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Paratesticular rhabdomyosarcoma (PRMS) is a rare and aggressive tumor in children and adolescents.Clinically, it is often revealed by the accidental discovery of a large painless bursa.The therapeutic strategy depends on the stage of the tumor and on the prognostic group according to the Intergroup Rhabdomyosarcoma Study (IRS) classification.We report the case of a patient treated in our institution for a paratesticular rhabdomyosarcoma of the embryonic type discovered at a late stage in an adolescent, with the aim of confirming the fatal evolution of this pathology with “awful” metastatic potential.

The chordoma is a very rare notochordal tumor, the cutaneous localization (chordoma cutis) is even rarer and generally follows a local invasion of the integument even a metastasis. The clinical presentation is non-specific and the diagnosis is often late. It is confirmed by the immunohistochemical characteristics of the tumor. Total surgical excision is necessary in order to avoid the local recurrence which represents a frequent character of this tumor. We report the case of a young patient with perineal chordoma evolving from childhood. To our knowledge, our patient represents the first case of chordoma cutis of the perineum without a history of chordoma.

A 59-year-old male patient was admitted to the emergency room with febrile right flank pain. The computed tomography scan and the magnetic resonance imaging had objectified lesion image occupying the upper half of the right kidney, measuring 82 mm, suggesting an infectious origin without excluding the infected tumor. He was put under antibiotics. A percutaneous biopsy revealed renal cell carcinoma with suppurative tumor necrosis. He underwent a right radical nephrectomy. The histopathological study revealed a collision tumor of papillary, chromophobe renal cell carcinoma and sarcomatoid dedifferentiation. It is the second case reported in English literature to date., (© The Author(s) 2022. Published by Oxford University Press.)

We report the first case of a 52-year-old nondiabetic male admitted for management of uremic syndrome associated with emphysematous pyelonephritis (EPN), renal and perinephric abscess, and emphysematous cystitis (EC) on a single functional kidney with a large abundance of spontaneous pneumomediastinum (SP) complicating a SARS-CoV-2 pneumonia. The patient has benefited from several dialysis sessions, intravenous antibiotics, and percutaneous drainage. His clinical course was complicated by acute respiratory distress syndrome, and unfortunately, he died nine days following admission., Competing Interests: None of the contributing authors have any conflicts of interest., (Copyright © 2021 Ibrahim Boukhannous et al.)

Adrenal gland myelolipomas are benign, hormonally inactive, and mostly asymptomatic and unilateral tumors. However, it could be symptomatic and bilateral in rare cases. The diagnosis is based on a CT scan and a histological study. We present a rare case of a surgically managed bilateral adrenal gland myelolipoma with a giant mass on the left side in a 40-year-old man who presented in our department for atypical abdominal pain. The patient underwent surgical resection of the left adrenal mass. Due to the resolution of the abdominal pain, a close follow-up for the right mass by CT scan was chosen., Competing Interests: None of the contributing authors have any conflict of interest, including specific financial interests or relationships and affiliations relevant to the subject matter or materials discussed in the manuscript., (© 2021 The Authors. Published by Elsevier Inc.)

Spermatocytic seminoma is a relatively rare testicular tumor and is characterized by a good prognosis. The discovery of a sarcomatous contingent modifies the prognosis of the indolent neoplasm. Only 20 cases being reported in English literature. We present the case of a 66-year-old man with a two-year history of left-sided scrotal pain and swelling. Tumor markers were normal. Ultrasound demonstrated a very large solid-cystic testicular mass. Orchidectomy was performed. Further imaging investigations revealed lung, vertebra, and retroperitoneal lymph node metastases. Histological examination and immunohistochemistry of the orchidectomy specimen concluded on spermatocytic seminoma associated with undifferentiated sarcoma component., Competing Interests: None of the contributing authors have any conflict of interest., (© 2021 Published by Elsevier Inc.)

Merkel cell carcinoma is a rare neuroendocrine skin tumor with a poor prognosis. Metastasis is frequent and is seen in the first few years after diagnosis. This report describes a case of renal metastasis from Merkel cell carcinoma which is an unusual clinical presentation., (© 2021 Published by Elsevier Inc.)

