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Ovarian epithelial dysplasia has been described in the ovarian surface epithelium by histologic, morphometric and nuclear profile studies. It could represent a potential precursor of ovarian malignancy in patients with genetic risk of ovarian cancer, although its natural history and progression to carcinoma are unpredictable. Diagnosis and identification of ovarian dysplasia would certainly be useful to understand the early steps of ovarian carcinogenesis. However, dysplasia in relation with ovulation induction seems to have a different pattern. We report dysplasia definitions and the current clinical management.

Ovarian remnant syndrome is defined as residual ovarian tissue non intentionally left in place by the surgeon during a bilateral salpingo-oophorectomy. Patients present various symptoms usually including chronic pelvic pain, pelvic mass, bowel obstruction, hydronephrosis due to ureteral compression. We report a case of adenocarcinoma arising in such an ovarian remnant revealed by vaginal bleeding 5 years after total abdominal hysterectomy and bilateral oophorectomy for uterine fibroids. It was regarded as stage IIIc according to the FIGO classification because of common iliac lymph node involvement while there was no ascitis, no peritoneal nor omental implant but a unilateral hydronephrosis induced by extrinsec ureteral obstruction. Complete cytoreductive surgery was achieved including partial bladder and lower ureteral resection with colpectomy, omentectomy, pelvic and para-aortic lymphadenectomy. Paclitaxel-Platinum combination chemotherapy was given for nine cycles.

To investigate the role of sentinel lymph node biopsy for microinvasive ductal carcinoma in situ of the breast.From January 2001 to January 2006, lymphatic mapping was performed using radiocolloid and/or blue dye technique. Full axillary lymph node dissection was accomplished systematically in 10 instances at the beginning of the study, and furthermore when the sentinel node was involved (macrometastatic or micrometastatic disease).Identification rate was 98% (40/41), the unsuccessful procedure occurred after incisional biopsy for diagnosis. The number of sentinel nodes removed was 2 in average (1-5). Sentinel node involvement was found in 10% of cases (4/40): 1 sentinel node macrometastasis pN1, 2 sentinel node micrometastases determined by hematoxylin and eosin staining pN1 (mi), 1 sentinel node micrometastasis detected only by immunohistochemical staining pN0 (mi).Sentinel lymph node sampling should not be currently applied for management of every ductal carcinoma in situ of the breast but a selective utilization is proposed in documented high risk subset of patients according to clinical, mammographic, and histologic features obtained by percutaneous biopsies. Ductal carcinoma in situ (DCIS) with proved or suspected microinvasion could be scheduled for sentinel node procedure a fortiori in cases undergoing mastectomy because of extensive DCIS before the occurrence of disturbances of lymphatic drainage induced by surgical breast dissection.

Identify the axillopectoral muscle (usually called Langer's axillary arch) and know the main surgical techniques of axillary sentinel node biopsies.We present the results of our five-year clinical prospective study: the presence of this anomaly is diagnosed peroperatively during a sentinel node biopsy.Langer's arch is identified in 1,7%, often with an unilateral distribution. Lymph nodes are just near or behind the muscle. Sentinel node biopsy dissection is difficult in about 40%.The embryological derivation and anatomical features of this muscle are described, with emphasis on the surgical applications. Its presence or absence should be ascertained in every sentinel node biopsy because of the risks of axillary dissection complications by this ectopic muscle.

Leiomyoma of the uterus is a frequent benign tumor of non menopausal women. Among possible complications, polycythemia is rare and often unrecognised. We report a very demonstrative case, that of a 52-year-old woman, who presented initially an episode of metrorrhagia. The difficulty of diagnosis and the treatment are detailed. The different physiopathological hypotheses are discussed in order to ameliorate our knowledge about this association between fibromyoma and polycythemia, and to optimise therapeutic management.

The rise of preoperative diagnosis thanks to new methods of micro and macrobiopsy and the development of sentinel lymph node have dramatically modified the surgical management of patients with breast tumor. The purpose of this study is to know if extemporaneous exams still have a place in the management of breast cancer.Retrospective study which compares the qualitiative evolution of frozen sections in breast tumor at Jean-Perrin center before the practice of percutaneous strereotaxic biopsy and after the training of sentinel lymph node operative biopsy.The results were in favour of a different distribution of anatomocytopathological activity with a decrease of frozen section in breast tumor and an increase of cytological imprints on sentinel nodes.The interest of histologic preoperative diagnosis and the failure of consensus in the sentinel lymph node just leave a restrictive position to frozen section in breast cancer.

