Hipertensión pulmonar y leiomiomas uterinos, ¿existe relación causal? Serie de casos y revisión fisiopatológica / Pulmonary Hypertension and Uterine Leiomyomas, Is there a Causal Relationship? Case Series and Pathophysiological Review

Introducción: Los leiomiomas uterinos son un tipo de neoplasia benigna de frecuente aparición en mujeres de edad reproductiva, relacionados con enfermedad tromboem- bólica venosa. Este vínculo surge del efecto producido por la compresión de fibromas que genera estasis venosa en la región pelviana. Sin embargo, este pareciera no ser el único factor que lo relaciona con el desarrollo posterior de hipertensión pulmonar, sino que su presencia es gatillo de una serie de fenómenos que influyen sobre la vasculatu - ra pulmonar y también a nivel sistémico. Método: Revisión de una serie de casos (seis) atendidos en nuestra unidad, seguido de una revisión sobre la relación entre leiomio- mas y distintas formas de hipertensión pulmonar con una revisión desde la fisiopatología. Resultado y conclusiones: Encontramos sustento bibliográfico en los múltiples caminos fisiopatológicos que relacionan los mediadores vasculares comunes, que parecieran ser el punto clave en la relación entre estas dos patologías.

Introduction: Uterine leiomyomas are a type of benign neoplasm that frequently appears in women of reproductive age, related to venous thromboembolic disease. This link arises from the effect produced by the compression of fibroids, which generates venous stasis in the pelvic region. However, this seems not to be the only factor that re- lates it to the subsequent development of pulmonary hypertension, but rather its presence is a trigger for a series of phenomena that influence the pulmonary vasculature and also at a systemic level. Method: Review of a series of cases (six) cared for in our unit, followed by a review on the relationship between leiomyomas and different forms of pulmonary hypertension with a review from the pathophysiology. Result and conclusions: We found bibliographic support in the multiple pathophysiological paths that relate the common vascular mediators, which appear to be the key point in the relationship between these two pathologies.

Amnios con cobertura antibiótica: eficacia en pacientes sometidas a conización / Amnions with antibiotic coverage: efficacy in patients undergoing conization

Objetivo: Comparar la evolución de la cicatrización en pacientes en quienes se aplicó amnios con cobertura antibiótica, con otro grupo en que no se aplicó, posterior a la realización de conización cervical en la consulta de patología cervical del Hospital Central de San Cristóbal, entre febrero y mayo de 2023. Métodos: Estudio experimental, comparativo, aleatorizado, longitudinal. Incluyó 66 pacientes, aleatorizadas en dos grupos: grupo 1 (control): no se aplicó el amnios (n = 30/45,5 %) y grupo 2 (experimental): se aplicó el amnios tratado con antibióticos (n = 36/54,5 %). La investigadora preparó, en quirófano, el amnios de placentas obtenidas por cesárea o parto vaginal. Se obtuvo consentimiento informado de donantes y receptoras. Resultados: Al día 14, ninguna paciente del grupo 1 presentaba epitelización. En el grupo 2, una paciente (2,7 %) tenía 50 % de epitelización y 35 (94,6 %) habían alcanzado el 100 % (p < 0,001). La epitelización fue total en 13,3 % del primer grupo y 94,6 % del segundo (Odds Ratio de 227 (IC 95 %: 24,0 a 2157,0; p < 0,001). No hubo ningún caso de infección cervical. Cinco pacientes (16,7 %) del grupo 1 y una del grupo 2 (2,8 %) presentaron ectopias (p = 0,051). No hubo asociación entre epitelización completa o parcial y características clínicas (p ˂ 0,05). Conclusión: El amnios con cobertura antibiótica se asocia a mejor evolución de la cicatrización en pacientes con conización cervical. Se comprobó su eficacia como terapéutica médica al ser aplicada sobre la herida operatoria(AU)

Objective: To compare the evolution of healing in patients in whom amnion with antibiotic coverage was applied, with another group in which it was not applied, after cervical conization performed in cervical pathology consultations of the San Cristobal Central Hospital, between February and May 2023. Methods: Experimental, randomized, longitudinal comparison. It included 66 patients, randomly divided into two groups. Group 1: in which amnion was applied (n = 36/54.5 %); Group 2: no treatment (n = 30/45.5%). The researcher prepared the amnions of placentas obtained by cesarean section or vaginal delivery, in the operating room. Informed consent was obtained from both donors and recipients. Results: On day 14, none of the patients in the group 1 had epithelialization. In the group 2, one patient (2.7%) had 50% epithelialization and 35 (94.6%) had reached 100% (p < 0.001). Epithelialization was total in 13.3% of the first group and 94.6% of the second group (Odds Ratio of 227 (95% CI: 24.0 to 2157.0; p < 0.001). There were no cases of cervical infection. Five patients (16.7%) in the group 1 and one in the group 2 (2.8%) had ectopias (p = 0.051). There was no association between complete or partial epithelialization and clinical characteristics (p ˂ 0.05). Conclusion: Amnion with antibiotic coverage is associated with better healing outcomes in conized patients. Its effectiveness as a medical therapy was proven when placed on the surgical wound(AU)

Inversión uterina no puerperal en paciente con leiomioma uterino: caso clínico / Non-puerperal uterine inversion in a patient with uterine leiomyoma: case report

La inversión uterina es una patología de presentación rara e infrecuente. Se presenta el caso de una paciente con inversión uterina no puerperal con requerimiento de histerectomía abdominal total. Sin antecedentes de importancia asistió al servicio de urgencias por un cuadro clínico de dolor abdominal de 10 días de evolución asociado a sangrado vaginal abundante con inestabilidad hemodinámica y sensación de masa vaginal. Al examen físico se evidenció una masa sobresaliente del canal vaginal de aspecto necrótico, por lo que se sospechó mioma nascens. Durante la estancia hospitalaria presentó inestabilidad hemodinámica, por lo que fue llevada a histerectomía abdominal de urgencia con hallazgo de inversión uterina. La inversión uterina no puerperal es infrecuente. Es importante realizar un buen diagnóstico clínico apoyado de las imágenes si se encuentran disponibles, la intervención quirúrgica es necesaria y proporciona un buen pronóstico. La histerectomía vaginal no es sencilla en estos casos, por lo que se recomienda la histerectomía abdominal total.

