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Resume Objectif Demontrer la faisabilite de l’hysterectomie par voie cœlioscopique en ambulatoire en France par l’evaluation de la qualite de vie postoperatoire. Methodes Nous avons mene une etude prospective randomisee monocentrique en France entre 2013 et 2016 incluant 42 patientes devant beneficier d’une hysterectomie par voie cœlioscopique. Le critere de jugement principal etait l’evaluation de la qualite de vie postoperatoire a l’aide du questionnaire standardise Euroquol la veille de l’intervention puis au 3e et au 30e jour postoperatoire. Les criteres de jugement secondaires etaient l’evaluation de la douleur postoperatoire, la qualite de vie globale, la consommation d’antalgiques et l’anxiete. Les patientes ont ete randomisees en deux groupe, le groupe A avec un sejour d’hospitalisation conventionnel de 2 a 3 jours et le groupe B avec un sejour court, la sortie se faisant le lendemain de l’intervention. Resultats Vingt et un patientes ont ete randomisees dans le groupe A ainsi que dans le groupe B. Nous n’avons pas releve des differences significatives entre les deux groupes de notre etude que ce soit sur notre critere de jugement principal ou nos criteres d’evaluations secondaires. A J3, la moyenne du score Euroquol etait de 0.68 pour le groupe A contre 0,50 pour le groupe B (p = 0,05). De meme, les moyennes des scores portant sur la douleur postoperatoire etaient comparables a hauteur de 70,6 dans le groupe A et 61,8 dans le groupe B (p = 0,21). La tendance etait a l’identique concernant le score de qualite de vie ou l’anxiete. Conclusion La realisation de l’hysterectomie cœlioscopique en ambulatoire parait faisable au vu de notre etude.

Title: Impact of Lymphadenectomy on Survival of Patients with Serous Advanced Ovarian Cancer After Neoadjuvant Chemotherapy: A French National Multicenter Study (FRANCOGYN). Introduction/Background* The population of interest to this study comprised individuals with advanced-stage ovarian carcinoma who were exposed to neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS). Those who had not received systematic lymphadenectomy (SL; Group 1) were compared to those who had received SL (Group 2). Outcome measures included progression-free survival (PFS), overall survival (OS), and surgical complications. (Group 1). Methodology This was a retrospective, multicenter cohort study in nine referral centers of France between January 2000 and June 2017. OS analysis using the multivariate Cox regression model was performed. PFS and surgery-related morbidity were analyzed. Result(s)* Of the 255 patients included, 100 were in Group 1 and 155 in Group 2. Patient majority was, on average, younger and less comorbid, with predominant R0 surgery in Group 2. Dindo–Clavien score was similar between the two groups (p = 0.15). Median OS was 26.8 months in Group 2 and 27.6 months in Group 1. SL was not statistically significant on OS (p = 0.7). Median PFS was 18.3 months in Group 2 and 16.6 months in Group 1. SL had positive impact on PFS (p = 0.005). Conclusion* Patients who had received SL (Group 2) had significantly higher PFS regardless of node-positivity status when compared to those who had not received SL