To review and describe the anatomoclinical cases of the endometrial cancers arising on polyps during a hormonotherapy by tamoxifen for breast cancer.In the surgical inventory 1990-2002 of the benign or malignant uterine lesions investigated by hysteroscopy with dilatationcurettage (DC) and/or hysterectomy, 108 single or multiple endometrial polyps were encountered and histologically analyzed.A malignant transformation of polyp was found in 5 instances, meaning a rate of 4.6% i.e. 5/108: 4 cases of adenocarcinoma, 1 case of sarcoma.The existence of endometrial polyps - symptomatic or not - does not seem compatible with the prolonged use of tamoxifen treatment owing the estrogen agonist potential effects of tamoxifen and its well-known hyperplastic and carcinogenic properties for the endometrium. The increased risk of endometrial cancer developing in polyps in this iatrogenic context is estimated between 2.5% and 10% in the literature.

Specify the role of axillary lymph node removal in micro-invasive in situ duct carcinomas (DCIS-MI) of the breast with a series of 107 consecutive cases.Single-centre, retrospective, anatomoclinical study with application of the European guidelines adopting as pathological definition the presence of areas of micro-invasion not exceeding 1mm. Axillary lymph node dissection was systematically complete and was preceded by the search for the sentinel node in 10 patients using the isotope method.Lymph node invasion was revealed in 8 cases in the global population (7.5%). All the cases except one exhibited typical deleterious histological features: comedo architectural sub-type, high nuclear grade, and size of the lesion3 cm. The lymph node invasion was of 18.5% in the sub-group of high-grade micro-invasive comedo-carcinomas measuring more than 3 cm.Contrary to those exhibiting pure DCIS, DCIS-MI patients require surgical exploration of the armpit, the most appropriate modalities of which are currently debated: classical axillary lymph node dissection or search for the sentinel lymph node; the selective lymphadenectomy procedure is not yet a consensually validated technique.

Three surgical approaches have been described for the treatment of women presenting an endometrial cancer. The aim of this study was to appreciate the current criteria that would offer guidelines for this choice. We reviewed the data available in the literature (search Medline). Only laparotomy and laparoscopy permit the carrying out of all the routine surgical staging according to the FIGO's criteria (classification 1988). Only one randomised study compares the results obtained by laparotomy and laparoscopy. Laparoscopy patients had significantly less morbidity. Overall survival did not differ in both groups with a limited follow-up. The other not randomised studies show that laparoscopy is usually proposed to patients having a lower IMC and presenting limited stages. No randomized study had compared laparotomy with the only vaginal surgery. The latter is generally proposed for patients having an associated comorbidity and presenting limited stages. In such cases, no difference in survival is highlighted. Obesity does not represent an absolute contra indication for any way. It makes the surgery generally more complex. A suspicious ovarian lesion, a large uterus are, currently, an indication for laparotomy. Laparoscopy can be accepted only if the uterine volume is lower than 500 g and without deep myometrial infiltration. Laparotomy surgery is the standard. The main indication of vaginal surgery is to permit treatment to high operatory risk patients. Laparoscopy is an option for the early stages. It is not recommended if an ovarian lesion or a deep uterine parietal infiltration are suspected. Whatever the route used, the surgeon must be trained.

We report four cases of mixed müllerian tumors of the endometrium arising in postmenopausal women taking tamoxifen for breast carcinoma. Various histopathologic features were encountered: one müllerian adenosarcoma and three malignant mixed müllerian tumors so called carcinosarcomas (in one case the sarcomatous component was homologous composed of tissues normally found in the uterus, while the others were heterologous because they were containing some elements normally not found in the uterus). Concern has been raised about prolonged tamoxifen treatment and subsequent occurrence of endometrial adenocarcinoma. Then, attention has been drawn through high-risk histologic subtypes including poorly differentiated patterns, uterine sarcomas and such mixed müllerian tumors. There is no consensus regarding internal surveillance of women receiving tamoxifen. The usefulness of pelvic sonography has not been demonstrated.

