Raja Faleh

Maternal tumor necrosis factor receptor 2 gene variants associated with pre-eclampsia in Tunisian women

The tumor necrosis factor receptor 2 (TNFR2) is expressed in placental tissue and it is involved in immune responses, inflammation, angiogenesis and blood pressure regulation; which makes it an attractive pre‐eclampsia (PE) candidate gene. Furthermore, TNFR2 expression is altered in the first trimester in placentas of women who are destined to develop PE. Therefore, we examined the association between maternal and fetal genetic variants of TNFR2 and PE.

Skin metastases revealing a bilateral ovarian invasive micropapillary serous carcinoma.

Skin involvement is a late complication that rarely occurs in ovarian cancer patients. This event invariably carries a bad prognosis in the course of an advanced stage ovarian carcinoma which is usually of the conventional serous type. Micropapillary serous carcinoma (MPSC) was recently recognized as a distinct neoplasm that seems to be less aggressive than conventional serous ovarian carcinoma. Indeed, a few cases of stage IV MPSC have been reported. Herein, we describe an unusual case of ovarian invasive MPSC occurring in a young woman, particularly by its mode of presentation as multiple subcutaneous nodules that were subsequently diagnosed as metastatic lesions. This case demonstrates the potential of MPSC for aggressive clinical behaviour.

Diagnostic clinique et échographique des macrosomies fœtales supérieures à 4 500 g

Resume La macrosomie fœtale est une situation a risque fœto-maternel et demeure une preoccupation majeure des obstetriciens et echographistes. Le risque de complications est dependant du degre de macrosomie et de la qualite de prise en charge. La macrosomie fœtale superieure a 4 500 g touche environ 1,5 % des naissances, elle pose un probleme majeur du fait de la frequence des complications et de l’absence de facteurs predictifs fiables. Face a cette situation, les estimations clinique et echographique sont les deux principaux moyens a notre disposition pour predire le poids fœtal et constituent donc un element decisionnel important dans la prise en charge de ces macrosomies. En revanche, ces deux methodes sont grevees d’erreurs et d’imprecisions qui sont d’autant plus importantes que le poids fœtal est eleve. De plus des discordances entre la clinique (mesure de la hauteur uterine) et l’echographie sont possibles, d’autant plus qu’il s’agit d’une femme diabetique. Afin d’ameliorer la performance de l’echographie, differents indices et formules ont ete developpes avec une sensibilite et specificite variables. Dans cette mise au point les auteurs resument les avantages et les inconvenients de la clinique et des mesures echographiques dans la prediction de la macrosomie fœtale.

Anaphylactic shock due to patent blue: case report and review of literature

Intraoperative search for the sentinal node using patent blue is considered a non risk procedure. We emphasize the highly exceptional nature of this adverse effect previously observed in other disciplines using this coloring agent. We present a case of allergic reaction to patent blue in a patient who underwent left mastectomy with sentinel lymph node. About 25 min after the dye injection, the patient developed increased heart frequency and allergic skin reaction. The patient was treated successfully with decreased inspired fraction of inhaled anesthetic and fluid replacement. The patient recovered uneventfully and was discharged from the PACU 3h after the end of surgery without skin changes and was discharged from hospital on the morning after surgery. Allergic reactions with the use of patent blue are far superior to the hypersensitivity reactions seen with anesthetic and adjuvant drugs. Therefore, the anesthesiologist must be aware of cardiovascular instability associated with skin changes during the use of patent blue, for early diagnosis and appropriate treatment of this hypersensitivity reaction to this dye. Skin tests done later confirmed allergy to patent blue dye; the tests induced a small syndrome reaction. Surgical personnel who use patent blue dye should be made aware of the risk of allergic reactions, sometimes severe, to this dye.

