Possible relation between borderline ovarian cancer and endocervical adenocarcinoma: case report.

Case: The patient, a 74-year-old women was diagnosed with intestinal-type endocervical adenocarcinoma that developed after 11 years from borderline ovarian cancer. The diagnosis was based on biopsy and magnetic resonance imaging; hysterectomy with pelvic lymphadenectomy was then performed.

Colposcopy today.

A brief digression of the advent and development of colposcopy is described, along with its advantages in the prevention and diag- nosis of uterine cervical cancer.

Conservative management of epithelial ovarian cancer.

We are currently faced with a progressive delay in the age at which women conceive for the first time. This raises the possibility of the appearance of gynecologic disorders that may affect fertility, including neoplasms of the ovary. Fertility-sparing surgery is defined as the preservation of ovarian tissue in one or both adnexa and/or the uterus. Borderline ovarian tumor should be treated with conservative surgery. Salpingo-oophorectomy, or even ovarian cystectomy, are the procedures of choice, with recurrence rates of 2-3% and up to 20% if a simple cystectomy is performed. Cystectomy is indicated in patients with bilateral borderline tumors or in patients with a residual ovary. Borderline tumors with invasive peritoneal implants behave as an invasive cancer in 10-30% of cases with a survival rate of 10-66% compared with 100% in borderline tumors without invasive implants. Prophylactic oophorectomy is recommended when desire of conception has been accomplished. Conservative surgery in invasive epithelial ovarian cancer is limited to Stage IA, grade 1 tumor, and in some highly selected grade 2 tumors of serous, mucinous or endometrioid type, well-encapsulated and free of adhesions. The standard oncological surgical procedure with preservation of the uterus and normal appearing ovary is recommended. This includes salpingo-oophorectomy, excision of any suspicious peritoneal lesion, multiple peritoneal biopsies, appendectomy (particularly in mucinous tumors), and pelvic and paraaortic lymphadenectomy.

Adenocarcinoma endometrioide en pólipo endometrial / Endometrioid adenocarcinoma in an endometrial polyp

Introducción: En raras ocasiones se diagnostica un adenocarcinoma originado en un pólipo endometrial. Material y métodos: De un total de 1.989 pólipos endometriales diagnosticados en 8 años y medio, 6 presentaban un adenocarcinoma endometrioi de. Se analizan sus características clínico-patológicas y evolución. Resultados: La histeroscopia diagnosticó un pólipo en todas las pacientes, y en 3 de ellas con signos sospechosos de malignidad. En todas las ocasiones la lesión estaba confinada al pólipo y no se observó infiltración miometrial en ningún caso. Los carcinomas fueron de la variedad endometrioide, y el endometrio adyacente era normal. Todas las pacientes están vivas y libres de enfermedad tras un seguimiento medio de 45 meses (entre 6 y 96 meses). Conclusión: Los pólipos endometriales pueden albergar un adenocarcinoma que en muchas ocasiones está confinado al pólipo, y que es de bajo grado de malignidad, por lo que se puede plantear un tratamiento conservador

Introduction: Endometrial polyps bearing an adenocarcinoma are rarely diagnosed. Material and methods: Of 1989 endometrial polyps diagnosed in eight and a half years, only six showed an endometrioid adenocarcinoma. Their clinicopathologic characteristics and outcome are discussed. Results: All polyps were diagnosed by hysteroscopy. Of these, three showed signs suspicious for malignancy. In all cases, the neoplasm was confined to the polyp without myometrial infiltration. Histological type was endometrioid and the adjacent endometrium was normal. All patients are alive and disease free after a mean follow-up of 45 months (range: 6-96 months). Conclusion: Endometrial polyps can bear an adenocarcinoma, which is often confined to the polyp and of a low grade of malignancy. Conservative treatment can be considered

Leiomiomatosis difusa del útero: aspectos clinicopatológicos en 5 casos / Diffuse uterine leiomyomatosis: clinicopathologic features in 5 cases

