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Background: Nipple-sparing mastectomy (NSM) with immediate breast reconstruction (IBR) is used increasingly when performing a prophylactic mastectomy. Few prospective studies have reported on complication rates. This complementary trial to the French prospective multicentre MAPAM trial aimed to evaluate the nipple-areola complex (NAC) necrosis rate in prophylactic NSM with IBR. Methods: Patient characteristics and surgical data were recorded. Morbidity after prophylactic NSM with a focus on NAC necrosis was analysed. Results: Among 59 women undergoing prophylactic NSM, 19 (32 per cent) of the incisions were partly on the NAC. Reconstructions were performed with 46 definitive implants and 13 expanders. The crude rate of postoperative complications was 25 per cent (15 patients). Complete NAC necrosis was reported in two women (3 per cent) and partial or total necrosis in nine (15 per cent). No NAC resection was necessary. Median BMI was lower in women with total or partial NAC necrosis compared with the others (20.0 versus 21.3 kg/m2 respectively; P=0.034). Conclusion: Results of this prospective study confirm that prophylactic NSM with IBR is associated with a low risk of total NAC necrosis. [ABSTRACT FROM AUTHOR]

Objectives. – The aim of this study was to determine the symptoms of bladder and ureteral endometriosis and to review the treatment approaches.Materials and Methods. – We conducted a retrospective studyover the period November 1989–July 2000. We reviewed the medical data of all women with bladder or utereral endometriosis who underwent a major surgery (ureteral reimplementation on psoas bladder, partial resection of the ureter, partial cystectomy).Results. – Eight women met the defined selection criterion, three with bladder injuryand five with ureteral injury. The only adverse postoperative complication was a passive ureteral reflux following ureteral reimplementation on psoas bladder. No recurrence on the urinary tract were reported.Conclusion. – Surgical treatment is indicated for patient suffering from symptomatic bladder or ureteral endometriosis. Isolated bladder injuries due to endometriosis are mostly treated by laparoscopic surgery. Ureteral endometriosis may deteriorate the renal function. The initial step of the treatment may include an uterolysis by coelioscopy or an ureteral dilatation by ureteroscopy together with a medical treatment. The renal function must be closely monitored. In case of persistent or recurrent endometriosis, an ureteral resection would be justified. [Copyright &y& Elsevier]

Objective: The aim of this study was to systematically determine the frequency of unusual localizations of sentinel lymph node in patients with early stage cervical cancer., Methods: We performed a comprehensive computer literature search of English and French language studies in human subjects on sentinel node procedures in PUBMED database up to December 2010. For each article two reviewers independently performed data extraction using a standard form to determine the route of unusual lymphatic spread of sentinel procedures in cervical cancer., Results: According to our search, 83.7% of detected sentinel lymph nodes in patients with cervical cancer were in expected localizations (i.e., external iliac, obturator, internal iliac or interiliac). The unusual localizations were: 6.6% in the common iliac chain, 4.31% parametrial, 1.26% sacral, 2% in the lower para-aortic area and 0.07% in the inguinal chain., Conclusion: The unusual localizations of sentinel lymph nodes impose to the gynecologic surgeons to be able to perform lymph node dissection in all the territories potentially affected., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objective: To determine the frequency of extrapelvic sentinel lymph node in patients with cervical cancer., Materials and Methods: We performed systematic searches (Medline, Pubmed; up to April 2010) to determine the route of lymphatic spread in cervical cancer and to review results on extrapelvic sentinel lymph nodes., Results: According to our search, 2.51% of detected sentinel lymph nodes in patients with cervical cancer were extrapelvic: 2% in the inguinal chain and 98% in the lower paraaortic area., Discussion and Conclusion: The unusual localizations of sentinel lymph nodes impose to the gynaecologic surgeons to be hardened in performing lymph node dissection in all the territories potentially affected., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Unlabelled: OBJECTIF: Since the treatment of breast cancer must be followed by a rigorous surveillance of the contralateral breast, especially in breast reconstruction context, we sought to determine contralateral breast cancer frequency after breast reconstruction during the ulterior surveillance., Patients and Methods: Retrospective cohort survey of 273 breast reconstructions led at Tours regional and university hospital. Cumulative incidence of sequential contralateral breast cancer has been evaluated., Results: For 6.6 follow-up, the prevalence was 1.8% and cumulated incidence at 4.6 ‰ person/years., Discussion and Conclusion: The probability of localization to contralateral breast after a primitive tumor of the breast is raised. The diagnosis of a sequential cancer must not be delayed by mammaplasty scars overhauls., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Background: In breast reconstruction, complementary surgery on the contralateral breast is sometimes necessary to obtain a satisfactory aesthetic result. This complementary mammoplasty for symmetry gives the surgeon the opportunity to verify the state of the mammary glandular tissue to rule out a possible occult tumour in the contralateral breast. Our objective was to determine the prevalence of borderline lesions and of in situ and invasive carcinoma in specimens of the contralateral breast in a mammoplasty for symmetry in patients with breast cancer., Methods: We conducted a retrospective study of 145 breast reconstructions with mammoplasty for symmetry conducted at the Tours Regional Teaching Hospital in France., Results: The glandular histologic result after mammoplasty was normal in 45.5% of patients, with benign pathologies in 38.9% and borderline lesions in 15.6% of patients. No invasive or in situ carcinoma was detected., Conclusion: Systematic histologic analysis of glandular mammary tissue sampled after reduction mammoplasty in the particular context of breast reconstruction after breast cancer makes it possible to discover lesions that were not seen in presurgical evaluation. The early management of these borderline occult lesions could reduce the incidence of breast cancer in these at-risk patients.