Breast diseases in women over the age of 65 in Monastir, Tunisia

As life expectancy is on the rise, it is predicted that a growing number of people will live beyond the age of 65 and therefore a higher number of elderly women will have breast diseases requiring significant health care and services. This study is aimed at investigating the characteristics, the treatment and outcomes of women older than 65 years old treated for breast diseases at our institution. This was a retrospective study covering the period from January 2003 to December 2011. It involved 92 patients aged over 65 and treated for breast disease in the Maternity Center of Monastir, Tunisia. The data included characteristics of patients and tumors, treatment and outcomes that were obtained through data extraction sheets. We reported a study of 92 women over the age of 65 of whom 77 women had malignant breast disease (83.6%) and 15 benign breast diseases (16.4%). Breast cancer was discovered at a mean age of 72.5 ± 6.6 years. Distant metastases were found in 5.3% of cases and infiltrative ductal carcinoma was detected in 85.7% of patients. Hormonal receptors were positive for estrogens in 64.7% of cases. Surgical treatment was performed in 73 patients and adjuvant treatment was prescribed for 67 women (86%). The complication rate was 16.6% among the 73 patients who underwent surgery. Benign breast diseases represented 16.3% of the mammary pathologies. Abscesses and fibrocystic mastopathy were the most frequent histological diagnoses. Despite great interest in geriatric gynecological pathology worldwide, many questions related to how optimally treat this patient population remain unanswered. In this study, a surgical treatment was performed in 94.8% of breast cancer patients and the complication rate was 16.6%.

Mucinous Breast Carcinoma: Anatomo-Clinical Radiological and Therapeutic Features

Introduction: Mucinous carcinoma of the breast constitutes 1% to 4% of all breast cancers. Two different forms of presentation are distinguished: pure mucinous carcinoma and mixed mucinous carcinoma. The purpose of our work was to clarify the anatomo-clinical and radiological particularities of this rare form of breast cancer. Materials and methods: This was a retrospective study of a series of 14 cases of mucinous carcinoma of the breast, including 8 pure mucinous carcinomas and 6 mixed mucinous carcinomas treated at the Maternity and Neonatal Center of Monastir between January 2009 and December 2017. Results: The frequency of mucinous carcinoma of the breast in our study period was 1.9%. The average of the patients was 55 years old. The average tumor size was 40 mm. Mucinous carcinoma of the breast was pure in 8 cases, mixed in 6 cases. The clinical size of pure CM was smaller than that of mixed CM (41 mm vs 45 mm) [p = 0.12]. Axillary adenopathies were found in 28.5% of patients. Mammography detected a total of 19 masses with three cases of multifocality. The average size was 27 mm, there was no significant difference between subtype sizes. Pure CMs had an oval shape in 83% of the cases with microlobulated contours in half of the cases, mixed CM rather had an irregular shape (71%) with indistinct contours (85%) (p = 0.01/p = 0.04). On ultrasound, pure CMs had a homogeneous hypoechogenic oval mass appearance with microlobulated contours enhancing ultrasound. The mixed CMs had an irregular shape of non-geometric contours and heterogeneous hypoechogenic appearance with posterior ultrasound attenuation (p = 0.06). Microcalcifications were present in 37% of pure CM and 60% of mixed CM (p = 0.13). Ganglionic invasion was noted in 28% of cases. The extension assessment was negative in all cases. The tumors were of low histological grade with predominance of SBR I and II grades. They expressed hormone receptors in 85% of cases. Overexpression of the HER2 gene was noted in only one case. Conclusion: It is important to distinguish between the two pure and mixed forms, because the therapeutic attitude and the prognosis depend on it. The pure form remains a favorable prognosis, whereas that of the mixed form matches that of infiltrating ductal carcinomas.

Devant cet impuberisme quels sont vos diagnostics

ResumeLes auteurs rapportent un tableau clinique atypique, celui d’un patient présentant un désordre du développement sexuel (46XY DDS). L’exploration a montré des taux de FSH et LH élevés, une testostéronémie basse, avec absence de gonades ainsi que tout dérivé des canaux de Müller et de Wolff à la laparoscopie.Les auteurs discutent les différentes possibilités diagnostiques pouvant correspondre à ce tableau clinique et insistent sur celui de syndrome de régression testiculaire embryonnaire, entité rare et originale.AbstractThe authors report a case of a 16-year-old Tunisian phenotypically female patient with an 46, XY karyotype. Serum assays showed high serum FSH and LH levels and low serum testosterone levels. Laparoscopic exploration was performed to distinguish between testicular feminization syndrome and gonadal dysgenesis. No gonads and no persistent Müllerian or Wolffian ducts were found.The authors suspected the diagnosis of embryonic testicular regression syndrome (TRS), a congenital condition in which the testes disappear during early embryonic development. A spectrum of pathological findings may be present, but few systematic descriptions have been reported in the literature.The authors describe a new case of suspected embryonic testicular regression syndrome and discuss the differential diagnoses.