Brain and lung metastasis of Bartholin’s gland adenoid cystic carcinoma: a case report

INTRODUCTION: Adenoid cystic carcinoma of Bartholin’s gland is a very rare disease. CASE PRESENTATION: A 48-year-old premenopausal woman of Caucasian origin was delivered adjuvant pelvic and inguinal radiotherapy after prior complete left Bartholin’s gland tumor excision and inguinal lymph node dissection for adenoid cystic carcinoma of Bartholin’s gland with one metastatic inguinal lymph node. Two years after primary treatment, she presented to the Emergency Room with acute headache, hypoacousia, decrease in visual acuity, and a decrease in right leg muscle strength. A cranial magnetic resonance imaging scan demonstrated three cystic brain lesions with associated perifocal edema. Chest and abdomen computed tomography scans and a magnetic resonance imaging scan of the pelvis did not find any metastatic or residual disease elsewhere. A physical examination found no local recurrence. Stereotactic brain biopsies with pathology examination revealed the presence of adenoid cystic carcinoma metastasis. She thus received 30Gy of brain radiotherapy but, three months later, the brain lesions did not decrease in size and left mid lobular lung lesions appeared on her chest computed tomography scan. A mid left lobe lung excision was undertaken followed by chemotherapy consisting of six cycles of cyclophosphamide, adriamycin and cisplatin. Five months after beginning chemotherapy, the brain disease progressed and our patient died. CONCLUSION: Our case report shows the difficulty in managing brain and lung metastasis of Bartholin’s gland adenoid cystic carcinoma as no consensus on the optimal treatment exists

Metilación de sitios CpG del virus del papiloma humano tipo 16 en el sitio de unión 1 de E2 (E2BS1), E2BS2 y el sitio de unión de Sp1 en muestras de cáncer de cuello uterino, según lo determinado por análisis de fusión de alta resolución-PCR

High-risk (HR) human papillomavirus (HPV)-associated carcinogenesis is driven mainly by the overexpression of E7 and E6 oncoproteins following viral DNA integration and the concomitant loss of the E2 open reading frame (ORF). However, the integration of HR-HPV DNA is not systematically observed in cervical cancers. The E2 protein acts as a transcription factor that governs viral oncogene expression. The methylation of CpGs in the E2-binding sites (E2BSs) in the viral long control region abrogates E2 binding, thus impairing the E2-mediated regulation of E7/E6 transcription. Here, high-resolution melting (HRM)–PCR was developed to quantitatively analyze the methylation statuses of E2BS1, E2BS2, and the specificity protein 1 (Sp1)-binding site in 119 HPV16-positive cervical smears. This is a rapid assay that is suitable for the analysis of cervical samples. The proportion of cancer samples with methylated E2BS1, E2BS2, and Sp1-binding site CpGs was 47%, whereas the vast majority of samples diagnosed as being within normal limits, low-grade squamous intraepithelial lesions (LSIL), or high-grade squamous intraepithelial lesions (HSIL) harbored unmethylated CpGs. Methylation levels varied widely, since some cancer samples harbored up to 60% of methylated HPV16 genomes. A pyrosequencing approach was used as a confirmation test and highlighted that quantitative measurement of methylation can be achieved by HRM-PCR. Its prognostic value deserves to be investigated alone or in association with other biomarkers. The reliability of this single-tube assay offers great opportunities for the investigation of HPV16 methylation in other HPV-related cancers, such as head and neck cancers, which are a major public health burden

