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Objective: To investigate the lymphatic drainage of Bartholin’s gland and its therapeutic implications in Bartholin’s gland carcinoma. Materials and Methods: Data were obtained from the anatomical study of ten fresh female cadavers with groin and pelvic dissections after lymphatic channel and node staining by injection of Lipiodol dye solution into Bartholin’s gland. Results: We distinguished three different lymphatic pathways: i) the superficial inguinal pathway, identified in 61.5% of cases, ii) the internal pudendal pathway (towards the pararectal fossa), identified in 30.8% of cases, and iii) the pelvic pathway, identified in 15.4% of cases, one after an inguinal pathway and the other following the labiocrural fold. No evidence of stained lymphatic structures was found in 31.6% of cases. The principal pathway was always ipsilateral. Conclusion: Ipsilateral groin lymphadenectomy offers the most effective ratio between oncological safety and surgery-related complications.

International audience; Objective: The aim of the present study was to evaluate evolution and prognosis of mucinous ovarian carcinomas (mOC), with respect to the two invasive patterns: expansile and infiltrative invasion. Methods: This was a descriptive, retrospective, multicenter study conducted in 13 French centres from 1 January 2001 to 31 December 2019. All patients operated on for epithelial ovarian neoplasia of the mucinous type (infiltrative/ expansile) were included, whether the surgery was performed immediately or after neoadjuvant chemotherapy. Results: A total of 94 women with mucinous carcinomas were included in the present study. Mucinous tumours were divided into 35 expansile (37%) and 59 infiltrative (63%) mOC. There was a statistically significant difference in early and late stages at initial diagnosis between expansile and infiltrative mOC. None of the expansile mOC showed metastatic lymph nodes, whereas almost a quarter of the infiltrative mOC were metastatic to the pelvic /para-aortic region. There was a clear difference in RFS, in favour of expansile mOC, with 90% survival at 5 years, compared with 60% for infiltrative mOC. Conclusions: Although infiltrative and expansile mOC belong to the same histological family, they present many distinctions in clinical presentation, histological invasion, and disease course.

The presence of lymphovascular space invasion (LVSI) is not yet included in international recommendations neither as a prognostic factor nor as a parameter for the decision to use adjuvant chemotherapy in FIGO stage I/IIa ovarian cancer (OC).This study set out to evaluate the impact of LVSI on Overall Survival (OS) and Recurrence-Free Survival (RFS) in patients managed for epithelial OC.Retrospective multicenter study by the research group FRANCOGYN between January 2001 and December 2018. All patients managed for epithelial OC surgery and for whom histological slides for the review of LVSI were available, were included. The characteristics of patients with LVSI (LVSI group) were compared to those without LVSI (No-LVSI group). A Cox analysis for OS and RFS analysis was performed in all the populations.French multicenter tertiary care centers RESULTS: Over the study period, 852 patients were included in the 13 institutions. Among them, 289 patients had LVSI (33.9%). There was a significant difference in the distribution of LVSI between early and advanced stages (p 0.001). LVSI was an independent predictive factor for poorer Overall and Recurrence-Free Survival. LVSI affected OS (p 0.001) and RFS (p 0.001), LVSI affected OS and RFS for early stages (p = 0.001; p = 0.001, respectively) and also for advanced stages (p = 0.01; p = 0.009, respectively).The presence of LVSI in epithelial ovarian epithelial tumors has an impact on OS and RFS and should be included in the routine pathology examination to adapt therapeutic management, especially for women in the early stages of the disease.

Introduction: Borderline ovarian tumours (BOT) represent 10–20% of epithelial tumours of the ovary. Although their prognosis is excellent, the recurrence rate can be as high as 30%, and recurrence in the infiltrative form accounts for 3% to 5% of recurrences. Affecting, in one third of cases, women of childbearing age, the surgical strategy with ovarian conservation is now recommended despite a significant risk of recurrence. Few studies have focused exclusively on patients who have received ovarian conservative treatment in an attempt to identify factors predictive of recurrence and the impact on fertility. The objective of this study was to identify the risk factors for recurrence of BOT after conservative treatment and the impact on fertility. Material and methods: This was a retrospective, multicentre study of women who received conservative surgery for BOT between February 1997 and September 2020. We divided the patients into two groups, the “R group” with recurrence and the “NR group” without recurrence. Results: Of 175 patients included, 35 had a recurrence (R group, 20%) and 140 had no recurrence (NR group, 80%). With a mean follow-up of 30 months (IQ 8–62.5), the overall recurrence rate was 20%. Recurrence was BOT in 17.7% (31/175) and invasive in 2.3% (4/175). The mean time to recurrence was 29.5 months (IQ 16.5–52.5). Initial complete peritoneal staging (ICPS) was performed in 42.5% of patients (n = 75). In multivariate analysis, age at diagnosis, nulliparity, advanced FIGO stage, the presence of peritoneal implants, and the presence of a micropapillary component for serous tumours were factors influencing the occurrence of recurrence. The post-surgery fertility rate was 67%. Conclusion: This multicentre study is to date one of the largest studies analysing the risk factors for recurrence of BOT after conservative surgery. Five risk factors were found: age at diagnosis, nulliparity, advanced FIGO stage, the presence of implants, and a micropapillary component. Only 25% of the patients with recurrence underwent ICPS. These results reinforce the interest of initial peritoneal staging to avoid ignoring an advanced tumour stage.

Resume Objectifs Le but de ce travail etait d’evaluer l’impact clinique du ratio de la dissemination metastatique ganglionnaire inguinale (LNR) chez les patientes prises en charge pour un cancer vulvaire de type epidermoide. Materiel et methodes La cohorte de l’etude etait representee par des patientes prises en charge pour un carcinome epidermoide vulvaire, entre janvier 2005 et decembre 2015, dans 5 institutions francaises avec bases de donnees prospectives. Population Au toal, 636 femmes, parmi lesquelles 508 (79,9 %) ont eu une chirurgie ganglionnaire inguinale. Le seuil significatif du LNR a ete determine par la methode du minimal valeur de p. Critere de jugement principal Comparaison de la survie globale et sans recidive selon le LNR. Resultats Au total, 176 femmes (34,6 %) avaient au moins un ganglion atteint. Il existait une difference significative de survie globale et de survie sans recidive selon que le LNR, soit > 0,2 ou non. Conclusion L’evaluation, dans notre etude, du ratio de ganglions positifs, semble demontrer que celui-ci pourrait etre considere comme un facteur pronostique a part entiere.

