Genital chronic graft-versus-host disease: an unmet need that requires trained gynecologists.

OBJECTIVE: Menopause and chronic graft-versus-host disease (cGvHD) are the leading causes of morbidity after allogeneic hematopoietic stem cell transplantation (alloHSCT). Genitalia are one of the target organs of cGvHD causing sexual dysfunction and local symptoms, which may impair women's quality of life. The aim of this study is to describe the prevalence and clinical characteristics of genital cGvHD. METHODS: A retrospective cross-sectional observational study was performed including 85 women with alloHSCT. All women were diagnosed and counseled by a trained gynecologist. Health-related quality of life was assessed by the Cervantes Short-Form Scale and sexual function was evaluated by the Female Sexual Function Index. RESULTS: Seventeen women (20%) included in the study were diagnosed with genital cGvHD. The main complaints were vulvovaginal dryness (42.2%) and dyspareunia (29.4%), the presence of erythema/erythematous plaques (52.9%) being the most frequent sign. Median time from transplant to diagnosis of genital cGvHD was 17 months among those with mild involvement, 25 months for moderate and 42 months for severe forms. Mortality was 29.4% in patients who developed cGvHD with genital involvement versus 8.8% among those without (p = 0.012). CONCLUSION: Early gynecological evaluation might allow to identify patients with mild forms of genital cGvHD, potentially enabling better management and improved outcomes.

Clinical and pathologic features of patients with non-epithelial ovarian cancer: retrospective analysis of a single institution 15-year experience.

PURPOSE: Non-epithelial ovarian cancers (NEOCs) are rare diseases. Despite their overall good prognosis, the best management and current prognostic factors remain unclear. The objective of our study was to assess the clinical and pathological features of NEOC patients treated in our institution in the last 15 years and to explore risk factors for relapse and survival. METHODS/PATIENTS: All patients with a pathological diagnosis of NEOC referred to the medical oncology department at Hospital Universitario Virgen del Rocio between 1999 and 2014 were included. Demographics, tumor characteristics, treatment procedures, and clinical follow-up were retrospectively collected. Risk factors for disease-free survival (DFS) and overall survival (OS) were assessed. RESULTS: Fifty-seven patients were included, 33 (58 %) had a sex cord-stromal tumor (SCST) and 24 (42 %) had a germ-cell tumor (GCT). Median age, non-conservative surgery rates and DFS were lower in the GCT cohort; however, salvage chemotherapy led to a high proportion of complete responses in this group translating into a 90 % 3-year OS rate in both NEOC subtypes. The only identified risk factors statistically significant were stage and tumour relapse that associated, respectively, with DFS (HR = 8.84; 95 % CI 1.85-42) and OS (HR = 11.02; 95 % CI 1.76-68.7). CONCLUSIONS: Despite their rarity, NEOCs remain a highly curable group of neoplasm. In our series, a more conservative treatment approach in ovarian GCTs revealed comparable OS outcomes to SCST. No new risk factors that would help in patient stratification were identified.

Endometrial polyp or neoplasia? A case-control study in women with polyps at ultrasound.

OBJECTIVES: To identify factors associated with endometrial neoplasia in women diagnosed with endometrial polyp at transvaginal ultrasound. METHODS: Within a population of 1390 consecutive patients undergoing hysteroscopy following an ultrasonographic diagnosis of polyps, we compared the cases with a final diagnosis of endometrial neoplasia with controls with benign endometrial polyps. The controls were selected randomly in a ratio of 4 : 1 (controls : cases). Bivariate statistical analysis and multiple logistic regression were used to measure the association between various variables and endometrial neoplasia. RESULTS: Sixteen cases of endometrial neoplasia were compared to 64 controls with confirmed benign endometrial polyps. All cases of neoplasia were among symptomatic women, while 40.62% of women with benign polyps had been referred to hysteroscopy after a routine ultrasound and were asymptomatic. Women with endometrial neoplasia were significantly older (mean age 64.19 ± 9.382 vs. 52.03 ± 9.846 years; p < 0.001) and had a significantly greater body mass index (median 27.66 vs. 24.59 kg/m(2); p < 0.001). Other factors statistically associated with endometrial neoplasia were postmenopausal status and bleeding as a main symptom. At multivariate analysis with logistic regression, the only factors showing a statistically significant association with endometrial neoplasia were older age (odds ratio 1.102; 95% confidence interval 1.015-1.198) and bleeding (odds ratio 13.7; 95% confidence interval 1.486-126.278). CONCLUSION: When polyps are diagnosed at ultrasound, bleeding and an older age are independently associated with endometrial neoplasia. A significant proportion of asymptomatic women is referred to hysteroscopy because of a polyp seen at routine ultrasound, although malignancy is highly unlikely in these cases.

Malignant and premalignant changes in the endometrium of women with an ultrasound diagnosis of endometrial polyp.