Emphysematous pyelonephritis (EPN) on a single kidney is an extremely uncommon necrosing infection of renal parenchyma due often to infection by a gas-producing bacteria in a patient with uncontrolled diabetes mellitus. The management associate aggressive fluid and electrolyte resuscitation with several dialysis sessions, control of blood sugar levels, and broad-spectrum antibiotics with an urgent drainage. This paper aims to describe a case of a 68-year-old diabetic male patient who presented with EPN on a single kidney managed by conservative treatment., Competing Interests: None of the contributing authors have any conflict of interest, including specific financial interests or relationships and affiliations relevant to the subject matter or materials discussed in the manuscript., (© 2021 The Authors. Published by Elsevier Inc.)

Solitary extramedullary plasmacytoma (EMP) involving the adrenal gland is an extremely rare malignancy. We report a case of a solitary adrenal plasmacytoma in an HIV-positive 50-year-old woman on antiretroviral therapy who presented with a rapidly progressing lumbar left masse. A CT scan objectified a locally advanced left adrenal mass measuring 135mm long axis. A biopsy was taken, and the histopathology with the immunohistochemical study objectified an adrenal gland plasmacytoma. The skeletal survey and the sternal suction biopsy did not show any abnormalities. The diagnosis of a solitary EMP of the adrenal gland was made. There are only 10 cases of solitary adrenal plasmacytoma with only one case associated with an HIV-positive patient reported in the literature. Therefore, this paper is aimed at presenting the second case of an HIV-positive patient diagnosed with solitary adrenal plasmacytoma., Competing Interests: None of the contributing authors have any conflict of interest, including specific financial interests or relationships and affiliations relevant to the subject matter or materials discussed in the manuscript., (Copyright © 2021 Mehdi Chennoufi et al.)

Testicular ENKTCL is a rare disease. Asia is the most affected. Primary testicular NK/T-cell lymphoma is rare. Metastases are early and the prognosis is poor. Metastases mainly involve the lymph nodes, skin, contralateral testis, bone marrow, spleen and central nervous system. Nasal metastasis giving rise to bifocal presentation is extremely rare. We report the management of a patient initially seen for a nasal swelling with a hidden history of scrotal swelling, in whom nasal biopsies as well as the analysis of the orchidectomy part made it possible to retain the diagnosis of ENKTCL of the testis with a nasal metastasis., Competing Interests: The authors do not declare any conflict of interest., (© 2020 Published by Elsevier Inc.)

Collecting duct carcinoma, also known as Bellini duct carcinoma (BDC) is a rare type of renal tumor, arising from the distal collecting ducts. The prognosis of this disease is extremely poor due to its rapid progression with widespread metastasis. The present study reported a case of CDC involving the left renal region of a 68-year-old female patient. CT scan showed a huge mass occupying the lower portion of the left kidney. The patient underwent enlarged nephrectomy. Anatomopathological examination showed collecting duct carcinoma of the kidney. Patient's evolution was exceptionally favorable: no recurrence, no locoregional metastasis and no distant metastasis., (© 2020 The Authors.)

Renal cell carcinoma (RCC) is an extremely rare and fatal tumor for women of childbearing age. Consequently, the cases published in the literature are limited and medical experience with therapeutic management of newly diagnosed RCC in pregnant women is poor. We report our clinical experience with a renal tumor diagnosed in first-trimester pregnancy complicated in postoperative by an inferior vena cava thrombosis. Further reporting of such a case should help to collect more data in purpose to establish a clear, systematic and evidence guide-ligne in front of this unique situation., Competing Interests: None of the contributing authors have any conflict of interest, including specific financial interests or relationships and affiliations relevant to the subject matter or materials discussed in the manuscript., (© 2020 The Authors.)

The discovery of a kidney stone in a living kidney donor is rare. The managing technique of this situation and the timing of the treatment of the stone is not well codified. Should it be treated before the removal of the kidney or in ex-vivo after nephrectomy and in cold ischemia ? We report a case of a 60-year-old mom who donates kidney willingly to her son. The decision of the transplant team was for the removal of the left kidney (upper calyx stone of 9 mm) and the treatment of the stone in ex-vivo by flexible ureteroscopy., (© 2020 The Authors.)