International audience; BACKGROUND: The aim of this study was to evaluate the impact of lymphovascular space invasion (LVSI) on overall survival (OS) and recurrence-free survival (RFS) in patients managed for stage I-IIa clear cell carcinoma, mucinous, low-grade serous and low-grade endometrioid ovarian cancer MATERIAL AND METHODS: Retrospective multicentre study of the research group FRANCOGYN between January 2001 and December 2018. All patients managed for stage I-IIa clear cell carcinoma, mucinous /low grade serous and endometrioid ovarian cancer and for whom the presence of histological slides for the review of LVSI was available, were included. Patient’s characteristics with LVSI (LVSI group) were compared to those without LVSI (No LVSI group). A cox analysis for OS and RFS analysis were performed in all population. RESULTS: Over the study period, 133 patients were included in the thirteen institutions. Among them, 12 patients had LVSI (9%). LVSI was an independent predictive factor for poorer Overall and recurrence free survivals. LVSI affected OS (p

We performed a systematic review in order to describe the clinical presentation, therapeutic management and outcomes of malignant myoepitelioma of the breast.A systematic search of MEDLINE and EMBASE references from January 1980 to Marsh 2020 was performed. We included articles that reported cases of malignant breast myoepithelioma. Data from eligible studies were independently extracted onto standardized forms by two reviewers.31 articles including 47 cases of malignant breast myoepithelioma and 3 other unpublished cases managed in our establishment were included in this systematic review. The average age at diagnosis was 60.7 years old [range 30-81]. The average size of the tumor was 46mm [range 10 -230]. 30 patients had a partial mastectomy and 18 a total mastectomy. Only 15% of patient (7/48) had an axillary sentinel lymph node biopsy of whom one was positive. 33% of patients (16/48) had an axillary lymph node dissection which was positive for one patient. 19% (n=9) had adjuvant radiotherapy and 15% (n=7) had adjuvant chemotherapy. 33% (n=10) of patients with partial mastectomy had at least one recurrence, versus 5.5% (n=1) after a total mastectomy. The average time between the diagnosis and the first recurrence was 25.4 months [range: 1-50]. 64% (n=7) had a second partial mastectomy and only 18% (n=2) had a total mastectomy. 27% of patient had chemotherapy after their first recurrence and 27% had radiotherapy if it was not received in first line treatment. 40% (n=4/10) of patients with partial mastectomy who recurred have had at least 2 breast recurrences. 28% (n=14) of all patients had distant metastases. 20% of patients (n=10) died whose 80% (n=8) had distant metastatic disease.This systematic review provided a precise summary of the clinical characteristics and treatment of patients presenting with Malignant breast myoepithelioma in the past 40 years. We anticipate that these results will help inform current investigations and treatment.

Objective The use of autologous fat grafting in the context of breast reconstruction is still a matter of controversy. The objective of this study was to compare the local relapse rate in women who had a fat grafting session in the context of breast reconstruction after breast cancer management, to those who had breast reconstruction without fat grafting. Methods We performed a retrospective, monocentric, case-control study from January 2007 to December 2017 in our hospital. The cases included women who underwent breast reconstruction with autologous fat grafting and controls, undergoing breast reconstruction without fat grafting. We compared survival and local recurrence between the two groups. Results 412 women were included: 109 (26.5%) in the lipofilling group and 303 women (73.5%) in the “no lipofilling” group. In the overall study population, lipofilling did not appear to be a predictive factor for recurrence, HR = 1.39 [0.63 - 3.06], p = 0.41; or a predictive factor for overall survival, HR = 0.84 [0.23 - 3.02], p = 0.79, or for distant metastases, HR = 1.10 [0.43 - 2.79], p = 0.84. In contrast, in the subgroup of women treated for invasive cancer, the multivariate analysis showed that lipofilling in this context was an independent predictive factor for local recurrence (HR= 5.06 [1.97 – 10.6], p = 0.04). Conclusion we found an increased risk of local recurrence after lipofilling in women who were managed for invasive breast cancer. This suggests that special consideration should be given to women who have had invasive breast cancer before lipofilling.

International audience; BACKGROUND: The aim of this study was to evaluate the impact of Lymphovascular Space Invasion (LVSI) on Overall Survival (OS) and Recurrence-Free Survival (RFS) in patients managed for high-grade serous epithelial ovarian cancer (HGSOC). MATERIALS AND METHODS: Retrospective multicenter study by the FRANCOGYN research group between January 2001 and December 2018. All patients managed for HGSOC and for whom histological slides for the review of LVSI were available, were included. The characteristics of patients with LVSI (LVSI group) were compared to those without LVSI (No LVSI group). A Cox analysis for OS and RFS analysis was performed in all populations. RESULTS: Over the study period, 410 patients were included in the thirteen institutions. Among them, 289 patients had LVSI (33.9%). LVSI was an independent predictive factor for poorer Overall and Recurrence-Free Survival. LVSI affected OS (p

Resume Objectif Les cancers du sein triple negatifs, definis par l’absence d’expression des recepteurs hormonaux et de la proteine HER2, sont consideres comme des tumeurs agressives et de mauvais pronostic en comparaison aux tumeurs hormonosensibles. L’objectif de l’etude etait d’evaluer les associations entre les facteurs hormonaux et les facteurs influencant le pronostic chez les patientes prises en charge pour tumeurs triple negatives. Methodes Toutes les femmes operees d’un cancer du sein triple negatif entre janvier 2009 et decembre 2013 ont ete incluses. Pour chaque patiente, les facteurs recueillis ont ete les donnees cliniques, anatomopathologiques, la prise en charge therapeutique, ainsi que les donnees de survie. Resultats Sur la periode de l’etude, 1682 femmes ont ete operees d’un cancer du sein, dont 1444 presentaient au moins une tumeur infiltrante. Cent cinquante-cinq patientes (10,7 %) avaient une tumeur triple negative. L’âge moyen au diagnostic pour les tumeurs triple negatives etait de 56,4 ans, soit significativement plus jeune que pour les autres types de tumeurs, p = 0,0001. Chez les patientes avec une tumeur triple negative, la parite etait le seul facteur hormonal identifie comme un facteur independant d’atteinte ganglionnaire axillaire (OR = 1,53 ; IC95 % [1,10–2,25] p = 0,02) et l’antecedent de THM comme facteur independant protecteur de recidive locoregionale (OR = 0,13 [0,005–0,64] p = 0,001). Nous n’avons pas trouve de facteur hormonal identifie comme predictif de metastase a distance. Nous n’avons pas retrouve de difference de survie en fonction de la parite (p = 0,72), de la categorie d’IMC (p = 0,62), de la prise ou non de THM (p = 0,49). Conclusion Les facteurs hormonaux semblent egalement avoir une implication pronostique pour les tumeurs triples negatives malgre l’absence d’expression des recepteurs hormonaux.

Resume Introduction L’objectif de ce travail est d’evaluer l’existence de facteurs predictifs de concordance entre les tailles mesurees a l’IRM mammaire et les tailles histologiques dans les cancers mammaires infiltrants de type lobulaire. Methodes Les patientes incluses dans l’etude ont ete traitees entre le 1er janvier 2007 et le 31 decembre 2016 pour un cancer mammaire lobulaire infiltrant isole ou associe a un contingent de carcinome canalaire infiltrant. Une analyse univariee puis multivariee a ete realisee pour determiner l’association entre differents facteurs clinico-histologiques et la discordance entre les tailles IRM et les tailles histologiques (seuil 5 mm). Resultats Durant la periode de l’etude, 384 patientes avec un cancer mammaire lobulaire infiltrant ont ete incluses. Nous disposions des donnees IRM de 246 patientes. Pour une discordance > 5 mm), en analyse univariee, les facteurs eligibles pour une analyse multivariee etaient le statut menopausique (OR 1,93[1,01–3,71], p = 0,04), la taille histologique (OR 0,97 [0,96–0,99], p Conclusion Ce travail nous a permis d’identifier des facteurs predictifs independants de discordance entre les tailles mesurees a l’IRM mammaire et la taille histologique de lesions de carcinome lobulaire infiltrant.

