Three-dimensional power Doppler angiography in endometrial cancer: correlation with tumor characteristics.

OBJECTIVE: To assess the correlation between intratumoral vascularization using three-dimensional power Doppler angiography (3D-PDA) and several histological tumor characteristics in a series of patients with endometrial carcinoma. METHODS: Ninety-nine women (mean age, 61.7 (range, 31-84) years) diagnosed as having endometrial cancer were assessed by transvaginal 3D-PDA before surgical staging. Endometrial volume (EV) and 3D-PDA vascular indices (vascularization index (VI), flow index (FI) and vascularization flow index (VFI)) were calculated using the Virtual Organ Computer-aided AnaLysis (VOCAL) method. All patients were surgically staged. Individual tumor features such as histological type, tumor grade, myometrial infiltration depth, lymph-vascular space involvement, cervical involvement, lymph node metastases and tumor stage were considered for analysis. Multivariate logistic regression (MLR) analysis was used to determine which 3D-PDA parameters were independently associated with each histological characteristic. RESULTS: MLR analysis showed that only EV and VI were independently associated with myometrial infiltration (EV: odds ratio (OR), 1.119 (95% CI, 1.025-1.221), P = 0.012; VI: OR, 1.127 (95% CI, 1.063-1.195), P = 0.001) and tumor stage (EV: OR, 1.103 (95% CI, 1.012-1.202), P = 0.025; VI: OR, 1.120 (95% CI, 1.057-1.187), P = 0.001), only VI was independently associated with tumor grade (OR, 1.056 (95% CI, 1.023-1.091), P = 0.001) and only EV was independently associated with lymph node metastases (OR, 1.086 (95% CI, 1.017-1.161), P = 0.001). CONCLUSION: 3D-PDA analysis of tumor vascularization in endometrial cancer correlates with some prognostic histological characteristics.

Triage for surgical management of ovarian tumors in asymptomatic women: assessment of an ultrasound-based scoring system.

OBJECTIVES: To prospectively evaluate an ultrasound-based scoring system as a method for triaging asymptomatic women presenting with an adnexal mass for surgical treatment. METHODS: Two hundred and four adnexal masses in 189 asymptomatic women undergoing elective surgical treatment at our institution were included in this prospective study. Patients were evaluated by transvaginal power Doppler ultrasound imaging before surgery. Patients were classified as low risk or high risk for malignancy according to an ultrasound-based scoring system. Women with a low risk for malignancy were scheduled for laparoscopy and patients with a high risk for malignancy were scheduled for laparotomy. However, patients classified as low risk by the ultrasound scoring system, but with a tumor size >or= 10 cm or clinical suspicion of pelvic adhesions, were instead considered to be at intermediate risk and were scheduled for laparotomy. Some patients classified as high risk were scheduled for an operative laparoscopy by an expert in gynecological oncology. RESULTS: One hundred and thirty-four (65.7%) masses were considered to be low risk and were treated by a laparoscopically guided procedure. All these tumors were benign. Forty-seven (23%) masses were classified as high risk, of which 39 tumors were malignant and eight benign. Twenty-three (11.3%) tumors were considered to be intermediate risk and were scheduled for primary laparotomy. In this group, 21 (91.3%) tumors proved to be benign and two (8.7%) were malignant. CONCLUSIONS: Ultrasound-based triage of asymptomatic women diagnosed with a persistent adnexal mass is effective for selecting the surgical approach.

[Breast cancer during pregnancy]. / Cáncer de mama durante el embarazo.

As women in western countries delay childbearing, it has been hypothesized that the incidence of breast cancer diagnosed during pregnancy will increase. Breast carcinoma during pregnancy(BCP) put the health of the mother in conflict with that of the fetus. The aim is to give optimal treatment to the mother to maximise the chances of survival, whilst minimising the risk of harm of the fetus. Few breast surgeons or oncologist develop expertise in this area owing the rarity of the association. We report the epidemiology, pathology, clinical picture, therapeutic management and fetal outcome of pregnant women with breast cancer treated in our institution.

