Cancer du sein triple négatif chez la femme enceinte : le pronostic est-il si mauvais dans le contexte africain ?

Le cancer du sein triple négatif est un groupe de carcinome du sein caractérisé par le manque d'expression des récepteurs hormonaux aux oestrogènes et à la progestérone (RE, RP) et HER2. Cette forme se caractérise également par son agressivité, un faible taux de survie et l'absence de thérapies ciblées. Dans cemanuscrit, nous en rapportons deux cas de survenant chez des femmes enceintes ayant bénéficié d'une chirurgie basée sur des mastectomies plus curage axillaire suivie d'une chimiothérapie et radiothérapie adjuvantes. Les deux évolutions ont été marquées par la survenue de métastases cérébrales. À travers ces cas, nous décrivons en mettant un accent sur les caractéristiquesclinique et le mauvais pronostic du cancer du sein triple négatif pendant la grossesse. Nous soumettons également une brève revue de la littérature sur cette situation pendant la grossesse

[Spontaneous pneumomediastinum: A rare complication of dermatomyositis]. / Pneumomédiastin spontané : une complication rare de la dermatomyosite.

Dermatomyositis is a rare connective tissue disease of unknown origin, including inflammatory myopathy and cutaneous manifestations. Several pulmonary complications associated to dermatomyositis were described; especially interstitial lung disease. Some rare and particular pulmonary complications were reported in the literature such as pneumodiastinum and pneumothorax. We are describing here, a case report about a female patient, who presented with dermatomyositis associated to pneumomediastinum as a severe and lethal complication without pneumothorax. It is a novel observation depicting this severe and rare complication. Brutal dyspnea and cervical subcutaneous crackling are alarming signs that should make practitioners think about this complication.

Giant pelvic retroperitoneal epidermoid cyst: a rare case report.

Epidermoid cyst is a frequent benign cutaneous tumor. The pelvic localization does not occur very often. The literature that taps into such cases is very limited in scope. Here is a report of a 27-year-old woman with a giant pelvic retroperitoneal epidermoid cyst. The use of ultrasound exploration and computed tomography has indicated ovarian origins. The surgery also revealed a retroperitoneal epidermoid cyst, uterus and ovaries were all intact. The evacuation of a cyst was found to contain lamellas of keratin. Histology permitted us to confirm the diagnosis. The patient was faring well after two years of followup.

Endometrial stromal nodule: report of a case.

Endometrial stromal nodule (ESN) is the least common of the endometrial stromal tumors. They are rare neoplasms which are diagnosed in most instances by light microscopy. Although such nodules are benign, hysterectomy has been considered the treatment of choice to determine the margins of the tumor required for diagnosis and to differentiate it from invasive stromal sarcoma Whose prognosis is totally different. We report a case of a 45 years old woman, with presurgical diagnosis of adnexal mass or uterine tumor. She underwent a total abdominal hysterectomy. Pathologic examination revealed an endometrial stromal nodule. Through this observation, we insist on the fact that the ESNs are rare and benign entities which must be differentiated from the other invasive malignant stromal tumors; this can change the final prognosis.

[Vogt-Koyanagi-Harada syndrome. Eight cases]. / Syndrome de Vogt-Koyanagi-Harada. A propos de huit cas.

PURPOSE: Vogt-Koyanagi-Harada disease is a rare systemic affection characterised by the association of ocular inflammatory manifestations and extra ocular lesions such as meningismus, tegumentary or auditory findings observed in pigmented population. Auto-immune origin of this syndrome is probable; a T-lymphocyte-mediated autoimmune process is directed against an unidentified antigen associated with melanocytes. METHODS: The aim of this retrospective study is to determine their clinical profile in our country. RESULTS: Eight consecutive cases of Vogt-Koyanagi-Harada disease were studied during a 22-year period. All the patients fulfilled the criteria of American Uveitis Society. All patients were female and had bilateral ocular involvement as panuveitis. Retinal serous detachment was observed in 4 patients, meningitis in 6 cases. 7 patients had hearing loss and 5 patients had cutaneous lesions represented by poliosis. Corticosteroids and/or immunosuppressive therapy were administered in all patients leading to improvement in 5 patients. CONCLUSION: Our series are concording with a usually good ocular prognosis. Immunosuppressive therapy should be used early in posterior segment involvement.

[Neurological involvement in Behçet's disease. 154 cases from a cohort of 925 patients and review of the literature]. / Manifestations neurologiques de la maladie de Behçet.

