy associated with antibiotic therapy was started with complete regression of symptoms after two months.

Decidualization of an ovarian endometrioma complicated by a sigmoid fistula during pregnancy: a case report.

BACKGROUND: During pregnancy, the discovery of adnexal masses remains frequent. Such masses are mostly benign. Ovarian endometrioma is a rare etiology. The diagnosis may be difficult in some situations, such as decidualization. It may be asymptomatic or result in complications for which magnetic resonance imaging is needed. CASE PRESENTATION: We describe an unusual case of decidualization of an ovarian endometrioma complicated by a sigmoid fistula during a 7-week, 1-day pregnancy in a Arabic patient aged 38 years who developed acute pelvic pain with fever. She had a medical history of unexplored secondary dysmenorrhea. The diagnosis was suspected on the basis of magnetic resonance imaging findings. The management was based on surgery, during which exploration revealed a mass at the expense of the left ovary being very adherent and fistulized to the sigmoid. We performed adnexectomy followed by digestive ostomy. The result of pathological study with immunohistochemistry led to a diagnosis of decidualization of an ovarian endometrioma altered by infection. CONCLUSION: Decidualization of an ovarian endometrioma can lead sometimes to unexpected complications. The decision to provide surgery must be made with caution without delaying treatment in the event of a deep suspicion of malignancy and/or complication. The particular and exceptional complication discovered in our patient is the fistulization to the sigmoid.

Management of adnexal masses' torsion during pregnancy.

With the increased use and quality of ultrasound in pregnancy, adnexal masses are being encountered with greater frequency. Most of the time such masses are asymptomatic. It can be discovered in an emergency. Surgical intervention may cause risks to the mother and her fetus, while observation without intervention may also lead to unfavorable complications, such as ovarian torsion or the development of a tumor. Therefore, the management requires a balance between the maternal and fetal risks. We report two cases of torsion of adnexal masses during pregnancy, and we provide a brief literature review on the management and prognosis of this condition in pregnancy.

[Cesarean-scar pregnancy: about a case and literature review]. / Grossesse sur cicatrice de césarienne: à propos d'un cas et revue de la littérature.

Cesarean-scar pregnancy is a rare form of the ectopic pregnancy which can be life-threatening or threaten patient's functional prognosis due to hemorrhage or early uterine rupture. We report the case of a 23-year old patient with ectopic pregnancy, gravida 3, para 2, with bi-scarred uterus who was diagnosed with cesarean-scar pregnancy due to metrorrhagias at 7 weeks of amenorrhea. Transvaginal ultrasound allowed early diagnosis and treatment was based on conservative therapy. This study and literature review aim to highlight the diagnostic and therapeutic features of this rare disorder whose knowledge can improve prognosis.

[Uterine rupture in patients with healthy uterus: misoprostol complication (case study and literature review)]. / Rupture utérine sur utérus sain: complication du misoprostol (à propos d'un cas et revue de la littérature).

Uterine rupture in patients with healthy uterus during the 2nd and 3rd trimester of pregnancy is a rare and severe obstetric complication involving maternal and fetal vital prognosis as well as obstetrical outcome of patients in the absence of diagnosis and early treatment. It mainly occurs in women who have had scarred uterus and it is anecdotal in those with healthy uterus. We report the case of a primiparous patient with unscarred uterus who had had uterine rupture during labour induction with misoprostol for fetal death in utero (FDIU) due to intrauterine growth retardation (IGR) and severe oligohydramnios at 31 weeks of amenorrhea (WA). This study and the literature review highlights the importance of administrating misoprostol for labour induction with extreme caution as well as the clinical features, the risk factors, the diagnostic method and the therapeutic treatment of this rare but potentially serious condition.

[Immature teratoma of the ovary: about a case]. / Tératome immature de l'ovaire: à propos d'un cas.