Uterine inversion is a rare and infrequent disease. The case of a patient with a non-puerperal uterine inversion that had to be treated with a total abdominal hysterectomy is presented in this study. With no important history of disease, she attended the emergency department presenting abdominal pain in the last 10 days associated with vaginal bleeding and mass sensation. The physical examination revealed a protruding necrotic-like mass through the vagina, hence the suspicion of a myoma nascens. During her hospital ward stay, she presented hemodynamic instability, urgent abdominal hysterectomy had to be done which revealed uterine inversion. Non-puerperal uterine inversion is infrequent. Precise clinical diagnosis is important supported by diagnostic imaging if available. The surgical intervention is necessary, giving a good prognosis. Vaginal hysterectomy is not easy in this type of cases, therefore total abdominal hysterectomy is recommended.

Síndrome de leiomiomatose cutânea e uterina múltipla: relato de três casos clínicos / Multiple cutaneous and uterine leiomyomatosis syndrome: report of three clinical cases

A síndrome de Reed ocorre em mulheres com múltiplos leiomiomas cutâneos e leiomiomatose uterina. Relatam-se três casos de pacientes do sexo feminino, acompanhadas em hospital universitário, com pápulas e nódulos eritêmato-acas- tanhados dolorosos em membros superiores e tórax, agravados por frio, pressão e estresse, e associados a miomatose uterina. Foram realizados diversos tratamentos prévios, sem sucesso, tais como: aplicação de corticoterapia e toxina botulínica intralesional, bloqueadores de canais de cálcio, neuromoduladores e analgésicos orais. Foi, então, realizado tratamento cirúrgico, com melhora dos sintomas. O co- nhecimento e o esclarecimento dessa síndrome é fundamental para estabelecer a relação com miomatose uterina e câncer de células renais, para que, então, a partir da lesão de pele, se faça o rastreio das demais neoplasias, diagnóstico precoce e a educação em saúde.

Reed syndrome occurs in women with multiple cutaneous leiomyomas and uterine leiomyomatosis. We report the case of three female patients followed at a university hospital with painful erythematous-brown papules and nodules on the upper limbs and chest, aggravated by cold, pressure, stress, and associated with uterine myoma- tosis. Several previous unsuccessful treatments were performed, such as the applica- tion of corticotherapy and intralesional botulinum toxin, calcium channel blockers, neuromodulators, and analgesics. Surgical treatment was performed with the im- provement of symptoms. Knowledge and clarification of this syndrome are essential to establish a relationship between uterine myomatosis and renal cell neoplasm, so that, after the skin lesion, screening for other neoplasms, early diagnosis, and health education can be carried out.

Autoeficacia para el tamizaje de cáncer cervical o de próstata: comparando mujeres y hombres colombianos / Self-efficacy in requesting cervical or prostate cancer screening: comparing Colombian females and males

Introducción: Los cánceres de cuello uterino y próstata tienen una importante carga de morbilidad en países en desarrollo. La autoeficacia para solicitar el tamizaje es un elemento clave en la prevención. Objetivo: Comparar la percepción de hombres y mujeres sobre autoeficacia para el tamizaje de cáncer cervical y de próstata. Métodos: Estudio mixto con 50 mujeres y 50 hombres. Se indagaron datos sociodemográficos. Se aplicó la escala de autoeficacia de detección del cáncer cervical, con una modificación de esta para medición de cáncer de próstata en hombres. La autoeficacia se clasificó por niveles y las variables asociadas a esta se identificaron con regresión robusta. Se realizaron entrevistas semiestructuradas a 27 individuos (18 hombres y 9 mujeres) con baja y alta autoeficacia, así como a individuos de "otra" religión, para conocer las diferencias en la intención del tamizaje. Se crearon tres categorías de análisis basadas en el modelo de creencias en salud. Resultados: Mujeres y hombres fueron similares, excepto en religión, ocupación y antecedentes de Papanicolaou o examen rectal. La autoeficacia fue mayor entre las mujeres (ß aj.:-15,29 IC del 95 %: -18,36 a -12,21) y los no creyentes (ß aj.: -5,38 IC del 95 %: -10,33 a -0,44). Ellas buscan más el tamizaje que los hombres, quienes necesitan tener síntomas para hacerlo, necesitan tener síntomas. La vergüenza e incomodidad son barreras expresadas por ambos sexos. En los hombres, el machismo es una fuerte barrera para solicitar el tamizaje. La religión asocia el sexo con impureza, siendo una barrera entre las mujeres. Los servicios de atención de la salud solo se centran en el cribado femenino. Conclusiones: Los roles de género y elementos de religión son expresiones culturales que determinan la intención de detección del cáncer en hombres y mujeres. Las intervenciones de los servicios de salud deben considerar estos elementos para mejorar la cobertura de detección temprana y reducir la morbimortalidad de estos dos tipos de cáncer.

