Quality of life in long-term cervical cancer survivors compared with healthy women and women with benign gynecological disorders.

OBJECTIVE: The impact of cervical cancer treatment on the quality of life of long-term survivors compared with the general female population is controversial, and no studies have been conducted comparing patients with benign gynecological diseases. The aim of this study was to compare the quality of life of cervical cancer survivors with that of healthy controls. STUDY DESIGN: A case-control study was conducted to compare the quality of life of 106 cervical cancer survivors from a tertiary hospital and 185 women admitted to a gynecological outpatient clinic from the same health area for a healthy woman check-up (n 46) or for a benign gynecological disorder (symptomatic, n 113; asymptomatic, n 26). To measure quality of life, self-administered questionnaires, such as the Functional Assessment Cancer Therapy-cervix and World Health Organization quality of life-brief version, were employed. Baseline scores were collected when patients first reported, and further evaluations were completed at 0-6, 7-12, 13-24, 25-60, and more than 60 months. For the contrastive analysis hypothesis, we employed R statistical software. RESULTS: Except for the environment domain at 0-6, 7-12, and 13-24 months (51.52 vs. 60.73, p < 0.0001; 52 vs. 60.73, p < 0.0001; 49.81 vs. 60.73, p < 0.0001, respectively), we found no statistically significant differences in the quality of life between cervical cancer survivors and controls. We did find differences in the physical health domain scores at 0-6 months (60.22 vs. 72.42, p = 0.039) and the social relationships domain scores at 13-24 months (54 vs. 71.42, p = 0.017) between cases and asymptomatic controls. CONCLUSION: Except for physical well-being, environment and social relationships, which were substantially better for controls, especially in the asymptomatic, long-term cervical cancer survivorsquality of life did not vary from that of controls.

Cross-sectional study on the impact of age, menopause and quality of life on female sexual function.

We sought to determine the prevalence of female sexual dysfunction (FSD) and to examine the influence of age, menopausal state and quality of life (QoL) on the female sexual function (FSF) of healthy women and those with benign gynaecological disease. With this purpose, we conducted a cross-sectional study, based on self-report questionnaires (sociodemographic, WHOQOL-BREF and FSFI), enrolling 107 women. Some 51.6% (n = 55) were diagnosed with FSD. We found no statistical significant differences between grouped reason for consultation and FSFI total score (p = .72) and its domains (p > .05). The results showed a negative strong correlation between age and FSFI total score (S= -0.71) and a positive moderate correlation between WHOQOL-BREF and FSFI total scores (S = 0.39). We observed statistically significant differences between menopausal state and FSFI total score (p = .001). In conclusion, the prevalence of FSD in our population was 51.6%. Our study results reveal that a reduction in FSFI scores has a negative impact on QoL and vice versa, regardless of the reason for consultation. Elderly age and postmenopausal state have deleterious effects on FSF.Impact statementWhat is already known on this subject? Poor QoL can adversely affect FSF and vice versa. The study of FSF is relatively recent and there is controversy regarding the deleterious effects of elderly age and menopause on FSF. The prevalence of FSD is difficult to precisely determine, given the studies' use of different definitions for FSD and the highly heterogeneous study populations, as well as the types of tests and questionnaires employed. Sexual difficulties are problems seldom discussed between patients and their physicians. Lack of time, misconceptions, shame and frustration, considering sexuality as too intimate to discuss in the doctor's office, uncertainty regarding therapeutic options and insufficient training of health professionals are just some of the reasons mentioned for not addressing sexual dysfunction in a general consultation.What do the results of this study add? Our study is the first research in Spain on the impact of age, menopause and QoL on gynaecological patients´ FSF. Our results indicate that an impaired FSF could be related to poorer well-being and QoL; however, benign gynaecological disease does not appear to affect FSF. Elderly age and postmenopausal state can have deleterious effects on FSF.What are the implications of these findings for clinical practice and/or further research? Sexuality is an important aspect of QoL. Therefore, gynaecologists should discuss issues of sexuality with their patients in routine visits, especially in case of elderly and postmenopausal women. In addition, gynaecologists should train in the diagnosis and treatment of the female sexual dysfunction.