Resume Objectifs Les nouvelles recommandations de l’Institut national du cancer de janvier 2017 preconisent la realisation d’un test virologique papillomavirus humain (HPV) complementaire lors du diagnostic d’atypies glandulaires au frottis cervicovaginal. L’objectif de cette etude etait d’evaluer la performance du test virologique HPV dans la detection de lesions histologiques cervicales significatives (neoplasie intracervicale [CIN] de grade 2 et plus) en cas de frottis AGC, avant l’application des nouvelles recommandations. Methodes Nous avons mene une etude de cohorte descriptive et retrospective en Alsace entre janvier 2014 et decembre 2016. Nous avons inclus, a partir de la base de donnees de l’association EVE, les patientes ayant presente des atypies glandulaires au frottis cervicovaginal. Resultats Au total, 1074 patientes ont presente un frottis avec atypie glandulaire, soit 0,18 % des frottis. Cent cinquante-deux patientes ont beneficie d’une recherche d’HPV. Nous avons observe 6 cas de CIN2 (3,9 %) et 12 cas de CIN3 (7,9 %). Il n’y a pas eu de diagnostic d’adenocarcinome in situ ou de carcinome invasif. La sensibilite de ce test etait de 88,9 % (IC95 % : [0,65 ; 0,99]), la specificite etait de 65,9 % (IC95 % : [0,55 ; 0,76]), la VPP etait de 34 % (IC95 % : [0,21 ; 0,49]) et la VPN etait de 96,8 % (IC95 % : [0,89 ; 0,99]). Conclusion Le test virologique HPV semble performant dans la prise en charge des atypies glandulaires avec une excellente VPN mais en raison de sa sensibilite moyenne et du risque de progression d’une eventuelle lesion histologique sous-jacente, les recommandations actuelles doivent etre appliquees avec precaution.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 39 - N° 2 - p. 102-115

The current paper presents the second part of chapter 6 of the second edition of the European Guidelines for Quality Assurance in Cervical Cancer Screening. The first part of the same chapter was published in a previous issue (Cytopathology 2008;19:342-54). This part provides guidance on how to manage and treat women with histologically confirmed cervical intraepithelial neoplasia. The paper describes the characteristics, indications and possible complications of excisional and ablative treatment methods. The three options to monitor the outcome after treatment (repeat cytology, HPV testing and colposcopy) are discussed. Specific recommendations for particular clinical situations are provided: pregnancy, immuno-suppression, HIV infection, post-menopause, adolescence and cyto-colpo-histological disparity. The paper ends with recommendations for quality assurance in patient management and some general advice on how to communicate screening, diagnosis and treatment results to the woman concerned. Finally, a data collection form is attached.

The current paper presents the first part of Chapter 6 of the second edition of the European Guidelines for Quality Assurance in Cervical Cancer Screening. It provides guidance on how to manage women with abnormal cervical cytology. Throughout this article the Bethesda system is used for cervical cytology terminology, as the European guidelines have recommended that all systems should at least be translated into that terminology while cervical intraepithelial neoplasia (CIN) is used for histological biopsies (Cytopathology 2007; 18:213-9). A woman with a high-grade cytological lesion, a repeated low-grade lesion or with an equivocal cytology result and a positive human papillomavirus (HPV) test should be referred for colposcopy. The role of the colposcopist is to identify the source of the abnormal cells and to make an informed decision as to whether or not any treatment is required. If a patient requires treatment the colposcopist will decide which is the most appropriate method of treatment for each individual woman. The colposcopist should also organize appropriate follow-up for each woman seen. Reflex testing for high-risk HPV types of women with atypical squamous cells (ASC) of undetermined significance with referral for colposcopy of women who test positive is a first option. Repeat cytology is a second possibility. Direct referral to a gynaecologist should be restricted to special circumstances. Follow-up of low-grade squamous intraepithelial lesion is more difficult because currently there is no evidence to support any method of management as being optimal; repeat cytology and colposcopy are options, but HPV testing is not sufficiently selective, unless for older women. Women with high-grade squamous intraepithelial lesion (HSIL) or atypical squamous cells, cannot exclude HSIL (ASC-H) should be referred without triage. Women with glandular lesions require particular attention. In a subsequent issue of Cytopathology, the second part of Chapter 6 will be presented, with recommendations for management and treatment of histologically confirmed intraepithelial neoplasia and guidance for follow-up of special cases such as women who are pregnant, postmenopausal or immunocompromised.