Introduction: Cervical and prostate cancers have a significant burden of disease in developing countries. Self-efficacy to request screening is a key element in prevention. Objective: To compare the perception of men and women on self-efficacy for cervical and prostate cancer screening. Methods: Mixed study with 50 women and 50 men. Sociodemographic data was investigated. The cervical cancer detection self-efficacy scale was applied, with a modification for measuring prostate cancer in men. Self-efficacy was classified by levels and the variables associated with it were identified with robust regression. Semi-structured interviews were conducted with 27 individuals (18 men and 9 women) with low and high self-efficacy and of "other religion" to know the differences in the intention of the screening. Three categories of analysis were created based on the health belief model. Results: Women and men were similar except for religion, occupation, and history of Pap smear or rectal exam. Self-efficacy was higher among women (Adj. ß: -15.29, 95% CI: -18.36 to -12.21) and non-believers (Adj. ß: -5.38, 95% CI: -10.33 to -0.44). They seek screening more than men because they need to have symptoms. Shame and discomfort are barriers expressed by both genders. In men, machismo is a strong barrier to request screening. Religion associates sex with impurity, thus, acts as a barrier among women. Health care services only focus on female screening. Conclusions: gender roles and elements of religion are cultural expressions, which determine the intention of cancer detection in men and women. Health services interventions should consider these elements to improve the coverage of early detection and reduce the morbidity and mortality of these two types of cancer.

Mapa de evidências efetividade clínica das Medicinas Tradicionais, Complementares e Integrativas para Câncer do Útero: informe executivo / Map of evidence clinical effectiveness of Traditional, Complementary and Integrative Medicines for Uterine Cancer: executive report

O mapa apresenta uma visão geral das evidências sobre os efeitos clínicos das terapias complementares e integrativas para o câncer do útero e do colo do útero. A partir da caracterização de centenas de estudos na série de mapas de evidências das Medicinas Tradicionais, Complementares e Integrativas (MTCI/PICS), foram selecionados e incluídos 26 estudos de revisão (18 revisões sistemáticas, 7 revisões sistemáticas e metanálises, e 1 metanálise). As revisões avaliaram o efeito de 28 tipos de intervenções distribuídos em 3 grupos ­ Fitoterapia e Plantas Medicinais; Terapias não-Farmacológicas; Suplementos / Produtos Naturais ­ e associadas a 33 desfechos de saúde distribuídos em 5 grupos: Curso da doença; Sintomas relacionados ao Câncer; Indicadores Metabólicos e Fisiológicos; Bem-Estar, Vitalidade e Qualidade de Vida; Saúde Mental.

Tumor de músculo liso uterino de potencial maligno incierto (STUMP): reporte de caso y revisión de la literatura / Uterine smooth muscle tumor of uncertain malignant potential (STUMP): case report and literature review

Myometrial smooth muscle neoplasms are the most common gynecologic tumors with a prevalence of 70-80% at age 50. Among women undergoing hysterectomy or myomectomy for a suspected diagnosis of leiomyoma, 0.01% receive a diagnosis of STUMP. Clinically, the average age of presentation is between 41-48 years. Tumors ranging from 3 to 30 cm have been described. Signs and symptoms are similar to leiomyomas, such as abnormal uterine bleeding, anemia, dysmenorrhea, pelvic pain, pelvic mass, infertility or other types of pain secondary to compression of adjacent organs. Due to the limited literature available, there is no definite management consensus, and treatment and follow-up options are limited to observational studies. The standard treatment is total hysterectomy with or without bilateral salpingo-oophorectomy; if fertility has already been completed, there is no role for adjuvant hormonal therapy or chemotherapy. The overall 5-year survival is 92-100%. A case of a 31-year-old woman with STUMP is presented.

Tumor de células epitelioides perivasculares (PEComa) uterino en una paciente pediátrica: reporte de caso / Uterine perivascular epithelioid cell tumor (PEComa) in a pediatric patient: case report

El PEComa es un tumor de células epitelioides, perivascular, de origen mesenquimatoso. Estos tumores corresponden a un grupo raro de neoplasias. Hay cerca de 100 casos reportados de los que solo el 30% son de origen ginecológico y el cuerpo uterino es el sitio más frecuente. Debido a su baja frecuencia de aparición no hay una conducta médica y tratamiento establecidos, por lo cual es un reto el manejo de esta entidad. La presentación en población pediátrica es extremadamente rara, con datos limitados de su frecuencia de presentación en este grupo etario. Presentamos el caso de una paciente de 13 años que consultó por dolor pélvico; se realizaron imágenes diagnósticas que documentaron una masa paraanexial derecha sólida; es llevada a cirugía obteniendo como hallazgo un tumor dependiente del cuerpo uterino cuya histología correspondía a un PEComa con características de comportamiento maligno

PEComa is a perivascular epithelioid cell tumor of mesenchymal origin. These tumors correspond to a rare group of neoplasms. About 100 cases have been reported, of which only 30% are of gynecological origin, and the uterine body is the most frequent site. Due to its low frequency of appearance, there is no established medical conduct and treatment, which is why the management of this entity is a challenge. Presentation in the pediatric population is extremely rare, with limited data on its frequency in this age group. We present the case of a 13-year-old patient who consulted for pelvic pain. Diagnostic images were performed that documented a solid right para-adnexal mass. She was taken to surgery, which evidenced a tumor dependent on the uterine body with histology corresponding to a PEComa with characteristics of malignant behavior