Introducción: La leiomiomatosis difusa del útero es una entidad rara que cursa con un aumento del tamaño uterino. Descripción de los casos: Se revisan las características clinicopatológicas de 5 casos. La sintomatología más frecuente fue por sangrado uterino. Tres de las pacientes tenían hijos, y 2 de ellas habían tenido algún aborto. En 3 ocasiones se efectuó una histerectomía subtotal. En las otras 2 se practicó una resección parcial por deseos de la paciente de conservar la fertilidad. Conclusión: La leiomiomatosis difusa uterina es una lesión benigna que puede afectar a la fertilidad o complicar de forma significativa el parto (AU)

Introduction: Diffuse uterine leiomyomatosis is a rare entity that increases uterine size. Cases description: The clinicopathologic features of five cases are reviewed. The most frequent symptom was uterine bleeding. Three of the patients had children and two of them had a past history of abortion. In three patients, subtotal hysterectomy was performed. In the remaining two, partial resection was carried out as the patients wished to preserve fertility. Conclusion: Diffuse uterine leiomyomatosis is a benign lesion that can affect patients’ fertility or complicate delivery (AU)

Importancia de la inestabilidad microsatélite en tumores borderline y carcinomas de ovario / Relevance of microsatellite instability in borderline tumors and ovarian carcinoma. AEBM reference 2003 award

El objetivo de nuestro estudio es determinar la inestabilidad de seis microsatélites (BAT25, BAT26, NME1, D17S250, D5S346 Y D2S123) y observar si está implicada en el desarrollo de los tumores esporádicos de ovario. El trabajo se ha realizado en 40 pacientes intervenidas quirúrgicamente por tumor de ovario esporádico. La comprobación de la inestabilidad se realizó por comparación del tejido sano y tumoral de cada una de las pacientes. Sólo se encontró inestabilidad en: inestabilidad en BAT26 en tumor borderline, inestabilidad en BAT25 en cistoadenocarcinoma de células claras e inestabilidad en NME1 encistoadenocarcinoma papilar seroso en diferentes pacientes. La inestabilidad microsatélite no parece estar implicada en la aparición o desarrollo de los tumores esporádicos de ovario (AU)

Endometrial cancer: factors affecting survival.

PURPOSE: To evaluate the influence in survival of clinical and pathological findings in patients with endometrial cancer. METHODS: In 152 women treated for endometrial cancer from 1982 to 1996, personal, obstetrical and oncological data, histology, grade, myometrial invasion, peritoneal cytology, FIGO stage and treatment were correlated with survival. RESULTS: Mean age was of 60.3 +/- 11.1 years old. Eight patients had a previous history of other neoplasms (seven of them gynecological). The mean clinical complaint was abnormal uterine bleeding. The most common histological type was endometrioid (84.9%), only 51 cases did not show myometrial invasion and 119 women were in Stage I at diagnosis. Peritoneal cytology was negative in 113 patients. Seven patients out of 85 in whom lymphadenectomy was performed showed metastasis. Seventeen of the patients died. The factors influencing survival were age, myometrial invasion and lymph node metastasis. CONCLUSION: Lack of myometrial invasion, absence of lymph node metastasis and age younger than 60 years seem to be the most significant predicting factors of survival.

Myometrial trophoblastic implant as a complication of surgically induced first-trimester termination of pregnancy.

Persistent trophoblastic tissue has been described in the abdominal cavity after surgical treatment of tubal ectopic pregnancy. More infrequently the cause of the ectopic trophoblast is linked to uterine perforation due to surgically induced termination of pregnancy (TOP). Ultrasonographic images may suggest an ectopic pregnancy. A case of myometrial trophoblastic tissue implantation following surgically induced first-trimester TOP is described.

Estudio de la inestabilidadmicrosatélite en tumoresborderline y carcinomade ovario / Microsatellite instability in borderline tumors and ovarian carcinoma

El objetivo de nuestro estudio es determinar la inestabilidad de tres microsatélites (BAT25, BAT26 y NME1) y observar si está implicada en el desarrollo de los tumores esporádicos de ovario. El trabajo se ha llevado a cabo en 40 pacientes intervenidas quirúrgicamente por tumor de ovario esporádico. La comprobación de la inestabilidad se realizó por comparación del tejido sano y tumoral de cada una de las pacientes. Sólo se encontró inestabilidad en 3 casos: en BAT26 en tumor borderline; en BAT25 en cistoadenocarcinoma de células claras, y en NME1 en cistoadenocarcinoma papilar seroso en diferentes pacientes. La inestabilidad microsatélite no parece estar implicada en la aparición o el desarrollo de los tumores esporádicos de ovario. (AU)

