Contribución de PET/CT a la diferenciación de derrame pleural benigno y maligno en pacientes con cáncer de ovario / The contribution of PET/CT to the differentiation of benign and malignant pleural effusion in patients with ovarian carcinoma

Objetivo En nuestro estudio el objetivo fue investigar la contribución de los hallazgos de la tomografía por emisión de positrones (PET)/tomografía computarizada (TC) en la diferenciación no invasiva entre el derrame pleural (DP) de origen benigno (DPB) y maligno (DPM) en pacientes diagnosticadas de un carcinoma de ovario (CO). Material y método Se incluyeron en el estudio a 32 pacientes diagnosticadas de CO con DP. Se efectuó análisis comparativo entre el DPB y el DPM para los siguientes parámetros: SUVmáx. del DP, índice objeto/fondo (TBRp: target/background ratio) del DP, dividiendo el SUVmáx. del DP por el SUVmedio del flujo sanguíneo mediastínico (MBP: medistinal blood pool), engrosamiento pleural, adenopatías supradiafragmáticas, DP unilateral o bilateral, diámetro del DP, edad de la paciente y niveles de CA125. Resultados La edad media de las 32 pacientes fue de 57±2,8 años. Se observó mayor frecuencia significativa de un TBRp>1,1, engrosamiento pleural y ganglios linfáticos supradiafragmáticos en el DPM respecto al DPB. Aunque no se detectó ningún nódulo pleural en las pacientes con DPB, estos estuvieron presentes en 7 pacientes con DPM. En la distinción DMP-DBP la sensibilidad del TBRp fue del 95,2% y la especificidad del 72,7%, la sensibilidad del engrosamiento pleural fue del 80,9%, y la especificidad del 81,8%, la sensibilidad de los ganglios linfáticos supradiafragmáticos fue del 38% y la especificidad del 90,9%, y la sensibilidad del nódulo pleural fue del 33,3% y la especificidad del 100%. No hubo diferencias significativas entre los 2 grupos respecto al resto de factores. Conclusión El engrosamiento pleural y el valor de TBRp determinados en la PET/TC pueden contribuir a la diferenciación entre DMP y DBP, especialmente en aquellas pacientes con CO en estadio avanzado y mal estado general, o que no son tributarias de ser sometidas a tratamiento quirúrgico (AU)

Objective The present study investigates the ability of non-invasive contribution of positron emission tomography (PET)/computed tomography (CT) to distinguish between benign pleural effusions (BPE) and malignant pleural effusions (MPE) in patients diagnosed with ovarian carcinoma (OC). Material and method Included in the study were 32 OC patients with a PE diagnosis. The cases with BPE and MPE were compared in terms of the PE maximum standardized uptake value (SUVmax), PE SUVmax/mean standardized uptake (SUVmean) value of the mediastinal blood pool (TBRp), the presence of pleural thickening, the presence of supradiaphragmatic lymph node, unilateral or bilateral PE, pleural effusion diameter, patient age and CA125 value. Results The mean age of the 32 patients was 57±2.8 years. TBRp>1.1, pleural thickening and supradiaphragmatic lymph node were observed significantly more frequently in the MPE than the BPE cases. While no pleural nodules were detected in patients with BPE, they were present in 7 of the patients with MPE. The rates of distinction between the MPE and BPE cases were as follows: the sensitivity of the TBRp value was 95.2% and specificity was 72.7%; the sensitivity of pleural thickness was 80.9% and specificity was 81.8%; the sensitivity of supradiaphragmatic lymph node was 38% and specificity was 90.9%; and the sensitivity of the pleural nodule was 33.3% and specificity was 100%. There were no significant differences between two groups in any other factors. Conclusion Pleural thickening and TBRp values ascertained through PET/CT may aid the distinction between MPE-BPE, especially in patients with advanced stage OC with a poor general condition, or those who cannot undergo surgery (AU)

The contribution of PET/CT to the differentiation of benign and malignant pleural effusion in patients with ovarian carcinoma.

