Gestational choriocarcinoma at Ibn Rochd Hospital, Casablanca, 2004-2010.

The aim of this retrospective study was to determine the frequency, risk factors, management and prognosis of gestational choriocarcinoma at the gynaecology-obstetrics C department of the Ibn Rochd Hospital in Casablanca, Morocco over a 7-year period (2004-2010). There were 18 760 pregnancies in the study period, among which 8 cases of gestational choriocarcinoma were recorded, a frequency of 43/100 000 or 1 case of gestational choriocarcinoma in 2345 pregnancies. Maternal age ranged from 20 to 48 years. It occurred after a hydatidiform mole in 4 cases, after spontaneous miscarriage in 2 and after normal delivery in 2 cases. All the patients presented with bleeding. Metastases were found in 3 patients, including 2 with pulmonary localization. Positive diagnosis was made mainly by ultrasound and human chorionic gonadotropin level and histological confirmation was done for all cases. Polychemotherapy was used to treat 4 cases, monochemotherapy to treat 3 and one case received only radiotherapy. Of the 8 cases, 2 patients died and 6 had complete remission.

[Partial hydatidiform mole in Morocco: an epidemiological and clinical study]. / Les môles hydatiformes partielles au Maroc: étude épidémiologique et clinique.

This retrospective study reviewed cases of partial hydatidiform mole (PHM) diagnosed at the University Hospital in Casablanca from 2000 to 2010 in order to examine the epidemiological, clinical, therapeutic and progressive pathological factors associated with PHM. All PHM cases confirmed clinically and sonographically at pathological examination were included. We identified 24 cases of PHM among 60 748 births and 1704 abortions, giving a frequency of 0.4 per 1000 pregnancies and 1.4% of abortions. The mean age was 26 years (range: 16-55 years). The circumstances of discovery and clinical ultrasound varied: 79.2% of patients sought consultation for bleeding; clinical thyrotoxicosis syndrome was found in 1 patient (4.2%). Physical examination showed increased uterine size in 83.3% of cases associated with a latero-uterine mass in 25%. The diagnosis was supported by an ultrasound examination combined with measurement of plasma betaHCG. Histological confirmation was made in all cases and treatment was endo-uterine aspiration. Neoplastic drift was observed in 1 case (4.2%) which went into remission with chemotherapy.

[Mammary fibromatosis (apropos of 1 case)]. / La fibromatose mammaire (à propos d'une observation).

Fibromatosis (desmoid tumors) is a rare entity expressing a mesenchymatous proliferation. The breast is an exceptional localisation. The origin is either the gland itself or the breast is an extension of a desmoid tumor originating from the chest wall or shoulder. Etiology is still unknown. Clinical and radiological features mimic the breast carcinoma. Diagnosis is made by histological studies which show a benign structure contrasting with its aggressive potential. Surgery is the treatment of choice and consists of wide excision which can lead to mutilation. Hormonotherapy is used if surgery is too invasive. We report a case of a female patient aged 21 years who presented for a mammary fibromatosis, treated by a large surgical excision. Evolution was marked by the appearance of an other localisation in the contralateral breast.

[Heterotopic pregnancies: 8 cases]. / Grossesses hétérotopiques: à propos de huit cas.

Heterotopic pregnancy is the combination of intra-uterine pregnancy and ectopic pregnancy in the same patient whatever is the localization of the ectopic pregnancy. The aim of this work was to summarize the epidemics and clinical factors, the diagnostic means and the therapeutic methods for the spontaneous heterotopic pregnancy in Moroccan context. In a period of 6 years (1993-1998), 8 patients were treated for heterotopic pregnancy in Lalla Meryem Maternity of Casablanca, with a rate of 0.2/1000. Patients' ages ranged from 19 to 37. The backgrounds were: abortions (4 cases), secondary sterility (2 cases) and genital infection (2 cases). Five patients consulted for metrorrhagia associated with pelvic pain. Two for pelvic pain and one for metrorrhagia. The diagnosis was confirmed before echography in 5 cases. All patients were operated on, 3 in a condition of haemorrhagic shock. Ectopic pregnancy lay at the level of the fallopian tube in 7 cases and at the level of the ovary in one. The treatment consisted of a salpingectomy in the 7 patients with tubal localisations, the ovary pregnancy benefited from ovariectomy. Evolution has been marked by expulsion of intra-uterine pregnancy in 6 cases. Two women were able to carry out their pregnancy. Heterotopic pregnancy is more and more frequent because of genital infection increase and especially the wide diffusion of the assisted medical procreation.

[Pelvic hydatid yst: apropos of 8 cases]. / Kystes hydatiques pelviens: à propos de huit cas.

