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Recent years have been marked by a considerable reduction in maternal mortality rates in Tunisia. 60% of these deaths occur in intensive care units. Given the downward trend in maternal mortality rates, severe maternal morbidity is currently considered by several Western authors as a relevant indicator in the assessment of the quality of care delivered to parturients. As a result, we undertook a retrospective study of a population of patients in the gravid-puerperal state in need of a transfer from the maternity ward to the Surgical Intensive Care Department of the Monastir University Hospital between January 1, 2011 and December 31, 2017.

A hematoma in the uterus or intrauterine hematoma is an effusion of blood that accumulates inside the uterine cavity during gestation. Hematomas, especially subchorionic hematomas, appear most often during the first trimester of pregnancy and can occur with or without vaginal bleeding. They are always a major cause for concern for pregnant women. We will consider pregnancy as a high risk pregnancy. It will then be necessary for the woman to keep rest and benefit from more exhaustive follow-up. This work, carried out from a case observed in our service and from a review of the literature, aims to highlight the existence of this entity and the possible unfavorable development with fetal and maternal risks.

The novel coronavirus disease 2019 (COVID-19) has exposed vulnerable populations, including pregnant women, to an unprecedented public health crisis. According to recent data, pregnancy in COVID-19 patients is associated with increased hospitalization, admission to the intensive care unit (ICU) and intubation. It has been suggested that pregnancy induced immune responses and cardiorespiratory changes can exaggerate the course of the COVID-19. The present is a case of a pregnant woman who presented with critical respiratory failure secondary to COVID-19 resulted in her admission to the ICU and mechanical ventilator support. After childbirth, maternal outcomes were marked by disseminated intravascular coagulopathy and cardiopulmonary arrest on day thirty-four of admission. As to the neonatal outcome, a preterm female baby was transferred to the neonatal intensive care unit (NICU) and intubated immediately due to progressive respiratory distress. She was diagnosed with bacterial pneumonia with no evidence of COVID-19 and recovered after twenty-one days after NICU stay. This case showed that the maternal COVID-19 may lead to acute respiratory distress syndrome, coagulation dysfunction and preterm delivery. The risk of vertical transmission by SARS-CoV-2 is probably very low.

La grossesse ovarienne représente une entité rare parmi les grossesses ectopiques. Son diagnostic et sa prise en charge ne sont pas toujours aisés. C´est une pathologie particulière, le clinicien est confronté à une sémiologie clinique pauvre et à un diagnostic échographique difficile. Les critères chirurgicaux restent difficiles à prouver. Nous avons colligé un cas de grossesse ovarienne. La patiente a consulté nos urgences pour des douleurs pelviennes, métrorragies et une aménorrhée de 9 semaines d’aménorrhée (SA). Le diagnostic préopératoire a été évoqué à l´échographie qui a montré une image latéro utérine droite de 7*8cm au dépend de l’ovaire droit. Une laparotomie a été réalisée en urgence. Le traitement chirurgical a été radical après l´échec du traitement conservateur. La grossesse ovarienne est une entité rare de la grossesse extra-utérine qui présente certaines particularités sémiologiques. Son diagnostic est difficile et se base sur des constatations per-opératoires. Sa prise en charge thérapeutique reste pour le traitement des grossesses extra-utérines, malgré le progrès de traitement médical, chirurgicale.

Despite the fact that it is rarely found in the appendix during pregnancy, ectopic decidua can, in some cases, cause the occlusion of the appendicular lumen by extrinsic compression due to the expansion of endometrial tissue or due to decidua polyp formation. This condition consequently leads to appendicular inflammation. We report the case of a 27-year-old primigravida woman, 32 weeks of gestation, who presented to our facility with a 2-day history of isolated right iliac fossa pain. The diagnosis of an acute appendicitis was suspected and a planned appendectomy was performed. Microscopical examination showed appendicular deciduosis.

