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ObjectivesThe objective of this study was to correlate clinical, radiological and pathological data of mammary microbiopsiesMethodsThis is a 20-month retrospective study from January 1, 2016 to Decembre 31, 2018 that included all patients who had a breast microbiopsies.ResultsOut of 86 patients, one patient was excluded because the pathological examination was not contributory. The average age of the patients was 39 years (range, 20 to 71 years). We performed mammary microbiosis for ACR 4 in 82% of the patients. Pathological examination concluded that there was benign mastopathy, mainly fibrocystic dystrophy in 76% patients (a radio-histological discordance) and infiltrating ductal carcinoma in two patients. One patient had a breast microbiopsy for ACR 3 with familial breast cancer ATCDs. The anatomopathology concluded to the benignity of the lesions. All ACR 5 patients, (n =12), had infiltrating ductal carcinoma.ConclusionsUltrasound guided mammary microbiopsy is a reliable examination that allows in most cases to determine the histological type of the mammary lesion when it is accessible to the biopsy, thus reducing the overall impact of the management of mastopathies. The problem arises when there is a radio-histological discordance, mainly in front of ACR4.

ObjectivesTo analyze the epidemiological, clinical and cyto-colo-histological data of patients who carried out colposcopy.MethodsProspective study, conducted during 4 years in the Gynecology department of our institution. We included all patients who had colposcopy, regardless of indication and without gynecological neoplastic pathology.ResultsOur study included 110 patients with so many pap smears: atypical squamous cells of undetermined significance (48%), high grade squamous intraepithelial lesions (HSIL) (11%), atypical squamous cells cannot exclude HSIL (22%), low grade squamous intraepithelial lesions (14%), atypical glandular cells (5%). Colposcopy showed atypical transformation: grade 1 (ATG 1) in 34% and grade 2 (ATG 2) in 66% of cases. Cervical biopsy revealed normal cervical squamous mucosa in 8%, cervicitis in 72% and condyloma in 8%. A case of CIN 1 was found in 6%, CIN 2 in 3% and CIN 3 in 2%. Cervical biopsy revealed one squamous cell carcinoma. Coloscopy sensitivity was 77% and specificity of 37%. The positive predictive value was 24% and the negative predictive value was 86%. For high grade dysplasia, colposcopy had a sensitivity of 100%, a specificity of 37%. A conization was performed in nine patients for squamous cell carcinoma or high grade dysplasia. Conization was performed in a patient with cyto-histological discordance. Histological study rebealed an in situ carcinoma in two cases.ConclusionsOur results showed that ATG 1 lesions at colposcopy regardless of the FCU abnormalities are predictive of benign biopsy lesions. We also tend to overestimate the ATG 2 lesions.

To assess the effect of early amniotomy on labor duration, maternal and neonatal outcomes during induction of labor (IOL). This was a randomized controlled trial, conducted over a period of eight months at a monocentric site. Singleton pregnancies in nulliparous and parous patients with cephalic presentation and Bishop score ≥ 6 were enrolled in the study. One hundred participants were randomized into two groups: early amniotomy (initiating IOL with amniotomy followed by oxytocin) versus late amniotomy (initiating IOL with oxytocin followed by amniotomy 4 hours later). The primary endpoint was the time to active phase (cervical dilation ≥ 5 cm) during IOL. Secondary outcomes were time to vaginal delivery, mode of delivery, and maternal and fetal outcomes. Early amniotomy reduced time to active phase by 2 hours and 46 minutes compared to the late amniotomy group (3 h 42 min vs. 6 h 28 min; p<0.0001). It also reduced time to vaginal delivery by 2 hours and 52 minutes (5 h 17 min vs. 8 h 9 min; p = 0.0003). The rate of cesarean section (CS) for failed IOL was significantly lower in the early amniotomy group (31.2% vs. 70.0%; p = 0.02), without any significant difference in the overall rate of cesarean section between the two groups (32.0% vs. 40.8%; p = 0.36). There was no significant difference in maternal or fetal outcomes. Early amniotomy in IOL significantly shortens the time to active phase as well as the overall duration of labor without compromising maternal and neonatal safety.