Sarcoma uterino de topografía cervical / Sarcoma of the uterus of cervical topography / Sarcoma de colo de utero

Introducción: Los sarcomas uterinos son tumores poco frecuentes. Se originan en el tejido uterino de origen mesodérmico (músculo, tejido conjuntivo o estroma), siendo los más frecuentes los leiomiosarcomas, seguidos de los sarcomas del estroma endometrial. La expresión clínica de la enfermedad puede ser con sangrados genital, distensión abdominal y/o síntomas compresivos. Muchas veces se diagnostican en pacientes que son hatadas quirúrgicamente con diagnóstico de miomatosis uterina y, lo más frecuente es el diagnostico anatomopatológico posto peratorio de la pieza quirúrgica. El rol de la cirugía (histerectomía y anexectomía) es fundamental en el tratamiento. Descripción: El video presenta la evaluación diagnóstica y el abordaje quirúrgico de una paciente en la que se diagnosticó un leiomiosarcoma uterino de topografía cervical. Conclusiones: Se trata de una patología poco frecuente, con la particularidad de la ubicación, generando dificultades diagnósticas (clínica y paraclínicas) así como de abordaje quirúrgico. Ver video en https://www.youtube.com/watch?v=9rr8R2L7CWs

Summary: Introduction: Sarcoma of uterus are rather unusual tumors. They ori ginate in the mesodermal tissue of the uterus (muscle, connective tissue or stroma), the most frequent ones being leiomyosarcoma, followed by endometrial stromal sarcomas. The clinical presentation of the disease may include genital bleeding, abdominal distention or compressive symptoms. They are often diagnosed in patients who are surgically treated with a diagnosis of uterine myoma, upon the postoperative pathological study of the surgical piece. The role of surgical treatment (hysterectomy and anexectomy) is of the essence. Description: The video presents the diagnostic assessment and sur gical approach of a patient who was diagnosed with leiomyosarcoma of the uterus with cervical topography. Conclusions: It it rather an unusual condition with a special loca tion. which results in diagnostic difficulties (both clini cal and paraclinical) as well as hi the surgical approach. Watch video at https://www.youtube.com/watch?v=9rr8R2L7CWs

Introdução: Os sarcomas uterinos sào tumores raros. Originam-se no tecido uterino de origem mesodérmica (músculo, tecido conjuntivo ou estróina), sendo os leiomiossarco- mas os mais frequentes, seguidos dos sarcomas estro- mais endometriais. A expressão clínica da doença pode ser com sangramento genital, distensão abdominal e/ou sintomas compressivos. São frequentemente diagnosticados em pacientes tratadas cirurgicamente com diagnóstico de miomatose uterina e, mais frequentemente, com diagnóstico da anatomia patológica pós-operatória da peça cirúrgica. O papel da cirurgia (histerectomia e anexectomia) é essencial no tratamento. Descrição: O vídeo apresenta a avaliação diagnóstica e abordagem cirúrgica de uma paciente diagnosticada com leiomiossarcoma de colo de útero. Conclusões: É uma patologia pouco frequente, pela particularidade da sua localização, gerando dificuldades de diagnóstico (clínico e complementar) bem como de abordagem cirúrgica. Veja o vídeo em https://www.youtube.com/watch?v=9rr8R2L7CWs

Leiomioma submucoso de gran tamaño: una presentación inusual. Reporte de Caso / Large submucosal leiomyoma: an unusual presentation

Se ha postulado que más del 70 % de las mujeres antes de la menopausia son diagnosticadas de leiomiomas; de estas un 25 % presentan sintomatología grave. La ecografía es la modalidad de imagen de primera elección para su estudio. Se tiene registros de progresión de leiomiomas a leiomiosarcomas, que conllevan a un mal pronóstico y son responsables de una cuarta parte de las muertes por neoplasias uterinas, con una sobrevida a 5 años que van desde 46-53 %, lo cual incentiva el diagnóstico precoz y eficaz de masas uterinas. El caso reportado es una presentación inusual de un leiomioma de gran tamaño, que por los hallazgos de imagen se reportó como una neoplasia maligna, su aspecto macroscópico totalmente atípico reforzaba la sospecha imagenológica. Solo se pudo determinar el diagnóstico definitivo mediante estudio histopatológico posterior a histerectomía. Las evaluaciones ginecológicas de rutina deben incluir exámenes especializados de imagen pélvica, la ausencia de presentación típica o síntomas característicos de una patología no debe ser motivo para obviar exámenes complementarios que permitan un diagnóstico oportuno y tratamiento eficiente de leiomiomas, incluso en casos de presentaciones inusuales y desafiantes para el diagnóstico, como el que se ha reportado en esta obra.

It has been postulated that more than 70% of premenopausal women are diagnosed with leiomyomas; Of these, 25% have severe symptoms. Ultrasound is the imaging modality of choice for its study. There are reports of progression from leiomyomas to leiomyosarcomas, which leads to a poor prognosis, and is responsible for a quarter of deaths from uterine neoplasms, with a 5-year survival ranging from 46-53%; this should encourage early and effective diagnosis of uterine masses. The reported case is an unusual presentation of a large leiomyoma, which due to its imaging characteristics, was reported as a malignant neoplasm. Its completely atypical macroscopic appearance reinforced the imaging diagnosis suspicion. The definitive diagnosis could only be determined by histopathological study after hysterectomy. Routine gynecological evaluations should include specialized pelvic imaging exams, the absence of a typical presentation or characteristic symptoms of a pathology should not be a reason to obviate ancillary testing that would allow a timely diagnosis and effective treatment of leiomyomas, even in unusual and challenging presentations, such as with the patient in this case report.