Objectives To evaluate the diagnostic value of serum/urinary biomarkers and the operability diagnosis strategy to make management recommendations. Methods Bibliographical search in French and English languages by consultation of Pubmed, Cochrane and Embase databases. Results For the diagnosis of a suspicious adnexal mass on imaging: Serum CA125 antigen is recommended (grade A). Serum CAE is not recommended (grade C). The low evidence in literature concerning diagnostic value of CA19.9 does not allow any recommendation concerning its use. Serum Human epididymis protein 4 (HE4) is recommended (grade A). Comparison of data concerning diagnosis value of CA125 and HE4 show similar results for the prediction of malignancy in case of a suspicious adnexal mass on imaging (NP1). Urinary HE4 is not recommended (grade A). The use of circulating tumor DNA is not recommended (grade A). Tumor associated antigen-antibodies (AAbs) is not recommended (grade B). The use of ROMA score (Risk of Ovarian Malignancy Algorithm) is recommended (grade A). The use of Copenhagen index (CPH-I), R-OPS score, OVA500 is not recommended (grade C). For the prediction of resectability of an ovarian cancer with peritoneal carcinomatosis in the context of a primary debulking surgery: It is not recommendend to use serum CA125 (grade A). The low evidence in literature concerning diagnostic value of HE4 does not allow any recommendation concerning its use in this context. No recommendation can be given concerning CA19.9 and CAE. For the prediction of resectability of an ovarian cancer with peritoneal carcinomatosis in the context of surgery after neoadjuvant chemotherapy: the low evidence in literature concerning diagnostic value of serum markers in this context does not allow any recommendation concerning their use in this context. Place of laparoscopy for the prediction of resectability in case of upfront surgery of an ovarian cancer with peritoneal carcinomatosis robust data shows that the use of laparoscopy significantly reduce futile laparotomies (LE1). Laparoscopy is recommended in this context (grade A). Fagotti score is a reproducible tool (LE1) permitting the evaluation of feasibility of an optimal upfront debulking (NP4), its use is recommended (grade C). A Fagotti score≥8 is correlated to a low probability of complete or optimal debulking surgery (LE4) (grade C). There is no sufficient evidence to recommend the use of the modified Fagotti score or any other laparoscopic score (LE4). In case of laparotomy for an ovarian cancer with peritoneal carcinomatosis, the use of Peritoneal Cancer Index (PCI) is recommended (grade C). For the prediction of overall survival, disease free survival and the prediction of postoperative complications, the clinical and statistical of actually available tools do not allow any recommendation.

Vulvar intraepithelial neoplasia (VIN) is classified into two entities: differentiated (dVIN) and vulvar high-grade squamous intraepithelial lesions (vH-SIL). dVIN is a premalignant lesion that develops on an existing vulvar lesion such as lichen sclerosus, while vH-SIL is associated with HPV infection. The two entities differ in terms of pathophysiology, background, prognosis, and management. The incidence of VIN in young women is rising and recurrence is common, even after radical surgery, which can cause significant disfigurement. Alternative strategies include topical treatments, ablation, and a watch-and-wait approach. There is currently no consensus on how these lesions should be managed. We review the literature in this field.

In a previous pilot study, we showed that polyunsaturated n-3 fatty acids of breast adipose tissues were associated with breast cancer multifocality. In the present study, we investigated biochemical, clinical and histological factors associated with breast cancer focality in a large cohort of women with positive hormone-receptors tumors. One hundred sixty-one consecutive women presenting with positive hormone-receptors breast cancer underwent breast-imaging procedures including a Magnetic Resonance Imaging prior to treatment. Breast adipose tissue specimens were collected during surgery of tumors. A biochemical profile of breast adipose tissue fatty acids was established by gas chromatography. Clinicopathologic characteristics were correlated with multifocality. We assessed whether these factors were predictive of breast cancer focality. We found that tumor size (OR = 1.06 95%CI [1.02-1.09], p 0.001) and decreased levels in breast adipose tissue of long-chain polyunsaturated n-3 fatty acids (OR = 0.11 95%CI [0.01-0.98], p = 0.03), were independent predictive factors of multifocality. Low levels of long chain polyunsaturated n-3 fatty acids in breast adipose tissue appear to contribute to breast cancer multifocality. The present results reinforce the link between dietary habits and breast cancer clinical presentation.

Background The purposes of this study were to evaluate the outcome of women with pure flat atypical atypia (FEA) diagnosed at vacuum-assisted breast biopsy (VABB) targeting microcalcifications and to determine whether clinical, radiological and pathologic parameters are able to predict which lesions will be upgraded to malignancy. Materials 2414 cases of consecutive VABB for microcalcifications using VA 8-, 10- or 11-Gauge stereotactically guided core biopsy performed between January 2005 and December 2011 from two french breast cancer centers were evaluated. Data of women with VABB-diagnosed pure FEA who underwent either excisional surgery or mammographic follow-up were analyzed. Cases with mass lesions or ipsilateral cancers were excluded. Two pathologists (FA,PM) reviewed the results of procedures performed. Clinical, radiological, as well as histological criteria have been studied in order to determine the correlation between these factors and carcinoma underestimation. Results and conclusion This study included 70 cases of pure FEA. Twenty women underwent surgical excision and 50 had clinical and mammographic surveillance only. In three women FEA was upgraded to breast cancer on excision. Clinical and mammographic follow-up for a mean of 56 months ± 27 in the group without excision showed two cancers in the same breast (Intermediate grade DCIS, and invasive ductal carcinoma 84 and 48 months respectively after VABB). Three factors were significantly predictive of underestimation or occurence of cancer for pure FEA when the radiologic lesions are calcifications: age≥ 57 years, radiologic size >10 mm and number of FEA foci ≥4.

Resume Objectif L’objectif de notre etude etait d’evaluer l’impact du jeune âge sur la presentation et le pronostic du cancer du sein. Methodes Il s’agit d’une etude descriptive retrospective monocentrique realisee au CHRU de Tours du 1er janvier 2007 au 31 decembre 2013. L’etude concernait toutes les patientes atteintes de cancer du sein infiltrant. La population a ete divisee en deux groupes en fonction de l’âge : ≤ 40 ans et > 40 ans. Nous avons etudie les differences de caracteristiques anatomopathologiques, de prise en charge, et de donnees de survie. Resultats Deux milles et quatre vingt trois patientes avec un cancer du sein infiltrant ont ete incluses. Cent cinquante cinq dans le groupe ≤ 40 ans et 1928 dans le groupe > 40 ans. Les caracteristiques histologiques et biologiques des cancers du sein infiltrant de ce groupe etaient de plus mauvais pronostic : grade 3, recepteurs hormonaux negatifs, Her 2 positif, triple negatif comparativement au reste de la population (p Conclusion Notre etude a retrouve une association significative entre le jeune âge et la presentation du cancer du sein. Les cancers du sein diagnostiques chez les femmes jeunes ont des caracteristiques differentes et apparaissent souvent plus agressifs par leurs caracteristiques histologiques. L’âge jeune etait egalement un facteur independant pejoratif de survie sans recidive.

We present the case of a young woman with abnormal vaginal bleeding two weeks after an abdominal myomectomy. The intervention was initially considered uncomplicated. Transvaginal sonography detected a pulsatile cystic area, just above the endometrium in the anterior wall of the lower uterine segment. Color Doppler analysis revealed the communication between an artery and a vein. Although, the ultrasound was completely sufficient for diagnosis, computed tomographic angiography was performed and confirmed the diagnosis of uterine pseudoanevrysm within the uterine myometrium. Selective arterial embolization was performed with complete recovery.