Introduction: Persistent Mullerian duct syndrome is a rare form of pseudohermaphroditism, possibly resulting from the absence of Mullerian duct inhibiting factor., Presentation of Case: We report the case of a 36 year-old patient with a syndrome of persistent Müllerian ducts (PMDS) of the female type. The Clinical examination revealed avacant scrotum, a normal penis. The spermogram analysis found azoospermia. Imaging using ultrasound and tomotensidometry found the presence of amass in the back of bladder. A Laparoscopic exploration revealed two slightly enlarged testicles, in a pelvic situation intimately confined to a rudimentary uterus with two tubes. The histological examination was in favor of a uterine endometrium and two fallopian tubes. The karyotype requested later was male 46 XY., Discussion: Since the first case, between 200 and 262 cases have been reported in literature around the world, this might reveal that the incidence and prevalence of this type of diseases are not well-estimated. The diagnosis is often a fortuitous discovery during a cryptorchidism surgery or inguinal hernia, more rarely during the management of a state of infertility or the degenerescence of the testis or Mullerian derivative. It is caused by either the anti-Mullerian hormone deficiency (AMH) or a dysfunction of its receptor., Conclusion: A multidisciplinary approach is necessary for surgical management. long-term prognosis is favorable, though fertility seem to be decreased and also it might lead to a riskiness of malignancy owing to cryptorchidism and preserved Mullerian remants., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Adrenal myelolipoma (MLS) is a rare, benign and non-functional neoplasm, composed of adipose tissue and myeloid. We report a rare case of adrenal myelolipoma of a 20-year-old female revealed with chronic abdominal pain. Computed tomography (CT) scan of the abdomen guided diagnosis and surgical resection was performed given symptomatic and bulky mass. Histological examination confirmed the diagnosis. At 18 months after the surgery, the patient had no evidence of recurrence. The diagnosis of MLS is radiological. Therapeutic abstention is the rule for a small, asymptomatic tumor. The surgical removal is indicated when it is bulky (exceeds 7cm), symptomatic or hormonal activity., Competing Interests: The authors declare no competing interests., (© Wassim Alaoui Mhammedi et al.)

A 68-year-old man presented with priapism and penile gangrene. The patient had no history of penis trauma or medications for erectile dysfunction. Corpus cavernosa aspiration cytology were positive for malignant cells. Total penectomy was performed. Enhanced chest and abdominal computed tomography showed a left renal tumor with pulmonary and hepatic metastases. Ultrasound-guided renal biopsy showed clear cell renal cell carcinoma., Competing Interests: The authors declare no competing interests., (© Mohammed Aynaou et al.)

Introduction: This study is designed to investigate whether the pharmacokinetics of the antituberculous agent isoniazid (INH) varied according to the circadian dosing-time., Methods: A total of 168 male mice aged 10 weeks and synchronized for 3 weeks to 12h light and 12h dark were used. A single INH (100mg/kg) dose was administered by intraperitonal (i.p.) route at either of the four different circadian stages (1, 7, 13 and 19h after light onset, HALO). At each circadian stage, blood samples were withdrawn at 0, 0.1, 0.2, 0.4, 1, 1.3, 2, 2.5, 4, 5, 6.3, 8, 24 and 48h following drug injection. The pharmacokinetics parameters (AUC 0-∞ , Ke, C max , T 1/2, Cl T and V d ) were calculated for each circadian-time., Results: There were relevant differences in C max between the four circadian groups (p<0.005), maximum and minimum C max were obtained when INH was injected at 1 HALO (490mgL -1 ) and at 7 HALO (270mgL -1 ) respectively. AUC 0-∞ also varied significantly according to the circadian-time of injection (2093mgL -1 h -1 at 1 HALO vs 759mgL -1 h -1 at 7 HALO) (p<0.05). The highest and lowest mean values of plasma clearance (Cl) were observed at 7 HALO (0.22Lh -1 kg -1 ) and 1 HALO (0.13Lh -1 kg -1 ) respectively (p<0.05). The Cosinor analysis showed a circadian rhythm in different pharmacokinetic parameters. C max and AUC 0-∞ have a significant circadian rhythm with an acrophase located at 2.64 HALO±0.21h (the beginning of the rest span) (p<0.001), whereas Cl T and V d showed a significant circadian rhythm with an acrophase located respectively at 7.4 HALO and at 8.66 HALO (the second half of the rest span) (p<0.001)., Conclusion: Plasma INH chronopharmacokinetics might be involved in the mechanism of circadian variation of toxicity since the time of optimal tolerance to INH corresponds to that of the lowest C max and AUC 0-∞ and the highest Cl T occured when this drug injected in the second half of light-rest phase (7 HALO)., (Copyright © 2016. Published by Elsevier Masson SAS.)

