Malignant transformation of superficial peritoneal endometriosis lesion.

A 63-year-old woman with no medical history underwent an abdominal surgery with hysterectomy and bilateral salpingo-oophorectomy for a 10 cm peritoneal cyst with increased cancer antigene-125. A large suspicious tumour of the Douglas space, with contact to the uterus and the rectal wall was described. The rest of the exploration was normal, specially the rest of the peritoneum. Histopathology revealed a malignant transformation of a superficial peritoneal endometriosis. Secondary surgery was thus completed by laparoscopy with bilateral pelvic and para-aortic lymph node dissections, omentectomy and multiple peritoneal biopsies. All staging samples were free of cancer; therefore no complementary therapy was administered. After 18 months of follow-up, consisting of clinical examination and pelvis magnetic resonance imaging every 6 months, we did not observe any recurrence. Malignant transformation of superficial peritoneal endometriosis is a rare disease and surgical management seems to be the main treatment.

Implantes peritoneales de tejido glial maduro (gliomatosis peritoneal) y de otros tejidos maduros asociados a teratoma ovárico inmaduro / Peritoneal implants of mature glial tissue (gliomatosis peritonei) and other mature tissues associated with ovarian teratoma

La gliomatosis peritoneal es una forma de extensión muy poco frecuente de los teratomas ováricos. Se caracteriza por la implantación miliar de tejido glial dentro de la cavidad peritoneal en pacientes con teratomas ováricos, generalmente inmaduros. Puede semejar un cuadro de carcinomatosis peritoneal. A pesar de su extensión intraperitoneal, la gliomatosis peritoneal no afecta adversamente al pronóstico del teratoma ovárico primario si los implantes de tejido glial se componen de tejido maduro y, por tanto, justifica tratamientos conservadores. El grado histológico del teratoma es el factor pronóstico que debe indicar el tratamiento complementario necesario. Su pronóstico es bueno, aunque se han descrito casos de malignización

Peritoneal gliomatosis is a very rare metastatic form of ovarian teratoma, characterized by miliary dissemination of glial tissue inside the peritoneal cavity in patients with an ovarian ­ usually immature ­ teratoma. Peritoneal gliomatosis may resemble peritoneal carcinomatosis. Despite peritoneal dissemination, if the glial tissue implants are composed of mature tissue, peritoneal gliomatosis does not adversely affect the prognosis of the primary ovarian teratoma. Consequently, conservative treatment is warranted. The main prognostic factor is the histological grade of the teratoma, which indicates the required complementary treatment. The prognosis of peritoneal gliomatosis is favorable, although cases of malignant transformation have been reporte (AU)

Radiological detection and diagnosis of pouch of Douglas lesions.

The pouch of Douglas (cul-de-sac) represents the caudal extension of the peritoneal cavity. It is the rectovaginal pouch in the female and the rectovesical pouch in the male. The cul-de-sac is in a dependent position when either upright or supine; it is, therefore, a frequent location for seeded lesions. Abnormalities in the cul-de-sac include metastases, abscesses, and endometriosis. These lesions may be detected by multiple modalities, including barium enema, computed tomography, and ultrasound. Examples of numerous cul-de-sac lesions are presented as they appear with different imaging modalities.