Cuando el cuerpo no puede / When the Body can't

En el presente trabajo nos proponemos visibilizar el padecimiento psíquico de las mujeres que atraviesan un cáncer ginecológico y que, además, deben hacer frente a la imposibilidad de gestar como consecuencia de la enfermedad. Y también reflexionar sobre el trabajo del psicólogo en este ámbito. Para cumplir con nuestro objetivo nos valdremos del episodio cinco de la segunda temporada de la serie televisiva estadounidense "New Amsterdam" (S2, E 5), estrenada en el año 2018 en Netflix, la plataforma de streaming estadounidense

In this paper we intend to make visible the psychological suffering of women who go through a gynecological cancer and who, in addition, must face the impossibility of gestating as a result of the disease. And also reflect on the work of the psychologist in this area. To meet our goal, we will use episode five of the second season of the American television series "New Amsterdam" (S2, E 5), premiered in 2018 on Netflix, the American streaming platform

Embarazo con miomatosis uterina complicado con isquemia intestinal: reporte de un caso / Pregnancy with uterine myomatosis complicated by intestinal ischemia: case report

Resumen Los miomas uterinos, también conocidos como fibromas o leiomiomas, son los tumores uterinos benignos más prevalentes. Afectan a las mujeres principalmente durante sus años reproductivos y se diagnostican hasta en un 70% de las mujeres blancas y en más del 80% de las mujeres de ascendencia africana durante su vida, con una prevalencia durante el embarazo del 2% al 10%. Pueden ser asintomáticos hasta en un 70% de las pacientes, y se estima que pueden ocurrir complicaciones en aproximadamente una de cada 10 mujeres embarazadas. Se han asociado a complicaciones y resultados adversos del embarazo, según su tamaño y ubicación en el útero, y pueden manifestarse de diferentes formas. Presentamos el caso de una mujer de 30 años, con embarazo en el tercer trimestre, quien consultó por dolor abdominal, con ecografías obstétricas durante su control prenatal que reportaban miomatosis uterina, quien presentó isquemia intestinal por un vólvulo de intestino delgado versus compresión extrínseca.

Abstract Uterine fibroids, also known as fibroids or leiomyomas, are the most prevalent benign uterine tumors, affecting women mainly during their reproductive years and are diagnosed in up to 70% of white women and more than 80% of women of African descent during their lifetime, with a prevalence during pregnancy of 2% to 10%; they may be asymptomatic in up to 70% of patients, and it is estimated that complications may occur in approximately one in 10 pregnant women. They have been associated with complications and adverse pregnancy outcomes, depending on their size and location in the uterus, they can manifest in different ways. We present the case of a 30-year-old woman, pregnant in the third trimester, who consulted for abdominal pain, with obstetric ultrasound scans during her prenatal check-up reporting uterine myomatosis, who presented intestinal ischemia due to small bowel volvulus versus extrinsic compression.

Pulmonary Benign Metastasizing Leiomyoma: Case Report of Late Occurrence in Postmenopausal Patient / Leiomiomatose Benigna Metastatizante Pulmonar: Relato de um Caso com Ocorrência Tardia em Paciente Pós-menopausa / Leiomiomatosis Benigna Metastatizante Pulmonar: Reporte de un Caso con Ocurrencia Tardía en Paciente Posmenopáusica

Introduction: Pulmonary benign metastasizing leiomyoma (PBML) is a rare condition that occurs most commonly in young women of reproductive age some years after hysterectomy. The aim of this study was to report a PBML case which occurred 33 years after hysterectomy in a postmenopausal patient. Case report: A 59-year-old female diabetic patient, G2P2A0, with dyslipidemia, a non-smoker and ex-alcoholic (quit in the 90s), with pulmonary symptoms was referred to the health service. A chest computed tomography (CT) revealed multiple pulmonary nodules. A previous history of hysterectomy at 26 years of age led to a diagnostic hypothesis of PBML. The patient underwent segmentectomy of the largest nodule (measuring 1.2 x 0.9 cm) located in the left lung. Histopathology and immunohistochemistry studies confirmed the diagnosis of PBML. Conclusion: The patient is currently in good physical condition (regression of previous pulmonary symptoms) and scheduled for clinical follow-up. A new chest CT will be performed in 6 months

Introdução: A leiomiomatose benigna metastatizante pulmonar (LBMP) é uma doença rara, ocorrendo mais comumente em mulheres jovens em idade reprodutiva alguns anos após a realização de histerectomia. O objetivo deste estudo foi relatar um caso de LBMP de ocorrência tardia, 33 anos após a realização de histerectomia, em uma paciente pós-menopausa. Relato do caso: Paciente do gênero feminino, 59 anos, G2P2A0, diabética, dislipidêmica, não tabagista e ex-etilista (parou na década de 1990), foi encaminhada ao serviço médico com sintomas pulmonares, sendo realizada tomografia computadorizada (TC) de tórax que revelou múltiplos nódulos pulmonares. Havia história prévia de histerectomia aos 26 anos de idade, sendo levantada a hipótese diagnóstica de LBMP. Paciente realizou segmentectomia do maior nódulo (medindo 1,2 x 0,9 cm) localizado no pulmão esquerdo. Exame anatomopatológico e imuno-histoquímica confirmaram o diagnóstico de LBMP. Conclusão: Atualmente, a paciente se encontra em seguimento clínico e em bom estado geral (sem os sintomas pulmonares apresentados inicialmente). Será realizada uma nova TC de tórax em seis meses

