Neuroendocrine appendiceal tumor and endometriosis of the appendix: a case report.

INTRODUCTION: Endometriosis of the appendix is very uncommon, accounting for only about 1% of all cases of endometriosis. However, endometriosis is found in the appendix in approximately 8-13% of patients with deep infiltrating endometriosis and is particularly common in patients with severe forms of deep infiltrating endometriosis. Neuroendocrine tumors are the most common neoplasms of the appendix and may be misdiagnosed when there are multiple endometriosis lesions in the pelvis. CASE PRESENTATION: We describe a case of a Caucasian patient with deep infiltrating endometriosis with rectal involvement, retrocervical lesions, and a right ovarian endometrioma with no suspected lesions in the appendix. She underwent laparoscopy and, after a systematic intraoperative evaluation, suspected involvement of the appendix was observed. The patient underwent ovarian cystectomy, excision of the pelvic endometriosis lesions, appendectomy, and anterior stapler discoid resection. Histopathological analysis of the appendix revealed endometriosis and a well-differentiated neuroendocrine carcinoma at the appendix tip. DISCUSSION: Our patient's case emphasizes the need to approach these lesions carefully and strengthens the indication for appendectomy when the appendix is affected in the setting of endometriosis. Despite the more likely diagnosis of appendiceal endometriosis, neuroendocrine tumors cannot be ruled out by imaging examinations, and both conditions can occur in the same patient.

Limitations of three-dimensional power Doppler angiography in preoperative evaluation of ovarian tumors.

BACKGROUND: This study describes the accuracy of three-dimensional power Doppler (3D-PD) angiography as secondary method for differential diagnosis of ovarian tumors. METHOD: Seventy-five women scheduled for surgical removal of adnexal masses were assessed by transvaginal ultrasound. Ovarian tumors were classified by IOTA simple rules and two three-dimensional blocks were recorded. In a second step analyses, a 4 cm(3) spherical sample was obtained from the highest vascularized solid area of each stored block. Vascularization index (VI), flow index (FI) and vascularization-flow index (VFI) were calculated. The repeatability was assessed by concordance correlation coefficient (CCC) and limits of agreement (LoA), and diagnostic accuracy by area under ROC curve. RESULTS: IOTA simple rules classified 26 cases as benign, nine as inconclusive and 40 as malignant. There were eight false positive and no false negative. Among the masses classified as inconclusive or malignant by IOTA simple rules, the CCCs were 0.91 for VI, 0.70 for FI, and 0.86 for VFI. The areas under ROC curve were 0.82 for VI, 0.67 for FI and 0.81 for VFI. CONCLUSIONS: 3D-PD angiography presented considerable intraobserver variability and low accuracy for identifying false positive results of IOTA simple rules.

Diagnósticos em 1048 biópsias mamárias realizadas em Uberaba - MG / Pathological diagnoses for 1048 breast biopsies from Uberaba, MG, Brazil

Com o objetivo de contribuir para o melhor conhecimento da patologia regional mamária, analisaram-se 1299 diagnósticos anatomopatológicos em 1048 biópsias de mama, realizadas em dois laboratórios da cidade de Uberaba. A patologia mais frequente foi a mastopatia fibrocística (29 por cento), seguida pelas neoplasias benignas (28 por cento) e pelas malignas (23 por cento). Oitenta e dois por cento das neoplasias benignas foram fibroadenomas, e 92 por cento das malignas foram carcinomas ductais. Noventa e seis por cento dos espécimes foram mamas femininas, e 4 por cento, mamas masculinas. Em homens, a patologia mais frequente foi a ginecomastia (83 por cento).