Histerectomía laparoscópica frente a no laparoscópica / Laparoscopic versus non-laparoscopic hysterectomy

Objetivo: Mostrar la evolución en nuestro servicio de las indicaciones y vías de abordaje de la histerectomía. Material y métodos: Se estudian los datos obtenidos de 418 pacientes sometidas a histerectomía en el período 1994-1998. Se comparan las indicaciones, la edad, el peso y la talla de las pacientes y las características de las piezas obtenidas. Resultados: La edad de las pacientes de nuestro estudio fue de 49,9 años (28-93), con una talla media de 159 cm (141-174) y un peso de 61,6 kg (42-92). Las indicaciones para la histerectomía abdominal han sido: fibromiomatosis (51,3 per cent), procesos neoplásicos (31 per cent) y prolapsos uterinos (1,3 per cent). En el caso de la histerectomía vaginal las indicaciones han sido: prolapso uterino (70,8 per cent), mioma uterino (18,58 per cent) y neoplasia (1,77 per cent). Las indicaciones para la histerectectomía vaginal laparoscópicamente asistida (HVLA) han sido: fibromatosis (37 per cent), prolapso (13,7 per cent), neoplasia (9,59 per cent), endometriosis el (9,6 per cent) y enfermedades anexiales asociadas (12,3 per cent). Se encontraron diferencias estadísticamente significativas entre los grupos para la edad y el peso de las pacientes. También se encontraron diferencias en el peso, el tamaño y el volumen de las muestras. La morbilidad durante este período que ha requerido de cirugía complementaria ha sido de un 4,7 per cent para la histerectomía abdominal, de un 5,5 per cent para la cirugía vaginal y de un 2,3 per cent para la HVLA. Conclusiones: En los últimos años hemos reducido el número global de histerectomías gracias a diferentes alternativas terapéuticas, observando un incremento progresivo de la técnica vaginal (pura o laparoscópica) frente a la abdominal (AU)

Role of microsatellite instability in borderline ovarian tumors.

This study was designed to establish the role of microsatellite instability (MSI) in the development of sporadic tumors of the ovary. The instability of 6 microsatellites (BAT25, BAT26, NME1, D17S250, D5S346 and D2S123) was determined by comparing MSI in healthy and tumoral tissue in each of 40 patients undergoing surgery for a sporadic ovarian tumor. BAT26 and D2S123 instability was detected in borderline tumors, and ovarian carcinomas were found to present instability in the microsatellites BAT25, NME1 and D17S250. Our findings indicate that microsatellite instability lacks a significant role in the appearance or progression of sporadic ovarian tumors.

The role of colposcopy in modern gynecology.