INTRODUCTION: Neurological involvement is well described in Behçet's Disease (BD), with variable prevalence of 5.3 to 30p.cent. The purpose of this retrospective study was to analyze the clinical patterns of neuro-Behçet (NB) and to compare them with different clinical features of 925 BD registered in the same period and the literature. METHODS: All patients of NB fulfilled the International Study Group Criteria for the diagnosis of BD. 93 patients with headache, without other neurological symptoms were excluded. The findings were supported by cerebrospinal fluid, computed tomography scan, magnetic resonance imaging and angiography. RESULTS: NB was present in 16.64p.cent of BD. A sex ratio male/female: 4.31. The mean age of patients with NB was 31.76 years. The average age of onset of NB was 29.83. The mean duration of the NB disease was 3.81 years. The findings were categorised in 2 main types: parenchymal and non-parenchymal involvement. Some patients had features of both types (mixed patterns). 94 patients (61.03p.cent) presented with parenchymal central nervous system (CNS) involvement. The most common findings were pyramidal signs, cranial nerve palsies, pseudobulbar syndrome and cerebellar signs. 27 patients (17.53p.cent) without parenchymal CNS which were divided into: intracranial hypertension in 24 patients (15.58p.cent) presenting headache, vomiting and bilateral papilloedema; cerebro-arterial involvement in 3 cases (one of them had cerebrovascular aneurysms). Mixed patterns were observed in 9 cases. Erythema nodosum and vascular involvement were more frequent in intracranial hypertension than in BD. Other clinical features were reported: pure meningeal pattern in 15 cases, pure peripheral nervous system involvement in 4 cases, isolated cranial nerves in 8 cases, chorea in one patient and pseudotumor of cervical medulla in other patient. 6 cases of juvenile BD and one case of familial Behçet were observed. 133 patients were treated (86.36p.cent). Mean duration of treatment was 7.46 month. We used corticosteroids, immunosuppressive agents (cyclophosphamid, azathioprine, chlorambucil) and anticoagulant in intracranial hypertension. The course of disease was good in only 54.13p.cent of cases, and was bad in 18.79p.cent. CONCLUSION: NB occurred frequently in men and is more serious especially in parenchymal CNS involvement: 7 deaths (6 from parenchymal CNS).

[Infectious endocarditis with negative blood cultures]. / Endocardites infectieuses à hémocultures négatives. A propos de 48 cas.

Blood culture is a key investigation for the diagnosis of infectious endocarditis (IE). When negative, there are diagnostic and therapeutic problems. The aim of this study was to determine the frequency, the clinical features and the aetiological factors of IE with negative blood cultures compared with IE with positive blood cultures compared with IE with positive blood cultures. The authors undertook a retrospective review of 98 cases of patients admitted for IE from 1991 to 2000 to the Department of Infectious Diseases and Cardiology of Sousse (Tunisia). Of the 98 patients, 48 (48.9%), 29 men and 19 women with an average age of 34.3 years, had negative blood cultures. An infectious agent was identified in 7 cases (14.5%) by serology, valve culture or cerebrospinal fluid including Brucella (2), Coxiella (1) and Candida (1). Therefore, in 41 cases (42%), the cause of IE was not determined. Transthoracic echocardiography was of diagnostic value in 96% of cases and transoesophageal echocardiography showed disease not observed on transthoracic echocardiography in 5 cases. The main complication was cardiac failure (27 cases). The mortality was 14.5%. Comparison of the two groups showed that negative blood cultures were associated with a higher incidence of previous antibiotic therapy, extracardiac signs of IE and cardiac failure. Early surgical indications and mortality were the same in both groups. This report confirmed the high frequency of IE with negative blood cultures. Previous antibiotic therapy seems to be an important aetiological factor but cannot explain this high frequency. Methodological problems of blood cultures and the absence of systematic investigation for rare infectious agents are other possible factors.

Joint manifestations in Behçet's disease. A review of 340 cases.

OBJECTIVES: To gain additional knowledge on the joint manifestations of Behçet's disease, with special attention to unusual forms. PATIENTS AND METHODS: Retrospective review of 340 cases with joint manifestations identified among 601 cases of Behçet's disease seen over a 15-year period. All the patients met International Study Group for Behçet's disease criteria. Radiographs of all joints with arthritis were obtained. Starting ten years ago, a radiograph of the sacroiliac joint was taken routinely. RESULTS: Joint manifestations were present in more than half the patients (56.57%) and were inaugural in 18.23% of cases. The knees and ankles were the joints most commonly affected. Monoarthritis and oligoarthritis were seen in 16.17% and 11.76% of cases, respectively and polyarthritis involving the large limb joints and the small joints of the hands and feet in 17.05% of cases. Unusual forms included polyarthritis with deformities and/or destruction (n: 8, including two patients who also met criteria for rheumatoid arthritis), pseudogout (n: 5), popliteal cyst (n: 3, including one case imitating deep vein thrombosis), myositis (n: 1), spondylarthropathy (n: 5), and Sjögren's syndrome (n: 2). Children were more likely than adults to have joint manifestations (73.68%) and polyarthritis (35.7%). CONCLUSION: Joint manifestations are common in Behçet's disease. Their unusual forms deserve to be known since they can raise diagnostic problems when they are inaugural.