RESUMO
Los pólipos endometriales representan un trastorno común en la práctica habitual en ginecología. Si bien se han identificado factores de riesgo asociados a su proliferación, se desconoce la causa exacta de su aparición. En ocasiones su manejo es controvertido, siendo difícil para el clínico optar en muchos casos por una actitud expectante con seguimientos periódicos dado que el riesgo de malignidad de esta entidad no es despreciable. El objetivo del presente artículo es la realización de una revisión exhaustiva de la literatura, a partir de las principales bases de datos, sobre el diagnóstico y manejo de pólipos endometriales, así como de la fisiopatología y epidemiología, con el fin de conocer la última evidencia científica sobre esta entidad.(AU)
Endometrial polyps are a common disorder in routine gynaecological practice. Although risk factors associated with their proliferation have been identified, the exact cause of their onset is unknown. Sometimes their management is controversial, in many cases it being difficult for the clinician to opt for a wait-and-see approach with periodic follow-ups, given that the risk of malignancy with this entity is not negligible. The objective of this article was to carry out an exhaustive review of the literature, based on the main databases, on the diagnosis and management of endometrial polyps, and their pathophysiology and epidemiology, to determine the latest evidence and scientific information regarding this entity.(AU)
Assuntos
Pré-Menopausa , Neoplasias do Endométrio , Endométrio/lesões , Endometriose/diagnóstico , Tamoxifeno , Hemorragia Uterina , Ginecologia , ObstetríciaRESUMO
El mioma uterino es la tumoración pélvica más frecuentemente diagnosticada en mujeres en edad reproductiva. En los últimos años se ha producido una búsqueda de tratamientos mínimamente invasivos que permitan conservar el útero. La ablación por radiofrecuencia vía transvaginal permite el tratamiento de los miomas uterinos de forma segura y efectiva.Presentamos un inusual caso clínico de perforación intestinal tras la ablación por radiofrecuencia de dos miomas y presentamos una revisión de la literatura existente en relación a esta complicación de la técnica.
Uterine leiomyoma are the most common pelvic tumours diagnosed in women of reproductive age. In recent years, the search for minimally invasive treatment that allows women to preserve their uterus has resulted in transvaginal radiofrequency ablation. This procedure is safe and effective.We present a case report of intestinal perforation after transvaginal radiofrequency ablation of two uterine leiomyomas. Finally, we present a review of the literature in relation to this complication of the technique.
Assuntos
Feminino , Gravidez , Adulto Jovem , Ciências da Saúde , Perfuração Intestinal , Ablação por Radiofrequência , Leiomioma , Neoplasias Pélvicas , Neoplasias , Mulheres , Gravidez , GinecologiaRESUMO
El tabique vaginal transverso es una malformación genital femenina muy infrecuente con una etiología desconocida y un manejo clínico aún por discernir. Presentamos el caso de una mujer de 17 años que presentaba estrechez del introito vaginal asociada a una intensa dismenorrea, con el diagnóstico final de esta entidad tras una exploración bajo anestesia. El conocimiento de esta anomalía junto con sus hallazgos clínicos y posibles entidades extragenitales asociadas permiten realizar un apropiado diagnóstico de sospecha y una correcta clasificación, lo que conlleva un manejo terapéutico más óptimo.(AU)
Transverse vaginal septum is a rare female genital malformation of unknown aetiology, and for which there is still no clear clinical management. The case is presented of a 17-year-old woman who had a narrow vaginal introitus associated with intense dysmenorrhoea. She was diagnosed with this disorder after an examination under anaesthesia. The knowledge of this anomaly, as well as its symptomatology and associated extra-genital pathologies, can lead to an appropriate suspected diagnosis and correct classification, and to a more optimal therapeutic management.(AU)
Assuntos
Humanos , Feminino , Adolescente , Genitália Feminina/anormalidades , Ductos Paramesonéfricos , Dor Abdominal , Hematocolpia , Pacientes Internados , Exame Físico , Ginecologia , Doenças dos Genitais FemininosRESUMO
BACKGROUND AND OBJECTIVE: Sentinel lymph node biopsy (SLNB) was created to reduce the morbidity associated with pelvic lymphadenectomy in the early stages of cervical cancer (CC), preserving its prognostic information. The goal is to assess the diagnostic validity of SLNB in CC in initial stages (IA1 with lymphovascular infiltration (LVI) +, IA2, IB1 and IIA1), thus avoiding unnecessary lymphadenectomies in many of the cases. MATERIAL AND METHOD: From January 2012 to April 2017, 23 patients with initial stages of CC were included in a cross-sectional study to evaluate the effectiveness of the SLNB in CC with a mixed technique of cervical injection of 99mTc-nanocolloid of albumin and methylene blue, using combined planar lymphoscintigraphy with multimodality SPECT/CT image and subsequent removal of the sentinel node (SN) by laparoscopy. RESULTS: The detection rate of SLNB with the mixed technique was 95.65%, with a negative predictive value (NPV) of 95.45% and sensitivity (S) of 100% in the case of bilateral drainage. The mean of excised SN was 3 (range 1-5). The bilateral detection rate in laparoscopy was 85.35%. The concordance between SPECT/CT and laparoscopy for the number and bilaterality of the SN using the Pearson coefficient was r = 0.727 and r = 0.833, respectively; p = 0.01. We only found one SN with a deferred result of micrometástasis and one false negative was detected. CONCLUSIONS: SLNB in CC using a mixed technique has a high detection and bilateral drainage rate, but S is still low if we include cases of unilateral drainage. A greater number of cases and the development of intraoperative ultrastaging could increase the S of the technique and to reduce the number of false negatives.