Tamoxifen--a non steroidal triphenylethyl compound--in addition to having antiestrogenic properties may provoke weak estrogenic effects, the well known "paradoxical effects" on the female genital tractus. Concern has been raised about prolonged tamoxifen treatment and subsequent occurrence of endometrial adenocarcinoma; subsequent attention has been drawn through high risk histologic subtypes including poorly differentiated patterns and uterine sarcomas.We report two cases of uterine sarcoma arising in postmenopausal women taking tamoxifen, 20 mg daily during 38 and 42 months, for breast carcinoma: one leiomyosarcoma and one endometrial stromal sarcoma; both cases were asymptomatic and detected by pelvic sonography.Further studies will be required to establish if there is a relationship between long term tamoxifen exposure and highly aggressive types of cancer of the uterine corpus exhibiting adverse histologic features such as uterine sarcomas. There is no consensus regarding uterine surveillance of women receiving tamoxifen. We advocate an annual gynecologic examination plus imaging by means of transvaginal ultrasonography.

To evaluate the place of ovarian transposition by laparoscopy in an effort to preserve ovarian function without compromising oncological safety among young women requiring intravaginal brachytherapy before surgery for cervical cancer.The series was represented by 20 cases, all FIGO stage I squamous cell malignant diseases of the cervix. Mean age: 32 years (range 23-40). Oophoropexy (7 instances) or lateral high ovarian transposition (13 instances) was performed by laparoscopy, just before brachytherapy using cesium 137.Continued hormonal function was achieved in 58% of the available cases, 50% (3/6) after oophoropexy, 68% (8/11) after ovarian transposition. Mean follow-up was 8.5 years (range 5-13). The mean radiation dose absorbed by the displaced ovary was 2.6 Gy (range 1. 2-5.9).Ovarian transposition through laparoscopy before brachytherapy should be advised for selected stage I squamous type malignant tumor size 2 cm without lymphatic/vascular channel invasion by neoplastic emboli and without lymph node involvement. This procedure has been abandoned in our institution, instead of this, primary surgical treatment is accomplished (laparoscopically-assisted vaginal) radical hysterectomy is associated with orthotopic ovarian conservation.

Leiomyomatosis is a benign smooth muscle tumor which can provoke serious complications in case of intracaval or intracardiac extension.A 61-year-old woman had undergone hysterectomy at the age of 45 years for a hemorrhagic fibroma. She underwent surgery for infiltrative breast cancer 3 months before hospitalization and was taking tamoxifen 30 mg/day. In the cancer context, the diagnosis of cavo-cardiac metastatic thrombus was proposed but not confirmed at pathology. The diagnosis of uterine tissue intravascular leiomyomatosis was established on the basis of pathology findings and immunohistochemistry results.Five other cases of leiomyomatosis after hysterectomy have been reported in the literature.

The role of axillary lymph node dissection for microinvasive ductal carcinoma in situ of the breast was analyzed in a series of 60 consecutive cases. Forty-four cases were subclinical mammographically-detected carcinomas revealed by the clusters of microcalcifications. Although pathologists differ in their criteria for microinvasion, the maximal size considered in this retrospective study was 2 mm. Axillary lymph node involvement was found in 3 cases (i.e. 5%) which harbored poor histologic features: comedocarcinoma subtype, high nuclear grade, and size of the ductal carcinoma in situ greater than 3 cm, requiring total mastectomy. While there is no need for axillary dissection in women with pure ductal carcinoma in situ, the management is quite different in proven microinvasion. Owing to the weakness of prognostic information given by cellular, biochemical and molecular features, instead of lymph node status, axillary dissection is still recommended in microinvasive ductal carcinoma in situ.

To assess the characteristic features of ovarian carcinoma mucocellular secondary to breast cancer.A retrospective pathology evaluation of ovariectomy specimens was conducted to compare the histological types with the original pathology diagnosis of breast cancer.Ten cases of ovarian carcinoma mucocellular were observed. Histologically, the ovarian stroma presented voluminous mucin-containing vacuoles in epitheliomatous cells with peripheralized nuclei. In 7 out of 10 cases, the primary breast cancer was invasive lobular carcinoma.These pathology findings are in agreement with comparative studies on the metastatic behavior of different histological types of breast cancer: invasive lobular carcinoma differs from invasive ductal carcinoma by its tropism for gastrointestinal and internal genital organs.

