Pelvic lymph node involvement and risk of recurrence in HPV-associated endocervical adenocarcinoma stage IA2-IB1 according to Silva's system in two Colombian cancer centers.

OBJECTIVE: To compare the pelvic lymph node involvement and risk of recurrence in patients with human papillomavirus (HPV)-associated endocervical adenocarcinoma stage IA2-IB1 undergoing hysterectomy and/or trachelectomy plus lymphadenectomy, according to Silva's classification system. METHODS: A retrospective cohort study was performed in two Colombian cancer centers. The cases were classified according to the Silva classification system. Clinical, surgical, and histopathological variables were evaluated. Recurrence risk was analyzed by patterns A, B, or C. A logistic regression model was performed for tumor recurrence. The Kaplan-Meier method was used to estimate overall survival and disease-free survival (DFS). A weighted kappa was performed to determine the degree of concordance between pathologists. RESULTS: A total of 100 patients were identified, 33% pattern A, 29% pattern B, and 38% pattern C. The median follow-up time was 42.5 months. No evidence of lymph node involvement was found in patients classified as A and B, while in the C pattern was observed in 15.8% (n = 6) of cases (P < 0.01). There were 7% of cases with recurrent disease, of which 71.5% corresponded to type C pattern. Patients with Silva pattern B and C had 1.22- and 4.46-fold increased risk of relapse, respectively, compared with pattern A. The 5-year DFS values by group were 100%, 96.1%, and 80.3% for patterns A, B, and C, respectively. CONCLUSION: For patients with early-stage HPV-associated endocervical adenocarcinoma, the type C pattern presented more lymph node involvement and risk of recurrence compared to the A and B patterns. The concordance in diagnosis of different Silva's patterns by independents pathologists were good.

Leiomiosarcoma de ovario: tumor infrecuente y de comportamiento agresivo / Leiomyosarcoma ovarian cancer: a rare tumour with aggressive behaviour

Resumen Los leiomyosarcomas pueden originarse en la mayor parte de los órganos desarrollados fuera del sistema nervioso central. Se han documentado casos de leiomyosarcomas de origen: intestinal, mesentérico, uterino, retroperitoneal, de tejidos blandos y vascular. Sin embargo, los casos de leiomyosarcomas primarios de ovario son extremadamente infrecuentes y pocos casos han sido descritos en la literatura. Se cree que estos leiomyosarcomas se originan en el músculo liso alrededor de los folículos o a partir de remanentes del conducto de Wolff a partir de las paredes de la vasculatura existente en el parénquima ovárico. La mayor parte de los casos se presentan en pacientes postmenopáusicas y con un pronóstico a corto plazo desfavo rable. El pilar del tratamiento continúa siendo la citorreducción tumoral completa obteniendo márgenes quirúrgicos negativos con miras a disminuir el potencial de recidiva. El beneficio de la utilización de quimioterapia adyuvante como parte del tratamiento de esta patología sigue siendo incierto.

Abstract Leiomyosarcomas may originate in most of the organs developed outside the central nervous system. There are documented cases of leiomyosarcomas of intestinal, mesenteric, ute rine, retroperitoneal, and of soft and vascular tissue origin. However, cases of primary ovarian leiomyosarcoma are extremely rare, with few cases reported in the international literature. Leiomyosarcomas are believed to be those that originate from the walls of existing vasculature in ovarian parenchyma, in the smooth muscle around the follicles, or from remnants of the Wolff duct. Most cases occur in post-menopausal patients, and have an unfavourable prognosis in the short term. The mainstay of treatment remains the complete tumour debulking, with negative surgical margins in order to reduce the potential for recurrence. The benefit of the use of adjuvant chemotherapy as part of treatment of this condition remains uncertain.

Síndrome de teratoma creciente: reporte de caso y revisión de la literatura / Growing teratoma syndrome: a case report and review of the literature

El síndrome de teratoma creciente (STC) es una condición poco común que se presenta en pacientes con tumores de células germinales no seminomatosos (TCGNS) de tipo teratoma inmaduro. Se caracteriza por la aparición de masas metastásicas que pueden alcanzar grandes volúmenes durante o después de la administración de la quimioterapia, asociado a la negativización de los marcadores tumorales. Histopatológicamente estas masas corresponden a un teratoma maduro. A continuación se presenta el caso de una paciente de 24 años, con diagnóstico de síndrome de teratoma creciente, incluyendo su evaluación, manejo quirúrgico y seguimiento a corto plazo.

The growing teratoma syndrome is a rare condition that occurs in patients with non-seminomatous germ cell immature teratoma. It is characterised by the appearance of metastatic masses that can reach large volumes during or after administration of chemotherapy, associated with the negative result for tumour markers. Histopathologically these masses correspond to a mature teratoma which is explained by a retroconversion phenomenon. The case is presented of a 24 year-old patient, diagnosed with growing teratoma syndrome, including her evaluation, surgical management, and short-term follow-up.