The hydatidosis fisues in the endemic state in Morocco, its pelvigenital localization is rare and doubtful. The objective of this study is to examine the epidemio-clinic appearance, the diagnosis means and the therapeutic flow of the pelvigenital hydatid cyst in Morocco. This retrospective study is about eight patients hospitalized and cured for pelvigenital hydatid cyst in lalla Meryem maternity of Casablanca during a period of six years (1992-1997). The hydatid cyst diagnosis was confirmed by anatomopathology. This affection represented 0.80% of the pelvic mass operated during the same periode. The majority of our patients was from rural origin, their age varies between 22 and 70 years old. The discovery circumstances were dominated by abdomino-pelvic mass. The diagnosis was nearly certain prior to the surgery for half of the cases. The genital organs were the most reached by the pelvic hydatidosis (75%). The treatment was purely surgical, adapted to each case in according to the localization, the volume and the contribution of the cyst. The medical treatment has been prescribed in one case in post surgery. The evolution was good in all the cases. The hydatidos cyst must always be present in mind when dealing with cyst pelvic formation in an endemic country like Morocco. The prophylaxia preserves its important value and must constitute a hinder against this disease in endemic countries.

[Granulomatous recurrent mastitis during pregnancy]. / Mastite granulomateuse récurrente et grossesse.

We report a case of granulomatous mastitis during pregnancy which raised important diagnostic and therapeutic problems. Several diagnoses were suspected and subsequently different therapeutic regimen were tried (antibiotic therapy associated with nonsteroidal antiinflammatory drugs, progestogens, vein tonicity drugs and bromocriptine). All were ineffective and the patients status worsened. Histology confirmed the diagnosis of granulomatous recurrent mastitis. Corticosteroid therapy and interruption of pregnancy successfully controlled the disease process.

[Hydatic cyst of the fallopian tube: a case report]. / Kyste hydatique tubaire: à propos d'un cas.

A 37-year-old woman was seen for pelvic pain. Ultrasonography and laparoscopy led to the diagnosis of bilateral hydrosalpinx. Analgesics and antibiotics were given several times but the clinical picture worsened. Laparotomy was performed and disclosed bilateral hydatidosis of the fallopian tubes requiring bilateral salpingectomy. Postoperatively, hydatic serology was strongly positive and a calcified hydatic splenic cyst was identified. Medical treatment with albendazole was prescribed for these multiple localizations of hydatid cysts.

[Premature rupture of fetal membranes. Its management is still disputed!]. / La rupture prématurée des membranes. Une prise en charge encore controversée!

The aim of this study is to have an idea about the epidemiologic and clinic profile of the PRM, the management of the PRM. We conclude from this retrospective study about 374 cases, that the PRM frequency is about 2.67%. It reaches particularly the young women, primipar (57.48%) and not happen of this accident. The diagnosis was clinical in general. In the doubtful cases, amniotic infection was present in 25.13%. The delivery was characterized by the complications were dominated by prematurity and neonatal infection which both caused a high perinatal mortality 49.3%). A better sanitary education of any pregnant woman, a regular follow-up of the pregnancies, a treatment of each etiologic factor of this accident, a good per and postnatal supervision could remarkably limit the incidence of this obstetrical accident and also improve the maternal and fetal prognosis.

[Hyperthyroidism in molar pregnancy]. / Hyperthyroïdie au cours d'une grossesse molaire.

INTRODUCTION: Hyperthyroidism is a rare complication of molar pregnancy. CASE REPORT: We report a 39-year-old woman who presented a thyrotoxic syndrome accompanying a molar pregnancy. Serum thyroid hormones were elevated and returned to normal level after uterine evacuation of a molar pregnancy. The authors detail the role of thyroid stimulating property of human gonadotropin chorionic hormone and its structural changes during the gestational trophoblastic diseases. These changes give the latter the thyroid stimulating properties and signs of hyperthyroidism. CONCLUSION: Molar pregnancy may be a cause of hyperthyroidism. The diagnosis of molar pregnancy should be a mention to thyrotoxicosique syndrome in a woman of childbearing age.

[Pregnancy in Gaucher disease]. / Grossesse et maladie de Gaucher.

Gaucher disease is a lysosomal storage disorder due to deficiency of glucocerebrosidase. The association with pregnancy exposes the worsening of the disease and complications of pregnancy and puerperium. We report a case of pregnancy in a woman of 35 years, suffering from Gaucher disease type 1. Pregnancy had a favorable outcome. Complications occurred. They were kept under control. The outcome was favorable. The authors discuss the evolution of the disease during pregnancy and management of complications. They can occur during pregnancy, post-partum and breastfeeding. Support begins with preconception consultation. It involves finding and correcting the biological problems and deficiencies, and management of complications. Genetic counseling is important, it helps prevent inbreeding.