We report a study of 41 radical hysterectomies performed through laparoscopic approach for carcinoma of the cervix uteri. According to the FIGO staging, the tumors were classified as 12 stages Ia2, 24 stages Ib, 4 stages IIa and 1 stage IIb. 17 patients were treated by exclusive surgical procedure. 24 patients received a combination of radiation therapy and surgery 2 patients had a tumor of the cervical stump after subtotal hysterectomy. The mean duration of the procedure was 270 minutes. The post-op stay was 6.5 days. There was no major operative and postoperative complication. Only one patient required a blood transfusion. The intravenous pyelogram control was correct in all cases. At this time, with a 4 to 76 months follow-up, no recurrence was observed. This experience suggests the faisability of the laparoscopic radical hysterectomy. This approach seems to be convenient in young and non obese women with a tumor less than 4 cm in the greatest diameter.

Epithelial ovarian cancer is usually diagnosed at an advanced stage with a bulky tumor in the pelvis and upper abdomen. The most common therapeutic strategy begins by a surgical operation that allows histologic diagnosis, accurate staging and maximal debulking. Since the papers by Griffiths at the end of the seventies, the volume of the residual tumor after surgery appears to be one of the most important prognostic factors in all series. Indeed, patients whose tumor is completely or optimally debulked have greater chances of prolonged survival of about 50% at 5 years. Surgeons experienced in this field can achieve optimal debulking in about 75 to 80% of cases. But, in order to reach this objective, they must often perform an ultra-radical operation with extensive peritonectomies, lymphadenectomies and intestinal resections. Moreover, since 1983, Hacker has shown that the initial tumor bulk was still a poor prognostic factor even after debulking. Today it can be demonstrated that the greater the tumor bulk the more aggressive must be the surgical procedure in order to be optimal and the final benefit will nevertheless be proportionally lower with a higher morbidity rate. This paradigm leads the surgeons to currently try to more accurately assess the initial tumor bulk in order to determine wether the tumor would be optimally debulked by means of a well-standardised operation. If not, the alternative strategy would be 3 chemotherapy courses as front-line treatment before debulking surgery, which hopefully would be easier. Trials are needed in order to validate this strategy despite the fact that some patients will unfortunately have their prognosis jeopardized by the chemoresistance of their tumor.

We report 6 cases of tuberculous peritonitis, focusing on the contribution of laparoscopic exploration. The initial diagnosis was erroneus in all cases: the polymorphous clinical presentations suggested another infectious disease or cancer disease. Laparoscopy was performed in 5 patients who had ascitis and in 1 with plastic peritonitis. At laparoscopy, the peritoneum showed miliary granulations and inflammatory adherences on the visceral or parietal sheats. Bacteriological analyses of the ascitic fluid were positive in only one case. The diagnosis was confirmed after culture of biopsy specimens and identification of the Kock bacilli or on the basis of objective evidence of an epithelioid giant-cell granuloma with caseous necrosis. Outcome was favorable after appropriate antibiotic therapy.

The study concerns 265 patients with axillary lymph node dissection for non-palpable breast cancer. The mammographically detected breast tumors were: 36 ductal carcinomas in situ (DCIS), 23 microinvasive carcinomas, 206 invasive carcinomas of which 179 were invasive ductal cancers (IDC), 25 invasive lobular cancers (ILC) and 2 mucinous invasive carcinomas. The histologic size of the invasive component wasor = 5 mm in 38 cases, 6-10 mm in 84 cases, 11-15 mm in 53 cases, 16-20 mm in 16 cases,20 mm in 15 cases. Axillary dissection was performed immediately during the initial surgical procedure in 209 patients (79%) or secondarily in 56 (21%) according to the results of intraoperative examination of surgical specimens on frozen sections. Axillary lymph node involvement was not found in DCIS, microinvasive carcinomas or invasive carcinomasor = 5 mm in size. Among all 206 invasive breast carcinomas, lymph node involvement was found in 7.8% (16/206) of cases. There were 9/84 (10.7%) in tumors10 mm, 7/122 (5.8%) in tumorsor = 10 mm. Thus, it is concluded that lymph node involvement is unlikely to be found in patients with non palpable breast cancers, specially those with carcinoma in situ, microinvasive breast tumors and invasive breast cancer with less than 5 mm maximum diameter size. Axillary dissection may be avoided in these patients. However, the use of new prognostic factors of lymph node involvement may help in the definition of patient group.

