Breast tuberculosis (TB) is a rare localization of extra-pulmonary TB. We report the first case observed in our daily activities to show the difficulties in the diagnosis and the good evolution in the treatment. In spite of the fact that it is rare, breast TB should not be ignored, especially in a country with high TB endemicity.

Umbilical endometriosis is a very uncommon condition which presents as a pigmented umbilical nodule, papular or cystic, with symptoms punctuated rhythmed by menses. The authors report the case of a 32-year-old with spontaneous umbilical endometriosis. Surgical resection was performed with a good cosmetic result and no recurrence at six months. A review of the literature allowed the authors to discuss the diagnosis difficulties and treatment in a underdeveloped country.

Background. Rhabdomyosarcoma (RMS) is a rare high-grade malignant tumor and the most common soft-tissue sarcoma, which occurs in young girl over 5 years old. Multimodality treatment associating with surgery, chemotherapy, and/or radiotherapy culminate in a >70% overall 5-year survival. This is the first case reported in 30 years of practice in Côte d’Ivoire, low- and middle-income country (LMIC). Objective. To summarize clinical data, the significant alternative chemotherapy efficiency and difficulties related to the prognosis evaluation in an LMIC. Case. A 2-year-old girl had been examined for a large mass in the vulvar region and clitoris. We carried out a biopsy for histopathologist exam. This allows pathologic, genetic, and biological characterization of nonmetastatic botryoid rhabdomyosarcoma. A multidisciplinary team decision of neoadjuvant chemotherapy was retained combining vincristine, cyclophosphamide, and actinomycin D or alternatively with Adriamycin. After 3 weeks of chemotherapy, significant volumetric reduction of tumor was observed. Yet a surgical removal was proposed but not performed because the patient has no longer consulted our medical center and was lost to follow-up. Therefore, we cannot assess the long-term evolution and prognosis. Conclusion. Embryonal RMS (ERMS) of clitoris is a rare malignant tumor of infant. Histology and immunohistochemistry are essential for diagnostic but unavailable in our context. We want to emphasize on the difficulties encountered in treatment and prognosis assessment. The primary free surgical removal of the vulva with adjuvant chemotherapy and/or radiotherapy must then be implemented in our practice.

Background: Uterine fibroids are the most common form of benign uterine tumors. African women of reproductive age usually present late with large and numerous uterine fibroids. Conservative surgical treatment requires ways to reduce intraoperative bleeding. This study attempts to describe innovative methods in the efficient management of fibroids in low-and middle incomes countries. We demonstrate the efficiency of the uterine tourniquet during abdominal polymyomectomy in intraoperative bleeding reduction despite removal of numerous myomas. Methods: A prospective, descriptive and analytical review was conducted on 92 patients who underwent open myomectomy in the gynecology department of the university hospital of Cocody (Côte d'Ivoire) over 3 years (2019 to 2020). Intraoperative surgical steps include placing a uterine tourniquet before removal of the myomas. The variations in mean hemoglobin levels before and after myomectomies were compared. The significance level was set at 5% (p < 0.05). Results: The patients' mean age was 38.5 years old, and 39% were nulliparous. Abnormal vaginal bleeding was the main symptom (67.4%). On physical exam the uterine size varied significantly from 20 to 30 cm. The average number of uterine fibroids enucleated was ten. The mean duration of the procedure was 155 minutes with an estimated average blood loss of 250 mL. The mean difference between preoperative and postoperative hemoglobin levels was not significant (p < 0.061). Only four patients (4.3%) received a blood transfusion. Conclusions: Placing a uterine tourniquet allowed enucleation of several uterine fibroids with relatively reduced blood loss in abdominal myomectomies. This technique can be an alternative to embolization in countries with limited resources.

Background: Vaginitis is a frequent and treated based on clinical evaluation in our countries in absence of microbiological laboratories. Evaluate the effectiveness of the management of vaginitis by ternidazole, neomycin sulfate, nystatin, prednisolone association.Methods: A five-month prospective study was carried out in three health facilities in Abidjan. Two-hundred and thirty-three patients with clinical signs of vaginitis were included after signed consent. Pregnant and breast-feeding patients, hypersensitivity or idiosyncrasy to ternidazole, neomycin sulfate, nystatin, prednisolone association were not included. Patients were divided into reference group (n=200) for which a microbiological analysis of vaginal secretions was carried out 2-4 days before treatment and control group (n=33) for which treatment was initiated straightaway. Evaluation criteria were clinical symptoms, microbiological balance carried out 10 to 14 days after treatment and occurrence of side effects. Statistical tests used were Khi2 and exact Fisher test (p<0.05).Results: Pathological leucorrhoea was differently observed in both group (p=0.001). During the follow-up visit, the persistence of symptoms was not different (p=0.99). This combination has demonstrated its efficacy in cases of Candida albicans vaginitis, bacterial vaginosis, trichomonas vaginalis vaginitis, and mixed vaginitis. A significantly improvement of symptoms (p=0.001) and low rate of biologically proven recurrence was observed in both groups. No allergic reactions linked was reported.Conclusions: In our countries this therapeutic combination appears to be an option for treated mixed vaginitis in first intention without preliminary samples of vaginal secretions.