[Diagnosis of conjoined twins in a pregnant woman at term]. / Diagnostic à terme de jumeaux conjoints.

Conjoined twins are a rare malformation of monozygotic and mono-amniotic twin pregnancies. We report the case of a patient in whom dicephalic conjoined twins was diagnosed in the antenatal period at 37 week amenorrhea. Fetal prognosis is very poor and, if the diagnosis has been made early, it most often requires therapeutic abortion. The purpose of this case study was to remind clinicians of this very rare disease, of the importance of ultrasound as an essential diagnostic tool to implement a strategy to manage patients in the postpartum period and of prognosis which is most often very guarded.

[8 amenorrhea week miscarriage in a patient positive for the SARS-CoV-2 virus]. / Fausse couche de 8 semaines d´aménorrhée chez une patiente positive au virus SARS-CoV-2.

A new coronavirus (SARS-CoV-2) highlighted at the end of 2019 in China is spreading around the world. Most often the cause of an infectious syndrome, associating mild symptoms (fever, cough, myalgia, headache and possible digestive disorders) to different degrees. SARS-CoV-2 can also cause serious lung disease and sometimes death. Here we present a case of a 21-year-old woman who consults for a miscarriage of 8 weeks of amenorrhea and has been diagnosed with concomitant SARS-CoV-2 infection. The importance of this observation is to make a remind of the mode of transmission, to discuss the severity of the virus in case of pregnancy and to discuss the therapeutic protocol used in our country in front of this epidemic.

[Radio-histological correlation of ACR4 microcalcifications in breast lesions: about 181 cases and literature review]. / Corrélation radio-histologique des lésions mammaires ACR4: à propos de 181 cas et revue de la littérature.

The Bi-RADS (Breast Imaging Reporting and Data System) classification developed by the ACR (American College of Radiology) is the classification system for radiological images recommended for breast cancer screening. The ACR 4 microcalcification is an indeterminate or suspected abnormality with 2-95% probability of malignancy, according to studies. This disparity pushed us to conduct this retrospective study of 181 patients in the Department of Obstetrics and Gynecology I at the Hassan II University Hospital, Fez, over a period of 5 years. This study aimed to report the histological results of breast lesions radiologically classified as ACR4 in order to assess their radio-histological correlation and to improve therapeutic approach. All patients underwent breast imaging examinations and then anatomopathologic examination was performed using different techniques. There was a clear predominance of benign lesions with a rate of 62% versus 29% of malignant lesions and only 9% were intermediate lesions. Adenofibroma was the most common histological finding (30% of cases), invasive ductal carcinoma was the most frequent malignant lesion (17% of cases). We performed a literature review which showed that our results were in line with findings of other studies, with a positive predictive value of 29%. Nevertheless, ACR classification divided into subcategories 4a, b and c should be used due to the significant number of unnecessary surgical interventions.

[Uterine fibroid associated with smooth muscle tumor of uncertain malignant potential (STUMP): about a case]. / Fibrome utérin associé à un STUMP (tumeurs musculaires lisses à potentiel de malignité incertaine): à propos d'un cas.

STUMP (smooth muscle tumor of uncertain malignant potential) are smooth muscle tumors that cannot be diagnosed as either benign or malignant due to their morphological characteristics. We here report the case of a 44 year old patient with no notable medical history presenting with an increase in the abdominal volume. Pelvic ultrasound and CT TAP scan were performed showing voluminous mass with tissue and fluid-filled component in the uterus. The patient underwent exploratory laparotomy during which two masses were detected, one in the uterus and the other in the retroperitoneal area. Anatomopathologic examination showed uterine myoma associated with a STUMP.

[Normal adnexal torsion and pregnancy: about a case]. / Torsion d'annexe saine et grossesse: à propos d'un cas.

Normal adnexal torsion is rare during pregnancy. We here report the case of a 22-year old patient presenting with acute lateropelvic pain associated with a 2-month history amenorrhea. Exploratory laparotomy showed severe ischemia due to torsion in a normal ovary. The patient underwent adnexal detorsion without ovarian pexy. The postoperative course was uneventful. Ultrasound examination after 3 weeks showed normal pregnancy. Ovarian torsion is an emergency that should not be ignored in pregnant women with acute pelvic pain. Conservative treatment is the gold standard and proper management is necessary to avoid possible maternal and fetal complications.

La grossesse hétérotopique spontanée: à propos de deux cas: Spontaneous heterotopic pregnancy: about 2 cases.

Heterotopic pregnancy is defined as the coexistence of intrauterine pregnancy (IP) and ectopic pregnancy (EP), regardless of its location. It is a type of bi-ovular dizygotic twin pregnancy, its occurrence in a spontaneous cycle is rare. This is a rare and serious pathology which may compromise maternal prognosis. We report two cases of heterotopic pregnancy treated in the Department of Gynecology and Obstetrics I at the University Hospital Hassan II of Fez, over a one-year period. Clinical, ecographic and therapeutic data of this pathology were reported. Pelvic pain was the main reason for consultation. The diagnosis of heterotopic pregnancy was suspected on ultrasound in both cases. The first patient underwent conservative treatment by laparoscopy while the second patient underwent salpingectomy by mini-transverse laparotomy. IP outcome was favorable both cases.

Exophthalmos Revealing a Krukenberg Tumor: A Case Presentation and Review of the Literature.

BACKGROUND: Krukenberg tumor is a well-known ovarian metastasis, usually of signet ring cell carcinoma in female patients. In the literature, there are a few documented cases of ocular metastasis in patients with Krukenberg tumor. CASE PRESENTATION: We report the case of a 35-year-old single Moroccan woman. She presented chronic pelvic pain, hematemesis and blurring of vision in the left eye. Clinical examination showed a pelvic mass and an exophthalmos with a divergent strabismus in the left eye. Pelvic and abdominal ultrasound showed a right tissular ovarian mass. Computed tomography (CT) scan of the abdomen and pelvis revealed an ovarian tumor and bone metastasis. Orbital magnetic resonance imaging (MRI) showed a hypertrophy of the left inferior rectus muscle behind the exophthalmos. Stomach endoscopy revealed an ulcerated and protruded mass of the antro-fundic junction. Histopathology and immunohistochemistry showed an infiltration of the gastric mucosa by atypically isolated signet ring cells similar to the tumor cells found in the ovarian histopathological exams. DISCUSSION: Krukenberg tumor is an uncommon metastatic tumor of the ovary. This article provides an overview of the major pathological manifestations of Krukenberg tumor, patient characteristics, clinical and laboratory features of the disease, prognostic factors, and current knowledge about its pathogenesis.

Primary chondrosarcoma of the breast: a case presentation and review of the literature.

Mammary sarcomas are uncommon tumors. When tumors like malignant cystosarcomaphyllodes and metaplastic carcinoma, where malignant cartilaginous areas may be present, are excluded, only nine cases have been reported to date.We report another case of primary chondrosarcoma of the breast here. A 24-year-old Mediterranean woman presented with a painful mass in the right breast and a physical examination revealed a palpable mass. An incisional biopsy was performed and primary chondrosarcoma was diagnosed based on histological examination. Our patient underwent a mastectomy. A preoperative clinical and cytological diagnosis of chondrosarcoma, even though possible in a few cases, is usually not attained due to its similar clinical behavior with other breast tumors.