Endometriosis and ovarian cancer: Their association and relationship.

OBJECTIVES: To study endometriosis-associated borderline or malignant ovarian epithelial tumors by analyzing their differential clinical features, as well as the histological pattern, survival and immunohistochemical data compared with those without associated endometriosis. STUDY DESIGN: Setting: Hospital Marina Baixa and San Juan University Hospital, Alicante, Spain. This retrospective study included clinical and pathological data from 36 operated cases with endometriosis-associated ovarian epithelial tumors and 305 cases of ovarian epithelial tumors without endometriosis, including borderline and invasive tumors. We also studied hormonal receptors and p53 protein expression in 13 cases with endometriosis-associated endometrioid and clear cell tumors, and report two cases with histologically-confirmed previous endometriosis. RESULTS: Associated endometriosis was observed in 10.5% of patients with borderline or invasive ovarian epithelial tumor, 53% of those with endometrioid, and 22% with clear cell tumors. Patients with endometriosis-associated ovarian epithelial tumors were younger, had lower parity, were more frequently premenopausal, had a lower tumor stage or were borderline, and in general had better prognosis and longer survival, although they also more frequently had an associated endometrial carcinoma. Associated endometriosis and endometrioid tumors were generally estrogen-receptor positive, whereas they were negative in the clear cell tumor component. p53 protein positivity was generally observed in clear cell tumors and in associated endometriosis. Two reported cases with previous, known endometriosis were followed in their evolution to borderline endometrioid carcinoma and clear cell carcinoma, respectively. CONCLUSIONS: Our results and review of the literature suggest that the association of ovarian epithelial tumors and endometriosis is a factor for good prognosis for ovarian cancer and that this association might correspond in many cases to an intermediate stage in the development of endometriosis to endometrioid, clear cell, or other invasive carcinomas.

Síndrome miasténico congénito en gestante: entidad clínica poco frecuente / Congenital myasthenic syndrome in pregnancy: an uncommon clinical entity

Los síndromes miasténicos congénitos son un conjunto de alteraciones hereditarias cuya patogenia en común es la disfunción de la transmisión neuromuscular. La clínica consiste en debilidad y fatigabilidad de la musculatura estriada, que puede debutar tras el nacimiento o primera infancia. En la mujer gestante, el síndrome miasténico congénito tiene un transcurso impredecible, y puede agravarse en algunos casos. La vía de parto de elección es la vaginal. La fase de dilatación no se ve alterada, pero sí la fase de expulsivo por afectación de la musculatura abdominal, por lo que será necesario el uso de la tocurgia y la administración de anestesia epidural desde el inicio del parto. Presentamos un caso de una gestante con síndrome miasténico congénito por mutación en el gen COLQ

The congenital myasthenic syndromes are a group of inherited disorders in wich neuromuscular transmission is impaired. The congenital myasthenic syndromes are characterized by fatigable weakness of skeletal muscle with onset at or shortly after birth or in early childhood. Some case reports have suggested possible worsening of the clinical condition during pregnancy. However, this risk has not yet been quantified in a significant number of patients. Vaginal delivery is the best one in a pregnant patient with myasthenic symptomatology. The first stage of labour isn’t affected. Nevertheless, the use of the instrumental delivery and epidural analgesia is necessary in the last stage of delivery due to weakness of abdominal muscles from fatigue. We show a case of a pregnant woman with congenital myasthenic syndrome because of mutation in the gene COLQ

A propósito de un caso; paciente joven con tumor desmoide de mama diagnosticado tras tumorectomía / Desmoid breast tumor diagnosed after lumpectomy in a young patient a case report

Presentamos el caso de una paciente de 16 años, sin antecedentes ginecológicos de interés, con previo diagnóstico de tumor filoides en línea intercuadrántica de mama derecha. Tras ser tratada con tumorectomía, y tras el estudio anatomopatológico de la pieza, resultó estar afecta de tumor desmoide en mama. Dada la escasa prevalencia de esta afección, y la afectación de los bordes quirúrgicos tras el tratamiento quirúrgico, consideramos necesario elaborar una revisión bibliográfica sobre el tumor desmoide en mama; etiología, clínica y tratamiento (AU)