Pseudomixoma peritoneal primario de origen ovárico / Primary pseudomyxoma peritonei originated from ovaries

Resumen ANTECEDENTES: El pseudomixoma peritoneal es muy raro; se caracterizada por ascitis mucinosa e implantes peritoneales relacionados con la rotura y diseminación del contenido de un tumor mucinoso. En 80 al 90% de los casos el tumor primario es apendicular y el ovario es una localización realmente excepcional. CASO CLÍNICO: Paciente de 49 años que acudió a consulta debido a un dolor abdominal. En las pruebas de imagen se visualizó una tumoración anexial izquierda y se advirtieron hallazgos sugerentes de pseudomixoma peritoneal. En la cirugía, la masa ovárica se objetivó parcialmente fragmentada, con el apéndice aumentado de tamaño y extensos implantes peritoneales; además de gran cantidad de mucina libre en la cavidad peritoneal. El análisis anatomopatológico determinó la existencia de un adenocarcinoma mucinoso en el ovario afectado, con inmunohistoquímica positiva para CK7+ y CK20+, múltiples implantes de mucina y el apéndice sin daño. Por lo anterior se diagnosticó: pseudomixoma peritoneal de origen ovárico. Luego de dos intervenciones quirúrgicas no se consiguió la citorreducción completa. La paciente permaneció estable durante siete años, momento en el que fue evidente el avance de los síntomas de la enfermedad, circunstancia que la condujo a la muerte. CONCLUSIÓN: Determinar el origen de un pseudomixoma peritoneal sigue siendo un reto pues, con frecuencia, tanto el apéndice como los ovarios se afectan simultáneamente. Por ello, la apendicectomía y la exploración bilateral de los ovarios deben ser prácticas de rutina. El análisis extenso de las muestras y la inmunohistoquímica pueden facilitar la catalogación de estos infrecuentes tumores.

Abstract BACKGROUND: Pseudomyxoma peritonei is very rare; it is characterized by mucinous ascites and peritoneal implants related to rupture and dissemination of the contents of a mucinous tumor. In 80 to 90% of cases the primary tumor is appendicular and the ovary is a truly exceptional location. CLINICALCASE: A 49 year old female patient presented for consultation due to abdominal pain. Imaging tests showed a left adnexal tumor and findings suggestive of pseudomyxoma peritonei. At surgery, the ovarian mass was partially fragmented, with an enlarged appendix and extensive peritoneal implants; in addition to a large amount of free mucin in the peritoneal cavity. The anatomopathological analysis determined the existence of a mucinous adenocarcinoma in the affected ovary, with positive immunohistochemistry for CK7+ and CK20+, multiple mucin implants and an undamaged appendix. Therefore, a diagnosis was made: pseudomyxoma peritoneum of ovarian origin. After two surgical interventions she did not achieve complete cytoreduction. The patient remained stable for seven years, at which time the symptoms of the disease became evident and led to her death. CONCLUSION: Determining the origin of a pseudomyxoma peritonei remains a challenge as often both the appendix and ovaries are affected simultaneously. Therefore, appendectomy and bilateral ovarian exploration should be routine practice. Extensive specimen analysis and immunohistochemistry can facilitate cataloging of these infrequent tumors.

