Struma ovarii: presentación de 37 casos y actualización de la evidencia disponible / Struma ovarii: 37 cases and an update of the current evidence

Objetivo: Determinar aquellos datos clínicos que puedan comportarse como factores de riesgo de mal pronóstico en el struma ovarii, así como establecer las directrices que nos ayuden a un precoz diagnóstico en esta rara entidad, comparando nuestros resultados con la evidencia científica publicada hasta el momento. Método: Estudio observacional retrospectivo de pacientes intervenidas por masa anexial con diagnóstico de «struma ovarii» en el Hospital Virgen del Rocío durante el periodo comprendido entre los años 2000-2016. Resultados: Se estudiaron un total de 37 casos. La edad media fue de 43,11 años con IMC medio de 30,43kg/m2, 11 casos (29,73%) eran pacientes menopáusicas y 26 (70,27%) estaban en edad fértil. En el 91,9% de los casos el comportamiento fue benigno y solo el 8,1%, presentaron malignidad. Clínicamente el dolor fue el motivo más frecuente de consulta (27,02%). En 22 casos se realizó anexectomía, en 11 marsupialización y en 4 se realizó histerectomía y doble anexectomía. Tras el estudio anatomopatolo??gico postoperatorio 3 resultaron struma ovarii maligno (8,1%): un carcinoma tiroideo folicular, otro papilar y un tumor carcinoide estrumal. Conclusiones: El struma ovarii es una rara entidad cuyo tratamiento no está establecido. La cirugía conservadora se recomienda en tumores benignos y puede ser una opción terapéutica en casos malignos seleccionados asociando la tiroidectomía total profiláctica y radioablación con 131I

Objective: To determine the medical data that could behave as risk factors for poor prognosis in the struma ovarii, as well as establishing the criteria that could be of help for an early diagnosis, comparing the results obtained, with the scientific evidence that has been published to date. Method: A retrospective observational study conducted on patients operated for adnexal mass with a struma ovarii diagnosis in the Hospital Virgen del Rocío during the period 2000-2016. Results: A total of 37 cases were analysed. The mean age was 43.11 years, and the mean BMI 30.43kg/ m2. Of the 37 cases, 11 (29.73%) were patients with menopause, and 26 (70.27%) were of fertile age. The behaviour was benign in 91.9% of the cases, and was malignant in only 8.1% of cases. As regards clinical symptoms, the pain (27.02%) was the most frequent reason for consulting a doctor. Adnexectomy was performed in 22 cases, marsupialisation in 11, and hysterectomy with bilateral adnexectomy in 4 cases. After the post-operative histology study, three (8.1%) of them were reported as malignant struma ovarii, with one follicular carcinoma of the thyroid, one papillary carcinoma of the thyroid, and one carcinoid stromal tumour. Conclusions: Struma ovarii is a rare condition for which there is no established treatment. Conservative surgery is recommended in benign tumours, and could be a therapeutic option for specific malignant tumours combined with a prophylactic total thyroidectomy and radio-ablation therapy with 131I

Factores de riesgo para carcinoma de endometrio de alto grado / Risk factors for high-grade endometrial carcinoma

El carcinoma de endometrio (CE) ha sido dividido de forma clásica en 2grupos: el tipo I, considerado de buen pronóstico y estrógeno dependiente y el tipo II, de peor pronóstico y estrógeno independiente. Esta subdivisión etiopatogénica no está tan clara cuando se habla de CE de alto grado. El objetivo del estudio es analizar los factores de riesgo asociados al CE de alto grado. Material y métodos: Estudio retrospectivo de cohortes multicéntrico en 3hospitales españoles de tercer nivel, Hospital Universitario Miguel Servet en Zaragoza, Hospital Clínico San Carlos en Madrid y Hospital Virgen del Rocío en Sevilla, en el que se estudió la presencia de los factores de riesgo asociados al CE de alto grado histológico: endometrioide G3 (CEG3), carcinoma seroso (CS), carcinoma de células claras (CCC) y carcinosarcoma uterino o tumor mülleriano mixto maligno (TMMM). Se analizaron las posibles diferencias entre los subtipos y atendiendo a si se trataba de CE tipo I/II. Se incluyeron 373 CE de alto grado, de ellos, 135 fueron CEG3 o de tipo I y 238 de tipo II: 96 CS, 64 CCC y 78 TMMM. Resultados: La diabetes, obesidad, nuliparidad y utilización de tratamiento hormonal de reemplazo no mostraron diferencias significativas entre los subtipos. El TMMM fue el que con menor frecuencia se asoció a HTA y, por el contrario, el que mostró mayor asociación a la utilización de tamoxifeno. Conclusiones: Los factores de riesgo asociados a CE de alto grado son similares en el tipo I y II

