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ObjectivesThe main objective of this study was to evaluate the sexual function in married menopausal women after surgery for non metastatic breast cancerMethodsThis is a prospective cohort-type study of 200 menopausal women diagnosed then operated on for breast carcinoma between January 2018 and March 2020. Patients were randomized after a multidisciplinary consultation in 2 groups: G1 with patients who had conservative breast surgery and G2 with those who had a mastectomy. Patients with immediate or delayed postoperative breast reconstruction were excluded. The data collection was done in an individual interview, in which 4 validated standardized psychometric assessment scales were used: The Arab Female Sexual Function Index (ArFSFI) for evaluation of sexual function The Locke and Wallace Marital Adjustment Test (MAT) for Assessment of Spousal Agreement The Hospital Anxiety and Depression Scale (HAD-S) for Assessment of Anxiety & Depression The Body-Esteem Scale for Adolescents and Adults (BESAA) for the evaluation of the body imageResultsThe two groups were comparable in terms of age and socio-economical characteristics of the patients and their spouses. The mean total FSFI scores were comparable (22 in G1vs 24.5 in G2, p = 0.084. There was a positive correlation between the husbands’ education level and the feminine sexual function (p = 0.042) and between marital agreement and sexual function (p = 0.004).ConclusionsThe technique of breast surgery for breast cancer does not influence the sexual function in menopausal women.

ObjectivesThe efficacy and utility of neoadjuvant chemotherapy (NAC) for Inflammatory breast cancer (IBC) are demonstrated. In node-negative patients after NAC, sentinel lymph node biopsy (SLNB) can be considered but not in IBC because of a low identification rate (IR) and a high false-negative rate(FNR). We aim to evaluate the SLNB identification fluorescence technique in this IBC population.MethodsBetween 2015 and 2019, data of all patients with NAC for carcinoma of the breast clinically classified as inflammatory (T4d) and without palpably suspicious nodes who underwent an SLNB during the definitive modified radical mastectomy with axillary clearance were retrospectively reviewed. Under general anesthesia 5 ml/12.5 mg of Infracyanine ® (Indocyanine green) were injected circumferentially around the areola; followed by a 15 min massage of the breast. The axillary incision was then performed and lymphatic vessels were visualized by a near-infrared camera. The sentinel node(s) were identified as being fluorescent and removed separately. After SLNB biopsy, mastectomy and axillary dissection were fully performed.ResultsA total of 22 patients with IBC underwent SLNB after NAC using the above-mentioned technique. The median age at the time of diagnosis was 44 years (range 25–62 years). The identification rate is 86% (19/22 patients). The false-negative rate was16% (2 patients among the 12 who had negative SLNB had a positive axilla lymph node examination).ConclusionsThe data of this study are encouraging but a larger sample is required. We do not have a clear explanation of why fluorescence provides better IR and lower FNR.

ObjectivesThe aim of this study was to evaluate the surgical morbidity and oncologic results on patients undergoing completion surgery for locally advanced-stage cervical cancer after initial concurrent chemo-radiotherapy (CCR).MethodsIt is a retrospective case/control study including all patients from 01/01/2000 to 31/12/2014 with advanced cervical cancer (stage IIB–IVA) treated with CCR (45 Gray pelvic external radiation therapy with concomitant chemotherapy (Cisplatin 40 mg/m2 per week) followed or not by uterovaginal brachytherapy) followed or not by surgery. Disease-free and overall survival rates at 3 and 5 years were compared.ResultsWe included 170 patients of whom 50 had CCR and catch-up surgery and 120 only CCR The two groups were comparable in terms of age at diagnosis, socio-economic characteristics of the patients, characteristics of the disease at diagnosis and after CCR. Hysterectomy was extra-fascial in 66% of cases. It was laparoscopic in 6% of cases. Pelvic lymphadenectomy was performed in 20% of cases. The operative complication rate was 23% with 12 immediate complications in 8 patients. The reoperation rate was 6%. The recurrence rate was 96% in the exclusive RCC group versus 66% in the surgery group with a significant difference in favor of surgery (p < 0.0001). The overall survival at 5 years after surgery was 55% versus 16% in the control group with a significant difference in favor of surgery (p < 0.0001).ConclusionsThe therapeutic impact of surgery based on completion hysterectomy with or without pelvic lymphadenectomy after CCR for locally advanced cervical cancer improved local disease control, overall and recurrence-free survival.