Resume Objectifs L’objectif de ce travail etait d’evaluer l’existence de facteurs predictifs de traitement conservateur apres chimiotherapie neo-adjuvante (CNA) dans les cancers mammaires infiltrants. Methodes Les patientes incluses dans l’etude ont ete traitees par une CNA, puis une chirurgie mammaire entre le 1er janvier 2007 et le 31 decembre 2013 pour un cancer mammaire infiltrant. Une analyse univariee, puis multivariee a ete realisee pour determiner l’association entre differents facteurs clinicohistologiques de la population et le traitement conservateur (TC) apres CNA. Resultats Durant la periode de l’etude, 229 patientes avec un cancer mammaire infiltrant ont beneficie d’une CNA, puis 73 ont eu un TC (32 %). En analyse univariee, les facteurs eligibles pour une analyse multivariee etaient l’âge (OR 0,97 [IC 95 % 0,95–0,99], p = 0,02), la taille radiologique (OR 0,97 [IC 95 % 0,96–0,99], p Conclusion Ce travail nous a permis d’identifier des facteurs predictifs independants de TC apres CNA qui vont etre integres dans un score qui sera evalue de facon prospective permettant d’apporter une aide pour le chirurgien et la patiente dans le choix du traitement chirurgical.

Resume Objectif Le but de ce travail etait d’evaluer les caracteristiques operatoires, histologiques ainsi que le pronostic des patientes traitees pour cancer du sein en fonction de leur indice de masse corporelle (IMC). Methodes Nous avons repris les donnees de toutes les patientes prises en charge pour carcinome du sein dans notre centre entre janvier 2009 et septembre 2013. l’IMC des patientes a ete categorise en : maigre, normal, surpoids et obese. Resultats Un total de 1599 patientes a ete evalue. Le recul moyen etait de 36,4 mois (1–265). Le nombre de patientes par categorie d’IMC etait de 66, 779, 463 et 291 pour les patientes maigres, de poids normal, en surpoids et obeses respectivement. Comme attendu les patientes en surpoids et obese avaient plus souvent de l’hypertension (18, 21, 35 et 47 % respectivement, p p p = 0,006), une plus grande taille tumorale histologique ( p = 0,038) ; une proportion plus importante de patientes avec atteinte ganglionnaire axillaire ( p = 0,03) avec un nombre de ganglions positifs plus important ( p = 0,02) par rapport aux autres categories d’IMC. Les patientes avaient les memes protocoles de traitements (notamment adjuvant). Il n’y avait pas de difference de la survie globale a 5 ans entre les differents groupes ( p = 0,30). Conclusions Notre etude montre une presentation clinique et histologique plus agressive pour les patientes obeses.

Background and objectives: The aim was to review the clinical impact of groin metastatic nodal disease in women with vulvar squamous cell carcinoma (VSCC) and to evaluate the impact of adjuvant rad...

About 6% of women with breast cancer present with synchronous metastases. Treatment remains palliative in international recommendations but the impact of loco-regional surgery remains controversial.We conducted a multicentre, cohort study to evaluate the impact of axillary lymph node (ALN) surgery on overall survival in stage IV breast cancer at diagnosis.Patients presenting with breast cancer and synchronous metastases between 2005 and 2014 were included. Follow up was conducted up to 1st June 2018. The only exclusion criterion was a history of previous malignancies. Breast surgery was defined as lumpectomy or mastectomy. Axillary surgery included full ALN dissection, and sentinel lymph node biopsy (SLNB). If the SLN was invaded on the frozen section, full axillary dissection was performed.152 patients were included. 71 women had no surgery, 81 had primary site surgery of which 64 (79%) had breast and axillary surgery and 17 (21%) breast surgery only. 5-year overall survival was 59.8% (95% CI=[49.5; 69.5]) for women with breast and axillary surgery, 23.5% (95% CI=[15.6; 33]) for women with breast surgery only and 9.8% (95% CI=[4.7; 17.5]) for women without any surgery, p 0.001. Combined with breast surgery, axillary surgery significantly added a mean of 33 months to patient overall survival.ALN surgery combined with breast surgery in metastatic breast cancer significantly increased overall survival. Thus surgical indications should not differ from those in women with breast cancer without metastases.

Resume Objectif Evaluer les delais d’acces aux traitements de radiotherapie adjuvante du cancer du sein et etudier l’impact sur le pronostic des patientes. Methodes Etude descriptive retrospective au centre hospitalo-universitaire de Tours entre le 1er janvier 2007 et le 31 decembre 2013. L’ensemble des patientes operees pour un cancer du sein sur cette periode ont ete incluses. Les patientes avec chimiotherapie (neo-adjuvante, adjuvante) ont ete exclues. Les delais d’acces a la radiotherapie adjuvante ont ete releves. La survie globale, la survie sans rechute et la survie sans recidive (loco-regionale ou metastatique a distance) ont ete utilisees pour etudier l’impact sur le pronostic. Resultats Sur les 1855 patientes presentant un cancer du sein de type infiltrant, les patientes justifiant d’une radiotherapie adjuvante etaient au nombre de 904 (48,7 %). En population globale, on retrouvait un lien significatif entre la survie sans recidive et un delai chirurgie-radiotherapie superieur a 90 jours avec en analyse multivariee (HR = 2,12 [1,03–46] p = 0,04). Ainsi, la realisation de la radiotherapie a plus de 90 jours de la date de la chirurgie apparaissait donc comme un facteur independant impactant la survie sans rechute dans la population globale. Chez les patientes beneficiant d’un traitement conservateur, la radiotherapie realisee a plus de 65 jours du traitement chirurgical conservateur, etait un facteur independant impactant negativement la survie sans recidive : HR = 2,29 [1,16–4,54], p = 0,02. La radiotherapie realisee a plus de 70 jours du traitement chirurgical conservateur, etait un facteur independant impactant negativement la survie globale : HR = 3,41 [1,005–112], p = 0,04. Conclusion Le delai d’acces aux traitements adjuvants du cancer du sein impacte la survie des patientes, notamment en cas de cas de chirurgie mammaire conservatrice.

International audience; Purpose: In the present study, we present a large institutional study to determine the influence of age≥ 80 years on breast cancer presentation and prognosis.Methods: The study is a retrospective analysis of our prospectively maintained breast cancer database study using data from of women managed from January 2007 through December 2013. Clinicopathologic characteristics were correlated with outcomes according to age (

Patterns of distant metastatic failure of endometrial cancer (EC) by specific anatomic site are not well described in the literature. In this manuscript, we evaluated the metastatic patterns of EC cancer and analysed the potential distribution of metastatic disease in this malignancy. Methods A total of 1444 women with EC were identified. Of which we extracted women with locoregional and distant recurrence or with distant recurrence alone. Women were scored based on first site of metastasis: multiple versus one site: bone, brain, lung, liver or sus diaphragmatic lymph nodes. Results 110 women developed distant metastatic disease with (n = 37(33.6%)) or without (n = 73(66.4%)) locoregional recurrence, including 39 women with exclusive first site of metastatic disease and 34 women with multiple sites of metastatic disease. When considering all women, the most common exclusive first site of metastasis was lung (42.8%). The median time to develop distant metastases was shorter after the completion of treatment for exclusive brain metastatic disease compared with other sites of metastatic− disease (7 months vs, 9 for lung, 10 for liver, 19 for bone and 27 months for sus-diaphragmatic LN; P = 0.004). The rate of 3-year overall survival was higher in the sus-diaphragmatic LN metastase group (83.3% vs 50.6% for lung, 37.3% for bone, 16.7% for brain and 0% for liver; P = 0.0059). Conclusion The present study has demonstrated the site-specific patterns of metastases. These data support current clinical practice of screening for site-specific metastatic disease after initial treatment of early stage EC based on concerning women-specific signs or symptoms.