To determine whether the French AmbUlatory Cesarean Section (FAUCS) technique reduces postoperative pain and promotes maternal autonomy compared with the Misgav Ladach cesarean section (MLCS) technique in elective conditions. One hundred pregnant women were randomly, but in a non-blinded manner, assigned to undergo FAUCS or MLCS. The primary outcome was a postoperative mean pain score (PMPS), and secondary outcomes were a combined pain/medication score, time to regain autonomy, surgical duration, calculated blood loss, surgical complications, and neonatal outcome. Women in the FAUCS group experienced less pain than those in the MLCS group (PMPS = 1.87 [1.04-2.41] vs. 2.93 [2.46-3.75], respectively; p < 0.001). Six hours after surgery, the combined pain/medication score for FAUCS patients was 33% lower than that for MLCS patients (p < 0.001). FAUCS patients more rapidly regained autonomy, with 94% reaching autonomy within 12 h vs. 4% of MLCS patients (p < 0.001). There were no differences in maternal surgical or neonatal complications between groups. Our results indicate that FAUCS can reduce postoperative pain and accelerate recovery, suggesting that this technique might be superior to MLCS and should be more widely used. One potentially key difference between FAUCS and MLCS is that MLCS includes 100 mcg spinal morphine anesthesia in addition to the same anesthesia used by FAUCS. Any interpretation of apparent differences must take the presence/absence of morphine into account.

IntroductionAdult granulosa cell tumor (AGCT) accounts for 5% of all ovarian cancers.Their histopathologic features are relatively nonspecific, resulting in misdiagnosis, a problem that has not been well characterized.ObjectiveTo study clinicopathological features and evolutionary characteristics of AGCT of the ovaryMethodsThis is a retrospective study of ten cases of AGCT of the ovary, collected in the pathology department of the M. Slim Hospital over a period of 16 years (2002 to 2017). Evolutionary data were collected from medical records of the gynecology department of the same hospital.ResultsThe average age of our patients was 58 years. Pelvic ultrasound allowed objectifying the ovary tumors in 8 cases and CT scans in 2 cases. All tumors were unilateral and confined to the ovary, without rupture.Seven patients were treated with unilateral adnexectomy and 3 with a hysterectomy and bilateral adnexectomy.Eight tumors were encapsulated with a smooth lobulated surface. Seven tumors were solid and 3 solid and cystic.Tumor size varied between 8,5 and 25 cm. The histopathological study allowed us to make the diagnosis in 6 cases. In 4 cases, an immunohistochemistry study was made to confirm the diagnosis.No recurrence was noted for all cases with a median follow up of 5 years.ConclusionAlthough the course of AGCT of the ovary is often indolent, an unpredictable disease course with recurrence rates up to 50%. Then, an attentive examination of tumor specimens must be done, evaluating prognostic factors as the stage, nuclear atypia, and tumor size.

IntroductionBreast cancer is the first women’s cancer in terms of frequency and mortality.New biomarkers have been tested in this cancer with prognostic and therapeutic implications.ObjectiveTo assess the prognostic value of the expression of p53 in breast cancerMethodsOur study was retrospective. An immunohistochemical study of the p53 protein was tested on tissue samples of breast cancer.We analyzed the correlation between this expression and other conventional prognostic factors: age, tumor size, lymph node invasion, modified SBR grade, profile expression of hormone receptors, and HER-2.ResultsThirty-five patients were enrolled in the study. The average age of our patients was 53.6 years. The average size of the nodules was 5.27 cm. Most tumors (80%) were invasive breast carcinoma of non-specific type, of histological grade II (52%). Almost half (49%) of our patients had lymph node metastases at the time of diagnosis. The immunohistochemical study revealed an expression of estrogen receptors in 37% of the cases, of progesterone receptors in 34% of the cases and of the HER-2 in 65% of the cases. As for the protein p53, it was expressed in 80% of the cases. We found no correlation between p53 expression and classical prognostic factors as well as survival.ConclusionAlthough several studies have found a correlation between the expression of p53 and the classic prognostic factors of breast cancer, the status of p53 cannot be applied routinely such as tumor stage, lymph node status, and histological grade.