Endometrial carcinoma (EC) has traditionally been divided into 2groups: type I, considered to have a good prognosis and to be oestrogen-dependent and type II, with a poorer prognosis and oestrogen-independent. The aim of the study is to analyse the risk factors associated with high-grade EC. Material and Methods: Retrospective multicentre cohort study in 3Spanish reference hospitals: Hospital Universitario Miguel Servet in Zaragoza, Hospital Clínico San Carlos in Madrid and Hospital Virgen del Rocío in Seville. We studied the presence of risk factors associated with high grade EC: G3 endometrioid (G3EC), serous carcinoma (SC), clear cell carcinoma (CCC) and malignant mixed mesodermal tumours (MMMT). Differences between subtypes were analysed depending on whether the EC was type I or II. A total of 373 cases of high-grade EC were included, of which 135 were G3EC or type I and 238 were type II (96 SC, 64 CCC and 78 MMMT). Results: Diabetes, obesity, nulliparity and use of hormonal replacement therapy showed no significant difference between subtypes. MMMT was less frequently associated with hypertension and conversely it showed greater association with the use of tamoxifen. Conclusions: Risk factors associated with high-grade EC are similar in type I and II

Clinical and pathologic features of patients with non-epithelial ovarian cancer: retrospective analysis of a single institution 15-year experience

Purpose. Non-epithelial ovarian cancers (NEOCs) are rare diseases. Despite their overall good prognosis, the best management and current prognostic factors remain unclear. The objective of our study was to assess the clinical and pathological features of NEOC patients treated in our institution in the last 15 years and to explore risk factors for relapse and survival. Methods/patients. All patients with a pathological diagnosis of NEOC referred to the medical oncology department at Hospital Universitario Virgen del Rocio between 1999 and 2014 were included. Demographics, tumor characteristics, treatment procedures, and clinical follow-up were retrospectively collected. Risk factors for disease-free survival (DFS) and overall survival (OS) were assessed. Results. Fifty-seven patients were included, 33 (58 %) had a sex cord-stromal tumor (SCST) and 24 (42 %) had a germ-cell tumor (GCT). Median age, non-conservative surgery rates and DFS were lower in the GCT cohort; however, salvage chemotherapy led to a high proportion of complete responses in this group translating into a 90 % 3-year OS rate in both NEOC subtypes. The only identified risk factors statistically significant were stage and tumour relapse that associated, respectively, with DFS (HR = 8.84; 95 % CI 1.85-42) and OS (HR = 11.02; 95 % CI 1.76-68.7). Conclusions. Despite their rarity, NEOCs remain a highly curable group of neoplasm. In our series, a more conservative treatment approach in ovarian GCTs revealed comparable OS outcomes to SCST. No new risk factors that would help in patient stratification were identified (AU)

No disponible

Actualizaciones en la detección precoz de la osteoporosis / Actualization in early detection of osteoporosis

La osteoporosis es una enfermedad sistémica del esqueleto, con amplia prevalencia sobre todo en mujeres postmenopáusicas. La ortopantomografía (OPMG) es una técnica radiológica de uso generalizado en las consultas de los odontólogos. En el presente estudio se hace una revisión de trabajos en los que, utilizando una serie de índices como: Mandibular Cortical Index (MCI), Mental Index (MI), Panoramic Mandibular Index (PMI), Antegonial Index (AI), Gonial Index (GI), medidos sobre OMPG se plantea la hipótesis de poder detectar precozmente la osteoporosis por este medio. Los resultados expuestos en los diferentes estudios avalan esta hipótesis y así se podrá remitir a los pacientes al especialista para que se les haga un estudio más exhaustivo sobre dicha patología (AU)

Osteoporosis is a systemic skeletal disease, with widespread prevalence especially in postmenopausal women. Orthopantomography (OPMG) is a widely used diagnosis technique in dental practice. The objective of this study is to make a systematic review of studies in which, using a series of indices as Mandibular Cortical Index (MCI), Mental Index (MI), Panoramic Mandibular Index (PMI), Antegonial Index (AI), Gonial Index (GI) measured on panoramic radiographs are useful for detecting early osteoporosis. The results reported in different studies support the possibility that OPMG could be an effective tool to detect early Osteoporosis and refer patients to a specialist to treat their disease (AU)

Periodontitis and osteoporosis: a systematic review.

BACKGROUND: Osteoporosis and periodontitis are frequent disorders that affect aging populations. It has been hypothesized that both conditions may be related. OBJECTIVE: To determine whether dental osteoporosis is a local manifestation of systemic bone loss having similar etiology and risk factors, or whether it is an independent process depending primarily on factors that cause periodontitis. METHODS: A systematic review of clinical trials assessing the relationship between osteoporosis and periodontitis was carried out. An electronic search was made based on Internet search engines, MEDLINE (from 1966 to December 2009) and the Cochrane Controlled Clinical Trials Register. RESULTS: A total of 145 studies dealing with the relationship osteoporosis-periodontitis were identified. Of them, 35 were considered suitable for selection. Studies on maxillary and/or mandible radiological findings have a positive correlation in the majority of the cases (18 positive vs. three negative), whereas the findings on clinical periodontal examination are inconclusive (six positive vs. five negative). There were ten studies in which a diagnosis of osteoporosis was made, based on the existence of non-traumatic fracture, while there were nine studies using radiographs for diagnosis, of which six studies were found to have a positive correlation. There was only one study based on a clinical periodontal examination that found a positive correlation. CONCLUSIONS: The majority of the studies suggested a relationship between osteoporosis and periodontitis. Further well-controlled studies are needed to better elucidate the inter-relationship between systemic and oral bone loss and to clarify whether dentists could usefully give an early warning for osteoporosis risk.