Epidermoid cysts are developmental cysts of the retrorectal space. They are benign lesions resulting from ectodermal inclusion during neural tube closure. Generally, they are misdiagnosed given that symptoms are often vague and nonspecific. They have a high infection rate (up to 30%) and can be easily mistaken for perirectal abscesses.We present a case of an epidermoid cyst in a 58-year-old woman with a retrorectal cyst mistaken for a perianal abscess, which was initially incised and drained and then, after MRI investigation, an anterior resection was performed.Epidermoid cysts have a high infection rate (up to 30%). Infected cysts can be easily mistaken for perirectal abscesses, pilonidal disease, or fistulae in ano. CT (computed tomography) used in conjunction with MRI (Magnetic Resonance Imaging) is the gold standard for establishing the diagnosis. A biopsy is never indicated. Surgery is the best treatment, even for asymptomatic lesions.Epidermoid cysts are rare and generally misdiagnosed. In fact, symptoms are often vague and nonspecific. Radiologic imaging (especially MRI) is essential for surgical planning and biopsy should be avoided. Once a presacral lesion is diagnosed, even if the patient is asymptomatic, complete resection remains the treatment of choice because of the risk of infection.

Insomnia is defined as a predominant symptom of dissatisfaction with sleep quantity or quality during different phases of the sleep cycle and affects 30%–60% of patients with cancer.1 It is common in most cancers notably breast cancer. Given this high rate and negative impact in breast cancer, early identification of insomnia symptoms should be a priority. However, in practice, sleep disturbance seems under-recognised, and research on sleep in breast cancer is uncommon. We evaluated the quality of sleep and the predisposing factors in breast cancer. This was a cross-sectional study at the departments of medical oncology in the University Hospitals of Monastir and Sousse in Tunisia. It was carried out from 15 January 2017 to 15 June 2017. Inclusion criteria were confirmed diagnosis of cancer, age over 18 years and giving informed written consent to participate. Exclusion criteria were severe cognitive impairments, severe psychiatric disorder and a sleep disorder other than insomnia. A questionnaire collected demographic and clinical characteristics. Patients were asked to complete the following self-administered rating questionnaires: Insomnia Severity Index (ISI), Hospital Anxiety and Depression Scale, Brief Fatigue Inventory (BFI) and Short Form-36 …

Recent years have been marked by a considerable reduction in maternal mortality rates in Tunisia. 60% of these deaths occur in intensive care units. Given the downward trend in maternal mortality rates, severe maternal morbidity is currently considered by several Western authors as a relevant indicator in the assessment of the quality of care delivered to parturients. As a result, we undertook a retrospective study of a population of patients in the gravid-puerperal state in need of a transfer from the maternity ward to the Surgical Intensive Care Department of the Monastir University Hospital between January 1, 2011 and December 31, 2017.

La pandémie récente de COVID-19 a entrainé une crise sanitaire mondiale sans précédent. La susceptibilité des femmes enceintes aux infections a engendré beaucoup d´interrogations quant au sujet du risque de transmission, du risque tératogène et des complications materno-fœtales. La vitesse avec laquelle l´infection a progressé, ainsi que l´ambigüité de son impact sur la grossesse en raison de l´absence de données scientifiques a sollicité les obstétriciens à adapter leur pratique en se basant sur des conduites pragmatiques. Nous avons donné de l´intérêt à ce sujet déclaré par l´OMS comme pandémie mondiale en début mars 2020 pour essayer de planifier la prise en charge obstétricale des patientes infectées par SARS-CoV-2 sur la base des données actuelles. A partir d´un cas hospitalisé dans notre service de gynécologie Mahdia et se basant sur les connaissances actuelles; ce travail a pour objectifs de décrire les différentes manifestations cliniques possibles chez la femme enceinte et d´établir les principes de la prise en charge en cas d´infection COVID-19.

Cervical agenesis is a rare congenital pathology linked to an abnormality in the development of the Mullerian system, the mechanism of this anomaly is unknown. We reported a case of complete cervical agenesis in a 17-year-old girl who underwent a successfully utero-vaginal anastomosis.