Treatment guidelines in ovarian cancer.

National and international specialists have met with the aim of writing down the guidelines for the treatment of epithelial ovarian cancer (in the Spanish Castilian language). These guidelines are based on the International Consensus that was published in English in the Annals of Oncology in 2005. This condition is the leading cause of death from gynaecological cancer in western countries. Its low rate of survival, barely 30% at 5 years, is above all due to late diagnosis and inappropriate surgery, so emphasis is put on these aspects. After describing the methodology for early detection and a scheme of surgical diagnostic procedures in view of the staging of an ovarian mass, the following therapeutic strategies will be recommended: cytoreductive surgery together with platinum chemotherapy under normal conditions, and also in the case of relapse. Likewise, very recent models of treatment focused on molecular targets are presented, and a broad section on methodology of clinical assays. As for this, co-operation among groups is crucial in order to make the conclusions of these studies valid for the development of new therapies.

Intratumoral blood flow in cervical cancer as assessed by transvaginal color doppler ultrasonography: Correlation with tumor characteristics.

The objective of this study was to evaluate whether intratumoral blood flow as assessed by transvaginal color Doppler ultrasonography (TVCD) correlates with some tumor features in cervical cancer. Clinical, sonographic, and histologic data on 49 women (mean age: 50.3 years, range: 25-85 years) diagnosed as having a carcinoma from the uterine cervix were reviewed. Intratumoral blood flow was assessed by TVCD in all cases. Subjective impression of the amount of flow (scanty, moderate, or abundant) as well as the lowest resistance index (RI) and highest peak systolic velocity (PSV, cm/s) were used for analysis. These data were correlated with some tumoral features such as histologic type, histologic grade, tumor volume, and tumor stage. Intratumoral blood flow was found in all cases. Abundant blood flow was found more frequently in squamous carcinoma, moderately or poorly differentiated tumors, tumors with larger volume, and advanced stage tumors (P < 0.0001). Significantly lower RI was found in moderately or poorly differentiated tumors and advanced stage tumors (P < 0.01) and significantly higher PSV was found in moderately or poorly differentiated tumors, tumors with larger volume, and advanced stage tumors (P < 0.01). No correlation was found between RI and PSV and histologic type. Our data indicate that intratumoral blood flow as assessed by TVCD correlates well with some tumor features in cervical cancer.

[F-18-FDG positron emission tomography in the diagnosis of ovarian recurrence. Comparison with CT scan and CA 125]. / Tomografía por emisión de positrones con F-18-FDG en el diagnóstico de recurrencia del cáncer de ovario. Comparación con TAC y CA 125.

OBJECTIVE: The aim of this study was to evaluate the clinical utility of FDG-PET for detecting recurrent disease in patients with ovarian cancer. MATERIAL AND METHODS: Twenty-one FDG-PET studies performed in 19 patients who had previously undergone surgery and chemotherapy for ovarian cancer were reviewed retrospectively. In a maximum interval of one week regarding the FDG-PET study, computed tomography (CT) was performed and CA-125 levels were measured. In 16 cases the relapse suspicion was due to elevation of the tumor marker CA125 and in 5 cases it was due to CT. PET images were obtained at 45 min after the intravenous injection of 370 MBq of FDG. The results of the visual interpretation were compared with the CA125 levels and the images of the CT, and related to the definitive diagnosis. Recurrence was confirmed in 19/21 cases, by means of pathological findings (11 cases) and clinical follow-up for a median of 11 months in the others. RESULTS: Recurrence was confirmed in 16 cases with increased CA-125 and the tumor marker was true-negative in 2 disease free cases, but there were 3 false-negative results (sensitivity of 84 % and accuracy of 86 %). CT correctly identified 9 cases with recurrence, but it was false-negative in 10 cases and false-positive in 2 disease free patients (sensitivity of 47 % and accuracy of 43 %). FDG-PET correctly detected the 19 cases with recurrence but it was false-positive in 2 cases with a sensitivity of 100 % and accuracy of 90 %. In 3 patients with CA125 false-negative and 10 patients with false-negative CT, FDG-PET was positive and recurrence was confirmed. CONCLUSION: These preliminary results suggest that in the follow-up of patients with ovarian cancer FDG-PET could detect recurrence with higher accuracy than CT, and even with higher sensitivity than the tumor marker CA125, being useful at the same time to locate the recurrence when the tumor marker is positive.