The current paper presents an annex in the second edition of the European Guidelines for Quality Assurance in Cervical Cancer Screening. It provides guidance on how to make a satisfactory conventional Pap smear or a liquid-based cytology (LBC) sample. Practitioners taking samples for cytology should first explain to the woman the purpose, the procedure and how the result will be communicated. Three sampling methods are considered as acceptable for preparing conventional Pap smears: (i) the cervical broom; (ii) the combination of a spatula and an endocervical brush; and (iii) the extended tip spatula. Smear takers should take care to sample the entire circumference of the transformation zone, to quickly spread the cellular material over a glass slide, and to fix the preparation within a few seconds to avoid drying artefacts. According to local guidelines, one of these three methods may be preferred. Sampling with a cotton tip applicator is inappropriate. Similar procedures should be followed for sampling cells for LBC, but only plastic devices may be used. The collected cells should be quickly transferred into a vial with fixative liquid according to the instructions of the manufacturer of the LBC system. Subsequently, the slide or vial and the completed request form are sent to the laboratory for cytological interpretation.

Resume Les immunomodulateurs representent une classe therapeutique utilisee depuis longtemps deja dans diverses disciplines medicales, mais n'ont fait que recemment leur apparition en gynecologie. Premier produit d'une nouvelle classe therapeutique, l'imiquimod (Aldara ® ) a montre son efficacite dans le traitement des lesions induites par les papillomavirus humains (condylomes acumines, dysplasies cervicales et vulvaires) en stimulant l'immunite du sujet infecte. D'utilisation facile, presentant peu d'effets secondaires, ils semblent offrir la voie therapeutique d'avenir pour ces pathologies virales frequentes, seuls ou en association aux vaccins therapeutiques ou aux traitements destructeurs en prevention des recidives. Ce travail propose de faire le point sur le mecanisme d'action des differents immunomodulateurs, leurs indications et leur efficacite en pratique gynecologique.

Mifepristone, a derivative of norethindrone, a first generation synthetic progestative, has a very potent antiprogestative activity and to a lesser degree antiandrogenic and antiglucocorticoid activities. This action makes it potentially useful in the treatment of multiple hormone dependent diseases in obstetrics-gynecology as well as in a variety of medical specialties such as neurology, ophthalmology, and oncology. Nevertheless, the label of abortive pill has incited numerous ethical and political debates concerning the permission to market this drug, and this has contributed to the delay in the assessment of the potential indications of mifepristone. Largely under-utilized in practice despite its increasing theoretical benefit, clinical studies should now de conducted. Thus, based on an international review of literature during the last ten years, we have shed light on the present and potential indications of mifepristone in medical practice.

Background. The initial manifestation of a lymphoma as an ovarian mass is unusual, with a reportedly poor prognosis. An exploratory laparotomy is often performed as the ovarian tumor can mimic an advanced epithelial carcinoma. The criteria of lymphoma used in the selection of a nonsurgical approach, that is, chemotherapy possibly associated with radiation, are rarely defined. Case. We report the case of a 36-year-old woman who presented with an ovarian tumor suggestive of advanced carcinoma. After an initial approach including optimal surgery, the diagnosis of large B-cell CD30+ non-Hodgkin malignant lymphoma was established. Complete remission was obtained after a chemotherapy regimen, appropriate to the specific histologic type of the lymphoma. Conclusion. The choice treatment of ovarian non-Hodgkin lymphoma (NHL) is chemotherapy. In the presence of an ovarian tumor, the possibility of ovarian NHL must be considered, and its clinical, biological, and/or radiological signs must be actively sought. Controlled biopsies must also be included to avoid mutilating surgery.