Desmoid tumor of the breast is an extremely rare entity. Histologically, it corresponds to a benign fibroblastic proliferation of a local evolution, with a high recurrence potential. We report the first case of elderly woman presented with desmoid-tumor of the breast as a manifestation of Gardner’s syndrome. A brief literature review was provided. We report the case of a 72-year-old woman who presented with five months history of painful and an exophytic mass of her left breast. She is known to have familial polyposis and had a total colectomy with Gardner’s syndrome. She had a history of osteomas of the maxilla. On clinical examination, there was an exophytic painless mass, on the upper medial quadrant of the breast. She had also lipoma in the left leg and pigmented skin lesions in legs. Her mammograms showed a suspicious stellar image. A computed tomography scan showed an ovoid lesion. Excision of the lesion was performed. Histopathology confirms a desmoid-tumor of the breast. Evolution was marked by lesion recurrence. In conclusion, desmoid tumor of the breast is rare, non-metastatic but locally aggressive. Clinical expression is often nonspecific. Treatment remains controversial; surgical excision is the treatment of choice.

Abrikossoff’s tumor or granular cell tumor is a rare soft and usually benign tissue neoplasm of neural origin. It occurs usually in the neck region or in the head. About 16% occur in the vulva. Some malignant cases have been reported in literature. Granular cell tumor was described first by Abrikossoff in 1926. The histogenesis of granular cell tumors is unknown. The clinical diagnosis of vulvar granular cell tumor is difficult. It may be mistaken for Bartholin gland cyst, lipoma or vulvar carcinoma when ulcerated. Histology is the mainstay of the positive diagnosis. Imagery is not essential for the diagnosis of Abrikossoff’s tumor. It is asked when the neoplasm is giant, or when there is a local recurrence or potential metastasis. Surgery is the gold standard treatment of Abrikossoff’s tumor. It consists of local excision with wide margins. Prognosis of granular cell tumor is usually good. Authors report a 25-year-old woman presented with an ulcerate tumor on the labium majus. The objective of this paper is to review the clinical and therapeutic aspects of Abrikossoff’s tumor located in the vulva from case report and literature review.

Primary neuroendocrine carcinoma of the breast is a rare tumor that has been considered special features within conventional breast carcinomas until recently. In this article, we present a case report of a 77-year-old woman with a metastatic grade I primary neuroendocrine carcinoma of the breast that has been growing for seven years. The patient was treated with hormone therapy with good outcome.

Les auteurs rapportent le cas d'une patiente de 58 ans, nulligeste, aux antécédents de maladie de Niemann-Pick qui a consulté pour une tuméfaction vulvo-périnéale de 10 cm, fluctuante et fistulisé avec une ulcération. La patiente était fébrile et présentant un état général altéré. Cette masse a fait craindre le développement d'une tumeur maligne vulvaire nécrosée et infectée sur une dermatose chronique. Elle a eu une incision en vue de drainage des collections purulentes associée à des biopsies multiples qui ont infirmé la présence d'un processus néoplasique. L'association lésionnelle et leurs distributions ont fait porter alors le diagnostic d'une hidradenite suppurative ou maladie de Verneuil. Ensuite le problème posé était celui du choix de la conduite de prise en charge ultérieure parmi les traitements médicamenteux et chirurgicaux décrits. Les auteurs discuteront à travers ce cas et une brève revue de la littérature récente les modalités du diagnostic, les complications et la prise en charge thérapeutique de cette maladie.