Introducción: La leiomiomatosis benigna metastatizante pulmonar (LBMP) es una enfermedad rara, que ocurre con mayor frecuencia en mujeres jóvenes en edad reproductiva pocos años después de la histerectomía. El objetivo de este estudio fue reportar un caso de LBMP de inicio tardío, 33 años después de la histerectomía, en una paciente posmenopáusica. Reporte del caso: Paciente de género femenino, 59 años, G2P2A0, diabética, dislipidémica, no fumadora y exalcohólica (parado en los 90), fue remitida al servicio por cuadro pulmonar, siendo sometida a tomografía computarizada (TC) de tórax, que reveló múltiples nódulos pulmonares. Existía antecedente de histerectomía a los 26 años, planteando la hipótesis diagnóstica de LBMP. Paciente fue sometida a segmentectomía del nódulo de mayor tamaño (de 1,2 x 0,9 cm) localizado en el pulmón izquierdo. El examen patológico y la inmunohistoquímica confirmaron el diagnóstico de LBMP. Conclusión: Actualmente la paciente se encuentra en seguimiento clínico y en buen estado general (sin los síntomas pulmonares presentados inicialmente). Se realizará una nueva TC de tórax en seis meses

Metastasizing leiomyoma during pregnancy

Uterine leiomyoma is a benign tumor of myometrial tissue which affects women of reproductive age. Its prevalence increases with age and has a peak incidence at the age of forty. The term "metastasizing leiomyoma" refers to a tumor of dense connective tissue and smooth myometrial muscle cells located outside the uterus. This group of tumors can metastasize to different organs, the lung being its main focus. We present the case report of a 33-year-old female gravida 3, para 1, abortus 1, at 11 weeks of pregnancy, with pelvic masses. The diagnosis was metastasizing leiomyoma during pregnancy.

Nódulo del estroma endometrial: Reporte de un caso infrecuente / Endometrial stromal nodule: A rare case report

Introducción: Los tumores del estroma endometrial representan menos del 2% de los tumores uterinos, estando dentro de las neoplasias menos comunes del cuerpo uterino. Se pueden dividir en cuatro categorías principales: nódulo del estroma endometrial, sarcoma del estroma endometrial de bajo grado, sarcoma del estroma endometrial de alto grado y sarcoma uterino indiferenciado. En el presente trabajo se describe el caso de un paciente con diagnóstico de nódulo del estroma endometrial. Caso clínico : Paciente femenino de 50 años de edad, quien refiere inicio de enfermedad en marzo de 2022, caracterizado por presentar sangrado uterino anormal anemizante y aumento de volumen abdominal, por lo que acude a facultativo foráneo, donde indican paraclínicos. Para el día 12 de julio de 2022, presentó dolor abdominal de aparición brusca de moderada a severa intensidad. Motivo por el cual acudió a nuestro centro. Se determina anemia y leucocitosis. Estudios de imagen reportan masa voluminosa, densidad mixta, bien delimitada. Otra lesión hiperecogénica, que corresponde a quiste unicameral de ovario derecho. Se decide resolución quirúrgica, mediante la realización de laparotomía exploradora más protocolo de endometrio, con evolución satisfactoria de la paciente. Conclusión : La histerectomía es el tratamiento de elección. El estudio anatomopatológico es fundamental para su diagnóstico final y diferenciación de los sarcomas estromales, ya que su pronóstico, tratamiento y seguimiento es diferente(AU)

Introduction: Endometrial stromal tumors represent less than 2% of uterine tumors, being among the least common neoplasms of the uterine body. They can be divided into four main categories: endometrial stromal nodule, low-grade endometrial stromal sarcoma, high-grade endometrial stromal sarcoma and undifferentiated uterine sarcoma. This paper describes the case of a patient with a diagnosis of endometrial stromal nodule.Clinical case : A 50-year-old female patient, who reported the onset of the disease in March 2022, characterized by abnormal uterine bleeding with anemia and increased abdominal volume, for which she went to a foreign physician, where they indicated paraclinical tests. On July 12, 2022, he presented abdominal pain of sudden onset of moderate to severe intensity. Which is why she came to our center. Anemia and leukocytosis are determined. Imaging studies report a voluminous mass, mixed density, well delimited. Another hyperechoic lesion, which corresponds to a unicameral cyst of the right ovary. Surgical resolution was decided by performing an exploratory laparotomy and endometrial protocol, with satisfactory evolution of the patient.Conclusion : Hysterectomy is the treatment of choice. The anatomopathological study is fundamental for its final diagnosis and differentiation of stromal sarcomas, since its prognosis, treatment and follow-up are different(AU)

Prevalencia y caracterización de mujeres vírgenes con diagnóstico de cáncer de cérvix, endometrio y ovario, un estudio de centro único / Prevalence and characterization of virgin women diagnosed with cervical, endometrial and ovarian cancer, a single center study