Aims: To determine factors predictive of the presence of residual tumor on the specimen from mastectomy performed after conservative treatment for breast cancer in order to limit potentially unnecessary mastectomies (free of residual lesions)., Materials and Methods: 294 patients treated in 2 expert centers for breast cancer with breast-conserving therapy (BCT) followed by mastectomy, according to French recommendations, were investigated between January 1, 1998 and January 1, 2005. Patients with residual tumor on the mastectomy specimen were compared with patients whose mastectomy specimens did not reveal any residual tumor. All the clinical risk factors (age, previous history of breast cancer, tumor focality) and histological risk factors (tumor size, histological type, positive margins, estrogen and progesterone receptor expression, histological grade) for residual tumor after BCT were compared between the 2 patient groups., Results: Of the 294 patients studied, 202 (68.71%) mastectomies had residual tumor and 92 (31.29%) were tumor-free. Four predictive factors for residual tumor were found in the univariate analysis: age under 45 years (p=0.01), absence of estrogen receptor expression (p=0.05), positive margins (p=0.01), and presence of lymph node metastases (p=0.05). The multivariate analysis revealed only 2 independent risk factors that were significantly associated with increased risk of residual tumor on the mastectomy specimen: age under 45 years (p=0.05) and presence of positive margins on the lumpectomy specimen (p=0.05)., Conclusion: Young age of patients (under 45-years-old) and presence of positive margins on the operative specimen are independent risk factors of residual tumor after conservative treatment of breast cancer.

Small cell carcinoma of the ovary of the hypercalcemic type is a rare tumour, usually lethal and occurring almost exclusively in young patients. In the majority of described cases, signs of this lesion were revealed by the associated hypercalcemia or by virtue of the physical tumour bulk alone. We report the first case of ovarian small cell carcinoma of the hypercalcemic revealed by a severe acute pancreatitis in a 19-year-old patient.

A case of late expulsion of a leiomyoma after uterine artery embolization (UAE) is reported in a 49-year-old woman who underwent UAE for a huge (13 cm x 12 cm; 1,061 cm(3)) bleeding- and bulk-related intramural leiomyoma diagnosed with ultrasonography. Free-flow embolization was performed with 150-400-microm polyvinyl alcohol particles and absorbable particle sponge. Symptoms and myoma size were successfully controlled until 44 months, at which time the patient reported vaginal discharge. A 7-cm necrotic, partly submucosal leiomyoma was detected. The patient refused hysterectomy and spontaneously expelled the leiomyoma through the cervix 6 months later. In conclusion, UAE necessitates long-term follow-up and women should be warned of late complications.