ObjectivesThe core needle biopsy (CNB) is an attractive alternative to surgical biopsy for the purpose of characterizing completely a malignant breast lesion for a tailored management. The purpose of this work is to study the concordance of the molecular profile of invasive breast cancer between the CNB and definitive pathology examination.MethodsWe conducted a case-control study where each subject was her own control, including all patients with primary malignant tumors of the breast, collected prospectively, in our Department of Pathology and Cytology and treated at the Department of Gynecology and Obstetrics of the same hospital from January 1, 2015, to July 31, 2017. The studied molecular profile parameters were estrogen receptors (ER), progesterone receptors (PR), HER2 receptors (HER2), and Ki67.ResultsWe included 521 patients. The concordance between CNB and definitive postoperative specimen analysis with regard to the molecular profile parameters in invasive breast cancer was respectively of 100% and 96.3% for ER and PR, with an excellent agreement (respectively, k=1 and k= 0.905). The agreement in the diagnosis of tumors HER 2 overexpression was strong (k= 0.679). There was a difference between Ki 67 tumoral status (cut off at 20%) in CNB versus definitive postoperative specimen analysis in 53.1% of the cases with a weak agreement (k= 0.193). Consistency between CNB and postoperative specimen analysis in the distinction of luminal A tumors was 72.8%, 66.7% for luminal B, 90.1% for Her2 type and 86.4% for the basal type.ConclusionsCNB was reliable in determining the hormonal receptors’ status and the HER2 negative invasive breast cancer.

ObjectivesThe choriocarcinoma is the most frequent and chemo-sensitive of the malignant gestational trophoblastic tumors. The main management challenge in young patients is to balance a fertility-sparing therapy with good survival rates and quality of life. The aim of this work is to evaluate the fertility of young women with choriocarcinoma after a fertility-sparing strategy.MethodsWe conducted a retrospective study of a prospective mono-centric database over a 20 year period (2000–2019) in the Tunisian Central Cancer Registry, the department of gynecology and Obstetrics, and the reproductive medicine unit in Farhat Hached Teaching Hospital in Sousse Tunisia. We collected all the pathology established cases of choriocarcinoma diagnosed in women under 40.ResultsThe cohort of 30 women included 18 (60%) who had a fertility-sparing therapeutic strategy and 12 (40%) who underwent hysterectomy ( all cases before 2010). There was no statistical difference between the fertility-sparing management group and the hysterectomy group in OS and DFS (respectively, P=0.09 and P=0.14). Among the fertility-sparing management group, 16 patients reported a pregnancy desire in the year following the diagnosis and stopped contraception in order to conceive. Twelve pregnancies in 5 patients were recorded with 4 live births.ConclusionsThe use of less-toxic chemotherapy protocols is a good option when dealing with fertility sparing strategy in managing choriocarcinoma in young women especially that the recommended standards have shifted to no surgery.

ObjectivesBreast cancer of young women is the most frequent solid cancer among women under 40. The main objective of this study is to evaluate the impact of the surgery for non-metastatic and operable breast cancer in young women on their couple’s relationship.MethodsThis is a prospective cohort-type study of 200 women under the age of 40 operated on for breast carcinoma between 2016 and 2019 in the department of Gynecology and Obstetrics of Farhat Hached Teaching Hospital Sousse, Tunisia. Patients were stratified based on whether they underwent conservative (G1) or radical (G2) breast surgery.The patient‘s couple relationships were evaluated by The Locke and Wallace Marital Adjustment Test (MAT): a standardized psychometric assessment scale validated in Arabic.ResultsThe two groups were comparable in terms of age and socio-economical characteristics of the patients and their spouses.The median tumor size at the time of cancer diagnosis was 3 cm (± 1.2) in G1 and 5.7 cm (± 1.4).The median MAT questionnaire score was 112 (± 31) in G1 and 124 (± 13) in G2 with p = 0.064.A couple dysfunction was found in 42% of G1 patients and 47% of G2 patients with a p = 0.136.ConclusionThe breast surgery technique for breast cancer (conservative treatment versus mastectomy without reconstruction) does not influence the marital agreement in young Tunisian married women diagnosed and operated in for breast cancer before the age of 40.

ObjectivesBreast cancer is the most frequent solid cancer among menopausal women. The main objective of this study is to evaluate the body image and the sexual function in menopausal women diagnosed with nonmetastatic and operable breast cancer.MethodsThis is a prospective cohort-type study of 200 menopausal women diagnosed then operated on for breast carcinoma between January 2017 and January 2019 in the department of Gynecology and Obstetrics of Farhat Hached Teaching Hospital Sousse, Tunisia. Patients were stratified based on whether they underwent conservative (G1) or radical (G2) breast surgery.The data collection used 2 standardized psychometric assessment scales validated in Arabic:The Body-Esteem Scale for Adolescents and Adults (BESAA) for the evaluation of the body image and The Arab Female Sexual Function Index (ArFSFI) for evaluation of sexual function.ResultsThe two groups were comparable in terms of age and of socio-economical characteristics of the patients and their spouses. The median tumor size at the time of cancer diagnosis was 3.6 cm (± 1.2) in G1 and 6.1 cm (± 2.6). The body image was lower after mastectomy with a significant difference for the item appearance( p = 0.047); without influencing any aspect of the sexual function. The results concerning the sexual function are synthesized in the following table 1.There is an inversely positive correlation between the husband’s education level and the feminine sexual dysfunction p = 0.042.Abstract 338 Table 1Comparison of the sexual function scores according to the Arab Female Sexual Function Index (ArFSFI)ConclusionAlthough the body image esteem is lower after mastectomy in menopausal women, there is no difference in their sexual function.