Assessment of a new logistic model in the preoperative evaluation of adnexal masses.

OBJECTIVE: To assess a new logistic regression model developed to predict malignancy in adnexal masses. METHODS: In the first part of this study, we developed a logistic model by applying logistic regression analysis in a series of 268 adnexal masses (203 benign and 65 malignant lesions) in 248 patients (mean age, 43.6 years; SD, 14.2 years) evaluated and treated at our institution. Eleven parameters were entered in the logistic regression analysis in a forward stepwise way. In the second part of the study, we evaluated the model's diagnostic performance in a further set of 135 adnexal masses (103 benign and 32 malignant tumors) in 129 patients (mean age, 44.4 years; SD, 14.6 years). This diagnostic performance was compared with that of age, tumor volume, Sassone's and Ferrazzi's B-mode ultrasonographic morphologic scoring systems, serum cancer antigen 125 level, and the tumor's lowest resistive index. Comparison was done by calculating the area under the receiver operating characteristic curve. RESULTS: In logistic analysis, only menopausal status, the presence of papillary projections, the logarithm of the cancer antigen 125 value, tumor blood flow location, and the lowest resistive index were retained in the model. The model had the best area under the curve (0.97), significantly higher than patient age (area under the curve, 0.78; P = .001), tumor volume (area under the curve, 0.68; P < .0001), cancer antigen 125 (area under the curve, 0.88; P = .008), lowest resistive index (area under the curve, 0.85; P = .011), Ferrazzi's scoring system (area under the curve, 0.89; P = .01), and maximal peak systolic velocity (area under the curve, 0.71; P< .0001). Comparison with Sassone's scoring system (area under the curve, 0.91) did not reach statistical significance, but a clear trend was found (P = .116). CONCLUSIONS: The model had the best diagnostic performance for discriminating between benign and malignant adnexal masses. A clinical prospective evaluation is needed to confirm its actual value.

Intraoperative electron beam radiotherapy during radical surgery for locally advanced and recurrent cervical cancer.

OBJECTIVE: The goal of this study was to determine the toxicity patterns and clinical usefulness of intraoperative electron beam radiotherapy (IOERT) in patients with unfavorable-outcome cervical cancer. METHODS: From January 1986 to June 1999, 67 patients (36 recurrent, 31 primary disease) were treated with IOERT. Previously unirradiated patients received preoperative chemoradiation to 45 Gy with cisplatin 20 mg/m(2) and 5-fluorouracil 1000 mg/m(2). IOERT median dose was 12 Gy for primary disease (range: 10-25) and 15 Gy for recurrent disease (range: 10-20). RESULTS: The 10-year control rate within the area treated with IOERT ("in-field" (IF)) for the entire group was 69.4, with 92.8 and 46.4% 10-year IF control rates for the primary and recurrent patients, respectively. IF control rate correlated with involvement of the parametrial margin (P = 0.001), amount of residual disease (P = 0.001), and pelvic lymph node involvement (P = 0.032). The overall incidence of toxic events that might be attributable to IOERT was 14.9%. Chronic pain was observed in 8 of 67 evaluable patients (11.9%) and motor neuropathy of the lower extremity in one patient (3.2%). CONCLUSIONS: IOERT is a valuable boosting technique in the management of advanced but resectable cervical cancer. Patients, especially recurrent cases, with positive lymph nodes, parametrial involvement, and/or incomplete resections have poor local control rates despite IOERT at the doses used in this study.