Introduction: Isoniazid (INH) is a widely used drug in the prophylaxis and treatment of tuberculosis. In the present study, isoniazid (INH)-induced toxicity was investigated according to the dosing-time in the 24-h scale in mice., Methods: Two studies were carried out on a total of 180 male Swiss mice synchronized for 3 weeks to 12-hour light (rest) and 12-hour dark (activity) cycle (L/D: 12/12). In the first study a potentially lethal dose of INH (180 mg/kg) was administered by intraperitoneal (i.p.) route at six different circadian-times: 1, 5, 9, 13, 17 and 21 hours after light onset (HALO). In the second one, a sublethal dose (120 mg/kg) was administered at three circadian-times (1, 9 and 17 HALO) in order to evaluate the variation of haematological toxicity. Rectal temperature, body weight loss, survival (study 1) and complete cell count (study 2) were determined as toxicity endpoints. The Cosinor and ANOVA methods were used for the data statistical analysis., Results: The Cosinor analysis of rectal temperature time series prior to treatment validated a circadian rhythm, which demonstrates that mice were well synchronized. Following INH injection, rectal temperature increased in all the six circadian stages at days 2 and 3. Body weight loss varied from -12% at 1 HALO to -7% at 13 HALO (P<0.001). The 24-h mean of mortality induced by INH was 38%. Such lethal toxicity varied according to the circadian dosing-time. Maximum (60%) and minimum (20%) survival rates were observed when INH was administered at 9 and 1 HALO respectively. The highest survival time (25 days) occurred when INH was injected at 9 HALO while the lowest survival time (7 days) occurred when INH was given at 1 HALO. The decrease of haematological variables (cytopenia) was dependent on the circadian dosing-time (P<0.001). The least haematological toxicity illustrated by leukopenia index, anaemia and thrombocytopenia was observed in the middle of the second half of the light-rest phase (9 HALO)., (Copyright © 2015. Published by Elsevier Masson SAS.)

The circadian time is an important process affecting both pharmacokinetics and pharmacodynamics of drugs. Consequently, the desired and/or undesired effects vary according to the time of drug administration in the 24 h scale. This study investigates whether the toxicity in liver as well as oxidative stress varies according to the circadian dosing-time of isoniazid (INH) in mice. A potentially toxic INH dose (120 mg/kg) was injected by i.p. route to different groups of animals at three different circadian times: 1, 9, and 17 Zeitgeber time (ZT). INH administration at 1 ZT resulted in a maximum hepatotoxicity assessed by the significant increase in both serum transaminase (ALAT: alanine aminotransferase) and (ASAT: aspartate aminotransferase) and antioxidant enzyme activities (catalase: CAT and superoxide dismutase: SOD). The highest malondialdehyde (MDA) level indicating an induction of lipid peroxidation resulting in oxidative damage was also observed at 1 ZT. Liver histopathology from INH groups at 9 ZT and at 1 ZT showed moderate to severe cytoplasma vacuolation, hepatocyte hypertrophy, ballooning, and necrosis. The circadian variation in INH toxicity may help realize a chronotherapy protocol in humans based on the selection of the best time associated to optimal tolerance or least side effects.

