La Tunisie Médicale

Non puerperal uterine inversion caused by an adenosarcoma: A Case Report.

Introduction: Eighty-five per cent of uterine inversions are puerperal. Non-puerperal uterine inversion is usually caused by tumours that exert a traction force on the fundus of the uterus. This causes the uterus to be partially or completely inverted. It is commonly related to benign tumours like submucosal leiomyomas. Nevertheless, malignancies are an infrequent association. Case presentation: We report a case of a 35-year-old female patient, medically and surgically free, gravida0 para0, complaining of menometrorrhagia associated with pelvic pain for 2 years. A suprapubic ultrasound scan showed an enlarged, globular uterus with a heterogeneous, undefined mass of 49 mm in size. MRI scan showed the appearance of a U-shaped uterine cavity and a thickened inverted uterine fundus with an endometrial infiltrating mass of 25 mm. Intraoperative exploration showed uterine inversion involving the ovaries; the fallopian tubes and the round ligaments and a necrotic intracavitary mass. The malignancy of the tumor was confirmed through anatomopathological examination as Adenosarcoma. Conclusions: Uterine inversion is rare outside the puerperal period, and malignant etiology must not be overlooked. Therefore, comprehensive care with meticulous etiological investigation is crucial.

Postoperative radiotherapy in the management of vulvar cancer

background: Vulvar cancer is a rare tumor whose prognosis depends on early treatment. Aim: The study aimed to evaluate the role of adjuvant radiotherapy (RT) in the treatment of vulvar cancer and to identify the prognostic factors influencing the tumor evolution. Methods: descriptive and analytical study included 38 patients treated by adjuvant RT, during the period from 1995 to 2020, for vulvar cancer in the oncological radiotherapy department of Farhat Hached University Hospital in Sousse. Results: All patients underwent adjuvant RT. After a median follow-up of 55 months, 24 patients are in complete remission (63.2%). We noted local and regional recurrences in 23.7% and 13.2% of cases. Two patients had distant bone progression. Overall survival (OS) was 72% at five years and 51% at ten years. The 5-year local (SSRL) and regional (SSRR) recurrence-free survival was 76% and 87%, respectively. In univariate analysis, the factors associated with OS were the size of the tumor (p=0.02), the quality of excision (p=0.000) and age (p=0.04). The quality of excision (p = 0.001) and inguinal dissection (p = 0.05) was associated with SSRL. In addition, those influencing the SSRR were lymph node invasion and the quality of excision. Conclusion: vulvar cancer requires early diagnosis in order to consider less invasive treatment with advances in RT techniques.

Exploring risk factors and survival rates in invasive cervical carcinoma: New perspectives

Introduction: Cervical cancer is a public health issue in Algeria, it ranks at second position among female cancers. Aim: This study sought to identify risk factors for cervical cancer and to determine their impact on patient survival Methods: This is a retrospective study on 200 patients diagnosed during a 3-years period between January 1, 2016 and December 31, 2018. This study investigated cervical cancer risk factors and survival outcomes associations. The analysis was made by Chi Square test.  The progression-free survival rate was estimated using the Kaplan–Meier method. Results: Our study revealed that squamous cell carcinoma was the most frequent diagnosis (69.9%), it also points to early sexual activity as a significant associated risk factor (P=0.05). This finding contrasts with the relatively small proportion of cases (12.12%) linked to hereditary causes. Patients with adenocarcinoma had a lower progression-free survival (PFS) (Log-Rank test P = 0.04). Poorer PFS was associated with earlier FIGO stages (Breslow: P =0.04; Tarone-Ware: P =0.04). Age at first sexual encounter and parity, however, did not significantly predict PFS. PFS was substantially better in T1-T2 pathological stages (P = 0.000). Conclusion: The prognosis depends on knowing these risk factors. Understanding these characteristics is crucial for improved therapy and results. We provide an up-to-date insight of current cervical cancer risk factors in oran city. These results highlight how crucial it is to comprehend risk variables and how they affect the prognosis of cervical cancer.

Giant uterine fibroid complicated by aseptic necrobiosis and cutaneous fistulation: A case report and brief review of literature

Background: Uterine fibroids are the most common tumors of the female reproductive system. Although often asymptomatic, they can lead to complications such as compression of adjacent organs, torsion, or aseptic necrosis. Cutaneous fistulation, though rare, is a complication presented in this case. Case presentation: We reported the case of a 41-year-old female with no significant medical history who presented to the emergency department with a 4-month history of pelvic pain and purulent discharge from the supraumbilical region. Physical examination revealed an enlarged abdomen and a 3-cm supra-umbilical parietal mass with fistulation to the skin, discharging pus. Abdominal computed tomography imaging demonstrated a 30-cm uterine fibroid complicated by aseptic necrobiosis and cutaneous fistulation. The patient was started on antibiotic therapy, followed by myomectomy and resection of the fistulous tract by laparotomy. Conclusion: Cutaneous fistulation of a uterine fibroid is a rare complication that requires prompt detection and an accurate diagnosis for effective management.

Intravenous Leiomyomatosis of the Uterus: An Intriguing Case Revealed through Anatomopathological Examination

Introduction : Intravenous leiomyomatosis (IVL), a rare type of uterine leiomyoma (its incidence is about 0.25% to 0.40% of patients who present uterine fibroma), is characterized by the formation and growth of benign leiomyoma tissue within the vascular wall or lymphatic lumen. Herein, we presented a case of early stage of IVL successfully treated by surgical removal and a review of actual medical recommendations. Observation : A 49-year-old woman, gravida 2 para 2, presented to our department with hypogastric pain. On physical examination, a palpable mass in the hypogastrium was noted. Pelvic ultrasound showed a huge uterus with multiple heterogeneous leiomyomas. As the patient was symptomatic and as she had completed their family plan, the decision to perform a total abdominal hysterectomy with bilateral salpingo-oophorectomy was taken. On pathological examination, intravascular growth of benign smooth muscle cell was found within venous channels lined by endothelium. The diagnosis of IVL of the uterus without malignant transformation was confirmed. The patient was monitored for 14 months, and subsequent computed tomography did not reveal any evidence of tumor recurrence. Conclusion : IVL is a benign, rare and potentially lethal pathology. Clinical manifestations are nonspecific. IVL needs surgical treatment for diagnosis and therapeutic purposes. They require close and prolonged follow-up because of the high risk of recurrence