Cáncer de endometrio: tratamiento quirúrgico en un hospital comunitario de España / Endometrial cancer: surgical treatment in a community hospital in Spain

Resumen OBJETIVO: Exponer los desenlaces quirúrgicos de las pacientes intervenidas por cáncer de endometrio, analizar si existen puntos de mejora en nuestra práctica clínica y aportar más datos a la evidencia publicada, para ayudar al avance en el tratamiento quirúrgico de las pacientes con esta enfermedad MATERIALES Y MÉTODOS: Estudio observacional, descriptivo y retrospectivo llevado a cabo en la Unidad de Oncología Ginecológica del Hospital Regional Virgen Macarena de Sevilla, España, entre junio de 2013 y febrero de 2020. Se reunieron los reportes quirúrgicos de pacientes intervenidas por alguna afección endometrial premaligna o maligna. Variables de estudio: edad, IMC, cirugías previas, diagnóstico histopatológico y estadio, vía de acceso quirúrgico y terapia coadyuvante. Se exponen los desenlaces relacionados con complicaciones quirúrgicas y tasa de curación, así como el tiempo de intervención, vía de acceso quirúrgico y estancia hospitalaria. RESULTADOS: Se estudiaron 250 pacientes, la mayoría (76%) con diagnóstico de adenocarcinoma endometrioide de endometrio. La vía de acceso quirúrgico más utilizada fue la laparoscopia (51.6%), con un porcentaje de complicaciones intraoperatorias del 10% y posoperatorias del 9.2%. El 88.4% de las pacientes permanece viva y libre de enfermedad después del tratamiento, con recaídas solo en el 11.6% y 8% de fallecimientos. CONCLUSIONES: El tratamiento inicial de elección, en pacientes con hiperplasia con atipias o cáncer de endometrio en estadios tempranos, es la cirugía, mediante histerectomía, doble anexectomía y en algunos casos linfadenectomía asociada. La elección de la vía quirúrgica de acceso debe individualizarse a las condiciones particulares de cada paciente. La laparoscopia ofrece múltiples ventajas, es una técnica en auge y cada día más practicada.

Abstract OBJECTIVE: To expose the surgical outcomes of patients operated on for endometrial cancer, to analyze if there are points of improvement in our clinical practice and to contribute more data to the published evidence, to help advance the surgical treatment of patients with this disease. MATERIALS AND METHODS: Observational, descriptive, and retrospective study carried out in the Gynecologic Oncology Unit of the Virgen Macarena Regional Hospital of Seville, Spain, between June 2013 and February 2020. Surgical reports of patients operated on for any premalignant or malignant endometrial condition were collected. Study variables: age, BMI, previous surgeries, histopathological diagnosis and stage, surgical access route and adjuvant therapy. Outcomes related to surgical complications and cure rate are presented, as well as operation time, surgical access route and hospital stay. RESULTS: 250 patients were studied, the majority (76%) with a diagnosis of endometrioid endometrial adenocarcinoma. The most used surgical access route was laparoscopy (51.6%), with a percentage of intraoperative complications of 10% and postoperative complications of 9.2%. 88.4% of patients remain alive free of disease after treatment, with relapses in only 11.6% and 8% deaths. CONCLUSIONS: The initial treatment of choice in patients with hyperplasia with atypia or early-stage endometrial cancer is surgery, by hysterectomy, double adnexectomy and in some cases associated lymphadenectomy. The choice of surgical approach must be individualized to the conditions of each patient. Laparoscopy offers multiple advantages; it is a technique that is on the rise and is being used more and more frequently.

Treatment and Impact of Cervical-Cancer-Related Lymphatic Disorders on Quality of Life and Sexuality Compared with Controls.