Le cancer du sein est le cancer le plus fréquent chez la femme, et son pronostic dépend en grande partie de l'existence de métastases. Le foie, le squelette et les poumons en sont les sites les plus fréquents, alors que les métastases génitales semblent plus rares et moins connues. La découverte d'une masse ovarienne chez une femme présentant un antécédent de cancer du sein pose le problème de son origine primitive ou secondaire. La fréquence rapportée dans la littérature des métastases ovariennes est d'environ 20 à 30 %. Cependant, lorsque l'on découvre une masse ovarienne chez une femme atteinte de cancer du sein, il s'agit trois fois plus souvent d'une tumeur ovarienne primitive que d'une métastase. La localisation utérine cervicale ou corporéale est encore plus rare. Leur diagnostic est souvent tardif, en raison de leur latence clinique; l'échographie, notamment par voie endovaginale et couplée au Doppler couleur, et le Frottis cervico-utérin doivent être réalisés de première intention sachant que leur rendement pour leur dépistage des masses ovariennes semble très faible. L'augmentation des marqueurs tumoraux CA 15-3 et ACE doit conduire à la recherche de métastases, mais ne fournit pas d'orientation diagnostique vers un site métastatique précis. Enfin, c'est l'examen anatomopathologique qui permettra de poser le diagnostic avec certitude. Les auteurs rapportent 3 observations de métastases génitales de cancer primitif mammaire (deux ovariennes et une cervicale utérine) soulignent l'intérêt de l'examen génital précis et régulier dans la surveillance des cancers du sein et discutent les facteurs prédictifs de leur survenue.

We here report the case of a 58-year old nulliparous patient with a history of Niemann-Pick disease who presented with vulvoperineal, fluctuant, fistulized swelling measuring 10 cm associated with ulceration. The patient was febrile with impaired general state This mass caused some concern about necrotic and infected malignant tumor of the vulva associated with chronic dermatosis. Incision and purulent drainage associated with multiple biopsies excluded the presence of a neoplastic process. The diagnosis of suppurative hidradenitis or Verneuil's disease was based on the associations between lesions and their distributions. Then, the problem that arose was that of the choice between drug treatment and surgical procedures. This study, including a short review of the recent literature, aims to outline the diagnostic modalities, the complications and the therapeutic management of this disease.

As life expectancy is on the rise, it is predicted that a growing number of people will live beyond the age of 65 and therefore a higher number of elderly women will have breast diseases requiring significant health care and services. This study is aimed at investigating the characteristics, the treatment and outcomes of women older than 65 years old treated for breast diseases at our institution. This was a retrospective study covering the period from January 2003 to December 2011. It involved 92 patients aged over 65 and treated for breast disease in the Maternity Center of Monastir, Tunisia. The data included characteristics of patients and tumors, treatment and outcomes that were obtained through data extraction sheets. We reported a study of 92 women over the age of 65 of whom 77 women had malignant breast disease (83.6%) and 15 benign breast diseases (16.4%). Breast cancer was discovered at a mean age of 72.5 ± 6.6 years. Distant metastases were found in 5.3% of cases and infiltrative ductal carcinoma was detected in 85.7% of patients. Hormonal receptors were positive for estrogens in 64.7% of cases. Surgical treatment was performed in 73 patients and adjuvant treatment was prescribed for 67 women (86%). The complication rate was 16.6% among the 73 patients who underwent surgery. Benign breast diseases represented 16.3% of the mammary pathologies. Abscesses and fibrocystic mastopathy were the most frequent histological diagnoses. Despite great interest in geriatric gynecological pathology worldwide, many questions related to how optimally treat this patient population remain unanswered. In this study, a surgical treatment was performed in 94.8% of breast cancer patients and the complication rate was 16.6%.

In recent years, the incidence of placenta accreta and associated complications has increased significantly. The authors report the case of a pregnant woman in the 5th month of pregnancy for premature rupture of the membranes. The placenta was inserted low. The evolution was marked spontaneous work followed by the expulsion of the fetus. The delivery of the placenta was haemorrhagic and incomplete. Ultrasonic testing showed a placental fragment integrated in the thickness of the myometrium. Conservative treatment with methotrexate was published a few days later and MRI showed that the anterior uterine sac was filled with blood clots associated with pelvic effusion. A laparotomy was then performed to resect the pouch and the one-piece fragment. The follow-up was uneventful.