OBJECTIVE: The present study investigates the ability of non-invasive contribution of positron emission tomography (PET)/computed tomography (CT) to distinguish between benign pleural effusions (BPE) and malignant pleural effusions (MPE) in patients diagnosed with ovarian carcinoma (OC). MATERIAL AND METHODS: Included in the study were 32 OC patients with a PE diagnosis. The cases with BPE and MPE were compared in terms of the PE maximum standardized uptake value (SUVmax), PE SUVmax/mean standardized uptake (SUVmean) value of the mediastinal blood pool (TBRp), the presence of pleural thickening, the presence of supradiaphragmatic lymph node, unilateral or bilateral PE, pleural effusion diameter, patient age and CA125 value. RESULTS: The mean age of the 32 patients was 57±2.8 years. TBRp>1.1, pleural thickening and supradiaphragmatic lymph node were observed significantly more frequently in the MPE than the BPE cases. While no pleural nodules were detected in patients with BPE, they were present in 7 of the patients with MPE. The rates of distinction between the MPE and BPE cases were as follows: the sensitivity of the TBRp value was 95.2% and specificity was 72.7%; the sensitivity of pleural thickness was 80.9% and specificity was 81.8%; the sensitivity of supradiaphragmatic lymph node was 38% and specificity was 90.9%; and the sensitivity of the pleural nodule was 33.3% and specificity was 100%. There were no significant differences between two groups in any other factors. CONCLUSIONS: Pleural thickening and TBRp values ascertained through PET/CT may aid the distinction between MPE-BPE, especially in patients with advanced stage OC with a poor general condition, or those who cannot undergo surgery.

Abdominal tuberculosis mimicking ovarian cancer. A case series report.

INTRODUCTION: Peritoneal tuberculosis (abdominal tuberculosis) can be confused with a malignant neoplasm. OBJECTIVE: To describe clinical and demographic characteristics of patients with abdominal tuberculosis mimicking advanced ovarian cancer, diagnosed in a national reference cancer center. METHODS: Clinical and pathological characteristics of nine patients with abdominal tuberculosis that clinically resembled advanced ovarian cancer are described. RESULTS: Median age was 47 years; the most common socioeconomic status was low (44%). Abdominal pain and weight loss occurred in 77.7%; ascites, in 55.5%; 22.2% had a positive COMBE test, and 100% had no history of pulmonary tuberculosis. CA-125 elevation was reported in 77.7%, with levels > 500 U/mL in 57.1%. Tomography reported carcinomatosis in 50% and pelvic tumor and ascites in 37.5%. All patients underwent surgery, where 62.5% were diagnosed by intraoperative pathology study as neoplastic disease. CONCLUSION: Tuberculosis is considered the great imitator, which is why abdominal tuberculosis diagnosis should be borne in mind when faced with a suspicious case, even when clinical presentation, imaging studies, and even intraoperative examination suggest ovarian cancer.

INTRODUCCIÓN: La tuberculosis peritoneal (tuberculosis abdominal) puede ser confundida con una neoplasia maligna. OBJETIVO: Describir características clínicas y demográficas de pacientes con tuberculosis abdominal que semeja cáncer de ovario avanzado, diagnosticados en un centro oncológico de referencia nacional. MÉTODOS: Se describen las características clínicas y patológicas de nueve pacientes con tuberculosis abdominal que clínicamente semejaba cáncer de ovario avanzado. RESULTADOS: La mediana de edad fue de 47 años, el estrato socioeconómico más común fue bajo (44 %). El dolor abdominal y la pérdida ponderal se presentaron en 77.7 %, ascitis en 55.5 %, prueba COMBE positiva en 22.2 % y ausencia de antecedente de tuberculosis pulmonar en 100 %. La elevación de CA-125 se reportó en 77.7 %, con > 500 U/mL en 57.1 %. La tomografía indicó carcinomatosis en 50 % y tumor pélvico y ascitis en 37.5 %. Todas las pacientes fueron sometidas a cirugía; 62.5 % fueron diagnosticadas mediante estudio patológico transoperatorio como enfermedad neoplásica. CONCLUSIÓN: La tuberculosis es considerada como la gran imitadora, por ello se debe tener en mente el diagnóstico de tuberculosis abdominal ante un caso sospechoso, aun cuando la presentación clínica, estudios de imagen e, incluso, el examen transoperatorio sugieran cáncer de ovario.