Background: Lymphatic disorders are frequent complications related to treatment for cervical cancer (CC). The aims of the study are to evaluate the impact of lymphatic disorders on quality of life (QOL) and sexuality in CC survivors after the completion of oncological treatment and to compare them with controls. Methods and Results: An ambispective cohort study was performed by using the Functional Assessment Cancer Therapy (FACT)-Cervix (Cx) fourth version, the World Health Organization Quality of Life-Brief Version (WHOQOL-BREF), and the Female Sexual Function Index (FSFI). Twelve patients affected by lymphatic disorders comprised the study group, 251 comprised the CC control group, and 185 comprised the non-CC control group. Regarding QOL, there were no statistically significant differences between the lymphatic disorder-unaffected and non-CC control groups, except in the WHOQOL-BREF environment domain. A weak positive correlation between lymphatic disorder and FACT-Cx additional concerns (σ = 0.135) was observed. Regarding sexuality, a weak negative correlation was detected between lymphatic disorders and FSFI sexual satisfaction (σ = -0.200) and a weak positive correlation was observed between lymphatic disorders and FSFI dyspareunia (σ = 0.148). We did not observe statistically significant differences in QOL satisfaction between the lymphatic disorder-affected and non-CC control groups. Symptomatic controls reported significantly higher physical health scores than the lymphatic disorder-affected group (p < 0.05). Regarding the psychological domain, the asymptomatic controls obtained significantly higher scores than the lymphatic disorder-affected group (p = 0.003). Conclusions: Lymphatic disorders notably influenced the QOL of CC survivors compared with the non-CC control groups. Lymphatic disorders had a significant negative impact on physical and psychological health. Sexuality was scarcely affected by lymphatic disorders.

Direct trocar insertion without previous pneumoperitoneum versus insertion after insufflation with Veress needle in laparoscopic gynecological surgery: a prospective cohort study.

The aim of this study was to determine whether direct trocar entry without prior pneumoperitoneum at umbilical level (DTI) can be a safe alternative to access the abdominal cavity in gynaecological laparoscopic surgery. We present a prospective observational analytical study of cohorts, comparing DTI with umbilical entry with trocar after previous insufflation with a Veress needle at umbilical level (V). The study period was performed from June 2013 to April 2016; data was collected on 600 patients who underwent gynaecological laparoscopic surgery. There were no significant differences in the risk of suffering a complication during the access manoeuvres between DTI (6.49%) and V (7.39%), OR 0.89 (95% CI: 0.42-1.81). The duration of the access manoeuvres was 69 s in DTI and 193 s in V (p < .001). The percentage of patients in whom two or more access attempts were performed was lower in DTI (7.8%) than in V (12.3%) (p > .05). We concluded that DTI is at least as safe as V, regarding the risk of suffering complications arising from access into the abdominal cavity. DTI has advantages with regard to V, such as: the shorter duration of access manoeuvres or the lesser number of unsuccessful entry or insufflation attempts. Impact statement What is already known on this subject? There are few international publications comparing DTI and V. When we conducted a search in PubMed for the terms 'Veress needle and direct trocar insertion', 51 publications were obtained. When we increased the restriction and added the terms 'laparoscopic entry and laparoscopy complications', 27 publications were obtained; thus, the uniqueness of our study. What do the results of this study add? We present a 3-year observational prospective study of cohorts that included 600 patients. The aim of this study was to determine that in laparoscopic gynaecological surgery, DTI is an access method to the abdominal cavity at least as safe as V, with respect to the risk of complications. On the other hand, DTI has some advantages such as the shorter duration of access manoeuvres or the lower number of failed entry attempts. What are the implications of these findings for clinical practice and/or further research? Given the limited number of publications that compared both techniques, our study indicates that DTI can be a safe alternative for access to abdominal cavity in gynaecological surgery, compared to the traditional V.

Tumor ovárico del seno endodérmico (Yolk Sac). Dolor abdominal en el puerperio inmediato como síntoma diagnóstico / Endodermal sinus ovarian tumor (Yolk Sac). Abdominal pain in the immediate puerperium as a diagnostic symptom

RESUMEN Los tumores del seno endodérmico ovárico (Yolk Sac), son neoplasias malignas de origen germinal, que se caracterizan por su diferenciación embriológica a partir de estructuras del saco vitelino. Son tumoraciones muy infrecuentes, de crecimiento rápido y que suelen desarrollarse en adolescentes y mujeres jóvenes, en edad reproductiva. Su diagnóstico se basa en la combinación de pruebas de imagen asociado a niveles plasmáticos elevados de marcadores tumorales como la alfafetoproteína. El manejo terapéutico es eminentemente quirúrgico (pudiendo ser conservador en pacientes con deseo genésico no cumplido), asociado a pautas de quimioterapia sistémica combinada con bleomicina, etopósido y platino. Exponemos el caso de una paciente que en el puerperio tardío, presenta un cuadro clínico de dolor, distensión abdominal y fiebre, siendo diagnosticada tras el tratamiento quirúrgico y el estudio histológico posterior, de un tumor del seno endodérmico ovárico.

