Search

Las enfermedades trofoblásticas gestacionales forman un conjunto heterogéneo de patologías infrecuentes. Agrupan patologías benignas (principalmente las molas hidatiformes) y los tumores trofoblásticos gestacionales. Las molas son el resultado de una anomalía de fecundación que origina un exceso de cromosomas paternos. Los tumores trofoblásticos gestacionales son el resultado de una transformación neoplásica de células del trofoblasto de un embarazo, independientemente de su naturaleza: embarazo molar (lo más frecuente), aborto o embarazo normal. El reto del tratamiento de las enfermedades trofoblásticas debe responder a varios problemas: garantizar la mejor supervivencia preservando la fertilidad de estas mujeres en edad de procrear.

La asociación de cirugía y quimioterapia a base de sales de platino ocupa un importante lugar en el tratamiento de los cánceres de ovario. Los principales avances terapéuticos de los últimos años se han centrado en las estrategias terapéuticas de mantenimiento en los cánceres de estadio avanzado. El uso de los inhibidores de las poli-ADP-ribosa polimerasas (PARP) y del bevacizumab de mantenimiento desde la primera línea terapéutica responde a una estrategia de individualización del tratamiento que ha mejorado el pronóstico de las pacientes candidatas a estos fármacos. Por lo tanto, los inhibidores de las PARP se han convertido en imprescindibles en caso de déficit de recombinación homóloga y en particular en presencia de mutación de BRCA. Sin embargo, en la población sin déficit de recombinación homóloga, la indicación de los inhibidores de las PARP, especialmente en relación con el bevacizumab, queda por especificar. Los retos actuales están dirigidos hacia la valoración de la quimiosensibilidad tumoral primaria y la identificación de los mecanismos de resistencia a los tratamientos para evitarlos mediante asociaciones terapéuticas innovadoras, sin olvidar el tratamiento de las pacientes con tumores resistentes o refractarios a las sales de platino.

An MRI is recommended for an ovarian mass that is indeterminate on ultrasound. The ROMA score (combining CA125 and HE4) can also be calculated (grade A). In presumed early-stage ovarian or tubal cancers, the following procedures should be performed: an omentectomy (at a minimum, infracolic), an appendectomy, multiple peritoneal biopsies, peritoneal cytology (grade C), and pelvic and para-aortic lymphadenectomies (grade B) for all histologic types, except the expansile mucinous subtypes, for which lymphadenectomies can be omitted (grade C). Minimally invasive surgery is recommended for early-stage ovarian cancer, when there is no risk of tumor rupture (grade B). For FIGO stages III or IV ovarian, tubal, and primary peritoneal cancers, a contrast-enhanced computed tomography (CT) scan of the thorax/abdomen/pelvis is recommended (grade B), as well as laparoscopic exploration to take multiple biopsies (grade A) and a carcinomatosis score (Fagotti score at a minimum) (grade C) to assess the possibility of complete surgery (i.e., leaving no macroscopic tumor residue). Complete surgery by a midline laparotomy is recommended for advanced ovarian, tubal, or primary peritoneal cancer (grade B). For advanced cancers, para-aortic and pelvic lymphadenectomies are recommended when metastatic adenopathy is clinically or radiologically suspected (grade B). When adenopathy is not suspected and when complete peritoneal surgery is performed as the initial surgery for advanced cancer, the lymphadenectomies can be omitted because they do not modify either the medical treatment or overall survival (grade B). Primary surgery (before other treatment) is recommended whenever it appears possible to leave no tumor residue (grade B).

Adjuvant chemotherapy by carboplatin and paclitaxel is recommended for all high-grade ovarian and tubal cancers (FIGO stages I-IIA) (grade A). After primary surgery is complete, 6 cycles of intravenous chemotherapy (grade A) are recommended, or a discussion with the patient about intraperitoneal chemotherapy, according to her risk-benefit ratio. After complete interval surgery for FIGO stage III, hyperthermic intraperitoneal chemotherapy (HIPEC) can be proposed, in accordance with the modalities of the OV-HIPEC trial (grade B). In cases of postoperative tumor residue or in FIGO stage IV tumors, chemotherapy associated with bevacizumab is recommended (grade A).

To assess the use of molecular genotyping to accurately diagnose and treat human chorionic gonadotropin (hCG)-producing tumors and to evaluate the discriminating capacity of molecular testing on prognosis and overall survival.

En France, les pathologistes sont rarement confrontés à la pathologie parasitaire. De ce fait, le diagnostic réalisé peut parfois être erroné ou imprécis du fait de la difficulté diagnostique majeure des parasites sur coupes, inhérente à cette activité à l’interface entre la Parasitologie et la Pathologie. Cette imprécision peut avoir des conséquences cliniques si aucun prélèvement n’est adressé en Parasitologie, et que seul le prélèvement fixé en formol et inclus en paraffine (FFPE) est disponible.

Aims To assess the cellular proliferation using the monoclonal antibody Ki-67, in paraffin embedded uveal melanomas irradiated by proton beam, as well as in non-irradiated uveal melanomas. Methods 30 enucleated eyes were included for histopathological study and Ki-67 immunostaining. Patients were enucleated between 1991 and 1996 for uveal melanoma, 14 after proton beam irradiation and 16 without treatment (control group). The mean follow up period was 2.5 years after diagnosis and 1 year after enucleation. Results A significant relation was found between Ki-67 score and mitotic index (r = 0.56, p = 0.001), histological largest tumour diameter (r = 0.38, p = 0.03), fibrosis (r = -0.35, p = 0.05), absence of tumoral pigmentation (p = 0.05), and presence of vascular thrombosis (p = 0.03). The Ki-67 score was significantly higher in the non-irradiated group (p = 0.01) and in the group of patients whose cause of enucleation was tumoral evolution (p = 0.005) compared with the group of patients enucleated after neovascular glaucoma. The Ki-67 score was very high in a case of orbital recurrence of uveal melanoma and metastatic death. 70% of metastasised tumours showed a Ki-67 score higher than the median value. Conclusion Ki-67 labelling is a reliable method of estimating the proliferative activity in uveal melanomas after proton beam irradiation. The Ki-67 score is significantly correlated with prognostic variables (mitotic index and histological largest tumour diameter), and with radiation effects after proton beam irradiation.

The aim of this study was to report a series of extracranial cephalic schwannomas. Fifteen patients with extracranial schwannomas treated between 1981 and 1999 are presented, and their clinical course during a median follow-up of 4.1 years is discussed. There is a female predominance. No specific factors have been identified. Their diagnosis is often delayed (median, 2.6 years). There is no predominant side. The orbit represents the most frequent location of schwannomas (26). The trigeminal nerve is the most often affected (53). Computed tomography and magnetic resonance imaging contribute to the diagnosis. Macroscopically, the schwannoma is a well-defined tumor of ovoid form and brownish color. It is formed of soft tissues and is fragmented easily. Diagnosis is often evident on microscopic examination. The only treatment is surgery. It consists of enucleation after opening the epineurium using an operating microscope, without interruption of the continuity of the nerve. The authors have observed only two relapses (the first two patients operated without a microscope). Total excision allows recovery. Nerve injuries have variable prognosis. It is necessary in juvenile populations to search for neurofibromatosis. All schwannomas required surgical treatment using an operating microscope to obtain total recovery.

L’allo-immunisation fœto-maternelle contre les antigènes plaquettaires humains (HPA) peut se produire avant la naissance et induire une thrombopénie fœtale ou néonatale (FNAIT). Le but de cette étude était d’identifier les caractéristiques histologiques du placenta associées à l’allo-immunisation plaquettaire et de déterminer leur signification clinique.