A 47 years old woman underwent autologous fat grafting to treat a 5×4 cm depression of the lower lid and the upper cheek secondary resection of squamous cell carcinoma and subsequent coverage by full thickness skin graft. 20 mL of autologous fat were harvested from lower abdomen, centrifuged and injected subcutaneously. The patient then gained a total of 15 kg over a period of 24 months. Eye dystopia developed while the grafted area became convex. MRI confirmed subcutaneous fat mass going to the orbital floor through the inferior septal defect. The fat excess was removed through a trans-conjonctival approach allowing for a progressive regression of diplopia after 2 months while the oedema reduced. The overall follow up from the resection-coverage and last examination was 5 years. In this case with a context of noticeable weight gain, the growth of a fat graft trapped between a sclerous plane and the eye, that penetrated the orbital cavity through a septal defect led have led to exophthalmos, ocular dystopia and diplopia. Systematic overcorrection in autologous fat grafting should be prevented, especially in functional areas and on low body mass index patient that might gain weight., (Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Introduction: The action plan for the maternal mortality is generally based on research studies' results carried out within hospital structure., Objectives: Determination and follow-up of the evolution of maternal mortality from 1998 to 2007 in a level 3 Tunisian maternity and identification of its main causes., Patients and Methods: It is a retrospective study carried out between January 1998 and December 2007. In our service, since 1984, maternal deaths are systematically recorded. Information about deaths are collected from the following sources: childbirth folder, folder of hospitalization in reanimation, after the autopsy, through information collected beside the family, or by the National System of Maternal Death Surveillance, only since 1999., Results: Thirty-one mother deaths were colligated during the study. The average age of patients was around 33 years. The global maternal mortality rate during the study was about 56 deaths for 100,000 live births. The trend was characterized by a net decrease to this rate to 2003, and stagnation after that or even an increase in 2007. Deaths were due, in 81% of cases, to a direct obstetric reason. Hemorrhage was the principal etiology, which was implicated in 35.48% of the total cases. Complications of preeclampsia were incriminated in 19.35% of the total number of cases. In this set, transfer rate was about 48.38%., Conclusion: The evolution over the years shows a net regression of maternal mortality. However, the trend was characterized by a recent stagnation. However most of cases were avoidable. Much progress has to be carried out in the cases of peripartum hemorrhages and preeclampsia, since they represent the main death causes.

Introduction: Intra-uterine fetal death (IUFD) of one twin is a relatively frequent complication of twin pregnancy. Prognosis of the surviving twin seems to be the main problem. Management is not consensual and suffers from the lack of guidelines., Objectives: To report the main involved etiologies, assess the surviving co-twin outcome and discuss strategies of management., Patients and Methods: Retrospective study of 33 twin pregnancies complicated by single intrauterine fetal death after 26 weeks of gestation, admitted in the department "A" of obstetrics and gynecology of the Tunisian center of maternity and neonatalogy from January 2000 to October 2008., Results: Prevalence was 2.98%. Chorionicity was precised for 28 GG; 67.9% (n=19) were bichorionic (BC) and 32.1% (n=9) monochorionic (MC). The mean gestational age at the time of fetal death diagnosis was 31 weeks+2 days. Main involved pathologies in case of BC pregnancy were: intrauterine growth restriction (36.8%), pre-eclampsia (21%) and gestational diabetes (15.8%) and in case of MC pregnancy: twin-to-twin transfusion syndrome (44.4%). Prematurity rate was 85.2%. IUFD of the second twin occurred in one case and neonatal death in six cases. Tranfontanellar ultrasound on the seventh day of life found cerebral abnormalities in six liveborns., Conclusion: Surviving co-twin prognosis was mainly compromised by prematurity and its consequences.