ABSTRACT Ovarian endodermal sinus tumors (Yolk Sac), are malignant neoplasms of germinal origin, which are characterized by their embryological differentiation from yolk sac structures. These tumors are very infrequent, of rapid growth and tend to develop in adolescents and young women of reproductive age. Its diagnosis is based on the combination of imaging tests associated with high plasma levels of tumor markers such as alpha-fetoprotein. The therapeutic management is eminently surgical (with a more conservative approach reserved for patients still considering later pregnancy), associated with patterns of systemic chemotherapy combined with bleomycin, etoposide and platinum. We present the case of a patient who, in the late puerperium, presents symptoms of pain, abdominal distension and fever, being diagnosed after the surgical treatment and the subsequent histological study of a tumor of the endodermal ovarian sinus.

Adenocarcinoma sincrónico de alto grado de endometrio y ovario; a propósito de un caso clínico / Synchronous high-grade adenocarcinoma of the endometrium and ovary; about a clinical case

RESUMEN El cáncer sincrónico endometrial y ovárico (SEOC) representa alrededor de un 5-10% de las neoplasias de endometrio y ovario. Cuando no existe extensión locorregional y presentan un patrón histológico de bajo grado, actúan como si fueran dos tumores primarios independientes, en lugar de comportarse como un cáncer en estadio avanzado. Los mecanismos para diferenciar si su origen es metastásico o por el contrario, son tumores primarios independientes conlleva una gran dificultad y ha generado una importante controversia dentro del estudio de este tipo de neoplasias. En este artículo, exponemos el caso clínico de una paciente de 46 años que presenta un tumor sincrónico de endometrio y ovario en estadio IA, desconocido hasta el estudio histológico de la pieza quirúrgica.

ABSTRACT Endometrial and ovarian synchronous cancer (SEOC) accounts for about 5-10% of endometrial and ovarian neoplasms. When there is no local extension and they present a low-grade histological pattern, they act as if they were two independent primary tumours, instead of behaving as an advanced stage cancer. Therefore, the differentiation of its origin (metastatic or independent primary tumours) is fraught with difficulty and has generated a significant controversy in the study of this type of neoplasms. In this article, we present the clinical case of a 46-year-old patient presenting a synchronous tumor of the endometrium and ovary in IA stage, unknown until the histological study of the surgical sample.

Mioma vaginal intraabdominal, masa pélvica de localización atípica / Intra-abdominal vaginal myoma, a pelvic mass of atypical location

La patología miomatosa del tracto genital inferior es uno de los motivos más frecuentes de consulta en Ginecología. Sin embargo, su localización vaginal resulta una situación infrecuente de difícil diagnóstico. En muchas ocasiones se lleva a cabo tras un hallazgo casual intraoperatorio. Las manifestaciones clínicas que producen los leiomiomas en esta localización son inespecíficas; el tratamiento quirúrgico es el de elección, generalmente mediante un abordaje por la vía vaginal(AU)

Myomatous disease of the lower genital tract is one of the most common reasons for gynecological consultation. However, vaginal location is infrequent and difficult to diagnose. On many occasions diagnosis is based on a fortuitous intraoperative finding. The clinical manifestations of vaginal leiomyomas are unspecific. Surgery is the treatment of choice, which is generally performed by vaginal approach(AU)

Adenocarcinoma mucinoso del paraovario: un tumor infrecuente / Mucinous paraovarian adenocarcinoma: a rare tumour