Resume Les grossesses apres cancer du sein sont des observations encore relativement rares. Leur survenue, avec leurs consequences hormonales, chez une femme traitee pour un cancer du sein ont longtemps ete redoutes pour leur effet potentiel sur le risque de recidive. Cependant, l’amelioration, grâce aux progres des connaissances, du pronostic du cancer du sein a permis a ces femmes d’envisager des grossesses apres leur cancer ; les recommandations actuelles ne les contre-indiquent pas en cas de remission complete. Cependant, ce contexte particulier suscite un certain nombre de questions telles que le delai entre le cancer et la grossesse, le deroulement de ces grossesses, le suivi oncologique et obstetrical, l’allaitement maternel et l’impact de la grossesse sur la maladie. Le but de ce travail etait d’apporter des elements de reponse a ces questions a travers une revue de la litterature.

Stage IV breast cancer was considered to be an incurable disease. Primary site surgery used to be reserved to control local complications. In the present study, we compared the survival of women who received therapeutic breast surgery for stage IV breast cancer at initial diagnosis to the survival of those who did not.Two French hospitals databases were retrospectively screened from 2005 to 2012. We identified all women with metastatic breast cancer at diagnosis. Patients' data were obtained by a review of their medical history. Data were analyzed according the four breast cancer subtypes (luminal A, luminal B, her 2 and triple negative).One hundred thirty nine women were included, of whom 69 had primary site surgery. TNM stage and phenotypes of breast cancer were comparable in the two groups but operated women were younger than women who did not (p0.0001). Average follow-up was 31±23.3 months [1-97]. Through logistic regression, we observed that tumor resection decreased death hazard ratio vs no surgery: HR 0.33, 95% CI [0.16-0.66] p=0.001. In the surgery group, there was no survival difference if women received chemotherapy (p=0.23). There were more patients with only one metastatic site in the surgery group (p=0.002) and they had been more treated with systemic therapy. When we compared tumor phenotypes individually, surgery increased survival on luminal A breast cancer patients (p.0001).Women with luminal A breast cancer and synchronous metastasis seemed to benefit from surgery. The development of a national reporting system or registers for outcomes would facilitate the investigation of the disease across a multitude of aspects of stage IV breast cancer.

Hormone receptors (estrogen receptor ER and progesterone receptor PR) are prognostic and predictive factors of outcome for invasive breast cancer. Some tumors only express one of these hormone receptors (ER or PR). ER negative/PR positive breast cancer is a rare subtype (1-4 %) and its existence still controversial. The aim of this study was to evaluate characteristics of this group of tumors.We collected data of all consecutive patients managed in our institution for invasive breast cancer between the 1st January 2007 and 31 December 2013. The aim of the study was to compare data of patients with ER-/PR+tumors with the three other subgroups.Of the 2071 patients included during the study period, 1.2 % were ER-/PR+. These patients were younger than those with the two ER+groups (p0.0001). The ER-/PR+tumors differed from the ER+groups for several histological prognostic factors: greater histological size (p=0.0004), higher histological grade, more HER2 overexpression/amplification, more association with ductal carcinoma in situ, more lymphovascular invasion, more nodal metastasis (p0.0001). Chemotherapy was more often used as an adjuvant treatment in addition of endocrine therapy. Survival was equivalent for patients with ER-/PR+tumors and ER+tumors and significantly higher than patients with ER-/PR- tumors (p0.0001).Women with ER-/PR+breast cancer have worse prognostic factors than women with ER+cancers but have better overall survival than women with ER-/PR- tumors. We may think that the more frequent association of chemotherapy and endocrine therapy is responsible for this better outcome.

International audience; Background - The purpose of this study was to develop a nomogram to predict 'poor prognosis recurrence' (PPR) in women treated for endometrial cancer (EC). Methods - The data of 861 women who received primary surgical treatment between January 2001 and December 2013 were abstracted from a prospective multicenter database. Data were randomly split into two sets: training and validation with a predefined 2/3 ratio. A Cox proportional hazards multivariate model of selected prognostic features was performed in the training cohort (n=574) to develop a nomogram predicting PPRs. The nomogram was validated in the validation cohort of 287 patients. Results - In the training cohort, 82 (14.3%) developed subsequent PPR. Age, histologic type and grade, lymphovascular space invasion status, FIGO stage, and nodal staging (SLN±pelvic and/or para-aortic lymphadenectomy) were independently associated with subsequent PPR. The nomogram showed an area under the receiver operating characteristic curve (AUC) of 0.82 (95% confidence interval (CI), 0.73-0.89) in the training set. The validation set showed a good discrimination with an AUC of 0.75 (95% CI, 0.65-0.83). Conclusions - We have developed a robust tool that is able to predict subsequent PPRs in women with FIGO I-III EC.

International audience; The fatty acids composition of adipose tissue may provide information on the nutritional part of the risk or evolution of breast cancer. To determine whether 1H NMR of adipose tissue provides information on the nature of the diet consumed, a dietary intervention with increasing percentage of polyunsaturated n-3 docosahexaenoic acid (DHA 22:6n-3, provided as DHASCO oil) was applied to a rat model of N-nitroso-N-methylurea-induced mammary tumors. Spectra of the lipid extracts were obtained from adipose tissues in five groups of Sprague–Dawley rats fed with a diet containing 7% peanut/rapeseed enriched with 8% (w/w) of an oil without (palm oil) or with low (1%), moderate (3%), or high (8%) DHASCO content. A control group received a basal diet with 15% peanut/rapeseed representative of the “Western” diet. After 5 months of those five controlled diets, adipose tissue was collected for analysis of the lipid extract using both 1H NMR analysis on an 11.7 T spectrometer and gas chromatography considered as gold standard. 1H NMR analysis showed a dose-dependent increase in DHA in the lipid extract of adipose tissues and a commensurate decrease in n-6 polyunsaturated fatty acids in the three DHA groups, which allowed one to follow n-6/n-3 ratio changes. The highest n-6/n-3 ratio was observed in the control Western diet group compared to the other diet groups. The integrated spectral regions showed separation between groups, thereby documenting a specific NMR lipid profile corresponding to each dietary intervention. Those diet-dependent NMR lipid profiles were consistent with that obtained with gas chromatography analyses of the same samples. This study is a proof of concept highlighting the potential use of the 1H NMR approach to evaluate dietary intervention in biopsies of adipose tissues.

Predicting the pattern of recurrence can aid in the development of targeted surveillance and treatment strategies. The objectives of this study were to identify patterns of recurrence in women with operable endometrial cancer (EC) and to identify high-risk periods for recurrence in function of age.The data of 1153 women who received primary surgical treatment for stage I-III EC between January 2001 and December 2013 were abstracted from a prospectively maintained multicentre database. The time to first recurrence was calculated from the date of diagnosis, and the associated hazard function was examined to determine the peak risk period of recurrence. We categorized age at diagnosis as65 and ≥ 65 years old and analysed the hazard rate (HR) by stratifying age groups.Women with EC aged ≥65 years maintain a significant recurrence rate during follow-up whatever the stratification (locoregional recurrence, distant recurrence, ESMO/ESGO/ESTRO subgroup). Multivariable Cox proportional hazard regression showed that the increased risk of recurrence of EC was associated with advanced age, advanced disease ESMO/ESGO/ESTRO subgroup but not with initial treatment received.The annual HR of recurrence is not uniformly distributed over time but is dynamic and markedly determined by prognostic factors at diagnosis.