Supporting ligaments of the uterine cervix and vaginal apex

Le col de l'utérus et l'apex vaginal sont soutenus par le ligament utérosacral (LUS) et cardinal (LC). Le LUS s'étend de la région autour des vertèbres sacrées S2-S4 vers la face dorsale du col de l'utérus et/ou du tiers supérieur de la paroi vaginale postérieure. Il contient plus de fibres nerveuses que le LC. Ce dernier est défini comme le fourreau peri-vasculaire s'insérant au niveau proximal autour de l'origine de l'artère iliaque interne, et au niveau du col et/ou le vagin en distal. L'étude de la géométrie spatiale des ligaments chez la femme vivante à l'IRM et après reconstruction 3D a permis d'identifier le LC sous la forme d'un maillage fibreux centré autour de l'axe des vaisseaux iliaques internes, partant dans une direction crânio­caudale vers l'utérus, le col, la vessie et le tiers supérieur du vagin. Les fibres du LC et du LUS convergent vers le col de l'utérus et le tiers supérieur du vagin. La reconstruction 3D a confirmé que le LC fonctionne dans une direction crânio­caudale et le LUS dans une direction dorso-ventrale. L'angle moyen entre le LC et l'axe corporel est de 18°, alors que l'angle moyen entre le LUS et l'axe corporel est de 92°. Le LC est plus long et plus courbé que le LUS. La tension théorique calculée au niveau du LC est de 52% plus importante que celle au niveau du LUS. En cas de prolapsus, il existe une élongation ligamentaire significativement plus importante lors de la manœuvre de Valsalva Des distorsions géométriques majeures sont constatées après cure de prolapsus par promontofixation, et sont plus marquées pour le LCThe uterine cervix and vaginal apex are supported by the uterosacral (USL) and cardinal (CL) ligaments. The USL extends from the presacral fascia between sacral vertebrae S2-S4 towards the dorsal margin of the uterine cervix and the superior third of the posterior vaginal wall. It contains more nervous fibers than the CL. The latter is defined as the perivascular sheath around the internai iliac artery, inserting distally into the cervix and the vagina The geometrical study of the ligaments in living women using MRI and 3D reconstruction shows the CL as a web-like structure around the internai iliac vessels, and going in a cranial to caudal direction towards the cervix and upper third vagina where fibers ofboth the CL and USL mingle together. The USL operates in a dorsal to ventral direction. The mean angles between the body axis and the CL and USL are respectively at 18° and 92°. The CL is longer and more curved than the USL. Theoretical calculated tension on the CL is 52% larger than on the USL. In case of pelvic organ prolapse, significant ligament elongation is observed during Valsalva maneuver. Major geometrical distortions exist after prolapse surgery by sacrocolpopexy, specially for the C

[Extra-uterine pregnancy]

International audienc

Etude des facteurs de surstadification des cancers de l'endomètre de risque intermédiaire et bas de récidive depuis les recommandations de L'INCA 2010

BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF

Facteurs prédictifs de reprise chirurgicale dans le traitement conservateur du cancer du sein stade pT1

BESANCON-BU Médecine pharmacie (250562102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Enhanced Recovery after Pelvic Organ Prolapse Surgery

The objective of this study was to review on the influence of enhanced rehabilitation in pelvic organ prolapse surgery outcomes, specifically focusing on length of hospital stay, hospital costs, pain, morbidity, and patient satisfaction. Following the PRISMA model and using PubMed as a source, eight articles pertaining to prolapse surgery and two articles concerning vaginal hysterectomies were selected, all published between 2014 and 2021. These studies revealed no significant difference in terms of operating time, intra- and post-operative complications, intra-operative blood loss and post-operative pain scores before and after the introduction of the ERAS program. Only one study noted a difference in readmission rates. There was, however, a noticeable decrease in intra-operative and post-operative intravenous intakes, opioid administration, length of stay, and overall hospital costs with the adoption of ERAS. Additionally, with ERAS, patients were able to mobilize more rapidly, and overall patient satisfaction significantly improved

Prenatal Diagnosis of a Segmental Small Bowel Volvulus with Threatened Premature Labor

Fetal primary small bowel volvulus is extremely rare but represents a serious life-threatening condition needing emergency neonatal surgical management to avoid severe digestive consequences. We report a case of primary small bowel volvulus with meconium peritonitis prenatally diagnosed at 27 weeks and 4 days of gestation during threatened premature labor with reduced fetal movements. Ultrasound showed a small bowel mildly dilated with thickened and hyperechogenic intestinal wall, with a typical whirlpool configuration. Normal fetal development allowed continuation of pregnancy with ultrasound follow-up. Induction of labor was decided at 37 weeks and 2 days of gestation because of a significant aggravation of intestinal dilatation appearing more extensive with peritoneal calcifications leading to the suspicion of meconium peritonitis, associated with reduced fetal movements and reduced fetal heart rate variability, for neonatal surgical management with a good outcome