Assuntos
Biópsia de Linfonodo Sentinela , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/patologia , Adulto , Estudos Transversais , Feminino , Humanos , Excisão de Linfonodo , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias do Colo do Útero/cirurgia , Adulto JovemRESUMO
BACKROUND: Ectopic pregnancy represents a common entity when the differential diagnosis of first trimester pathologies is performed. Extratubal location, nonetheless, is an in unfrequent situation that delays and difficults the diagnoses. CASE REPORT: 41-year-old women who goes to clinic for a pregnancy test, which proved positive done. During normal ultrasonographic we observed attached with endometrial 8 mm thick, without gestational sac inside, no free liquid in the bottom of the pouch of Douglas. In the left cornual region had a suggestive image of ectopic pregnancy, of 2.8 cm, with embryo without cardiac activity, tested with Doppler color, according to 6 weeks of amenorrhea was observed. The level of ß-HCG was 17,656 mU/mL, which confirmed the diagnosis of corneal ectopic pregnancy. Multidose protocol of methotrexate and folinic acid was prescribed at a dose of 50 mg on days 1, 3, 5 and 7, and 5 mg in the days 2, 4, 6 and 8, respectively. After 14 days of treatment a new ß-HCG study control was made, which results was 2,519 mU/mL. From that time we take a weekly control studies of the ß-HCG until was negative (six months later). The multidose protocol of methotrexate and folinic acid is an effective treatment in patients with cornual ectopic pregnancy.
Assuntos
Abortivos não Esteroides/administração & dosagem , Metotrexato/administração & dosagem , Gravidez Cornual/tratamento farmacológico , Adulto , Feminino , Humanos , GravidezRESUMO
Gastrointestinal stromal tumors are the most common mesenquimal neoplasms of the gastrointestinal tract. A preoperative diagnose of GIST it is very difficult to make, but up to 5% of the cases initially appear as a pelvic mass. Clinical case: 45-year-old patient attended in medical service by unspecific pain in the lower abdomen of several weeks of evolution. The abdominopelvic tomography evidence collection of 9×8 cm above of the uterus and sigma's right with air in the cavity, it is was compatible with pelvic abscess. Due to increased pain, we realized emergency exploratory laparotomy, which showed a 14 cm tumor, dependent of the small intestine, without ascites or involvement other organs of the digestive or reproductive tract. The excision of the tumor was successfully (non intraoperative rupture). The pathological study reported a bowel piece of 20 cm, in which a tumor of 14 cm with large central cavitation was identified. Histologically showed diffuse growth pattern and neoplastic epithelioid cells with low rate of mitosis (mitosis 1-2/5 mm2). The immunohistochemistry test reports strong expression of DOG-1 and focal expression in CD117 (c-kit), with very low proliferation index (Ki67). The molecular pathology study identified a mutation in exon 11, codon 557-558, the c-kit gene in the p.W557_K558del position. We use imatinib (400 mg/24 h) from the second month after surgery. Today keep in treatment, and clinical and laboratories following every month: in addition, to CT scans scheduled every 6 months.