IntroductionModified Scarff Bloom and Richardson score (or Nottingham histologic grading) has become widely accepted as a powerful indicator of prognosis in breast cancer. It combines nuclear grade, tubular formation, and mitotic rate. Each element is given a score of 1 to 3 (1 being the best and 3 the worst) and the score of all three components are added together to give the ‘grade’.The majority of studies that analyze the reliability of this grade, compare it to that found on the surgical specimen. Few studies have examined its interobserver variability in core biopsies.ObjectiveTo evaluate the interobserver variability of Nottingham histologic grade in scoring breast cancer in core biopsies among 2 general pathologists.MethodsThis is a retrospective study of 65 cases of invasive ductal carcinoma that were independently evaluated by two pathologists and graded according to the Nottingham histologic system. A detailed histopathological assessment was carried out and analyzed statistically using the Kappa agreement score.ResultsThe mean size of biopsies was 15 mm. There was a substantial agreement among the 2 pathologists in scoring tubular formation, pleomorphism, and final grading (Kappa=0.7, 0.65 and 0.8 respectively). A fair agreement was noted in scoring mitosis (Kappa=0.35).ConclusionThe interobserver variability of Nottingham grading in scoring breast cancer in core biopsies remains good. The relatively weak agreement in scoring mitosis is secondary to the small size of the micro-biopsies, not covering the 2 mm2 fields necessary to grade this parameter. This often leads to an extrapolation of the number of mitoses.

IntroductionIn breast cancer, attention has focused on the prognostic value of tumor- stroma ratio (TSR), mainly in the triple-negative subtype, which generally has a poor prognosis.Little prognostic data are available for other carcinoma types.ObjectiveTo determine the prognostic value of TSR in estrogen receptor (ER) positive invasive breast carcinomas.MethodsTSR was measured in hematoxylin and eosin-stained surgical specimens of 70 consecutive EP positive breast carcinomas. Tissue from the most invasive part of the tumor was used. A part of the sample was selected where both tumor and stromal tissue were available. Scoring percentages were given per 10-fold per image field.Tumors with a low ratio had ≥50% of stroma and a high ratio had <50% of stroma.The relationship of TSR to routinely used prognostic histopathological parameters (tumor size, grade, mitotic activity index, lymph-node status, vascular invasion, and HER2 status) was analyzed.ResultsAll tumors were of no special type. The mean age of patients was of 65 years. There was no multifocality. Sixty percent of tumors had a high ratio and 40% a low ratio.High ratio tumors were significantly correlated with large size (p=0.02), grade 3 (p=0.045), presence of vascular invasion (p=0.0034) and lymph node metastasis (p=0.0012). No significant association was found with the mitotic activity index and HER2 status.ConclusionHigh TSR was related to poor histopathological parameters in EP positive breast carcinomas, contrasting data in triple-negative breast cancer, and highlighting the importance of considering ER status when interpreting the prognostic value of TSR.

IntroductionLeiomyoma with bizarre nuclei (LBN) is defined histologically by significant cytologic atypia, but high mitotic rate and tumor cell necrosis are absent. Despite its benign clinical behavior, differential diagnosis from leiomyosarcoma can sometimes be difficult.There have been a few sizable studies that have described the clinical and pathologic features of LBN with follow-up data.Objective we investigated the clinical and pathologic features of LBN and compared them with related studies.MethodsA total of 10 patients diagnosed with LBN in our department were included.In all cases, clinical data, macroscopic with microscopic features, and follow-up data were evaluated.ResultsThe median age of the patients was 46 years. Six patients had undergone hysterectomy and 4 myomectomies. The mean tumor diameter was 6 cm.The tumor was intramural in all cases. Margins were regular in 7 cases, but expansive in 3 cases.Microscopically, the bizarre cell distribution was multifocal. Their density was low in 8 cases and high in 2 cases. Mitosis was observed in 3 cases, not exceeding 8/10 high power fields. The prognosis was favorable in all cases, with no signs of recurrence or metastasis after a median follow up of 10 years.ConclusionLBN is a histologic variant of benign uterine smooth muscle tumors. Expansive margins, a multifocal distribution with a high density of the bizarre cells, are possibly noted. Other morphologic criteria for malignancy, such as high mitotic rate and coagulative tumor cell necrosis, should be excluded. Additional sampling may be needed for an accurate diagnosis.

This study examines the role of microfinance institutions (MFIs) in advancing sustainable development by integrating environmental and social objectives into their operations. Using panel data from 30 MFIs across nine countries (2018–2023), the analysis applies Ordinary Least Squares (OLS), Instrumental Variables (2SLS), and Generalized Method of Moments (GMM) to assess policy impacts over time. “Access to environmental finance” is used as a validated instrument to address endogeneity. Results show that green lending and environmental risk management significantly reduce greenhouse gas emissions and improve gender empowerment. Larger institutions with stronger governance achieve better outcomes, and dynamic models (GMM) confirm the persistence of these effects over time. The findings highlight the importance of regulatory support, green finance infrastructure, and institutional capacity-building for scaling sustainable microfinance.