Transvaginal color Doppler assessment of venous flow in adnexal masses.

OBJECTIVE: To analyze the usefulness of transvaginal color Doppler assessment of venous flow in the differential diagnosis of adnexal masses. MATERIAL AND METHODS: Ninety-one consecutive patients (mean age: 46.6 years, range: 16-81 years) diagnosed as having an adnexal mass were evaluated by transvaginal color Doppler sonography prior to surgery. Color Doppler was used to detect and analyze the flow velocity waveform from arterial and venous blood flow within the tumor. For arterial signals the resistance index and peak systolic velocity, and for veins the maximum venous flow velocity, were calculated. Receiver operator characteristic curves were plotted to determine the best venous flow velocity cut-off. According to our previous study using arterial Doppler, a tumor was considered as malignant when flow was detected and the lowest resistance index was < or = 0.45. Using venous Doppler a mass was considered as malignant when flow was detected and the venous flow velocity was > or = the best cut-off found on the receiver operator characteristic curve. Definitive histopathological diagnosis was obtained in all cases. Sensitivity, specificity, positive predictive value and negative predictive value for B-mode morphology (evaluation performed according to Sassone's scoring system), arterial Doppler, venous Doppler, and a combination of both arterial and venous Doppler were calculated. RESULTS: Twenty-five masses (27.5%) were malignant and 66 (72.5%) benign. Arterial and venous flow was found more frequently in malignant than in benign masses (92% vs. 41% (P < 0.001) and 72% vs. 21% (P < 0.001), respectively). The resistance index was significantly lower in malignant tumors (0.42 vs. 0.60, P = 0.0003). No differences were found in peak systolic velocity. Venous flow velocity was significantly higher in malignant masses (18.1 cm/s vs. 8.9 cm/s, P = 0.0006). The best cut-off of venous flow velocity was 10 cm/s. Sensitivity, specificity, positive predictive value and negative predictive value for morphology, arterial Doppler, venous Doppler, and the combination of both arterial and venous Doppler were 92%, 71%, 45%, 96%; 76%, 95%, 87%, 91%; 68%, 94%, 81%, 89%; and 88%, 91%, 79%, 95%, respectively. CONCLUSIONS: Our results indicate that preoperative evaluation by venous flow assessment of adnexal masses may be useful to discriminate between malignant and benign tumors.

Comparative study of transvaginal ultrasonography and CA 125 in the preoperative evaluation of myometrial invasion in endometrial carcinoma.

OBJECTIVE: To compare the ability of transvaginal sonography and serum CA 125 levels to predict myometrial invasion in patients with endometrial carcinoma. DESIGN AND METHODS: Prospective study in 50 consecutive patients (mean age 60 years, SD 10.5, range 29-77 years) diagnosed as having endometrial cancer and scheduled for surgical staging. All patients were evaluated by transvaginal ultrasonography. Endometrial thickness was measured in all cases and myometrial invasion was estimated as < 50% or > or = 50%. Serum CA 125 level was determined in each patient. A cut-off level of > or = 35 IU/ml was considered to predict myometrial invasion of > or = 50%. All patients underwent surgical staging, and definitive histopathological findings regarding myometrial invasion were used as the 'gold standard'. Sensitivity, specificity and positive predictive value (PPV) and negative predictive value (NPV) were calculated for transvaginal ultrasonography and CA 125 and compared. RESULTS: On histopathological analysis, myometrial invasion was found to be < 50% in 35 (70%) cases and > or = 50% in 15 cases (30%). Mean endometrial thickness in patients with superficial invasion was significantly lower than in those with deep invasion (13.4 mm (95% CI 11.2-15.7) vs. 18.7 mm (95% CI 15.0-22.3), respectively; p = 0.014). Median CA 125 was significantly higher in patients with deep invasion than in those with superficial invasion (30 IU/ml, interquartile range (IQR) 46.0 vs. 16.9 IU/ml, IQR 13.9, respectively; p = 0.002). The sensitivity, specificity, PPV and NPV for transvaginal ultrasonography were 86.7% (95% CI 59.5-98.3), 94.3% (95% CI 80.8-99.3), 86.7% (95% CI 59.5-98.3) and 94.3% (95% CI 80.8-99.3), respectively. The sensitivity, specificity, PPV and NPV for CA 125 were 40% (95% CI 16.3-67.7), 91.4% (95% CI 76.9-98.2), 66.7% (95% CI 29.9-92.5) and 78% (95% CI 63.4-89.5), respectively. The sensitivity of transvaginal ultrasonography was significantly higher than that of CA 125 (p = 0.008). No differences were found in terms of specificity, PPV or NPV. CONCLUSION: Our results indicate that transvaginal ultrasonography is more sensitive than CA 125 in predicting myometrial invasion in endometrial cancer.

