[Third National Ovarian Consensus. 2011. Grupo de Investigación en Cáncer de Ovario y Tumores Ginecológicos de México "GICOM"]. / Tercer Consenso Nacional de Cáncer de Ovario 2011. Grupo de Investigación en Cáncer de Ovario y Tumores Ginecológicos de México "GICOM".

INTRODUCTION: Ovarian cancer (OC) is the third most common gynecologic malignancy worldwide. Most of cases it is of epithelial origin. At the present time there is not a standardized screening method, which makes difficult the early diagnosis. The 5-year survival is 90% for early stages, however most cases present at advanced stages, which have a 5-year survival of only 5-20%. GICOM collaborative group, under the auspice of different institutions, have made the following consensus in order to make recommendations for the diagnosis and management regarding to this neoplasia. MATERIAL AND METHODS: The following recommendations were made by independent professionals in the field of Gynecologic Oncology, questions and statements were based on a comprehensive and systematic review of literature. It took place in the context of a meeting of two days in which a debate was held. These statements are the conclusions reached by agreement of the participant members. RESULTS: No screening method is recommended at the time for the detection of early lesions of ovarian cancer in general population. Staging is surgical, according to FIGO. In regards to the pre-surgery evaluation of the patient, it is recommended to perform chest radiography and CT scan of abdomen and pelvis with IV contrast. According to the histopathology of the tumor, in order to consider it as borderline, the minimum percentage of proliferative component must be 10% of tumor's surface. The recommended standardized treatment includes primary surgery for diagnosis, staging and cytoreduction, followed by adjuvant chemotherapy Surgery must be performed by an Oncologist Gynecologist or an Oncologist Surgeon because inadequate surgery performed by another specialist has been reported in 75% of cases. In regards to surgery it is recommended to perform total omentectomy since subclinic metastasis have been documented in 10-30% of all cases, and systematic limphadenectomy, necessary to be able to obtain an adequate surgical staging. Fertility-sparing surgery will be performed in certain cases, the procedure should include a detailed inspection of the contralateral ovary and also negative for malignancy omentum and ovary biopsy. Until now, laparoscopy for diagnostic-staging surgery is not well known as a recommended method. The recommended chemotherapy is based on platin and taxanes for 6 cycles, except in Stage IA, IB and grade 1, which have a good prognosis. In advanced stages, primary cytoreduction is recommended as initial treatment. Minimal invasion surgery is not a recommended procedure for the treatment of advanced ovarian cancer. Radiotherapy can be used to palliate symptoms. Follow up of the patients every 2-4 months for 2 years, every 3-6 months for 3 years and anually after the 5th year is recommended. Evaluation of quality of life of the patient must be done periodically. CONCLUSIONS: In the present, there is not a standardized screening method. Diagnosis in early stages means a better survival. Standardized treatment includes primary surgery with the objective to perform an optimal cytoreduction followed by chemotherapy Treatment must be individualized according to each patient. Radiotherapy can be indicated to palliate symptoms.

[Malignant neoplasm in burn scar: Marjolin's ulcer. Report of two cases and review of the literature]. / Neoplasia maligna en cicatriz de quemadura: úlcera de Marjolin. Informe de dos casos y revisión de la literatura.

BACKGROUND: Marjolin's ulcer forms part of a group of neoplasms that originate in a burn scar, a phenomenon associated with superficial tissue trauma. The frequency of Marjolin's ulcer is low and represents between 2 and 5% of all squamous cell carcinomas of the skin. This condition is found three times more frequently in men than in women and is thought to be more aggressive than conventional squamous cell carcinoma of the skin. CLINICAL CASES: We present two cases of squamous cell carcinoma that originated on a burn scar. 41 year old woman with gasoline burn on the left foot, 3 months old, in whom an exofitic ulcerated lesion on the right calcaneum region has evolved since she was 32 years old. Left transtibial amputation was decided. Another woman who started its suffering 9 years after a thorax burn with a progressive fungus lesion on the scar area. For its size and as it was a high degree neoplasia, surgical resection and radiotherapy to the zone of the primary with 50 Gy in 25 fractions was decided. CONCLUSIONS: Marjolin's ulcer usually occurs in old burn sites that were not skin grafted and were left to heal secondarily. Although it is believed that there is a latency period of 25-40 years after burn injury before the occurrence of malignancy, this may occur in a period as short as 3 months. Recurrence after radical surgery is 14.7%. Nonetheless, because of the aggressive behavior of this type of cancer, appropriate radical treatment allows an adequate control of the disease. Early grafting of the burn site can prevent the formation a malignant neoplasm. This condition should be suspected in a non-healing chronic ulcer on a burn scar.