Tuberculosis abdominal que mimetiza cáncer de ovario. Reporte de una serie de casos / Abdominal tuberculosis mimicking ovarian cancer. A case series report

Resumen Introducción: La tuberculosis peritoneal (tuberculosis abdominal) puede ser confundida con una neoplasia maligna. Objetivo: Describir características clínicas y demográficas de pacientes con tuberculosis abdominal que semeja cáncer de ovario avanzado, diagnosticados en un centro oncológico de referencia nacional. Métodos: Se describen las características clínicas y patológicas de nueve pacientes con tuberculosis abdominal que clínicamente semejaba cáncer de ovario avanzado Resultados: La mediana de edad fue de 47 años, el estrato socioeconómico más común fue bajo (44 %). El dolor abdominal y la pérdida ponderal se presentaron en 77.7 %, ascitis en 55.5 %, prueba COMBE positiva en 22.2 % y ausencia de antecedente de tuberculosis pulmonar en 100 %. La elevación de CA-125 se reportó en 77.7 %, con > 500 U/mL en 57.1 %. La tomografía indicó carcinomatosis en 50 % y tumor pélvico y ascitis en 37.5 %. Todas las pacientes fueron sometidas a cirugía; 62.5 % fueron diagnosticadas mediante estudio patológico transoperatorio como enfermedad neoplásica Conclusión: La tuberculosis es considerada como la gran imitadora, por ello se debe tener en mente el diagnóstico de tuberculosis abdominal ante un caso sospechoso, aun cuando la presentación clínica, estudios de imagen e, incluso, el examen transoperatorio sugieran cáncer de ovario.

Abstract Introduction: Peritoneal tuberculosis (abdominal tuberculosis) can be confused with a malignant neoplasm. Objective: To describe clinical and demographic characteristics of patients with abdominal tuberculosis mimicking advanced ovarian cancer, diagnosed in a national reference cancer center. Methods: Clinical and pathological characteristics of nine patients with abdominal tuberculosis that clinically resembled advanced ovarian cancer are described. Results: Median age was 47 years; the most common socioeconomic status was low (44%). Abdominal pain and weight loss occurred in 77.7%; ascites, in 55.5%; 22.2% had a positive COMBE test, and 100% had no history of pulmonary tuberculosis. CA-125 elevation was reported in 77.7%, with levels > 500 U/mL in 57.1%. Tomography reported carcinomatosis in 50% and pelvic tumor and ascites in 37.5%. All patients underwent surgery, where 62.5% were diagnosed by intraoperative pathology study as neoplastic disease. Conclusion: Tuberculosis is considered the great imitator, which is why abdominal tuberculosis diagnosis should be borne in mind when faced with a suspicious case, even when clinical presentation, imaging studies, and even intraoperative examination suggest ovarian cancer.

Volumen metabólico tumoral en paciente con cáncer de ovario reestadificado con PET/CT- FDG-F18 / Tumour metabolic volume in a patient with ovarian cancer restaged with PET/CT-FDG-F-18

Resumen El F18-FDG PET/CT es una herramienta de gran utilidad en el proceso de reestadificación de los casos que tienen sospecha de recaída en el contexto de carcinoma de ovario con excelente rendimiento diagnóstico y pronóstico, suministrando datos cuantitativos como el volumen metabólico tumoral (MTV) y lesión glicolitica total (TLG). De manera rutinaria se reporta el valor de captación estandarizado máximo (SUVmax) en las lesiones tumorales, sin embargo, hay que tener en cuenta que es improbable que un solo píxel refleje la actividad de tumores metabólicamente heterogéneos con precisión. Con el fin de resolver el dilema del uso del SUVmax, se han introducido varios parámetros cuantitativos en PET para estimar la medición de manera más exacta y objetiva de la biología de la neoplasia. En años recientes se ha hecho énfasis en la carga metabólica tumoral mediante el uso del MTV y la TLG como marcadores pronósticos y predictores de recaída.