Pilot study of concurrent cisplatin, 5-fluorouracil, and external beam radiotherapy prior to radical surgery +/- intraoperative electron beam radiotherapy in locally advanced cervical cancer.

PURPOSE: The purpose of this study was to describe the feasibility of a combined preoperative chemoradiation program followed by radical surgery in advanced cervical cancer. MATERIALS AND METHODS: From February 1988 to April 1997, 40 patients with carcinoma of the cervix were treated with preoperative external beam radiotherapy to 45 Gy in 5 weeks. Patients received concurrent continuous infusion cisplatin (20 mg/m2) and 5-fluorouracil (1500 mg) chemotherapy during the first (days 1-4) and fifth (days 22-25) weeks of the radiation course. Radical surgery was performed 4-6 weeks after the completion of the preoperative treatment. Intraoperative radiotherapy was given to 20 patients, based on intraoperative assessment. RESULTS: Toxicity associated with chemoradiation was usually mild except in two patients who presented WHO grade 4 bone marrow aplasia. Three patients developed postoperative ureterovaginal fistula, and five patients developed long-term hydronephrosis that needed ureteral stenting. Clinical response was observed in 95% of the patients (55% complete response). The analysis of the surgical specimens revealed complete pathological response in 67.5% of the cases and partial pathological response in 32.5%. As expected, the degree of pathological response was predicted by the degree of clinical response (P = 0.001). Nine-year local control, distant metastases-free survival, disease-free survival, and overall survival were 86, 84, 81, and 85%, respectively. Patients displaying a complete pathological response had statistically significant improved local control (P = 0.004), distant metastases-free survival (P = 0.009), disease-free survival (P = 0.002), and overall survival (P = 0.038). CONCLUSIONS: Cisplatin plus 5-fluorouracil preoperative chemoradiation is active and usually well tolerated in locally advanced carcinoma of cervix, inducing a high rate of clinical and pathological complete responses. When this therapy is followed by radical surgery, the local control rates are excellent, even in patients with advanced stages or poor response. These improved local control rates may be achievable only through extensive surgical resection, with a parallel increase in the complication rates.

Chemoradiation followed by surgery: its role in local control in advanced cervical cancer.

The aim of this study was to improve local control and consequently survival, by using chemoradiation followed by surgery. After a median follow-up of 57+ months, 95% CI (9-111) five year overall survival (OS) was 81.8%, 90% and 85.7% in stage Ib2-IIa bulky, IIb and III-IVa, respectively (p = NS). Disease-free survival (DFS) was 81.8% 80% and 71.4% (p = NS) and disease-free survival of local failure (DFSLF) was 95.4%, 80% and 100% (p = NS) for stage Ib2-IIa, bulky, IIb and III-IVa respectively. Distant metastases were present in every group, ranging from 13.6% to 17% in the early bulky and advanced groups respectively. Pathologic findings revealed complete response (CR) (no residual disease or scattered microscopic tumoral foci) in 27/40 (67%), and partial response (PR) in 11/40 (27%). According to the pathologic response, DFS was 92.6% and 50% (p = 0.0029) and DFSLF was 100% and 77.8% (p = 0.0127) in complete and partial response respectively. This therapeutical approach promoted a high rate of pathologic complete response (PCR) PCR as well as of local control in this group at high risk for recurrence.

