Latifa Fellah

Long-term nonsurgical control with ulipristal acetate of multiple uterine fibroids, enabling pregnancy.

MR images depict a marked response to Ulipristale Acetate in a woman with large uterine fibroids, and demonstrate no significant regrowth during pregnancy or 12 weeks postpartum

Échographie et seins denses : où en est-on ?

The use of ultrasonography in dense breast remains a controversial topic. It is acknowledged that ultrasound as an adjunct to mammography increases the detection rate of breast cancers. However, the main limitation of US, in addition to its operator dependent nature, is its low specificity, leading to a high rate of false positive results. Several techniques can be used to improve the performance of US and cost/effectiveness ratio, such as Doppler imaging, harmonic imaging, spatial and frequency compound imaging, all of which are routinely available, and elastosonography, contrast US and 3D US which are still in development.

Papillomatose juvénile mammaire

The authors report a patient with juvenile papillomatosis of the breast presenting with a palpable mass and illustrate the correlation between mammographic, sonographic and pathologic features.

Fibroadenoma: can fine needle aspiration biopsy avoid short term follow-up?

OBJECTIVE To confirm whether fine needle aspiration biopsy (FNAB) can avoid close monitoring, a source of worry for women patients with a suspected fibroadenoma found by ultrasound, and requiring their compliance. PATIENTS AND METHODS Over 39months, 427 nodules with a diagnosis of fibroadenoma were sampled in 372 patients using ultrasound-guided FNAB. The sonographic appearance of all the nodules suggested BI-RADS category 3 fibroadenomas. The mean size of the fibroadenomas was 9mm. The mean duration of follow-up was 29.7months. RESULTS Seven nodules had atypical cytology: a microbiopsy and/or excision found a simple fibroadenoma (n=3), mastitis (n=1), a fibroadenoma associated with a papilloma (n=1), fibrosis (n=1) and normal tissue (n=1). Seven other nodules were resected during treatment for synchronous cancer, and were diagnosed as fibroadenomas. Two hundred and seventy-six nodules were followed-up (121 patients were lost to follow-up [n=132]) and the appearance of 263 nodules (95.29%) was stable. Seven nodules, which had increased in size, underwent another FNAB or microbiopsy or surgery. Five nodules were not found again. The borders of one nodule showed modifications. CONCLUSION The use of fine needle aspiration biopsy, interpreted by an experienced cytologist, means that short term follow-up of fibroadenomas can be avoided.

Non-puerperal uterine inversion.

We report a case of non-puerperal uterine inversion, illustrating the correlation between MRI and pre-operation macroscopic images.

The Place of Extensive Surgery in Locoregional Recurrence and Limited Metastatic Disease of Breast Cancer: Preliminary Results

The aims of this study were first to clearly define two different entities: locoregional recurrences and limited metastatic disease and secondly to evaluate the place of extensive surgery in these two types of recurrence. Material and Methods. Twenty-four patients were followed from June 2004 until May 2014. All patients underwent surgery but for 1 patient this surgery was stopped because the tumour was unresectable. Results. The median interval between surgery for the primary tumour and the locoregional recurrence or metastatic evolution was 129 months. Eight patients had pure nodal recurrences, 4 had nodal and muscular recurrences, 5 had muscular + skin recurrences, and 8 had metastatic evolution. Currently, all patients are still alive but 2 have liver metastases. Disease free survival was measured at 2 years and extrapolated at 5 years and was 92% at these two time points. No difference was observed for young or older women; limited metastatic evolution and locoregional recurrence exhibited the same disease free survival. Conclusion. Extensive surgery has a place in locoregional and limited metastatic breast cancer recurrences but this option must absolutely be integrated in the multidisciplinary strategy of therapeutic options and needs to be planned with a curative intent.

An Unusual Cause of Breast Pain

We report the case of a 30-year-old woman, two pregnancies (first delivery at the age of 27), menarche at the age of 13 who presented to the emergency department for the recent occurrence of a right breast pain. There was a familial history of early onset of breast cancer (one maternal cousin at the age of 36). She had no personal history of breast pathology. Clinical examination revealed a 5 mm-wide tubular induration of the upper lateral quadrant of the right breast (Fig. 1). The area was very sensitive to palpation, although it did not look inflamed. No homolateral adenopathy was found, neither was another lesion. Breast ultrasound was performed and showed a hypoechogenic subcutaneous and uncompressible linear structure (Fig. 2). There was no visible flow with color Doppler ultrasound inside the lesion (Fig. 3). Altogether, we came to the diagnosis of a breast superficial vein thrombosis, also called Mondor’s disease.

Chemotherapy-Related Amenorrhea in Breast Cancer: Review of the Main Published Studies, Biomarkers of Ovarian Function and Mechanisms Involved in Ovarian Toxicity

Breast carcinoma is the most common cancer in women of reproductive age. In Europe and in the United States, approximately 30% of all breast cancers occur before menopause and 15% of women are diagnosed in the reproductive age (age of 45 or younger). Adjuvant chemotherapy prolongs disease-free survival (DFS) and overall survival (OS), especially in young women, but also induces long-term and severe side effects such as temporary or definitive ovarian function suppression which results in potential loss of fertility and premature exposure to the risks of menopause including cardiovascular diseases, osteoporosis, hot flashes and genitourinary dysfunctions Bines et al. (1996). The probability of menopause with chemotherapy depends on the type of regimen used and on the age of the patient. In the literature, the estimated risk of amenorrhea varies between 0% and 60% in women younger than 40 years and between 40% and 100% in women older than 40 years. Beyond age and the type of regimen used, important variations reflect different durations of follow-up and variable definitions of menopause and of chemotherapy-related amenorrhea Bines et al. (1996).

Mastite et allaitement

Resume Les pathologies inflammatoires et infectieuses du sein durant l’allaitement sont un phenomene frequent mais mal connu. Avant d’arriver au stade ultime de l’abces, il peut y avoir une mastite parfois precedee d’un engorgement. Des mesures adaptees et preventives permettent de traiter ces etapes et d’eviter ainsi la formation d’un abces. Le radiologue peut aider a confirmer le diagnostic clinique, traiter les abces et enfin eliminer un cancer inflammatoire. L’echographie a toute sa place dans cette indication, la mammographie etant realisee qu’en cas de suspicion de cancer inflammatoire.

Imagerie des cancers du sein inflammatoires

Resume Les cancers du sein inflammatoires sont rares (1-5 %), de mauvais pronostic, necessitant une prise en charge multidisciplinaire rapide. Ils se manifestent cliniquement par des signes inflammatoires (sein chaud, rouge, oedematie, douloureux) d’installation rapide, frequemment associes a la palpation d’une masse mammaire ou ganglionnaire axillaire. En mammographie, il existe frequemment des anomalies, suspectes dans plus de 86 % des cas. L’echographie permet de mieux detecter les masses au sein du parenchyme densifie et ainsi d’orienter les prelevements biopsiques. Le scanner et l’IRM permettent d’etablir au mieux le bilan d’extension et le suivi sous traitement.