Resume But de l’etude : La chirurgie des cancers avances de l’ovaire a pour but d’obtenir un residu tumoral minimal necessitant parfois des exereses digestives. Patientes et methodes : La survie globale et sans rechute, la morbidite et mortalite postoperatoires de soixante-deux patientes presentant un cancer de l’ovaire de stade III ont ete etudiees retrospectivement en fonction de differents parametres (stade, grade histologique, residu tumoral postoperatoire, vitesse de normalisation du CA 125 , complications postoperatoires et duree d’hospitalisation). Deux groupes de patientes etaient individualises en fonction de la chirurgie pratiquee (groupe 1 : chirurgie gynecologique et digestive 〚 n = 17〛 ; groupe 2 : chirurgie gynecologique exclusive 〚 n = 45〛). Toutes les patientes etaient traitees par une polychimiotherapie adjuvante a base de sel de platine. L’âge moyen etait de 60 ans (extremes : 20–83). Sept stades IIIa, dix stades IIIb et 45 stades IIIc etaient repertories. Resultats : La mortalite postoperatoire etait de 3,5 % (2/62). La morbidite postoperatoire de 26 % (13/62). La realisation d’une resection gastro-intestinale et/ou d’une splenectomie n’influencait ni la duree d’hospitalisation globale, ni la duree d’hospitalisation en unite de soins intensifs, ni la morbidite aspecifique ou specifique liee a l’acte chirurgical. La survie globale a cinq ans etait de 56 %. Seul un residu tumoral postoperatoire de moins de 2 cm 3 est un element influencant la survie globale (56 % versus 23 % ; p = 0,03) et la survie sans rechute (84 contre 46 % ; p = 0,02). Conclusion : Les exereses digestives necessaires a l’obtention d’un residu tumoral postoperatoire minimal ne semblent pas accroitre la mortalite ni la morbidite postoperatoire de la chirurgie des cancers avances de l’ovaire.

Authors report a left colon ischemia six days after laparoscopic para-aortic lymphadenectomy in the staging of advanced cervical carcinoma. Before surgery, positron emission tomography scanning was performed: there were no para-aortic nodal metastasis. The histologic examination confirmed the radiological staging. Positron emission tomography scanning could avoid surgery in the case of patients with high risks morbidity factors.

Summary With the same aspect o f multiple peritoneal leiomyomas, the diagnosis o f typical leiomyomatosis peritonealis disseminata was established in two women aged 43 and 49, while in a third case the mature metastasis o f a primary low-grade bilateral ovarian stromal sarcoma in a woman aged 63 was diagnosed.

Objective To assess the prevalence of human papillomavirus (HPV) type 16 and 18, herpes simplex virus (HSV) and human cytomegalovirus (HCMV) in cervical biopsies in order to evaluate their relationship in cervical intraepithelial neoplasia (CIN) and cancer. Setting Colposcopy clinic; Service de Gynecologie-Obstetrique I, Hopital de Hautepierre, Hopitaux Universitaires de Strasbourg and Laboratoire Commun ULP/Synthelabo et U74 INSERM, Institut de Virologie de la Faculte de Medecine de Strasbourg, France. Subjects Forty-two women with low grade and high grade CIN, twenty women with cervical squamous cancer and twenty-two women with normal cervix assessed by cytological, colposcopical and histological analysis. Methods Viral DNA was detected by PCR technique in colposcopically directed biopsies. Results The prevalence of HPV16 and/or HPV18 with HSV and/or HCMV was significantly higher in cancers (25%) or high grade CIN (29%) than in normal cervices (0%). On the contrary, when only HPV DNA was found, there was no significant difference between cancers (30%), high grade CIN (29%) and normal cervices (9%). Conclusions The results support the hypothesis of a role of herpes viruses (HSV and HCMV) as cofactors in cervical carcinogenesis.

We describe a case of unilateral tibial agenesis which was initially observed at 21 weeks' gestation. Unlike bilateral tibial hemimelia syndrome, a rare autosomal dominant condition, unilateral tibial agenesis, which accounts for about three-quarters of all newborns with this condition, has not previously been described. This case could have been a sporadic abnormality but, in view of the association with other observations (distal bifurcation of the femur, club foot), could be considered as an autosomal recessive inherited condition with variable penetrance. Ultrasonographic features and the genetic prognosis are discussed. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 36 - N° 7 - p. 623-624