Introducción: El cáncer de endometrio, el cáncer de ovario y el cáncer cervicouterino son las neoplasias, dentro del cáncer del aparato reproductor femenino, que se consideran más frecuentes en la actualidad. La aparición de cáncer ginecológico en mujeres vírgenes demuestra que se deben consideran otras factores causales de la enfermedad, sin embargo, en nuestro país, no hay la suficiente evidencia de documentación sobre estos casos. El objetivo del presente estudio medir la prevalencia de cáncer de cuello uterino, útero y ovarios en mujeres vírgenes atendidas en un centro de referencia de Ginecología Oncológica de Guayaquil. Metodología: El estudio es observacional y transversal, se realizó en el Hospital de Especialidades Teodoro Maldonado Carbo, del Instituto Ecuatoriano de Seguridad Social, Guayaquil-Ecuador, de enero del 2013 al diciembre del 2017. Se incluyeron pacientes con cáncer cervicouterino, de útero y ovarios divididos en Grupo 1 (G1) Mujeres vírgenes y Grupo 2 (G2): Mujeres con vida sexual activa. Las variables fueron edad, órgano afectado, comorbilidades, antecedente familiar de cáncer, tipo histológico y muerte. La muestra fue no probabilística, tipo censo. Se utiliza estadística analítica, la muestra dividida en 2 grupos se compara usando Chi2. Se reporta Odds Ratio con intervalo de confianza del 95%. Resultados: En G1 fueron 44 casos y en G2 fueron 337 casos. Lo que representa una prevalencia de 11.55% (IC95% 11.38-11.71%). Cáncer de Ovario en G1 fue 29/44 casos (66%) versus 95/337 casos (28.2%) en G2 P<0.0001 con OR: 4.92 (2.53-9.60). Cáncer de endometrio en G1 13/44 casos (29.5%) versus 54/337 casos (16%) en G2, OR 2.20 (1.08-4.47) P=0.03. Cáncer cervical en G1 2/44 casos (4.5%) y en G2 188/337 casos (55.8%) OR 0.38 (0.009-0.159) P<0.0001. La mortalidad en G1 fue 30/44 casos en G2 fue 130/337 casos, OR 4.14 (2.12-8.08) P>0.0001. Conclusión: En mujeres sin antecedentes de vida sexual, existe mayor riesgo de cáncer de ovario y de endometrio y el riesgo de cáncer de cérvix se disminuye un 96%. La mortalidad de este grupo de mujeres se duplica por la mayor existencia de cáncer de ovario y endometrial.

Introduction: Endometrial cancer, ovarian cancer and cervical cancer are the neoplasias, within cancer of the female reproductive system, which are considered more frequent today. The appearance of gynecological cancer in virgin women shows that other causal factors of the disease must be considered, however, in our country, there is not enough documentary evidence on these cases. The objective of this study is to measure the prevalence of cervical, uterine and ovarian cancer in virgin women treated in a reference center for Gynecology Oncology in Guayaquil. Methodology: The study is observational and cross-sectional, it was carried out at the Teodoro Maldonado Carbo Specialties Hospital, of the Ecuadorian Social Security Institute, Guayaquil-Ecuador, from January 2013 to December 2017. Patients with cervical, uterine and cervical cancer were includ-ed. ovaries divided into Group 1 (G1) Virgin women and Group 2 (G2): Women with an active sexual life. The variables were age, affected organ, comorbidities, family history of cancer, histological type, and death. The sample was non-probabilistic, census type. Analytical statistics are used, the sample divided into 2 groups is compared using Chi2. Odds Ratio is reported with a confidence interval of 95%. Results: In G1 there were 44 cases and in G2 there were 337 cases. Which represents a prevalence of 11.55% (95% CI 11.38-11.71%). Ovarian cancer in G1 was 29/44 cases (66%) versus 95/337 cases (28.2%) in G2 P <0.0001 with OR: 4.92 (2.53-9.60). Endometrial cancer in G1 13/44 cases (29.5%) versus 54/337 cases (16%) in G2, OR 2.20 (1.08-4.47) P = 0.03. Cervical cancer in G1 2/44 cases (4.5%) and in G2 188/337 cases (55.8%) OR 0.38 (0.009-0.159) P <0.0001. Mortality in G1 was 30/44 cases in G2 it was 130/337 cases, OR 4.14 (2.12-8.08) P> 0.0001. Conclusion: In women with no history of sexual life, there is a greater risk of ovarian and endometrial cancer and the risk of cervical cancer is decreased by 96%. The mortality of this group of women doubles due to the increased existence of ovarian and endometrial cancer

Gran mioma uterino: manejo prequirúrgico con uso de agonistas de gnrh: reporte de un caso / Large uterine myoma: presurgical management with the use of gnrh agonists: case report

Introducción: Los leiomiomas uterinos son los tumores pélvicos benignos más comunes entre las mujeres. Se estima que 60% de las mujeres llegan a tener miomatosis a lo largo de la vida (1). La necesidad de tratamiento médico y/o quirúrgico es muy importante de evaluar, ya que los fibromas son una fuente importante de morbilidad ginecológica. Objetivos: Describir el caso de un gran mioma uterino con manejo prequirúrgico de análogos de GnRH, analizando los hallazgos obtenidos en el caso según la evidencia actual. Discusión: Se reporta el caso de una mujer de 29 años sin antecedentes mórbidos conocidos, con presencia de una gran masa abdominal, motivo por el cual se realizó una ecotomografía abdominal que evidenció una masa sugerente de un gran mioma uterino subseroso. Se realizó miomectomía vía laparotomía previo tratamiento médico con análogos de GnRH. Actualmente la frecuencia de miomas de gran tamaño es poco frecuente, por lo que se busca discutir el impacto del tratamiento médico previo a la cirugía en mujeres jóvenes. Conclusiones: La experiencia con el uso prequirúrgico de agonistas de GnRH indica una ventaja en el trabajo bien definida y su uso como tratamiento coadyuvante a la cirugía está bien establecido. Sin embargo, se debe tener en cuenta la posibilidad de recurrencia de los miomas