[Physical violence during pregnancy in Morocco]. / Sévices physiques durant la grossesse au Maroc.

INTRODUCTION: Physical abuse are a serious social problem and an issue of perinatal health. MATERIAL AND METHODS: This article presents the results of a survey conducted at the CHU Ibn Rochd of Casablanca (Morocco), over a period of one year, in order to determine their frequency, risk factors, maternal diseases and obstetric complications. RESULTS: The results of our survey found that women who reported physical abuse have a frequency of 12.3% (107 cases). The average age of these women is 22.3 years; 65.6% of parturients are illiterate, 45% are from a disadvantaged socioeconomic status, 47% originated from a rural county; 37% are unmarried; half of the abused are multiparous with an average of 3.2 living children; 23% of the pregnancies are unplanned. Lastly, 37.3% of pregnant partners are unemployed and 67% have toxic habits. Obstetric complications are fairly frequent and mental effects are not negligible with 3 attempted suicides and attempted homicide. CONCLUSION: Early identification of abuse suffered by pregnant women and taking measures to prevent them could reduce the occurrence of these adverse effects.

[Pregnancy and extra-gastrointestinal stromal tumor: an exceptional association]. / Grossesse et tumeur stromale extra-digestive : une association exceptionnelle.

Extra-gastrointestinal stromal tumors (EGIST) are rare entities. The coexistence of a gastrointestinal stromal tumor and pregnancy is exceptional. We describe a case of this association, three years after the first diagnosis of EGIST made during exploratory laparotomy for abdominal-pelvic mass. We report the diagnostic difficulties and management of pregnancy on recurrence of EGIST tumor.

[Complete hydatiforme mole in Morocco: epidemiological and clinical study]. / Les môles hydatiformes complètes au Maroc : étude épidémiologique et clinique.

OBJECTIVE: Complete hydatidiform moles (CHM) are a real public health problem, especially in the "southern countries" and Asia, because of their impact on the female reproduction and the risk to progression to either invasive mole or choriocarcinoma. PATIENTS AND METHODS: We collected the cases of CHM referred to our department over a period of ten years (2000 to 2009). We will present our results, emphasize the modalities of diagnosis, treatment and evolution, with a review of literature. RESULTS: During this study, we identified 254 cases of CHM, and recorded 57,987 births and 1627 abortions. Their incidence was 0.43% of pregnancies. The mean age of our patients is 25 years old (16 to 55). Relative risk observed was much increased among women under 20 years old (×6.8) and those over 40 years old (×15). Both of nulliparous and primiparous patients represented 52.3% of the cohort. Eighty-five percent of patients belonged to an agricultural environment associated with a low socio-economic status. Uterine bleeding was the most common symptom accounting for 93.7%. Toxic syndrome was present in 18.5% of patients. Physical examination showed a highly increased uterine size in 85% of cases associated with lateral uterine mass in 25% of cases. The diagnosis was suspected using ultrasonography in all cases associated with an elevated level of plasmatic ß-human chorionic gonadotrophin (ßhCG). All cases were confirmed histologically. Treatment used was endo-uterine aspiration in all cases. Recurrence of CHM was documented in 25 patients or 9.4%. Neoplasic progression was observed for 6.3% of cases. All of them have evolved into remission with chemotherapy. DISCUSSION AND CONCLUSION: CHM continue to be a public health problem in Morocco, their incidence is among the highest ones. In fact, this studied population corresponds to the lowest socio-economic status and generally described as population at risk. It is subject to drastic weather's conditions causing loss of fresh products. Extreme ages and degree of parity are also risk factors described in the literature. Early diagnosis, appropriate treatment, and supervision of molar pregnancies are obligatory. Despite of the unfavourable initial conditions, our study shows that relevance and continuing care can significantly reduce the morbidity of moles.

[Demons-Meigs syndrome: information on a new case and review of the literature]. / Syndrome de Demons-Meigs: à propos d'une nouvelle observation et revue de la littérature.

Demons-Meigs syndrome is a benign tumor of the ovary. It is very rare and its physiopathology remains obscure. We report a case of Demons-Meigs syndrome in a woman aged 51 years. It was discovered following a right pleural effusion syndrome with ascites and an abdominopelvic mass. Rate of serum CA 125 was 412IU/mL. Surgical exploration revealed ascites of one litre with no suspicious peritoneal lesion and an ovarian fibrothecoma of 70 mm. There were no post-operative complications and three months later, the level of CA 125 was negative with a total drainage of effusions.