Ovarian teratomas are tumors resulting from pluripotent germ cells. We here describe 3 different types of teratomas: mature, immature and monodermal teratomas. Immature teratoma accounts for less than 1% of ovarian cancers and mainly affects young subjects. We report the case of a 25 year female patient, admitted with abdomino pelvic mass. She underwent ultrasound and a pelvic CT scan followed by conservative treatment based on left annexectomy associated with multiple biopsies. Anatomopathological examination showed immature ovarian teratoma. Patient's treatment was supplemented by a hysterectomy with lumbo-aortic curage and omentectomy. We highlight, through this study and review of the literature, the predisposing factors for this type of rare and severe tumor and the radiological features suggesting these rare histological types of ovarian tumors, in order to improve the prognosis and multidisciplinary management of patients.

Spontaneous hemorrhagic strokes during pregnancy: case report and review of the literature.

Hemorrhagic stroke is responsible for significant morbidity and mortality. Postpartum and pregnancy are risk period. Only urgent care in intensive care units may improve prognosis. We report the case of 22 years old's Morrocan, who presented to our department with an intense headache headset followed a few hours later by consciousness disorder. Clinical examination at admission has objectified a woman obsessed with a GCS 13, normotensive, the labstix is negative. A brain scan was performed showing left temporal intra parenchymal hematoma with ventricular flooding and subfalcine herniation. An external ventricular shunt was made. The patient was extubated on day 2 of hospitalization, with progressive neurological improvement. Concerning obstetrical care, the pregnancy has evolved harmoniously without any growth retardation or other abnormalities, with full-term vaginal delivery of a healthy 3kg200 baby. although Hemorrhagic stroke during pregnancy is rare, the prognosis is reserved. An adequate care in intensive care unit is required.

Vulvar lipoma: a case report.

INTRODUCTION: Vulvar lipoma is a rare tumor localization and only a few cases have been reported. The clinical characteristics of vulvar lipoma are well known. However, it is important to distinguish lipomas from liposarcomas. We report a case of vulvar lipoma and discuss its clinical features, including diagnostic aspects, with emphasis on histopathological evaluation of all excised lesions. We also report and discuss patient management and treatment outcomes. CASE PRESENTATION: We report the case of a 27-year-old Moroccan woman. Our patient presented with a painless and slow-growing right vulvar mass that had evolved over one year, which had suddenly become uncomfortable when walking. A physical examination revealed a single soft and pasty mass in her left labium majus, which could be mobilized under her skin towards her mons pubis. The largest dimension of the mass measured 6cm. Magnetic resonance imaging showed a homogenous hyperintense mass with a well-defined contour in her left labium majus; a fat-suppressed magnetic resonance image demonstrated a marked signal intensity decrease. The mass was completely removed surgically. A histological examination revealed a circumscribed benign tumor composed of mature adipocytes, confirming the diagnosis of vulvar lipoma. CONCLUSION: Vulvar lipomas must be differentiated from liposarcomas, which demonstrate very similar clinical and imaging profiles. The final diagnosis should be based on histopathological evaluation. A precise diagnosis should allow for appropriate surgical treatment.

Embryonal rhabdomyosarcoma of the cervix presenting as a cervical polyp in a 16-year-old adolescent: a case report.