Background: Cervical pregnancy is the rarest of ectopic pregnancy. The classical treatment remains hysterectomy, in particular when diagnosis is made late. The possibilities of more and more premature diagnoses, sometimes before any clinical expression, let suspect the possibility of conservative treatments. We report two cases of medical treatment for early diagnosed cervical pregnancies., Aim: Through a review of the literature, we resume diagnostic criteria and various therapeutic possibilities., Case Reports: The two cases were diagnosed in the first trimester. The treatment consisted in intramuscular administration of methotrexate. The first patient had ultrasound-Guided feticide before the administration of methotrexate., Conclusion: Actually, vaginal ultrasound allows early diagnosis of cervical pregnancies, even before the beginning of vaginal bleeding. This advancement allowed conservative treatment. In this situation, current reference is the methotrexate to which can be associated an intracardiac potassium chloride injection in case of embryo positive heart activity.

Objective: To report the epidemiological and anatomoclinical features of breast cancers referred to a department of gynecology from the screening program of l'Ariana state in Tunisia., Material and Methods: A longitudinal retrospective Study was done over a period of 4 years (2004-2006 ) at the unit "A" gynecology department of the maternity of Tunis. We collected all the cases with histologically confirmed breast cancer diagnosed within the mammography screening program of l'Ariana state, referred to our unit for treatment., Results: 10 patients with histologically confirmed breast cancer were collected during the study period, treated at our unit. Mean age of patients was of 48.8 years. Clinical examination was initially negative in 50% of cases. Mean clinical tumor size was 18 mm, while invasive ductual carcinoma represents the most frequent histological type. One patient (10%) had histological axillary involvement. Conservative surgery was performed for 8 (80%) of the 10 patients., Conclusion: This pilot study of mammography screening confined to a Tunisian state, precludes to the future profile of BC In Tunisia, showing that an early diagnosis can lead to a dramatic reduction of mean clinical tumor size, less histological poor prognostic features, more conservative surgery and a slight improvement of survival. A structured extended screening program must be installed to achieve these goals but requires an important financial and human investment.

Introduction: Trophoblastic diseases correspond to a very heterogeneous group., Objective: To establish the importance of imaging in the management of trophoblastic diseases., Patients and Methods: Retrospective study from 1995 to 2008, including all patients with a gestational throphoblastic disease in our department., Results: Seventy-four cases were identified with 58 molar pregnancies, 14 trophoblastic tumors and two cases of hydatiform mole coexistent with a twin live fetus. Ultrasound's sensibility in case of hydatiform moles was 75.86%. It was sharply more important in case of a complete mole with a detection rate of 96.15% against 28% in case of partial mole. In trophoblastic tumors, ultrasound coupled with Doppler had shown signs of invasion in half of the cases. Four patients presented with lung metastases. Magnetic resonance imaging was performed in two cases., Discussion and Conclusion: Ultrasound is of high-performance in the positive diagnosis of complete moles. Furthermore, it shows signs of invasion in case of trophoblastic tumors. In those cases, a radiological assessment guides the management even in the absence of histological proofs.

Objective: The purpose of this study was to estimate the place and the results of fertiloscopy in the management of female infertility., Materials and Methods: Retrospective study over a period of eight years including the patients presenting infertility without pathology raising of an evident surgical indication. We analyzed the perioperative data, the results as well as the complications of this intervention., Results: One hundred and eighty-eight fertiloscopic procedures succeeded (84%). For 84 patients (37.6%) we realized a coelioscopy. In 44% for failure of the exam and in 66% for lesions found in the fertiloscopy and requiring surgery. Two complications without major consequence will be deplored: two rectal injuries., Conclusion: Fertiloscopy is a safe and reliable procedure. It can be substituted to laparoscopy in the routine assessment of infertile women management in case of not obvious surgical indication.