UNLABELLED: The purpose of this review is to demonstrate that colposcopy, introduced in 1925--which is, notably before the development of great technological advances in modern gynecology--continues to be a valid technique without essential innovations to the original method described at the beginning of the last century. Colposcopy was developed in Germany during the rise of Nazism with the Second World War being an important barrier for the spread and diffusion of the technique. Colposcopy, however, continued to progress in a few countries such as Spain, Italy, Brazil, France and Switzerland. When colposcopy was introduced in the United States during the 70s, its use was mostly restricted to specialists who were almost exclusively dedicated to cervical pathology and knowledgeable about cytopathology, anatomic pathology, and colposcopy and who were competent both in the diagnosis and treatment of cervical lesions. These circumstances were completely different from what happened in the majority of European countries where colposcopists were trained as gynecologists and their histocytological knowledge, which was focused on the lower genital tract, was somewhat more extensive than that acquired by specialists in gynecology. There are two clearly different trends in relation to the use of colposcopy with characteristic geographic distribution: countries with an Anglo-Saxon influence in which colposcopy is performed selectively, and countries with a German medical inheritance in which colposcopy is carried out routinely during a standard general gynecological consultation. However, this difference is not restrictive and by no means can it be stated that colposcopy is systematically being used by all European or Latin American gynecologists for reasons related to training in the colposcopic technique. In 1977, we introduced the concept of dynamic colposcopy with the aim of differentiating it from the descriptive immobility of the original classification of Hinselmann (1954) that had remained almost unchanged by his immediate followers. Briefly, the objective was to turn colposcopy into a diagnostic tool able to identify the pathological substrate corresponding to traditional colposcopic images. We established ten differential signs that allow us to classify an ATZ area as subsidiary or not to be biopsied. The classification system proposed in Rome (International Federation of Cervical Pathology and Colposcopy [IFCPC], 1990) supports our original concept because by identifying major or minor changes in the original images, a diagnosis of the severity of the lesion can be established. With regard to specificity, the figures range between 48% and 10% with 96% for sensitivity. Obviously, a wide range of colposcopic specificity must be related to the expected efficacy of the method. When after biopsy of an atypical colposcopic image, only a low-grade lesion is detected, should this be considered a false positive colposcopic result? Although histopathologic findings are accepted as the "gold standard"...it is well known that a certain degree of subjectivity can be present. Inter- and intra-observer differences (when the same pathologist is reviewing the diagnosis after a certain time lapse) may be present. It has been argued that microbiopsy under colposcopic control gives rise to a wide error range and that it cannot be considered representative of the lesion. It is likely that this situation may occur when colposcopy-guided biopsy is performed by inexperienced hands or when biopsy is limited to small and insufficient sampling. A very important colposcopic sign, such as complete visual inspection of the squamocolumnar junction is frequently missed. Any lesion with boundaries in the endocervix, cannot be simply assessed by means of microbiopsies from the ectocervix unless there is no doubt regarding the severity of the lesions. Microcolpohysteroscopy (MCH) may be of great value in these cases by showing the limits of endocervical involvement. CONCLUSIONS: According to the evidence presented here, it can be concluded that "colposcopy is in good health" and that probably the popularity of this technique in the field of gynecology would increase if cytopathologists and gynecologists' tasks were limited to their own fields rather than turning them into improvised specialists for their counterpart disciplines. The coordinating role of the gynecologist as a specialist for integral women's health should continue to be defended and in this respect, colposcopy should be considered a routine technique in daily practice.

Factores pronóstico en el carcinoma endometrial / Prognosis factors in endometrial carcinoma

Se analizan los diversos factores pronóstico en el carcinoma de endometrio y su valor predictivo en la progresión de esta enfermedad (AU)

Subespecialidades / Subspecialities

No disponible

Reconstrucción vaginal mediante la técnica de McIndoe / Vaginal reconstruction through McIndoe's technique

Objetivo: La finalidad de este trabajo es la de analizar nuestra experiencia en la reconstrucción vaginal mediante la técnica de McIndoe.Sujetos y métodos: La agenesia vaginal es una malformación que tiene una incidencia de 1/5.000 recién nacidas.Presentamos nuestra experiencia en la reconstrucción vaginal mediante la técnica de McIndoe, en 25 casos realizados durante un período de 17 años. Evaluamos las técnicas diagnósticas empleadas, los motivos de consulta, la técnica quirúrgica, las complicaciones a corto y largo plazo, y la evolución de estas pacientes. Conclusiones: La mayoría de las pacientes (99 por ciento) tienen relaciones sexuales satisfactorias.Consideramos que se trata de la técnica quirúrgica de elección por su facilidad y buenos resultados. (AU)

HPV: ¿una nueva epidemia que afecta a la mujer? / Human papilloma virus. A new epidemic affecting women?

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Role of color Doppler ultrasonography in the diagnosis of endometriotic cyst.

We studied the role of color Doppler ultrasonography in the distinction between endometriomas and other adnexal masses. Three hundred and fifty-two ovarian lesions were studied, comparing sonographic diagnosis with pathologic findings. On color Doppler sonography, an endometriotic cyst usually appeared as a cystic lesion with diffuse internal echoes and low vascularization. The sensitivity and specificity of color Doppler transvaginal sonography in detecting endometriotic cysts were 91.8% and 95.3%, respectively. The positive and negative predictive values were 95.5% and 91.5%, respectively. In our experience, transvaginal sonography with color Doppler interrogation is a useful technique in the diagnosis of pathologic ovarian conditions, including cystic endometriosis.

Laparoscopia e histerectomía / Laparoscopy and hysterectomy

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