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We report a 50-year-old woman case with an extensive necrotizing fasciitis (NF). The NF appeared 10 years after a tension free vaginal tape procedure for urinary stress incontinence. Vital prognosis was engaged due to the initial sepsis severity. This kind of complication is rare and could be under estimated. NF usually appear soon after surgery, whatever within the year following implantation. Anyway, NF are always related to a vaginal erosion of the tape.

A descriptive analysis of available data on reported cases of uterine carcinosarcomas associated with tamoxifen therapy is undertaken. The role of aromatase inhibitors as alternative to tamoxifen therapy in the adjuvant setting of breast cancer is discussed. The eventual implications of the presumed association of uterine carcinosarcoma and tamoxifen therapy on the choice of the therapeutic agent in the adjuvant setting of hormone-sensitive breast cancer are discussed.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 38 - N° 2 - p. 173-178

Rhabdomyosarcoma (RMS) of the uterine corpus is rare in adult females. This tumor can be encountered in two distinct histopathological contexts: usually as a component of a malignant mixed mullerian tumor and exceptionally as a pure heterologous sarcoma. We report two cases of pure RMS of the uterine corpus occurring in postmenopausal women. The two patients suffered from vaginal bleeding and preoperative diagnosis was achieved in both cases. Both patients benefited from exploratory laparotomy, total hysterectomy and bilateral salpingo-oophorectomy. Both of them were free from the disease 15 months and 1 year respectively, after initial surgery. These two observations are worthy of publication because pure RMS of the uterine corpus is exceptional in postmenopausal women.

Resume Objectifs Les sarcomes uterins sont des tumeurs rares de l’uterus de mauvais pronostic. Ils sont caracterises par une grande heterogeneite histologique et leur symptomatologie n’est pas specifique. Le but de cette etude est d’analyser notre experience sur les sarcomes uterins, d’analyser leurs caracteristiques histopathologiques et cliniques, de discuter des difficultes diagnostiques et therapeutiques qui leur sont associees et de comparer notre serie aux donnees de la litterature. Patientes et methodes Il s’agit d’une etude retrospective des cas de sarcomes uterins pris en charge dans le service de gynecologie-obstetrique du centre hospitalier de Belfort entre 1996 et 2005. Nous nous sommes interesses aux caracteristiques cliniques des patientes, aux caracteristiques anatomopathologiques, aux stades tumoraux en utilisant retrospectivement la classification de la Federation internationale de gynecologie–obstetrique (FIGO), aux types de traitements et au devenir des patientes. Resultats De 1996 a 2005, 15 cas de sarcomes ont ete pris en charge dans notre service. Notre etude comportait six types histologiques : carcinosarcome ( n = 5), leiomyosarcome ( n = 3), rhabdomyosarcome ( n = 2), adenosarcome ( n = 2), sarcome stromal ( n = 2) et sarcome indifferencie ( n = 1). La moyenne d’âge des patientes au moment du diagnostic a ete de 67,6 ans (extremes : 48 a 91 ans). Les metrorragies ont represente la symptomatologie initiale la plus frequente chez dix patientes (67 %). Le delai entre l’apparition de la symptomatologie initiale et le diagnostic histologique de sarcome a ete en moyenne de 17,1 semaines (extremes : une a 60 semaines). Chez dix patientes (67 %), le diagnostic de sarcome a ete porte retrospectivement apres analyse histologique de la piece d’hysterectomie et chez trois de ces patientes seulement (30 %), l’association examen clinique et echographie pelvienne avait permis de suspecter une pathologie maligne. Une biopsie d’endometre a ete realisee chez neuf patientes et cette biopsie a ete negative dans trois cas (33,5 %). Quatorze patientes (93 %) ont beneficie d’un traitement chirurgical : hysterectomie totale avec annexectomie bilaterale chez toutes et lymphadenectomie pelvienne complementaire chez quatre d’entre elles. Au moment du diagnostic, huit patientes ont ete considerees stade I de la FIGO, une patiente stade II, trois patientes stade III et deux patientes stade IV. Chez six patientes, un traitement complementaire a ete associe a la chirurgie : association radiocurietherapie dans trois cas ; curietherapie dans un cas et chimiotherapie dans deux cas. Au moment de l’analyse, quatre patientes ont ete perdues de vue, quatre patientes sont decedees et avec un recul moyen de 25 mois, l’evolution a ete favorable chez sept patientes. Discussion et conclusion Les sarcomes uterins sont des cancers rares de mauvais pronostic. Ces tumeurs n’ont pas de symptomatologie specifique et sont caracterisees par une grande heterogeneite anatomopathologique. Leur diagnostic doit etre precoce, car la survie des patientes est correlee au stade tumoral a la decouverte. Paradoxalement, ce diagnostic est souvent retarde et pose retrospectivement lors de l’analyse histologique de la piece d’hysterectomie.