Neoplasia maligna en cicatriz de quemadura: úlcera de Marjolin: informe de dos casos y revisión de la literatura / Malignant neoplasm in burn scar: Marjolin's ulcer: report of two cases and review of the literature

BACKGROUND: Marjolin's ulcer forms part of a group of neoplasms that originate in a burn scar, a phenomenon associated with superficial tissue trauma. The frequency of Marjolin's ulcer is low and represents between 2 and 5% of all squamous cell carcinomas of the skin. This condition is found three times more frequently in men than in women and is thought to be more aggressive than conventional squamous cell carcinoma of the skin. CLINICAL CASES: We present two cases of squamous cell carcinoma that originated on a burn scar. 41 year old woman with gasoline burn on the left foot, 3 months old, in whom an exofitic ulcerated lesion on the right calcaneum region has evolved since she was 32 years old. Left transtibial amputation was decided. Another woman who started its suffering 9 years after a thorax burn with a progressive fungus lesion on the scar area. For its size and as it was a high degree neoplasia, surgical resection and radiotherapy to the zone of the primary with 50 Gy in 25 fractions was decided. CONCLUSIONS: Marjolin's ulcer usually occurs in old burn sites that were not skin grafted and were left to heal secondarily. Although it is believed that there is a latency period of 25-40 years after burn injury before the occurrence of malignancy, this may occur in a period as short as 3 months. Recurrence after radical surgery is 14.7%. Nonetheless, because of the aggressive behavior of this type of cancer, appropriate radical treatment allows an adequate control of the disease. Early grafting of the burn site can prevent the formation a malignant neoplasm. This condition should be suspected in a non-healing chronic ulcer on a burn scar.

[Breast fibromatosis: a lesion mimicking cancer]. / Fibromatosis de mama: una lesión simuladora de cáncer.

BACKGROUND: Breast fibromatosis (BF) is a rare benign pathological entity. Its etiology is unknown, but it has been associated with surgical trauma and certain genetic disorders. CLINICAL CASES: Case 1. The patient was a 17-year-old female with a 20 x 15 cm firm and fixed mass in the right breast. A core-needle biopsy was taken with a pathology report of a phyllodes tumor. Mammography revealed a well-differentiated lesion with no evidence of muscle invasion. The patient underwent wide surgical resection with thoracotomy and chest wall resection of the affected ribs. Pathology reported a 19 x 18 x 9 cm BF with a positive surgical margin. Oral colchicine was administered and at 3 months of follow-up the patient is disease free. CASE 2. The patient was a 49-year-old female with a 7 x 5 cm solid right breast mass located at the medial-upper quadrant and fixed to the pectoralis major muscle. Mammography and magnetic resonance imaging revealed a mass infiltrating thoracic muscles. Wide surgical resection was performed with immediate latissimus dorsi reconstruction. Pathology report showed a BF with muscle invasion. At 3 months postsurgery, the patient is disease free. CONCLUSIONS: BF is a rare entity with a locally aggressive behavior. The infiltrative nature of this disease is associated with a tendency to recur locally. Its clinical and imaging features can mimic breast cancer. Differential diagnosis should be made before attempting treatment. The standard therapeutic modality is wide surgical resection, and radiotherapy is reserved for some cases with positive surgical margins.

Fibromatosis de mama: una lesión simuladora de cáncer / Breast fibromatosis: a lesion mimicking cancer

BACKGROUND: Breast fibromatosis (BF) is a rare benign pathological entity. Its etiology is unknown, but it has been associated with surgical trauma and certain genetic disorders. CLINICAL CASES: Case 1. The patient was a 17-year-old female with a 20 x 15 cm firm and fixed mass in the right breast. A core-needle biopsy was taken with a pathology report of a phyllodes tumor. Mammography revealed a well-differentiated lesion with no evidence of muscle invasion. The patient underwent wide surgical resection with thoracotomy and chest wall resection of the affected ribs. Pathology reported a 19 x 18 x 9 cm BF with a positive surgical margin. Oral colchicine was administered and at 3 months of follow-up the patient is disease free. CASE 2. The patient was a 49-year-old female with a 7 x 5 cm solid right breast mass located at the medial-upper quadrant and fixed to the pectoralis major muscle. Mammography and magnetic resonance imaging revealed a mass infiltrating thoracic muscles. Wide surgical resection was performed with immediate latissimus dorsi reconstruction. Pathology report showed a BF with muscle invasion. At 3 months postsurgery, the patient is disease free. CONCLUSIONS: BF is a rare entity with a locally aggressive behavior. The infiltrative nature of this disease is associated with a tendency to recur locally. Its clinical and imaging features can mimic breast cancer. Differential diagnosis should be made before attempting treatment. The standard therapeutic modality is wide surgical resection, and radiotherapy is reserved for some cases with positive surgical margins.