Tamoxifen, a non-steroid anti-oestrogen derivative of diethylstilboestrol, is the main drug used for hormone therapy for hormone-dependent breast cancer. This ambivalent drug has both antagonist and agonist effects. While tamoxifen blocks tumour growth it can also have an undesirable agonist effect on the genital tract. The uterus is a target organ for this paradoxical action due to proestrogenic stimulation of the endometrium and the myometrium. We observed eleven cases of uterine fibromyoma during treatment with tamoxifen which required hysterectomy due to increased tumour volume. The pathology report on the surgical specimens did not show any evidence of malignancy. Differential diagnosis is based on sarcomatous degeneration of the fibromyoma and presence of intra-myomatous metastases from the breast. Hysterectomy is indicated in menopaused patients with a symptomatic fibromyomatous uterus before starting long-term anti-oestrogen therapy for hormone-dependent breast cancer.

Incisional hernia occurred in a patient after laparoscopic hysterectomy. The greater omentum was incarcerated in the tract of the suprapubic trocar (12 mm diameter). Diagnosis and treatment were performed during a second laparoscopy procedure. The greater number of trocar instruments and their larger diameter increases the risk of parietal morbidity after laparoscopic procedures. Elective closures of trocar incisions is recommended when exceeding 10 mm. Prevention of extra-umbilical incisional hernias and dehiscences appears to be more effective when suture is performed under laparoscopic vision with the trocar inserted. Both the aponevrosis and the peritoneal membrane should be treated.

Two women (63 and 68 years) presented with primary angiosarcomas of the skin which had developed on an area of chronic lymphoedema after radiosurgical treatment for breast cancer 4 and 13 years earlier. Immunohistochemistry tests formally eliminated epithelial metastasis and produced evidence in favour of lymphatic or capillary vascular proliferation. Endothelial affinity for anti-factor VIII and positive tests for certain markers of intermediary filaments (actin, vimentin) confirmed the vascular and conjunctive tissue origin of the tumours.

Three rare cases of tumours of the cervix are reported: embryonal rhabdomyosarcoma, granulocyte sarcoma and lymphoma. There were particular problems with diagnosis in each case requiring histochemistry, immunohistochemistry and ultrastructure examinations. Embryonal rhabdomyosarcoma is a uncommon tumour in the adult. Clinically, there is a vegetative formation but no botryoid aspect. Striated muscle cell proliferation, suggested by the morphology of the malignant cells was confirmed by immunohistochemistry which demonstrated desmine and vimentine and by the ultrastructural study which demonstrated Z lines in the cytoplasm of the malignant cells. Granulocyte sarcoma is characterized by a non-tumoural non-destructive infiltration of inflammatory-like cells. Their granulocyte nature is confirmed by histochemistry, the Leder's reaction on frozen samples, immunohistochemistry (expression of NP57). Electron microscopy can also be used. The diagnosis of lymphoma is difficult due to the non-tumoural nature of the lymphomatous infiltration which can simulate inflammatory reaction. In our case, the diagnosis was made on the tumoural aspect of the biopsy made in the deep infiltration zone of an adjacent organ (bladder). Immunohistochemistry demonstrated the lymphoid nature of the tumour and identified a B phenotype. The ultrastructural study gave little information.

Vaginal ultrasonography of the uterus using a high frequency endocavitary probe was performed in 300 postmenopausal women: 150 receiving no replacement nor suppressive hormone therapy and 150 receiving adjuvant anti-estrogen treatment in the form of tamoxifen because of breast cancer. Evidence was found of hydrometra in 84 cases (28%): 10 in the group taking no hormone therapy (6.6%) as compared with 74 in the group exposed to tamoxifen (49.3%). The difference was statistically significant (p0.01). In addition, mean thickness of the endometrium was estimated at 6 mm (range: 2-40) in the first group versus 12 mm (range: 3-60) in the second (p0.001). It emerged from this comparative ultrasound study that the incidence of postmenopausal hydrometra was influenced by taking tamoxifen. Fluid secretion appearances seen one out of two in treated patients reflect the paradoxical proestrogenic type action of tamoxifen on the uterine mucosa.