The role of transvaginal ultrasonography combined with color velocity imaging and pulsed Doppler in the diagnosis of endometrioma.

OBJECTIVE: To assess the diagnostic accuracy of transvaginal ultrasonography alone and combined with color velocity imaging and pulsed Doppler in differentiating ovarian endometriomas from other nonendometriotic masses. DESIGN: Prospective study with pathological confirmation of sonographic diagnosis. SETTING: Department of Obstetrics and Gynecology at a university hospital. PATIENT(S): A series of 78 consecutive patients diagnosed as having an adnexal mass and scheduled for surgery, between January 1995 and March 1996. INTERVENTION(S): Transvaginal ultrasonography and color velocity imaging and pulsed Doppler was performed before surgery in all patients. A total of 82 masses were diagnosed (four patients had bilateral masses). CA-125 plasma levels were measured in all patients. Ultrasound diagnosis was compared with definitive histopathological diagnosis. MAIN OUTCOME MEASURE(S): The presence of a round-shaped homogeneous cyst with low-level echoes was considered as sonographic diagnosis of ovarian endometrioma. The typical vascular pattern from endometrioma was considered as "pericystic flow at the level of the ovarian hilius." The sensitivity, specificity, and positive and negative predictive values were calculated for transvaginal ultrasonography alone and combined with color velocity imaging and pulsed Doppler. RESULT(S): Twenty-seven (32.9%) of the 82 masses were proven to be ovarian endometriomas. Morphological assessment diagnosed correctly 24 (88.9%) of 27 endometriomas (false-positive rate: 9%). Typical flow pattern was present in 90.5% of endometriomas (false-positive rate: 80%). CA-125 levels in patients with endometrioma (45.6 +/- 6.3 U/mL; mean +/- SEM) were significantly higher than in patients with nonendometriotic masses (26.5 +/- 5.5 U/mL). The sensitivity, specificity, and positive and negative predictive values of transvaginal ultrasonography alone and combined with color velocity imaging and pulsed Doppler were 88.9%, 91%, 84.2%, and 94.5%, and 76.2%, 88.9%, 82.4%, and 82.4%, respectively. For CA-125 levels, using a cutoff > or = 35 U/mL, these figures were 79.3%, 84.6%, 79.3%, and 84.6%, respectively. CONCLUSION(S): The use of color velocity imaging and pulsed Doppler does not improve the diagnostic accuracy of transvaginal ultrasonography alone in the diagnosis of ovarian endometrioma.

Intento de suicidio en adolescentes / Attempted suicide in adolescents

Objetivos: Conocer la prevalencia del suicidio en adolescentes de un Hospital de tercer nivel. Describir los factores que se asocian con el suicidio en adolescentes. Material y Métodos: En el Hospital de Pediatría del Centro Médico Nacional Siglo XXI, se revisaron los expedientes de los casos de intento de suicidio que ingresaron de junio de 1989 a septiembre de 1993; se recabó la información acerca de los factores de riesgo aceptados en la literatura, así como otras características de los pacientes en relación con los objetivos planteados. Tipo de estudio: descriptivo, transversal, retrolectivo. Forma de análisis: estadística descriptiva. Resultados: Se obtuvo información en 20 casos; 17 (85 por ciento) correspondieron al sexo femenino; la edad promedio fue de 14ñ1 año. La prevalencia en el estudio fue de 12 por cada 1000 ingresos en mayores de diez años de edad. Se encontraron como factores asociados la disfunción familiar en el 100 por ciento, existió enfermedad crónica en algún familiar cercano en el 65 por ciento que condicionó que en el 50 por ciento de los casos existiera disponibilidad de medicamentos en el hogar; en el 75 por ciento de los pacientes se identificaron datos de depresión. El 55 por ciento correspondió al nivel socioeconómico medio. En el 25 por ciento existió el antecedente de intento suicida en algún familiar o amigo cercano y en el 35 por ciento se identificó un padecimiento psiquiátrico. El 20 por ciento de los casos habían intentado previamente una acción suicida. Tres pacientes emplearon un método violento; en el resto predominó la ingesta de fármacos; en esta serie un paciente falleció. El tratamiento inicial empleado por el pediatra dependió del método utilizado y predominó la atención del proceso agudo con la instalación de soluciones parenterales, ayuno, lavado gástrico y el empleo de medicamentos. Conclusiones: el pediatra debe mantenerse alerta ante un adolescente con un cuadro que sugiera intoxicación o trauma físico ante a posibilidad de un intento suicida. El pediatra debe buscar en la vigilancia médica de adolescentes los factores de riesgo para el intento suicida