Abstract The F18-FDG PET/CT is a very useful tool in the re-staging process of cases that are suspected of relapse in the context of ovarian carcinoma. It has an excellent diagnostic and prognostic performance, providing quantitative data such as tumour metabolic volume (MTV) and total lesion glycolysis (TLG). The maximum standardised uptake value (SUVmax) is routinely reported in tumour lesions; however it must be taken into account that it is unlikely that a single pixel accurately reflects the activity of metabolically heterogeneous tumours. In order to resolve the dilemma of the use of the SUVmax, several quantitative parameters have been introduced into PET in order to estimate the measurement of the biology of the neoplasm in a more exact and objective way. In recent years, emphasis has been placed on tumour metabolic load through the use of MTV and TLG as prognostic markers and predictors of relapse.

[The value of immunohistochemistry using SMARCA4/BRG1 in the diagnosis of small cell ovarian carcinoma hypercalcemic type. A report of two cases]. / Valor de la determinación inmunohistoquímica de SMARCA4/BRG1 en el diagnóstico del carcinoma de ovario de célula pequeña variante hipercalcémica. Presentación de dos casos.

Small cell carcinoma of ovary-hypercalcemic type is an undifferentiated carcinoma. We describe two cases in women aged 32 and 29. Both presented with large masses and complete surgical extirpation was impossible. Histologically, the images were similar, with diffuse cell proliferation, accompanied by the presence of follicle-like spaces. In both cases it was necessary to make a differential diagnosis with entities such as adult or juvenile granulosa cell tumour, small cell carcinoma of pulmonary type, dysgerminoma and even peripheral neuroectodermal tumour. The absence of SMARCA4/BRG1 immunostaining proved very useful in the diagnosis of hypercalcemic small cell ovarian carcinoma.

Carcinomas epiteliales del ovario de alto y bajo grado: estado del arte / High and low-grade epithelial ovarian cancer state of the art

El cáncer epitelial del ovario en Colombia es la segunda causa de morbilidad y mortalidad por tumores ginecológicos después del carcinoma de cuello uterino. Por lo regular se presenta en estados avanzados y la sobrevida es pobre. Recientes estudios de tipo clínicopatológicos y moleculares han develado nuevas teorías sobre la carcinogénesis, proponiendo un modelo dual con tumores tipos I y II. Se busca con este artículo ampliar y actualizar la información sobre estas nuevas teorías y profundizar en el conocimiento histopatológico y molecular. Para la revisión de la literatura se estructuró una estrategia de búsqueda utilizando los términos carcinoma de ovario, tumores tipo I-II, KRAS, BRAF, p-53 (MeSH y no Mesh), los cuales se articularon con operadores booleanos en las siguientes bases de datos: pubmed, ebscohost, embase, filtrando los resultados por artículos de revisión...

In Colombia, epithelial ovarian cancer is the second cause of morbidity and mortality for gynecological malignancies after uterine cervix cancer. Usually this condition is detected in advanced stages and overall survival is poor. Recent clinical, pathologic and molecular studies have provided new theories on ovarian carcinogenesis and have proposed a new dualistic model that categorizes ovarian cancer into two groups designated type I and type II. This article seeks to increase and update information on these new theories and deepen histopathological and molecular knowledge. A search strategy was designed for literature review including the terms, ovarian carcinoma, type I-II tumors, KRAS, BRAF, p53 (MeSH and not Mesh), which were articulated with Boolean operators in the following data bases: pubmed, ebscohost, embase, filtering the results by review articles...