Introduction: Uterine leiomyomas are the most common benign pelvic tumors in women. It is estimated that 60% of women develop myomatosis throughout life (1). The need for medical and / or surgical treatment is very important to assess, since fibroids are an important source of gynecological morbidity. Objectives: To describe the case of a large uterine myoma with presurgical management of GnRH analogues and to summarize updated evidence on their use. Discussion: The case of a 29-year-old woman with no known morbid history is reported, with the presence of a large abdominal mass, which is why an abdominal ultrasound scan was performed, which revealed a mass suggestive of a large subserous uterine myoma. Myomectomy was performed via laparotomy after medical treatment with GnRH analogues. Currently, the frequency of large fibroids is rare, so we seek to discuss the impact of medical treatment prior to surgery in young women. Conclusions: Experience with the presurgical use of GnRH agonists indicates a well-defined treatment advantage and its use as adjunctive treatment to surgery is well established. However, the possibility of recurrence of fibroids should be taken into account

Angioleiomioma uterino: a propósito de un caso / Uterine angioleiomyoma: report of clinical case

Resumen El angioleiomioma es un tumor benigno perivascular que raramente se localiza en el útero. Se expone el caso de un angioleiomioma de gran tamaño en una mujer de 30 años con sangrado menstrual abundante y masa abdominal palpable. La paciente fue sometida a miomectomía y diagnosticada de angioleiomioma por el estudio histológico. Ante síntomas persistentes, la angiomiomectomía o la histerectomía simple son eficaces.

Abstract Angioleiomyoma is a benign perivascular tumor that is rarely located in the uterus. This paper presents a case of a large angioleiomyoma in a 30-year-old woman with heavy menstrual bleeding and a palpable abdominal mass. The patient underwent myomectomy and was diagnosed with angioleiomyoma by histological examination. For persistent symptoms, angiomyomectomy or simple hysterectomy are effective.

Accuracy of Transvaginal Ultrasound in the Diagnosis of Intrauterine Lesions / Acurácia da ultrasonografia tranvaginal no diagnóstico de lesões intrauterinas

Abstract Objective To evaluate the accuracy of transvaginal ultrasound in the diagnosis of intrauterine lesions, using hysteroscopy as the gold standard. Methods This was a prospective observational study with 307 patients. All patients underwent hysteroscopy after a previous transvaginal ultrasound to compare the results. The hysteroscopy was performed by experienced examiners, and transvaginal ultrasounds were performed in various public and private services, which is reflective of routine healthcare practices in obstetrics and gynecology. The sensitivity, specificity, and accuracy of the transvaginal ultrasound were calculated using hysteroscopy as the gold standard. The level of agreement between the two exams was calculated using the Kappa test. Results Themean age was 56.55±12.3 years. For endometrial polyps, we observed a sensitivity of 39.8%, specificity of 72.7%, accuracy of 52.8%, and Kappa index of 0.11 (p=0.025). For fibroids, the sensitivity was 46.7%, specificity was 95.0%, accuracy was 87.9%, and Kappa index was 0.46 (p<0.001). For endometrial thickening, the sensitivity was 68.7%, specificity was 41.7%, accuracy was 47.6%, and Kappa index was 0.06 (p=0.126). For endometrial atrophy, we found a sensitivity of 6.7%, specificity of 99.3%, accuracy of 90.2%, and Kappa index of 0.10 (p=0.006). For the other findings, the sensitivity was 15.6%, specificity was 99.6%, accuracy was 87.3%, and Kappa index was 0.23 (P<0.001). Conclusion Our study demonstrated a low level of accuracy of transvaginal ultrasound for the diagnosis of endometrial lesions, when performed by a non-experienced professional. Thus, it is important to consider the use of hysteroscopy to avoid unnecessary and inappropriate treatments.

Resumo Objetivo Avaliar a acurácia do ultrassom transvaginal para o diagnóstico de lesões intrauterinas, tendo a histeroscopia como padrão de referência. Métodos Foi realizado um estudo observacional prospectivo em 307 pacientes, submetidas à histeroscopia após ultrassonografia prévia para comparação dos resultados. A histeroscopia foi realizada por duas médicas com experiência, e os exames de ultrassom foram realizados em diversas fontes, públicas ou privadas, como ocorre no cotidiano da assistência à saúde em nosso meio. Foram avaliados sensibilidade, especificidade e acurácia, tendo a histeroscopia como padrão-ouro. O nível de concordância foi avaliado pelo teste de Kappa. Resultados A idade média foi de 56,55±12,3 anos. Os resultados para pólipo endometrial foram: sensibilidade 39.8%, especificidade 72,7%, acurácia de 52,8%, e índice Kappa 0,11 (p=0,025). Para mioma, sensibilidade 46,7%, especificidade 95,0%, acurácia 87,9%, e índice Kappa 0,46 (p<0,001). Para espessamento endometrial, sensibilidade 68,7%, especificidade 41,7%, acurácia 47,6%, e índice Kappa de 0,06 (p=0,126). Para atrofia, sensibilidade 6,7%, especificidade 99,3%, acurácia 90,2%, e índice Kappa 0,10 (p=0,006). Para outros achados, sensibilidade 15,6%, especificidade 99,6%, acurácia 87,3%, e índice Kappa 0,23 (p<0,001). Conclusão Nosso estudo demonstrou baixo nível de acurácia da ultrassonografia transvaginal para o diagnóstico de lesões endometriais, quando realizada por profissional não experiente. Assim, é importante considerar o uso da histeroscopia para evitar tratamentos desnecessários e inadequados.