Influence of in utero fetal death on perineal tears in vaginal deliveries

Abstract The aim of this work was to evaluate and compare the incidence of perineal tears and Obstetrical anal sphincter injuries (OASIS) after vaginal delivery following a in utero fetal death (IUFD) compared with those with a live-birth. We conducted a single-center, retrospective cohort study using a database of all women who underwent a spontaneous vaginal delivery in the level III maternity ward. Exclusion criteria were breech presentation, cesarean section birth, instrumental delivery, multiple pregnancy, delivery before 24 + 6 weeks of gestation (WG) and termination of pregnancy for medical reasons. Women from the database were divided into two groups: an "in utero fetal death" (IUFD) group and a control group. Women were included in the IUFD group if they had a spontaneous vaginal delivery following a fetal demise after 24 + 6 WG in cephalic presentation between January 2006 and June 2020. Women in the "control" group were selected from the same database and were included if they underwent a spontaneous vaginal delivery of a live fetus in cephalic presentation, after 24 + 6 WG, during the same period. Each woman in the "IUFD" group was matched to two women (ratio 1:2) in the control group for parity, maternal age, body mass index, gestation and birth weight. The primary outcome was the presence of a sutured or unsutured perineal tear. During the study period, 31,208 patients delivered at a level III maternity hospital. Among them, 215 and 430 women were included in the IUFD group and the control group respectively. The two groups were comparable for all demographic and clinical characteristics except for an epidural analgesia (92% versus 70% in the control group, p < 0.01) and labor induction (86% versus 17% in the control group, p < 0.01). The incidence of any perineal tears was 13% (28/15) in the IUFD group versus 16% (70/430) in the control group. Relative risk of any perineal tears was non significative (RR = 0.8 IC95% [0.5–1.2]). The incidence of first-degree perineal tears was 10% in the IUFD group and 11% in the control group. The incidence of second-degree perineal tears was 18% in the IUFD group and 28% in the control group. Relative risk of first-degree perineal tears (RR = 0.88 95% CI [0.5–1.4]) and second-degree tears (RR = 0.51 95% CI [0.2–1.4]) were non significative. No obstetrical anal sphincter injury was found in either group. Vaginal delivery following a fetal demise did not appear to be either a risk factor or a protective factor for perineal tears. But there as a trend toward a lower incidence of second degree perineal tears in this context

Fetal scalp lactate microsampling for non-reassuring fetal status during labor: a prospective observational study.

International audienceOBJECTIVE: The aim was to study the predictive value and feasibility of fetal scalp lactate microsampling in the management of non-reassuring fetal status during labor. METHODS: A prospective observational study was conducted on cord blood gas samplings from 7,617 singleton and cephalic deliveries at > or =37 weeks of gestation. In this population, 450 fetal scalp blood samples (FBS) were performed for abnormal fetal heart rate (FHR) patterns. Microvolume scalp lactate measurements were compared to scalp pH, neonatal cord blood gas parameters (pH, lactate, base deficit) and the Apgar score. RESULTS: Scalp lactate correlated significantly with scalp pH (r = -0.56, p = 0.001), umbilical artery pH (r = -0.39, p = 0.03), umbilical artery lactate (r = 0.48, p = 0.01) and umbilical artery base deficit (r = 0.51, p = 0.01), but not with Apgar scores. Using receiver operating characteristic curves, a scalp lactate cutoff value of 5 mmol/l was the most predictive for neonatal acidosis. Sampling failure with scalp lactate was inferior to scalp pH (1.3 vs. 14%, p < 0.001). CONCLUSION: Lactate microsampling in fetal scalp blood was found to be an attractive alternative to pH analysis and a useful 2nd-line tool for monitoring fetal asphyxia during labor