ObjectivesPrimitive Carcinoma of the Fallopian tube is extremely rare and represents 0,1 to 1% of all malignant tumors of the pelvis. The aim of this study is to describe its clinical and prognostic features.MethodsIt is a retrospective study conducted in the Tunisian Central Cancer Registry during a 15 year period (2004 – 2018) collecting all the pathologically established and confirmed cases of primitive carcinoma of the Fallopian tube.ResultsThe incidence of Primitive Carcinoma of the Fallopian tube was 1/1559 of all the Ovarian, fallopian tube, and peritoneal cancers in our registry. The mean age at the diagnosis was 54.2 years. Pelvic pain was the main symptom. Pelvic clinical examination reported a mass in 86% of the cases. Pelvic ultrasound revealed a para-uterine image in all cases but could not differentiate between an ovarian tumor, a Fallopian tube one, or a tubo-ovarian infectious abscess. The perioperative diagnosis was evocated during laparoscopy in only 12% of the cases. The different pathological diagnoses of Primitive Carcinoma of the Fallopian tube were: tubal carcinoma in situ, tubal Carcinoma, tubal adenocarcinoma, and tubal papillar adenocarcinoma. An optimal cytoreduction surgery was possible in 86% of the cases. During the follow-up, the recurrence rate was 24% and the overall survival rate at 3 years was 82%.ConclusionsPrimitive Carcinoma of the Fallopian tube is a very rare entity in our daily practice. Diagnosis is rarely made before surgery or the pathological study. The 3-year prognosis is relatively good.

ObjectivesSertoli Leydig cell tumors (SLCT) belong to the group of sex cord-stromal tumors. SLCTs of the ovary are rare (less than 0.5% of all ovarian tumors). The aim of this study is to establish the epidemiological and prognostic features of such a rare tumor entity.MethodsWe conducted a retrospective study over a 12 year period (2004–2015) in the Tunisian Central Cancer Registry. We collected all the pathology established cases of ovarian SLCT.ResultsThe incidence of ovarian SLCT was 1.5% of all the Ovarian, fallopian tube, and peritoneal cancers in our registry. The mean age at the diagnosis was 30 years [14 – 79 ] with a 2-peak distribution: 14 –30 years (46.15% of the patients) and 50 – 80 years. Endocrine symptoms were present in 76,92% of the patients (virilization: 38.46%). Testosterone serum levels were high in 33.33% of the patients. The pathological FIGO staging was IA in 15.38%, IC in 61.53%, and IIIC in 23.07%. A fertility-sparing surgery was performed in 46.15%. Adjuvant chemotherapy (bleomycin, etoposide, and Cisplatin) was delivered in 46.15%. The recurrence rate in the conservatively operated group was 16.67% and the overall progression rate was 47.46%. The overall survival at 5 years was 38%.ConclusionsOur results suggest that ovarian SLCT are rare but can occur at any age, even in menopausal women. The clinical features are essentially endocrine symptoms. In young women, fertility-sparing surgery is feasible but with a 16.67% recurrency rate and 38% 5- year overall survival.

ObjectivesThe aim of this study was to investigate the clinical and prognostic features of women under 45 with the incidental diagnosis of endometrial adenocarcinoma (EC) during infertility work-up, with special attention given to treatment approaches and survival rates.MethodsThe medical records of 228 patients who were diagnosed with EC at our center between 2008 and 2018 were included in the study and analysed retrospectively. Out of these patients, 9.6% (n=22) were ≤ 45 years. Eleven patients had a history of infertility and had been diagnosed with EC during a hysteroscopic evaluation for infertility. We compared these patients to the other eleven patients diagnosed with EC under 45 with no infertility history.ResultsThe mean age at diagnosis was comparable in both groups (39.8 ± 6.7 vs 39.7 ± 5.5 years, p=0.98). The mean duration of infertility was 5.4 ± 2.1 years. The Body mass Index was high in both groups (33.0 ± 5.4 vs 30.3 ± 4.5 years, p=0.48). There were no significant difference in terms of early stage cancer (p=0.79). Fertility sparing treatment was initiated in 9 patients but after 6 months only 3 had a complete pathological response. There was no difference in OS and DFS between the 2 groups (respectively, p=0.97 et p=0.48).ConclusionsThe investigation of the endometrium during infertility work-up may lead to the diagnosis of asymptomatic EC that does not seem to have any specific prognostic features even though it may allow a fertility sparing treatment.