Background: Therapeutic interruption of the pregnancies of the 2nd and 3-rd quarter is often badly accepted by the patients and it is original that his realization is easy, effective and the less traumatic possible. In this indication, the sulprostone (Nalador) is a big contribution., Aim: The purpose of our study is to review this product, to describe our experience concerning its use in the therapeutic interruptions of pregnancies and to study alternatives in case of failure or of against indication in its use., Methods: It is about a forward-looking study opened from the 01-07-02 led in the service "A" of the CMNT. We brought together 30 women where a therapeutic interruption of the pregnancy was put and who did'nt present of against indications to the sulprostone., Results: The average age was of 27 years with extremes from 18 to 39 years 50% of our patients were nullipares. The terms of pregnancy varied from 16 to 28 LIMITED COMPANIES with an average of 20 LIMITED COMPANIES. The indications of these terminations of pregnancy were maternal in 33.33% of cases and foetal in 66.66% of cases. The average number of light bulbs of Nalador used by the women was of 2.25 with extremes going from 1 to 4. The delay of eviction from the beginning of the induction was on average of 21 hours, with a rate of success of 90%. We did not regret any break uterine Delivery was incomplete requiring a uterine revision under general anesthetic in 5 cases. Tolerance was good in general In case of failure alternatives were: the misoprostol (cytotec *), the Probe extra amniotic dries and the wet Probe., Conclusion: The sulprostone by intravenous way constitutes an effective method of medical interruption of the pregnancy in the 2-nd and 3-rd quarter with a satisfactory tolerance and a rate of success of 90 %.

Purpose: Uterine sarcomas are rare tumours characterized by clinical and histopathological diversity and poor prognosis. We analyzed diagnostic, prognostic and therapeutic difficulties encountered with these tumors by insisting on the importance of early diagnosis., Patients and Methods: From 1997 to 2004 ten patients with uterine sarcoma who underwent surgery in the obstetrics and gynecology unit at the Tunis maternity center were included in this retrospective study. The tumors were classified at the time of diagnosis using the FIGO staging system. The histological diagnosis was based on the WHO classification., Results: There were 5 cases of leiomyosarcoma, 2 cases of carcinosarcoma, 2 cases of endometrial stromal sarcoma and 1 adenosarcoma. There were four cases of stage I, two cases of stage II, two cases of stage III and two of stage IV tumors. The diagnosis of uterine sarcoma was strongly suspected and proved before the initial operation in 20% of cases and during this operation in 60% of cases. Diagnosis was only established at the histological exam in two cases. Total hysterectomy with bilateral salpingo-oophorectomy was performed in 90% of patients. Radiation therapy was performed in four. Chemotherapy was delivered in two patients. After an average of four years five patients were in remission, three had died and two were lost to follow-up., Conclusion: Early preoperative or intra-operative diagnosis is essential while awaiting for more effective chemotherapy protocols or therapeutic strategies.

Dermoïd cysts are benign tumours, resulting of an embryologic defect. They usually have good prognosis, only a single case of malignant transformation of a sublingual dermoid cyst has been brought back in literature. We report a case of carcinomatous transformation of a dermoïd cyst of the scalp, in a 54 years old man.

Objective: To establish the epidemiologic profile of holoprosencephalia and determine benefits of ultrasound and foetopathologic examination to the diagnostic. METHODS AN MATERIAL: [corrected] Retrospective study about 17 cases of holoprosencephalia observed in CMNT between Janaury 1992 and September 2000., Results: Ultrasound diagnosis was made in 13 cases (75%). Ultrasound criteria were; absence of median structure of the brain and unique ventricule. The prognosis was always bad. Foetopathologic examination revealed 7 cases of lobar holoproencephalia and 10 of semi lobar. Fascial dysmorphia were noted in 82% of cases., Conclusion: The foetopathology and genetic counselling looking for fascial, dysmorphia in family's members gives a good evaluation of recurrences.

The omphalocele is an average coelosomie, frequency of which is estimated at 1/5000 births. We confront diagnosis antenatal with the exam foetopathologic in purpose of 41 cases of omphalocele brought together over a period going from January 1, 1991 till December, 2000 in the unity of foetopathologie from the CMNT. The frequency of omphaloceles is 4.88% of the children malformed and of 1.64% of the set (group) of the performed an autopsy children. An association malformative was found in 85.4% of cases and a karyotype typical aberration trisomie 13.18 and 21 was identified in 17% of cases. The preview of the children bearers of this deformation is especially bound (connected) to the existence and to the gravity of associated abnormalities. The omphalocele required a multidisciplinary making coverage intervernir obstetriciens, néonatologistes, surgeons pediatre and foetopathologistes.