The association between polyps and endometrial cancer is under debate. The main objectives of this study were to study the frequency and the characteristics of malignant and premalignant endometrial changes in women with endometrial polyp at ultrasound. The study population consisted of 1,390 consecutive patients that were referred to office hysteroscopy because of the ultrasonographic diagnosis of endometrial polyps. A total of 16 cases of endometrial neoplasia were diagnosed (1.15%). The frequencies of atypia and cancer in our population were 0.14% and 1.01%, respectively. All patients, except one, were postmenopausal (93.8%). All had undergone the initial ultrasonographic assessment because of symptoms (bleeding in the 93.8%). The neoplasia was not confined to the polyp in 75% of the cases. Nine cases had a lower risk disease (56.25%; atypical hyperplasia or endometrial cancer stage IA-G1,2), while seven had a higher risk cancer (43.75%; ≥ stage IA-G3). Patients with a higher risk disease were found to be significantly younger, and their polyps were smaller, albeit non-significantly. In spite of the common practice to refer all women with an ultrasound diagnosis of polyp to hysteroscopy, our data show how the prevalence of endometrial neoplasia in these patients is low (1.15%). Moreover, the malignancy is not confined to a polyp in most of the cases.

Lesiones epiteliales no neoplásicas de la vulva / Non-neoplastic epithelial vulvar lesions

Introducción. Las lesiones epiteliales no neoplásicas vulvares son entidades que se conocen desde el s. xix; la falta histórica de acuerdo en su nomenclatura y la inclusión en este término de un cajón de sastre de lesiones vulvares han hecho que aún hoy se sigan usando términos ambiguos y haya dudas en su manejo clínico. Objetivo. Presentar nuestra experiencia clínica en el manejo y el tratamiento de las lesiones epiteliales no neoplásicas vulvares. Material y métodos. Estudio retrospectivo de 14 pacientes que presentaban lesión vulvar no filiada. Resultados. Se realizó 14 biopsias vulvares: 2 de hiperplasias de células escamosas (14,2%), 9 de liquen escleroso (64,2%), 1 por asociación (7,2%) y 2 de tejido fibroadiposo (14,2%). Conclusión. Las lesiones epiteliales no neoplásicas vulvares deben sospecharse ante toda paciente con prurito vulvar crónico y se requiere biopsia dirigida de estas lesiones, lo que nos permitirá un correcto diagnóstico, tratamiento y seguimiento (AU)

Introduction. Non-neoplastic epithelial vulvar lesions were first identified in the xix century. Because of the historical lack of agreement about their nomenclature and the inclusion of a mixed bag of vulvar lesions under this term, ambiguous terms continue to be used and there are doubts abut the clinical management of these entities. Objective. To present our clinical experience in the treatment and management of non-neoplastic epithelial vulvar lesions. Material and methods. We performed a retrospective study of 14 patients with unclassified vulvar lesions. Results. Fourteen vulvar biopsies were performed: squamous cell hyperplasia was found in 2 patients (14.2%), lichen sclerosus in 9 (64.2%), the association of both types of lesion in 1 (7.2%) and connective tissue in 2 (14.2%). Conclusion. Non-neoplastic epithelial vulvar lesions should be suspected in all patients with chronic vulvar pruritus. These lesions require selective biopsy for appropriate diagnosis, treatment and follow-up (AU)

Esplenosis peritoneal: hallazgo casual e infrecuente en cirugía obstétrica / Peritoneal splenosis. An incidental and infrequent finding in obstetric surgery

La esplenosis o autotrasplante de tejido esplénico, consecuencia de la rotura traumática del bazo, es una entidad benigna, normalmente asintomática y no necesita tratamiento. Presentamos el caso de una embarazada con antecedentes de rotura traumática del bazo en la infancia y en la que se descubrieron accidentalmente múltiples focos de esplenosis diseminados por la cavidad abdominal. Habitualmente, el diagnóstico se realiza con la exploración de la cavidad abdominal durante una laparotomía. En cirugía ginecológica, y especialmente en la obstétrica, ésta es una práctica inusual. Dado que no implica riesgos y aportaría una valiosa información, es recomendable que sea incorporada a la rutina quirúrgica

Splenosis, or autotransplantation of splenic tissue, which usually follows traumatic splenectomy, is a benign entity. It is normally asymptomatic and does not require treatment. We present the case of a pregnant woman with a history of traumatic splenectomy in childhood. Multiple foci of splenic tissue were disseminated throughout the abdominal cavity. Diagnosis is usually made through examination of the abdominal cavity during laparotomy. This practice is unusual in gynecologic surgery, especially in obstetric surgery. Because abdominal cavity examination does not pose a risk to the patient and provides useful information, we recommend that it become routine surgical practice

Carcinoma de vulva en paciente con liquen escleroatrófico de larga evolución / Vulvar carcinoma in a patient with chronic lichen sclero-atrophic

Se desconoce la relación entre la distrofia vulvar y el carcinoma de vulva, si bien no parece que ésta sea etiológica. Dado que es frecuente la coexistencia de ambas lesiones, el clínico está obligado a descartar un proceso maligno ante cualquier lesión vulvar y a hacer un seguimiento apropiado mientras la lesión persista (AU)