We developed a risk scoring system (RSS) for predicting breast conservative surgery (BCS) in women receiving neoadjuvant chemotherapy(NAC) for breast cancer. BCS rate in the training set was 32.6%, associated with five variables: age < 50years, primary radiological tumor diameter < 60mm, absence of multifocality, absence of breast inflammation and hormone receptor status. These variables were assigned scores ranging from 0 to 9. The discrimination of the RSS was 0.78(95%CI 0.69-0.86) in the training set. The area under the curve of the receiver operating characteristics for predicting BCS after internal and external validation was 0.77(95%CI 0.68-0.85) and 0.75(95%CI 0.66-0.84), respectively.

The incidence of vulvar intra-epithelial neoplasia (VIN) is increasing in the developed countries especially in young women. There is little consensus regarding the optimal management. Surgery used to be the gold standard. Alternatives to surgery are now needed for the treatment of VIN. Many studies investigated the effectiveness of Imiquimod 5% cream in this pathology. We present a literature review of the results published on the subject.

Resume Objectif Etude comparative des complications per- et postoperatoires de deux methodes chirurgicales du traitement de l’endometriose digestive en chirurgie robot-assistee : la technique du « shaving » (exerese la plus complete possible du nodule au contact du tube digestif sans effraction de la muqueuse) et la resection colorectale. Methode Vingt-huit femmes operees en laparoscopie robot-assistee pour de l’endometriose sous-peritoneale profonde avec atteinte digestive confirmee a l’histologie ont ete incluses. Six femmes ont eu une resection digestive et vingt et une ont eu une procedure de shaving . La morbidite immediate, a deux mois et a un an ont ete comparees entre les deux groupes. Resultats Les durees d’intervention etaient plus courtes ( p = 0,0002) et les saignements etaient moins importants dans le groupe shaving (200 mL vs 560 mL ; p = 0,04) que dans le groupe resection. Nous avons observe un cas de conversion en laparotomie dans le groupe resection et une plaie de vessie dans le groupe shaving . Les durees d’hospitalisation etaient plus longues dans le groupe resection ( p = 0,0001) que dans le groupe shaving . A la reevaluation a deux mois, il n’y avait pas de difference significative entre les deux groupes pour le nombre de femmes en remission complete, pour les douleurs pelviennes, les symptomes urinaires ou digestifs ou les dyspareunies. Deux femmes du groupe resection ont rapporte des signes fonctionnels digestifs qui persistaient 24 mois apres l’intervention. Conclusion La morbidite operatoire immediate et tardive est plus importante en cas de resection digestive. La chirurgie de l’endometriose profonde, meme en laparoscopie robot-assistee, reste pourvoyeuse de complications operatoires importantes.

International audience; PURPOSE: This study was designed to compare conventional closure with a drain and quilting suture of mastectomy dead space for preventing wound seroma. METHODS: Consecutive patients undergoing mastectomy for breast cancer were included in this retrospective observational study. Patients received conventional closure with drainage or quilting suture for wound closure. Propensity score (PS) matching was performed based on potential confounders to minimize selection bias. The primary outcome was the rate of type 2 or 3 wound seroma according to the common terminology criteria for adverse events (CTCAE) definition. RESULTS: A total of 119 patients were included (quilting suture n = 59; conventional closure n = 60). Type 2 or 3 seroma was observed in 6.8 % of the quilting suture group and 21.7 % of the conventional closure group (crude odds ratio 0.26; 95 % confidence interval 0.08-0.86; p = 0.03). The overall seroma rate was 15.2 % in the quilting suture group and 51.7 % in the conventional closure group (p < 0.001). Persistent pain at days 15-21 was significantly less frequent in the quilting suture group than in the conventional suture group. PS matched analysis confirmed these findings, in particular the lower rate of type 2 or 3 seroma in the quilting suture group than in the conventional closure group (PS-matched odds ratio 0.16; 95 % confidence interval 0.04-0.72; p = 0.02). CONCLUSIONS: Quilting suture of the mastectomy dead space is associated with significantly less frequent seroma than conventional closure with drain.

Resume Objectif L’apparition d’un serome post-operatoire constitue la principale complication de la mastectomie. En 2011, Ouldamer et al. ont choisi d’adapter une technique de capitonnage utilisee en chirurgie reconstructrice a la loge de mastectomie. Notre etude a pour but d’evaluer l’interet de cette technique de capitonnage dans la prevention des seromes post-operatoires. Patientes et methodes Il s’agit d’une etude prospective observationnelle, realisee au centre hospitalo-universitaire de Tours. Cent quarante-quatre patientes ayant beneficie d’une mastectomie entre le 1 er janvier 2011 et le 1 er octobre 2012 ont ete incluses. Les patientes ont ete reparties en 2 groupes, un beneficiant d’un drainage post-operatoire classique et le deuxieme beneficiant d’un capitonnage de la loge de mastectomie sans drainage. Resultats Le capitonnage de la loge de mastectomie reduit significativement l’apparition de serome post-operatoire (OR = 0,15 ; IC 95 % [0,06–0,39] ; p p p Conclusion Cette etude montre un benefice a la realisation du capitonnage de la loge de mastectomie non seulement sur l’incidence de survenue des seromes mais aussi sur la duree d’hospitalisation, sans augmentation des douleurs post-operatoires.

Resume Objectif L’hyperemesis gravidarum correspond a la forme la plus severe des nausees et vomissements de la grossesse. Cette complication de la grossesse a ete peu etudiee en France. Le but de cette etude etait de preciser les caracteristiques de l’hyperemesis gravidarum dans une cohorte de femmes francaises. Methodes Cent neuf femmes, hospitalisees dans les services de gynecologie du CHRU de Tours au 1er trimestre de la grossesse pour hyperemesis gravidarum entre 2001 et 2010, ont ete incluses dans cette etude de cohorte retrospective. Les caracteristiques cliniques et biologiques, et les issues de grossesses ont ete analysees a partir des dossiers des patientes. Resultats La prevalence de l’hyperemesis gravidarum dans notre centre a ete evaluee a 3,9 pour 1000 accouchements durant la periode de l’etude. Les femmes etaient d’origine etrangere dans 53 % des cas. La duree moyenne de la premiere hospitalisation etait de 4,6 ± 2,6 jours (extremes : 1–17) et 12,8 % des femmes etaient hospitalisees a plusieurs reprises. L’hyperemesis gravidarum recidivait dans un tiers des cas. L’activite serique de l’ALAT etait superieure a 35 UI/L dans 25,7 % des cas a l’admission ou durant l’hospitalisation. L’elevation de l’ALAT etait significativement associee a un IMC > 25 kg/m2 (OR, 3,98 ; IC 95 % : 1,29–12,59 ; p = 0,006), a une perte de poids superieure ou egale a 6 kg (OR, 4,52 ; IC 95 % : 1,53–13,77 ; p = 0,002) et a une duree d’hospitalisation superieure ou egale a 6 jours (OR, 3,43 ; IC 95 % : 1,19–9,97 ; p = 0,009). Les issues de grossesse n’etaient pas differentes chez les femmes ayant une ALAT elevee par rapport a celles qui avaient une ALAT normale. Le taux de prothrombine a l’admission etait inferieur a 70 % dans 25,6 % des cas, en rapport avec une carence en vitamine K. Conclusion Cette etude de cohorte francaise a montre que l’hyperemesis gravidarum etait frequemment associee a l’origine etrangere, a des anomalies de tests hepatiques et a une diminution du taux de prothrombine. L’elevation de l’ALAT serait un facteur de severite de cette maladie.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 44 - N° 1 - p. 83-87