We report the case of a 16-year-old patient with no relevant gynecologic history, who was diagnosed with a phyllodes tumor in the border between the lower and upper outer quadrants of the right breast. The patient was treated with a tumorectomy/lumpectomy, and after pathological study of the specimen, was diagnosed with a desmoid breast tumor. Given the rarity of this entity, and the positive microscopic surgical margins, we consider that a literature review of desmoid breast tumor (etiology, clinical presentation and treatment) is timely (AU)

Evisceración vaginal traumática en mujer posmenopáusica / Traumatic vaginal evisceration in a postmenopausal woman

La evisceración vaginal es una emergencia médica rara que se presenta con mayor frecuencia en mujeres posmenopáusicas con antecedente de cirugía pélvica o vaginal, especialmente histerectomía, y cierta disfunción del suelo pélvico. Sin embargo, la evisceración espontánea vaginal sin antecedentes de cirugía previa en este tipo de pacientes es aún más infrecuente. Se describe a continuación un caso de evisceración vaginal traumática en una mujer posmenopáusica (AU)

Vaginal evisceration is a rare medical emergency that usually occurs in postmenopausal women with a history of pelvic or vaginal surgery, especially hysterectomy, and some pelvic floor dysfunction. Spontaneous vaginal evisceration without previous surgery in these patients is even more uncommon. We discuss a case of spontaneous vaginal evisceration after vaginal trauma in a postmenopausal woman (AU9

Cáncer neuroendocrino de mama. A propósito de un caso / Neuroendocrine breast cancer. A case report

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Sarcomas de mama posradiación / Radiation-induced sarcomas of the breast

El cáncer de mama es la neoplasia más frecuente en la mujer. El tratamiento conservador implica el tratamiento adyuvante con radioterapia. Alrededor del 60% de los pacientes con cáncer reciben radioterapia durante el curso de su enfermedad. Los sarcomas son tumores raros y corresponden al 0,03-0,8% de toda la patología tumoral. Su origen es controvertido siendo asociado a traumatismos, exposición a agentes químicos, linfedema crónico y radioterapia. El porcentaje de sarcomas radioinducidos supone el 0,1-0,4% de los mismos. Ya en 1904 Perthes y posteriormente Cahan describieron la asociación de radioterapia como desencadenante en la patogénesis de los sarcomas. El mejor conocimiento actual de la biología aporta nuevos indicios sobre su origen. La distancia temporal entre la exposición a la radiación y la aparición del sarcoma es el criterio principal que ha sido modificado por la mayor parte de los investigadores, y está entre 3-10 años. El tratamiento de elección, sigue siendo la cirugía con amplios márgenes de seguridad. Respecto al tratamiento adyuvante, la radioterapia y quimioterapia tienen un efecto limitado. El pronóstico es desfavorable, con una supervivencia global a los 5 años, que oscila del 17-58%, significativamente menor que la de los sarcomas de partes blandas de novo. Debido al escaso número de casos recogidos en la literatura, es difícil definir el protocolo de actuación más correcto, por lo que pretendemos ofrecer una revisión de las manifestaciones clínicas, técnicas de imagen, tratamiento y pronóstico de los sarcomas radioinducidos, aportando a la vez 2 nuevos casos de sarcomas radioinducidos tras neoplasia mamaria (AU)

Breast cancer is the most common neoplasm in women. Conservative treatment involves adjuvant therapy with radiotherapy. About 60% of cancer patients receive radiotherapy during the course of their disease. Sarcomas are rare tumors and account for 0,03-0,8% of all tumoral disease. Their origin is controversial and has been associated with trauma, exposure to chemicals, radiation and chronic lymphedema. The percentage of radiation-induced sarcomas represents the 0.1-0.4% of these tumors. As early as 1904, Perthes, and later Cahan, described the association of radiotherapy as a trigger in the pathogenesis of sarcomas. Greater current knowledge of biology provides new clues to the origin of sarcomas. The time interval between radiation exposure and the appearance of a sarcoma is the main criterion that has been modified by most researchers and is between 3 and 10 years. The treatment of choice is still surgery with wide safety margins. Regarding adjuvant treatment, radiotherapy and chemotherapy have limited effect. Prognosis is poor, with an overall 5-year survival ranging from 17% to 58%, significantly lower than that of de novo soft tissue sarcomas. Due to the small number of cases reported in the literature, it is difficult to define the most appropriate protocol. Consequently, our aim is to provide a review of the clinical manifestations, imaging techniques, treatment and prognosis of radiation-induced sarcomas and to report two new cases of radiation-induced sarcomas after breast cancer (AU)