Risk of anti-TNF therapy on pregnancy, breastfeeding, live vaccines and related information in patients with inflammatory bowel disease: Real-world data from a nationwide study.

BACKGROUND: Anti-TNF are usually maintained during pregnancy in patients with inflammatory bowel disease (IBD) but safety is still a concern for them. AIMS: To provide data on management of anti-TNF agents during pregnancy, safety of live vaccines (BCG-MMR-rotavirus) and breastfeeding in newborns and dedicated information delivered to IBD women. METHODS: We performed an observational study in 25 centers from 2016 to 2018. We administered questionnaires to women with IBD receiving anti-TNF during pregnancy with newborn follow-up ≥ one year. RESULTS: Of 153 patients, 52 % maintained anti-TNF during the third trimester. Anti-TNF was shortly resumed in 79 % (58/73) after delivery. The rate of breastfeeding was 44 % (68/153) without any complication; 38 % of the mothers denied to breastfeed based on physician's advice. 26 % (34/129) of the newborns received live vaccines before 6 months-old (BCG:30 %; MMR:63 %; Rotavirus:8 %) and only 3 complications occurred (local BCGitis=1, fever=2). Information concerning anti-TNF during pregnancy/post-partum was delivered to 92 % of the patients, mainly by a gastroenterologist (97 %) who discussed with the obstetrician or the paediatrician in only 48 % and 25 %. CONCLUSION: In IBD patients, maintaining anti-TNF during pregnancy and breastfeeding is safe. Accidental live vaccines before 6 months did not lead to significant adverse events. The communication about these questions remains to improve.

[Chamberlain biopsy is not necessary when mature teratoma is evident on imagery]. / Un Chamberlain inutile devant un tératome mature évident à l'imagerie.

INTRODUCTION: Mature teratoma represents 60 % of germinal cells tumours of the mediastinum. Most patients with these tumours are asymptomatic, so the neoplasms are usually discovered by accident during routine chest X-ray examination. They have specific and almost pathognomonic radiological features. However, patients can be symptomatic and may present with chest, back, or shoulder pain; dyspnoea; fever; pleural effusion; cough; and bulging of the chest wall. CASE REPORT: We report the case of a young woman presenting with a giant mediastinal mature teratoma compressing the left lung. The patient was admitted for dyspnoea and non productive cough. The chest X-ray showed a mediastinal mass and a chest computed tomography scan revealed a heterogeneous pluritissular mass lesion of the mediastinum. Complete surgical removal is the treatment of choice for mature cystic teratomas, with optimal results and an acceptable surgical risk. This approach allows confirmation of the diagnosis and is the only way to rule out the presence of malignancy. Surgical biopsy by the Chamberlain method is therefore not strictly necessary. DISCUSSION: When chest X-ray and a computed tomography scan show specific radiological features of teratoma, a complete resection should be undertaken if the patient is fit for surgery. This will confirm the anatomico-pathological diagnosis, exclude the presence of malignant cells and it represents the treatment of choice of mature teratomas.