The authors report their experience with immediate breast reconstruction following salvage mastectomy for local recurrence of invasive breast cancer after conservative treatment. From January 1987 to December 1992, among 91 immediate breast reconstructions, 41 were performed for this indication. The results and complications were analyzed for each of the three techniques used: simple prosthesis (n = 5), latissimus dorsi flap with prosthesis (n = 26), trans abdominalis musculocutaneous flap--TRAM flap (n = 10). Immediate flap reconstruction appears to be required in cases of either early or late local relapse since the skin has been irradiated and the mastectomy must be extensive. The transrectus abdominalis flap allows more extensive resection and gives better cosmetic results without the need for a prosthesis.

A retrospective series of 34 cases of breast cancer combined with uterine cancer is reported. Cancers of the endometrium differed from cervical cancers by their number, 2.2 x more frequent (22 vs 10) and by the sequence of onset: they generally precede breast cancer, whereas they tend to follow cervical cancers. In contrast to the breast cancer/uterine cervical cancer association, which is considered to be fortuitous, the breast cancer/cancer of the uterine body association appears to be determined by a hormonal context. Through a review of the literature, a unifying endocrine theory is constructed, based on the role of hyperestrogenesis in mammary and endometrial carcinogenesis.

The authors report a retrospective series of 32 patients who were operated on by resection of bowel at various stages during the progress of epithelial pathology of malignant ovaries. These operations were carried out in one group during the initial operation, in a second group during a "second-look" operation and in a third group when late recurrences had occurred. Removal of bowel was possible to remove completely or to optimum effect malignant cell bearing areas in 22 cases (59%) and less than optimal reductions in 15 cases (41%). Forty-five different segments of bowel were resected consisting of 18 of the rectum and sigmoid, 11 of the right side of the colon, 9 transverse or left colon, and 5 of the small intestine and 2 of the stomach. One patient died from cardio-respiratory failure immediately after the operation. Seven cases had septic abdominal complications but they settled quickly without further surgery. It was not possible on studying the follow-up of these patients to find any statistically significant improvement in those who had complete or optimum resection as compared with those who were less completely operated on, and those who were operated on in a late stage of the illness. All the same even if it is not possible to show that there is a significant improvement in survival in the populations that have been compared in this study, it does seem advisable to practice bowel resection in order to reduce as much as possible cancer bearing cells so that chemotherapy can be applied more effectively and thus improve the prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

The authors report a case of an ovarian abscess presenting as acute sciatica with pyrexia in a 36-years-old woman with an intrauterine contraceptive device. Imaging (plain X-ray of abdomen and CT scan) was clear-cut, showing an air pocket as a result of abscess formation and dental calcifications which enabled a preoperative diagnosis of dermoid cyst. The outcome was successful following appropriate surgical treatment and unilateral tubo-oophorectomy.

Tamoxifen is the most widely used non-steroidal antiestrogen compound for adjuvant treatment of postmenopausal breast cancer. Tamoxifen has both antiestrogen and estrogen-agonistic activity, which depends on the target tissue involved owing its systemic distribution. Upon the endometrium the agonistic estrogenic effect, so-called "paradoxical" effect, is suggested to induce proliferative changes such as hyperplasia or carcinoma. The authors report four cases of endometrial cancer developed in postmenopausal patients with breast cancer receiving tamoxifen. According to the literature data, the relationship of the tamoxifen to the endometrial remains uncertain: women with breast cancer are at increased risk for this neoplasm sharing common aetiologic hormonal factors and, in most published case reports, the uterine cavity has not been checked up before starting tamoxifen administration.

The results of pelvic and para-aortic lymphadenectomy performed in 24 patients with primary ovarian cancer are reported. The lymph node invasion rate was 20 percent in stages where the disease was apparently limited to the pelvis, and 73 percent in more advanced stages. Invasion was as frequently found at postoperative second-look laparotomy (54 percent) as at initial exploratory laparotomy (46 percent). Retroperitoneal expansion equally involved the pelvic and para-aortic lymph nodes: among 12 patients with positive lymphadenectomy, 8 had combined pelvic and para-aortic invasion, 2 had exclusively pelvic invasion and 2 had exclusively para-aortic invasion. We would therefore recommend to perform lymphadenectomy during the first operation, particularly in presumed stage I or II cancer, and to dissect the lymph nodes in both the pelvic cavity and the lumbo-aortic region.

