Myoma praevia and pregnancy.

The association of myoma and pregnancy is becoming more frequent due to the increasing age of first pregnancy. It may affect the outcome of fertility, pregnancy, labor and peripartum course. A 37 years old patient was referred to our unit for discovering uterine leiomyoma at 37 weeks of pregnancy. Ultrasound screening showed a praevia isthmic leiomyoma measuring 16cm. A caesarean delivery was scheduled and a large interstitial isthmic uterine myoma measuring 25cm was found. Hysterectomy was corporeal. The post-operative and puerperium course was normal.

[Acquired vaginal stenosis: about a case and literature review]. / Sténose vaginale acquise: à propos d'un cas et revue de littérature.

Vaginal stenosis or gynatresia is a congenital disease and it is part of Mayer-Rokitansky-Kustner-Hauser syndrome. Acquired vaginal stenosis is a rare complication of vaginal delivery and may be caused by an infection, charlatans, birth injury or postpartum hypoestrogeny. We report a case of postpartum complete vaginal stenosis secondary to vaginal injuries as a result of medical negligence. The study involved a 19 year old patient, who had had dead child born vaginally at home, presenting with a two-year history of secondary amenorrhea associated with chronic pelvic pain. The patient reported the occurrence of multiple not sutured vaginal tears. Pelvic MRI showed complete extended vaginal stenosis of about 25mm with upstream haematological retention and bilateral hematosalpinx. The patient underwent release of vaginal adhesions followed by regular vaginal dilation. Only two cases have been reported in the literature. Pain and dyspareunia were the most common symptoms. All cases were treated by a release of the synechias and vaginal dilation.

[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.

[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.