Se denomina tumor del paraovario a aquel que se desarrolla en los tejidos cercanos al ovario. Dado que generalmente no producen manifestaciones clínicas, su diagnóstico se suele realizar de forma incidental durante cirugías, estudios de fertilidad o post-mortem. Aunque la degeneración neoplásica de estas lesiones es altamente infrecuente, cuando ocurre puede dar lugar a tumores tanto de bajo como de alto grado. Presentamos un caso de adenocarcinoma mucinoso del paraovario intervenido en nuestro centro y revisamos la literatura disponible del tema (AU)

Paraovarian tumors are those that arise from tissues surrounding the ovaries. Given that they do not normally cause symptoms, they are usually diagnosed during surgery, fertility studies, or post-mortem. Neoplastic transformation of these lesions is highly infrequent but can give rise to low-grade (borderline) as well as high-grade tumours. We present a case of paraovarian mucinous adenocarcinoma and provide a review of the available literature on the subject (AU)

Metástasis ovárica única de angiosarcoma mamario como localización infrecuente / Single ovarian metastases of breast angiosarcoma as unusual location

Los angiosarcomas son tumores vasculares extremadamente raros con alta tasa de proliferación e invasión. Están caracterizados por células anaplásicas que se originan en las paredes de los vasos sanguíneos. Poseen mal pronóstico debido a su comportamiento altamente agresivo, el cual condiciona una elevada probabilidad de recurrencia local y extensión multiorgánica. Se presentan principalmente en: pulmón, hígado, ganglios linfáticos y huesos. Su tratamiento es controvertido debido escasa casuística disponible acerca de esta estirpe tumoral, aunque parece claro que el tratamiento principal es la cirugía y que el tratamiento posterior puede ser la quimioterapia adyuvante(AU)

Angiosarcomas are extremely rare vascular tumors with high rate of proliferation and invasion. They are characterized by anaplastic cells originating in the walls of blood vessels. They have poor prognosis because of their highly aggressive behavior, which determines a high probability of local recurrence and spreading to multiple organs. They occur mainly in lung, liver, lymph nodes and bones. Treatment is controversial due to small number of cases available about this tumor type, although it seems clear that the main treatment is surgery and subsequent treatment can be adjuvant chemotherapy(AU)

Uso de la traquelectomía radical en cáncer de cérvix con histología infrecuente: a propósito de 2 casos / Use of radical trachelectomy in cervical cancer with rare histology: two case reports

La traquelectomía radical es una intervención que permite preservar la fertilidad en mujeres jóvenes con cáncer de cérvix en estadio precoz. Su seguridad ha sido sobradamente demostrada en el tratamiento de la estirpe escamosa, pero existen dudas sobre la conveniencia de usarla en histologías vinculadas tradicionalmente a un peor pronóstico. Presentamos aquí 2 casos atípicos de cáncer de cérvix (adenocarcinoma de células claras y carcinoma escamoso con adenocarcinoma coexistente) intervenidos mediante traquelectomía radical previa biopsia de ganglio centinela pélvico (AU)

Radical trachelectomy is a surgical technique that allows young women with early invasive cervical carcinoma to preserve their fertility. Although its safety has been demonstrated in squamous histology, doubts remain about the advisability of this intervention in histological types traditionally associated with a worse outcome. We describe two cases of rare cervical tumors (clear cell adenocarcinoma and synchronous invasive squamous cell carcinoma and invasive adenocarcinoma) treated with radical trachelectomy after pelvic sentinel node biopsy (AU)

Tumor ovárico no epitelial: tumor de Sertoli-Leydig / Non-epithelial ovarian cancer: Sertoli-Leydig cell tumor

Los tumores de Sertoli-Leydig son un tipo infrecuente de tumor de ovario de estirpe no epitelial; concretamente, pertenecen al grupo de los tumores de los cordones sexuales-estroma, con una incidencia aproximada de un 2-5% de todas las neoplasias ováricas malignas. Presentamos el caso de una paciente de 42 años intervenida de un tumor de Sertoli con focos sarcomatoides. El diagnóstico de estos tumores es difícil de establecer prequirúrgicamente, y debido a la escasez de publicaciones, existe mucha controversia acerca de la estadificación quirúrgica idónea y sobre la conveniencia de realizar o no tratamiento adyuvante (AU)