Purpose the aim of our study was to investigate whether there is radiological margin that optimize resection of non-palpable invasive or in situ ductal carcinoma. Materials and methods Data were collected for all patients undergoing wire localization prior to therapeutic surgical excision between January 2010 and December 2013 at our institution. A 5 and 10-mm radiological margins were considered adequate for invasive ductal carcinoma (IDC) and in situ ductal carcinoma (DCIS) respectively. Clear histological margins were defined as no ink on the tumor for IDC and ≥2 mm for DCIS. Data were analyzed both in order to assess accuracy of the technique and in order to determine what radiological threshold should be taken. Results Three hundred seventy seven women were included to the study. The radiological thresholds permitted negative histological margins in 94.7%, 60.9% and 80.9% in the pure invasive ductal carcinoma group (IDC, n = 133), the pure ductal carcinoma in situ group (DCIS, n = 92) and the mixed group (both IDC and DCIS, n = 152) respectively. In an ROC analysis evaluating the ability of radiological thresholds to obtain free pathological margins: the AUC was 0.79 (0.71–0.87, 95% confident interval, p = .0007) for Pure IDC group, 0.67 (0.57–0.87, 95% confident interval, p = .0005) for pure DCIS group, and 0.72 (0.62–0.80, 95% confident interval, p Conclusion We found that a radiological margin of 10 mm is needed in presence of an in situ component and 5-mm radiological margin seems enough in case of pure IDC tumors.

Purpose The aim of the study was to investigate the management and prognosis of axillary cancers from unknown primaries (CUPax). Methods We included all patients with lesions described as axillary nodal metastases from an unknown primary referred to four French tertiary breast cancer centres between January 1988 and December 2012. The inclusion criteria comprised: no sign of primary breast cancer on clinical examination nor on imaging (mammography, ultrasonography and breast MRI) and no primary tumour identified elsewhere. Results CUPax represented 1.8% of all metastatic axillary lymphadenopathies in our institutions. The overall survival rate was 71%, and 16.7% of patients had secondary inflammatory breast cancer signalling a posteriori that CUPax originated from the breast. Factors that favourably affected survival according to univariate analysis were: histological type of non specific adenocarcinoma (versus other types, p = 0.02), only one lymph node involved (versus several, p = 0.04), a normal CA153 serum-level (p = 0.02), no distant metastasis at initial assessment (p = 0.02), no secondary distant metastasis (p = 0.005) and radiotherapy to the ipsilateral breast/chest wall/lymph nodes (p = 0.04). On multivariate analysis including these factors, a histological type of non-specific adenocarcinoma (p = 0.03) and distant metastases (p = 0.03) were identified as independent factors affecting survival. Conclusion We believe that these results will shed light on current investigations and treatment of this rare entity.

We present a large institutional study to determine factors predictive of axillary lymph node (LN) metastasis in breast cancer according to molecular subtype.We conducted a retrospective analysis of our prospectively maintained breast cancer database study using data from of women managed from January 2009 through December 2013. Clinicopathologic characteristics were correlated with lymph node status and outcome according to breast cancer molecular subtyping.LN metastases were detected in 464 (32.1%) of 1444 women with breast cancer. By multivariate analysis, independent factors predictive of LN involvement were: for the luminal A subtype (n=776): tumour size: OR=1.05 [95% CI: 1.03-1.07] P0.0001; lymphovascular invasion: OR=3.06 [95% CI: 1.80-5.20] P0.0001 and tumour grade: OR=1.65 [95% CI: 1.07-2.58] P=0.026. For luminal B subtype (n=441): age: OR=0.97 [95% CI: 0.95-0.99] P=0.004; tumour size: OR=1.03 [95% CI: 1.01-1.05] P=0.002; lymphovascular invasion: OR=3.21 [95% CI: 1.92-5.44] P0.0001; inflammatory breast cancer: OR=12.36 [95% CI: 2.18-243.3] P=0.019. For the HER2 subtype (n=72): lymphovascular invasion: OR=7.87 [95% CI: 2.10-35.2] P=0.003. For the triple negative subtype (n=155): parity: OR=1.53 [95% CI: 1.10-2.25] P=0.02; tumour size: OR=1.03 [95% CI: 1.01-1.05] P=0.002 and lymphovascular invasion: OR=7.13 [95% CI: 2.46-22.8] P=0.00048.This retrospective study provides valuable insight into LN involvement of patients with primary breast cancer according to molecular subtyping.

To develop a risk scoring system (RSS) for predicting recurrence in women with borderline ovarian tumours (BOTs).Cohort study of women with BOTs.French multicentre tertiary care centres.A cohort of 360 women with BOTs who received primary surgical treatment between January 2000 and December 2013.Clinical and pathological factors affecting recurrence in women with BOTs.The development of a model for the prediction of recurrence in women with BOTs.Overall the recurrence rate was 20.0% (72/360). Recurrence was associated with five variables: age 45 years; preoperative serum tumour marker CA125 150 IU/mL; a serous histological subtype; International Federation of Gynecology and Obstetrics (FIGO) stage other than IA; and ovarian surgery other than bilateral salpingo-oophorectomy (BSO; i.e. cystectomy and unilateral salpingo-oophorectomy). These variables were included in the RSS and assigned scores ranging from 0 to 6. The discrimination of the RSS was 0.82 (95% confidence interval, 95% CI 0.79-0.85). A total score of 8 points corresponded to the optimal threshold of the RSS, with a rate of recurrence of 11.8% (35/297) and 58.7% (37/63) for women at low risk (8 points) and women at high risk (≥8 points), respectively. The diagnostic accuracy was 85.0%.This study shows that the risk of BOT recurrence can be accurately predicted so that women at high risk can benefit from adapted surgical treatment.Our RSS permitted women with BOTs at low risk to be distinguished from women with BOTs at high risk of recurrence.

International audience; Background - The European Society of Medical Oncology (ESMO)/European Society of Gynaecological Oncology (ESGO)/European Society for Radiotherapy & Oncology (ESTRO) classification for endometrial cancer (EC) now includes a high-intermediate risk (HIR) group of recurrence due to the adverse prognostic role of lymphovascular space involvement (LVSI) and grade 3 for women at intermediate risk. However, optimal surgical staging, and especially the place of lymphadenectomy, remains to be elucidated. We aimed to establish whether systematic nodal staging should be part of surgical staging for women with HIR EC. Methods - We abstracted from a prospectively maintained multicentre database the data of 181 women with HIR EC based on uterine factors (endometrioid type 1, grade 1-2 tumors with deep (≥50%) myometrial invasion and unequivocally positive LVSI, and those with grade 3 tumors with