INTRODUCTION: Embryonal rhabdomyosarcoma of the female genital tract is rare in the cervix. It has been mainly discussed in the context of individual case studies. It tends to occur in children and young women. Treatment ranges from radical surgery to conservative surgery, followed by chemotherapy. CASE PRESENTATION: A 16-year-old Moroccan adolescent girl presented to our center with a protruding mass from her vaginal introitus, as a polyp of 6cm. An examination revealed a polyp within her vagina, thought to be arising from her cervix and a polypectomy was performed. Microscopic findings are consistent with an embryonal rhabdomyosarcoma (botryoide type). A computed tomography of her thorax, abdomen and pelvis were performed and residual disease was found as a mass located at her cervix, which measured approximately 4.5cm in its widest dimensions, without evidence of metastatic disease. Due to the fact that she is young, after discussions in a multidisciplinary meeting, she was subsequently treated with four cycles of multi-agent chemotherapy. Two cycles of chemotherapy and radiotherapy were administered due to the lack of response, but she presented vaginal bleeding with persistence of the same mass in computed tomography. Hence a total interadnexal hysterectomy was made. A histologic examination found residual embryonal rhabdomyosarcoma (botryoide type) located in all her cervix and she is currently under chemotherapy. CONCLUSIONS: The presence of a cervical polyp in an adolescent is a gynecologic oddity and must necessarily be examined histologically because it might be a rhabdomyosarcoma. This is extremely important because diagnosis at an early stage of the disease is a highly favorable prognostic factor that allows "fertility-sparing surgery" for these young patients.

Peritoneal tuberculosis in pregnancy: a case report.

Peritoneal tuberculosis in pregnancy is one of the least common forms of extrapulmonory tuberculosis in pregnancy. Early diagnosis is important to prevent obstetrical and neonatal morbidity. We report the case of a 37-year-old pregnant woman who presented with abdominal volume increase, night-sweat, anorexia, loss of weight and abdominal pain at 23 weeks. A peritoneal laparoscopic biopsy was performed and confirmed the diagnosis of tuberculous peritonitis. The patient received antituberculosis chemotherapy. The recovery was good as gave birth to a healthy infant of 3200Kg at 37th week's gestation by vaginal delivery.

Correlates of HPV: a cross-sectional study in women with normal cytology in north-central Morocco.

INTRODUCTION: Epidemiological studies have shown the association between risk of developing cervical cancer and the persistence of high-risk papillomavirus types in addition to some co-factors. However, little is known about co-factors associated with human papillomavirus (HPV) infection, especially in developing countries. This study aims to determine HPV status and associated risk factors in women with normal cytology living in the north-central area of Morocco. METHODOLOGY: From February 2007 to December 2008, a total of 925 women consulting in the gynaecological department of Fez University Hospital were asked about sociodemographic characteristics and reproductive and sexual health. Cervical samples were collected for cytological examination and HPV DNA detection. Data collected from 751 women with normal cytology were used in this study to assess the correlation between HPV infection and potential risk factors. RESULTS: High prevalence of HPV infection was detected (42.5%). The highest infection rate was observed in women aged > 45 years and in those with history of abortion (OR:3.76; 95%CI[1.77-7.98]) fibroma, polyp or cysts (OR:1.68; 95%CI[1.07-2.65]). No significant association was detected with other reproductive health and risk factors including oral contraception. CONCLUSION: In spite of the insignificant association of HPV infection with age, health authorities should seriously consider and implement strategies to increase and maintain a cervical cancer screening programme in women aged 45 and above. More attention must be given to women with gynaecological history (abortion, fibroma, polyp or cysts) since these events may be predictors of HPV infection. Investigations on partner sexual behaviour and some specific hygienic habits, especially public Turkish bath use, are needed to clarify the HPV incidence in this region.

Ovarian hyperstimulation syndrome in a spontaneous pregnancy with invasive mole: report of a case.

It is known that most cases of Ovarian Hyperstimulation Syndrome (OHSS) are associated with the therapies for ovulation induction. However, OHSS may rarely be associated with a spontaneous ovulatory cycle, usually in the case of multiple gestations, hypothyroidism or polycystic ovary syndrome. We report a case of severe OHSS in spontaneous pregnancy with invasive mole in a 34 years old woman. The clinical picture showed abdominal pain, massive ascites, nausea, dyspnea and amenorrhea. After imaging examinations and laboratory tests, the diagnosis was established. The patient was managed expectantly with no complications. Although spontaneous ovarian hyperstimulation is a rare entity, it is important that the physician recognizes this condition. Prompt diagnosis and successful management is likely to avoid serious complications, which may develop rapidly.