[Pheochromocytoma and pregnancy. A case report]. / Feocromocitoma y embarazo. Reporte de un caso.

BACKGROUND: Pheochromocytoma is a tumor originating in the chromaffin cells. These tumors secrete catecholamines which act on target organs and cause hypertensive crises. They are rare during pregnancy, and a differential diagnosis must be carried out mainly with pregnancy-induced hypertension. CLINIC CASE: A 22-year-old patient in week 11.5 of pregnancy presented at the Hospital General Dr. Miguel Silva in Morelia, Michoacán with hypertension that had existed for more than two years with poor adherence to treatment. At the time of referral to our unit she presented a hypertensive crisis that had been unresponsive to all antihypertensive treatments. Following the establishment of a study protocol, a diagnosis of posterior left adrenal pheochromocytoma was made. After subsequent pharmacological treatment with alpha and beta blockers, a left adrenalectomy was performed. The patient did not require antihypertensive treatment following surgery. The histopathological report indicates the presence of a nodular and vascularized left adrenal gland weighing 25 g and measuring 5 x 4 x 3.5 cm. Gland consistency was soft, and the presence of cystic lesions in parenchymal tissue was noted. A yellowish-brown color and sponge-like appearance were also present. Such features support a diagnosis of pheochromocytoma. The pregnancy continued normally until week 32, when the patient presented to our department with active-phase preterm labor. A Cesarean section was performed with the delivery of a live female weighing 1400 gr. The infant is currently alive and well. CONCLUSION: Thus, it is important that obstetrician knows this disease and its management during pregnancy; so we present this case report.

[Genital tuberculosis and pregnancy to term. Case report]. / Tuberculosis genital y embarazo a término. Reporte de caso.

Tuberculosis continues to be a worldwide public health issue, known as "the great pretender" resembling many diseases. Overall 1% of women infected with Mycobacterium species develop genital tuberculosis (GT) which is widespread more commonly during their fertility age, 20-40 years old. GT is the second most common cause of extra pulmonary tuberculosis. One of the clinical manifestations in these patients is Infertility; with a poor prognosis of a successful pregnancy even with a correct diagnosis, medical and/or surgical treatment. Most pregnancies result in ectopic pregnancies or abortions. In low income countries GT may account for 5-20% of infertility cases. It was widely believed that pregnancy represented a period of risk to women infected with tuberculosis; and actually abortion is suggested. We report a case of a 21 year old female patient who came to the General Hospital Dr. Miguel Silva in the city of Morelia, Michoacán with the diagnosis of late puerperium postpartum complicated with retained placental tissue to perform a uterine curettage. The patient had fever and anemia for which we had to perform a laparotomy exploration of the doubt of uterin perforation; the surgical findings were pathognomonic of GT for which we continue to realize Hysterectomy. The macro and microscopically pathologic findings consists in GT, confirming the diagnosis with Ziehl-Neelsen acid stain. GT findings must always be differentiated from ovarian cancer.

[Angiomiofibroblastoma of the vulva. Report of case]. / Angiomiofibroblastoma de la vulva. Reporte de caso.

Angiomyofibroblastoma is a benign mesenchymal tumor of the lower genital tract described in 1992 by Fletcher and his group. Must be differentiated mainly from aggressive angiomyxoma, which has a high local recurrence rate. We report the case of a 21 year old patient who attended the General Hospital Dr. Miguel Silva, in Morelia, Michoacan, because post-term pregnancy of 41.1 weeks gestation, with a bulky vulvar tumor, asymptomatic with four years of evolution. Cesarean section and vulvar tumor resection were performed. The surgical specimen measured 14 x 10 x 5 cm, had a polypoid aspect, multilobulated, with nodules of varying size. From a microscopic point of view the tumor was well defined, formed by loose connective tissue septa, with stromal fusiform cells and benign characteristics, between collagen fibers, with abundant vessels. The histochemical studies were positive for desmin and vimentin. These anatomopathological findings are diagnostic of vulvar angiomyofibroblastoma, benign course tumor, does not resort nor does it generate metastases after simple surgical resection; however, recurrence in the vagina is reported. Must be differentiated from other mesenchymal neoplasms of the genital tract.

[Cotyledonoid dissecting leiomyoma of the uterus. A malignant-looking benign tumor]. / Leiomioma cotiledonoide disecante del útero. Un tumor benigno de apariencia maligna.

The cotyledonoid dissecting leiomyoma of the uterus, or Stenberg tumor, is a rare variant of a smooth muscle benign tumor, classified in the group presenting an unusual growth pattern; clinically, it affects women in reproductive age. We report the case of a 43 year-old woman, who turned up at the Centro Estatal de Atencion Oncologica (State Cancer Care Center) in Morelia, Michoacan, presenting abnormal uterine bleeding and uterine fibroid of major elements. When performing a palpatory bimanual exam, a loose uterus of approximately 7 by 6 inches was identified; it ached when moving. The laboratory tests reported normal parametriums; the ultrasound showed, however, uterine fibroids of major elements. The uterus was enlarged due to a tumor of exophytic growth, which resembles placental cotyledons extended over the uterine surface, composed by smooth muscle nodules that dissected the uterine wall, and with infiltrative appearance in parametriums and the myometrial wall. Despite this microscopic aggressive appearance, a number of ultrastructuctural studies and immunohistochemical techniques proved its benign nature. This can help patients who want to preserve fertility avoid radical surgery.