Resume Objectif Le but de ce travail etait d’evaluer les caracteristiques operatoires, postoperatoires ainsi que le pronostic des patientes traitees pour cancer endometrial en fonction de leur indice de masse corporelle (IMC). Patientes et methodes Nous avons repris les donnees de toutes les patientes prises en charge pour carcinome endometrial dans notre centre entre janvier 2000 et septembre 2012. L’IMC des patientes a ete categorise en : maigre, normal, surpoids et obese. Resultats Un total de 192 patientes a ete evalue. Le recul moyen etait de 52,6 mois (1–153). L’IMC et les extremes dans chaque categorie etaient de : 16,97 kg/m 2 (14–18), 22,97 kg/m 2 (20–24,9), 27,61 kg/m 2 (25,7–29,4) et 37,34 kg/m 2 (30–71). Comme attendu, les patientes en surpoids et obese avaient plus souvent de l’hypertension (8,3 %, 31,43 %, 58,13 % et 59,7 % respectivement, p p = 0,0004). Les patientes avec IMC normal avaient plus souvent eu un traitement hormonal substitutif a la menopause par rapport aux autres categories ( p = 0,02). Le temps operatoire, la duree moyenne d’hospitalisation n’etaient pas differents dans les 4 groupes. Dans le groupe patientes obeses, il y’ avait plus de saignement peroperatoire ( p = 0,05), plus d’abces de paroi ( p = 0,05), plus d’eventration ( p = 0,02) et plus de re-interventions pour complications ( p = 0,03). Les patientes avaient les memes protocoles de traitements (que ce soit chirurgical ou adjuvant) et les tumeurs avaient des caracteristiques histologiques equivalentes entre les differents groupes sauf pour l’atteinte ganglionnaire pelvienne ou les patientes obeses avaient moins de ganglions pelviens atteints (positifs) ( p = 0,03). Il n’y avait pas de difference de la survie globale a 5 ans entre les differents groupes ( p = 0,54). Discussion et conclusion Notre etude montre une equivalence de survie entre les patientes obeses et non obeses malgre le fait que les patientes obeses presentaient significativement moins d’atteinte ganglionnaire pelvienne.

Resume Objectif Evaluer la rentabilite diagnostique du prelevement endocervical (PEC) fait dans le cadre des urgences gynecologiques en etudiant ses circonstances de realisation et ses resultats bacteriologiques. Patientes et methodes Nous avons inclut dans notre etude toutes les patientes qui ont eu un prelevement endocervical avec un examen gynecologique au cours d’une consultation au service des urgences gynecologiques du CHU de Tours entre le 1 er janvier 2012 et le 31 decembre 2012. Nous avons evalue la rentabilite diagnostique de realisation du prelevement endocervical (taux de positivite en cas de realisation du PEC, taux de correction diagnostique en cas d’IGH). Resultats Sur la periode de l’etude, 614 (12,4 %) femmes consultant aux urgences ont eu un prelevement endocervical. Le PEC etait positif chez 102 d’entre elles (16,6 %) avec un diagnostic retenu d’IGH chez 64 patientes. Le PEC avait une pertinence maximale en cas de douleurs pelviennes spontanees ou provoquees et quasi nulle chez les femmes enceintes chez qui la realisation des PEC doit etre restreinte. Il a malgre tout retabli le diagnostic d’IGH dans 46,8 % des cas d’IGH averes. Conclusion La rentabilite diagnostique du prelevement endocervical dans notre service d’urgences gynecologiques etait faible en considerant la population globale, mais il a permis de retablir le diagnostic d’IGH chez un peu moins de la moitie des IGH averees, et semble peu rentable parmi les femmes enceintes.

Background: Estimation of fetal weight is essential in contemporary obstetrics. Clinical estimations using maternal and fetal characteristics and ultrasound methods exist. We compared a simple clinical estimation that is in use in low resourced facilities in Cameroon and ultrasound in a completely Caucasian environment. Methodology: In this cross –sectional study, consented pregnant women with singleton pregnancies were carefully selected and enrolled. Those with adjuvant pathologies that increased uterine volumes were eliminated. We measured fundal heights and applied the Kornyuy – Mbu’s formula for birth weights and compared these with echographic estimations and actual birth weights. We calculated the percentage error between estimated birth weights (EBW) and actual birth weights (ABW) for accuracy and the ratio by percentage of estimation within 10% of actual birth weights. Results: The average birth weight was 3,529 + 0.35g. We did not have any baby who weighed 4,000g. The mean maternal age was 29, 2 + 4 years. The median gravidity and parity were 2 and1 respectively. The mean gestational age at delivery was 40.8 + 0.6 weeks. Clinical method underestimated and echographic method overestimated birth weights slightly but with no significance difference (P=0.130). Clinical method was able to estimate birth-weights within 10% of actual birth weight in all the subjects as against only 50% of the subjects with ultrasound. Conclusion: Clinical estimation of birth weight as described by Kornyuy and Mbu is as accurate as routine echographic estimation in cases that are well selected.

Resume Objectif Identifier la part des antecedents familiaux chez les patients de sexe masculin pris en charge pour carcinome mammaire, ainsi que la survenue de cancers extra-mammaires, notamment prostatiques. Patients et methodes Les patients pris en charge pour un cancer du sein primitif histologiquement prouve entre le 1er janvier 1997 et le 31 juillet 2012 dans les services de gynecologie et de chirurgie viscerale du CHRU de Tours ont ete inclus. Nous avons recueilli les donnees concernant la clinique (incluant les co-morbidites et l’indice de masse corporelle) ainsi que les antecedents personnels et familiaux de cancers. Resultats Sur la periode de l’etude, 32 tumeurs mammaires primitives ont ete operees chez 31 hommes. Un antecedent familial de cancer du sein a ete retrouve chez 32 % des patients. Neuf patients (29 %) ont eu un deuxieme cancer primitif (cancer extra-mammaire) et 16,1 % ont eu un adenocarcinome prostatique associe. Conclusion Le cancer du sein chez l’homme se developpe souvent dans un contexte familial de cancer du sein. Son diagnostic doit amener au depistage de cancer de prostate, surtout chez l’homme jeune avec des antecedents familiaux.

Resume Objectif Identifier les modes de diagnostic des cancers du sein bilateraux et synchrones (CSBS) et determiner la part de l’imagerie dans ce diagnostic. Patientes et methodes Entre janvier 2006 et juillet 2012, nous avons releve les cas de CSBS pris en charge au CHU de Tours, definis par des carcinomes invasifs ou les carcinomes canalaires in situ diagnostiques simultanement et jusqu’a trois mois suivant le premier diagnostic. Nous avons recueilli les donnees concernant la clinique (incluant les comorbidites et l’indice de masse corporelle en kg/m2) ainsi que les examens d’imagerie realises pour identifier l’apport de ces examens dans le diagnostic des CSBS. Resultats Sur les 2322 patientes avec cancer du sein pris en charge dans notre centre sur la periode de l’etude, 46 patientes ont ete incluses. Un antecedent familial de cancer du sein a ete retrouve chez 41,3 % des patientes. Au total, 56,52 % des patientes presentaient au moins un signe d’appel clinique. Le tableau diagnostique le plus frequent (32,6 %) etait l’association d’une lesion clinique et d’une anomalie radiologique. L’IRM mammaire a permis de diagnostiquer une lesion controlaterale occulte pour 19,6 % des patientes ayant un CSBS. Discussion et conclusions L’examen clinique et l’imagerie conventionnelle (mammographie/echographie mammaire) permettent le diagnostic de la majorite (76 %) des cancers mammaires controlateraux synchrones. L’histoire familiale, la presence d’une tumeur multifocale ou d’un carcinome lobulaire infiltrant doivent encourager a une exploration du sein controlateral, notamment par IRM afin d’eliminer un carcinome controlateral.