Malignant transformation of endometriosis is a rare event. The ovaries are the most common sites reported in the literature. Postmenopausal cancer arising in extragenital endometriosis is still more exceptional. Hormone replacement therapy and perhaps, to a lesser extent, Tamoxifen could be risk factors for the malignant transformation of endometriosis. We herein report the case of a patient who has developed, after 11 years of hormone replacement therapy, an extragenital endometrioid carcinoma in the vesico-uterine pouch.

We report a 50-year-old woman case with an extensive necrotizing fasciitis (NF). The NF appeared 10 years after a tension free vaginal tape procedure for urinary stress incontinence. Vital prognosis was engaged due to the initial sepsis severity. This kind of complication is rare and could be under estimated. NF usually appear soon after surgery, whatever within the year following implantation. Anyway, NF are always related to a vaginal erosion of the tape.

International audience; Carcinosarcomas are rare uterine cancers and carry poor prognosis. Although these tumours usually arise de novo, some cases developed under tamoxifen therapy have been reported. We report two more cases of uterine carcinosarcoma occurring in two postmenopausal patients benefiting from tamoxifen therapy as adjuvant treatment of breast cancer. A review of the literature is undertaken.

International audience; Rhabdomyosarcoma (RMS) of the uterine corpus is rare in adult females. This tumor can be encountered in two distinct histopathological contexts: usually as a component of a malignant mixed mullerian tumor and exceptionally as a pure heterologous sarcoma. We report two cases of pure RMS of the uterine corpus occurring in postmenopausal women. The two patients suffered from vaginal bleeding and preoperative diagnosis was achieved in both cases. Both patients benefited from exploratory laparotomy, total hysterectomy and bilateral salpingo-oophorectomy. Both of them were free from the disease 15 months and 1 year respectively, after initial surgery. These two observations are worthy of publication because pure RMS of the uterine corpus is exceptional in postmenopausal women.

International audience; A descriptive analysis of available data on reported cases of uterine carcinosarcomas associated with tamoxifen therapy is undertaken. The role of aromatase inhibitors as alternative to tamoxifen therapy in the adjuvant setting of breast cancer is discussed. The eventual implications of the presumed association of uterine carcinosarcoma and tamoxifen therapy on the choice of the therapeutic agent in the adjuvant setting of hormone-sensitive breast cancer are discussed.

Sarcoma of the uterus are rare uterine cancers with poor prognosis. They are characterised by pathological diversity and their symptomatology is not specific. The aim of this study was to review our experience with uterine sarcomas, to analyze their clinical and histopathological features, to discuss about diagnostic and therapeutic difficulties associated with these tumours and to compare our findings with previously published data.A retrospective review, from 1996 to 2005, of cases of uterine sarcomas diagnosed and treated at the department of obstetrics-gynaecology, Belfort Hospital. Clinical and pathological features, types of treatment, tumoral stage according to the FIGO histological classification and patients' outcome were recorded.From 1996 to 2005, 15 cases of uterine sarcomas have been diagnosed in our department. Our study included six histological types: carcinosarcoma (n=5), leiomyosarcoma (n=3), rhabdomyosarcoma (n=2), adenosarcoma (n=2), stromal sarcoma (n=2), and undifferentiated sarcoma (n=1). Patients' mean age at the time of diagnosis was 67.6 years (range: 48-91 years). Vaginal bleeding was the most common presenting symptom, being present in 10 patients (67%). The mean time from onset of symptomatology and pathological diagnosis of sarcoma was 17.1 weeks (range: one to 60 weeks). In 10 patients (67%), definitive diagnosis of sarcoma was achieved only after surgical specimen analysis and in only three of them (30%), physical examination combined with pelvic ultrasonography had suspected malignancy. Dilation and curettage was performed in nine patients and failed to rule out neoplasia in three cases (33.5%). Fourteen patients (93%) underwent surgery: total hysterectomy with bilateral salpingo-oophorectomy in all of them and pelvic lymphadenectomy in four of them. Eight patients were in FIGO stage I, one patient in stage II, three patients in stage III and two patients in stage IV. Six patients benefited from adjuvant treatment: external beam radiotherapy and brachytherapy in three cases, brachytherapy in one case and chemotherapy in two cases. At the time of analysis, four patients were lost to follow-up, four patients were dead and with an average follow-up of 25 months, seven patients had a favourable outcome.Uterine sarcomas are rare cancers with poor prognosis. Their symptomatology is non-specific and they are characterized by histopathological diversity. Early diagnosis is essential because patients' survival is correlated to tumour stage. However, preoperative diagnosis is often difficult and definitive diagnosis is frequently achieved after pathological analysis of hysterectomies specimens.

Malignant transformation of endometriosis is a rare event. The ovaries are the most common sites reported in the literature. Postmenopausal cancer arising in extragenital endometriosis is still more exceptional. Hormone replacement therapy and perhaps, to a lesser extent, Tamoxifen could be risk factors for the malignant transformation of endometriosis. We herein report the case of a patient who has developed, after 11 years of hormone replacement therapy, an extragenital endometrioid carcinoma in the vesico-uterine pouch.