Sertoli-Leydig cell tumors are a rare type of non-epithelial ovarian cancer; these tumors belong to the group of sex cord-stromal tumors and account for approximately 2-5% of all malignant ovarian tumors. We report the case of a 42-year-old woman who underwent surgery for a Sertoli tumor with sarcomatoid foci. Diagnosis of these tumors is difficult before surgery and, due to the scarcity of publications on the topic, there is controversy about the appropriate surgical staging and the role of adjuvant therapy in the management of this entity (AU)

Entrada laparoscópica directa umbilical con trocar sin neumoperitoneo previo: una alternativa segura / Transumbilical direct trocar entry without prior pneumoperitoneum: a safe alternative

Objetivo. Comparar la entrada directa umbilical con trocar sin neumoperitoneo previo en laparoscopia con el uso de la aguja de Veress. Método. Se revisan las hojas quirúrgicas de 183 pacientes en las que se usó la vía laparoscópica, dividiéndolas en 2 grupos: G1: usando la aguja de Veress, y G2: usando la entrada umbilical del trocar sin neumoperitoneo previo. Se recogieron las complicaciones producidas. Resultados. La edad media era de 40 años y el IMC medio de 29. Solo se registraron 3 casos de enfisema preperitoneal y en todos ellos se usó la aguja de Veress. Conclusión. Según nuestra experiencia, y en concordancia con la literatura, el método de entrada directa umbilical del trocar sin neumoperitoneo previo es un método seguro, sin complicaciones en nuestra serie, presentando ventajas: mayor velocidad de consecución del neumoperitoneo, ausencia de riesgo de embolismo gaseoso, simplificación de los pasos quirúrgicos y menor tasa de fallos en la entrada (AU)

Objective: To compare transumbilical direct trocar entry without prior pneumoperitoneum in laparoscopic surgery with Veress needle insertion. Method: The surgical records of 183 patients who underwent laparoscopy were reviewed. The patients were divided into two groups according to the surgical technique employed: group 1: Veress needle insertion; group 2, transumbilical direct trocar entry without prior pneumoperitoneum. The complications were recorded Results: The mean age was 40 years and the mean body mass index was 29. There were only three cases of preperitoneal emphysema, all occurring in group 1. Conclusion: In our experience, and in agreement with the literature, transumbilical direct trocar entry without prior use of Veress needle is a safe alternative. There were no complications in our series. This alternative offers certain advantages, such as more rapid achievement of the pneumoperitoneum, the absence of risk of gas embolism, simplification of the surgical steps, and lower rate of entry failures (AU)

Metástasis ováricas y mamarias bilaterales de melanoma con localización primaria desconocida / Bilateral breast and ovarian metastases from melanoma of unknown primary site

Las metástasis mamarias bilaterales de melanoma son infrecuentes y generalmente en el momento del diagnóstico este tumor posee otros sitios de diseminación. El pronóstico clínico es malo, con una supervivencia habitualmente menor a un año a pesar de efectuar un tratamiento agresivo. La afectación ovárica por un melanoma metastásico tampoco es habitual y puede confundirse con un tumor primario, representando un reto diagnóstico tanto clínico como anatomopatológico. Presentamos un caso atípico de melanoma de localización primaria desconocida que comenzó clínicamente con metástasis mamarias y ováricas bilaterales(AU)

Bilateral breast metastases from melanoma are rare and, at the time of diagnosis, usually show other sites of dissemination. The clinical prognosis is poor, with an average survival of less than 1 year despite aggressive treatment. Malignant melanoma involving the ovary is also uncommon and may be confused with a primary tumor, presenting a clinical and pathological diagnostic challenge. We report an unusual case of melanoma of unknown primary site that presented clinically as bilateral breast and ovarian metastases(AU)