The authors report two cases of Demons-Meigs' syndrome, one following an ovarian fibrothecoma and the other an ovarian fibroma. There was a striking rise in the serum CA 125 level which was higher than 200 UI/ml, suggestive of cancer of the ovary in both cases. With the help of the literature data, the clinicopathological features of this rare condition and the different hypotheses concerning its aetiology are commented.

The authors report a case of endometriosis (adenomyosis + endometrioma) which occurred in a female patient aged 69 years, who had undergone the menopause 15 years previously and who had been taking Tamoxifen for 7 years as an adjuvant treatment for cancer of the breast. Tamoxifen, a non-steroidal anti-estrogen derived from diethylstilbestrol, has a variable antagonist/agonist so that estrogenic stimulation of the female genital tract may occur, particularly of the endometrial mucosa. The reactivation of the endometriosic foci which had become quiescent under the impact of the natural menopause, which, by iatrogenic analogy is included in the series of paradoxical uterine effects of tamoxifen.

The authors report their experience concerning 110 cases of acute salpingitis that were diagnosed and controlled laparoscopically one month after antibiotic treatment had been achieved. During the second look laparoscopy three parameters were appreciated: pelvic adhesions, tubal patency, and residual inflammation. Laparoscopic findings at the time of early second look have shown relationship between the occurrence of tubal sequelae and the seriousness of initial PID: the relation was statistically significant regarding pelvic adhesions and tubal patency. Chlamydia trachomatis infections were associated with a poorer reproductive potential outcome. Second look laparoscopy seems particularly indicated after severe form of PID (pyosalpinx, tubo-ovarian abscess), in the presence of Chlamydia trachomatis, among young nulliparous woman wishing to conceive.

Ovarian preservation is recommended for young patients with early invasive cancer of the uterine cervix. We describe the laparoscopic technique of ovariopexy we performed among seven patients before brachytherapy and Wertheim surgery and we report our functional results: menopause was avoided in four instances but three failures were observed. The laparoscopic procedure could be improved with coagulation and section of the utero-ovarian ligament, mobilization of the infundibulopelvic ligament; finally the ovary could be transposed in the paracolic gutter. According to the authors, this protocol must be applied only to patients with stage IA or IB squamous cervical cancer, aged less than 35 years.

The authors report a retrospective clinicopathologic study of 8 cases of uterine metastases from breast cancer. This is the largest surgical series dealing with this subject to be published to date. Not autopsy case has been considered. Much information has come out of this analysis and out of the international literature review: secondary location in the uterus can occur many years after the diagnosis and treatment of primary cancer of the breast; infiltration of the endometrium appears as common as infiltration of the myometrium; the histological type is nearly always invasive lobular carcinoma. The later was found in seven out of eight cases; the evaluation of hormone receptor levels in the surgical specimens has shown that most breast cancers metastasizing to the uterus are hormone-dependent.

The authors report a case of spontaneous rupture of the liver during pregnancy which occurred in a 31-year old multiparous woman with pre-eclampsia. In the literature, this rare event is associated with both maternal and fetal high mortality rates. Histopathological studies have shown periportal parenchymal lesions, larger sinusoidal fibrin deposits and hemorrhagic infarctions. Our case was successfully managed with termination of pregnancy by cesarean section without surgical procedure toward subcapsular hematoma. Long term follow-up using liver scans is needed.

The magnesium ion, which is a bivalent cation and is necessary for life, is a co-factor in more than 300 enzyme reactions. It has an action on uterine myometrium causing it to relax by stimulating B2 adrenergic receptors and cyclical AMP. It competes with the calcium ion which brings about inhibition of myosine kinase, and therefore a drop in phosphorylated myosine. Deficiency of magnesium is one explanation for uterine overactivity; because it is difficult to estimate how important it is in certain premature labours because this is caused often by many factors, and the levels of plasma magnesium and of blood cell magnesium give poor information about the magnesium pool. The tocolytic properties of magnesium are interesting. One has to distinguish between oral magnesium-therapy, given as a preventive from the first trimester of pregnancy, and parenteral magnesium therapy which can be curative and which, like beta-mimetics, is indicated in threatened premature delivery.

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