[Uterine cancer in women 45 years old and under without risk factors. Report of 10 cases]. / Cancer du corps utérin chez les femmes de 45 ans et moins sans facteurs de risque. Une série de dix cas.

Ten cases of malignancy of the body of the uterus in women aged 45 and under without risk factors are analysed. These included 4 sarcomas, 4 glandular adenocarcinomas, 1 adenosquamous carcinoma and 1 papillary serious carcinoma. Often advanced and moderately differentiated, these tumours were characterised by their aggressiveness and poor prognosis.

[Rectal neoplasia during pregnancy and the puerperium: report of 3 cases and review of the literature]. / Néoplasie rectale et gravido-puerpéralité. Rapport de trois cas et revue de la littérature.

Three cases of rectal carcinoma associated with pregnancy led the authors to review the general literature. The lesion is most often an adenocarcinoma, diagnosed late at an advanced stage of progression in young women. Results of treatment are poor and the outcome fatal.

[Residual ovary after hysterectomy. Is castration at peri-menopause necessary to prevent ovarian cancer?]. / L'ovaire restant après hystérectomie. Faut-il, à la périménopause, une castration pour prévenir le cancer ovarien?

OBJECTIVE: Evaluation of the risk of ovarian carcinoma associated with uni or bilateral adnexal preservation following gynecological surgery for benign lesions. MATERIAL: Gynecological surgery history of 190 patients with a primary ovarian carcinoma diagnosed and/or treated in the Navarre Teaching Hospital Group between 1981 and 1991 inclusive. RESULTS: Two patients, i.e. 1%, had undergone conservative surgery prior to the diagnosis of ovarian neoplasia. CONCLUSION: Ovary left in place after conservative surgery undergoes malignant change less than in the population as a whole.

Sebaceous glands and hair follicles in the cervix uteri.

We report a case of ectopic ectodermal structures in the ectocervix of a 51-year-old female. Sebaceous glands and numerous abnormal hair follicles were present in the stroma of an otherwise normal cervix.

[Ovarian remnant syndrome. A case report of a malignancy]. / Le syndrome de l'ovaire rémanent. A propos d'une observation maligne.

We operated on a patient who had already had total abdominal hysterectomy with bilateral salpingo-oophorectomy who developed a pelvic mass. The Pouch of Douglas was filled with a friable cystic mass of which the anatomo-pathological diagnosis was of a borderline serous cyst adenoma that probably was ovarian in origin. The case is interesting because of the radiopathological hypotheses that are brought up and by the various ways of treatment that have been suggested.

[Catamenial rectal bleeding and sigmoid endometriosis]. / Rectorragie cataméniale et endométriose sigmoïdienne.

We describe a case of menstrual rectal bleeding due to sigmoid endometriosis. The history led us to the diagnosis and since a small biopsy of the lesion and scanning could not help us to a conclusive diagnosis we carried out histological examination of a piece removed at operation. This case has led us to estimate the incidence, the difficulties of diagnosis and the present therapeutic measures.