Características clínicas, diagnóstico e tratamento de mulher com síndrome de Meigs: relato de caso e revisão narrativa / Clinical characteristics, diagnosis and treatment of a woman with Meigs syndrome: case report and narrative review

O objetivo deste estudo é descrever o caso de mulher com síndrome de Meigs e apresentar a revisão narrativa sobre o tema. Paciente do sexo feminino, 30 anos, nulípara, encaminhada ao hospital por massa anexial e história prévia de drenagem de derrame pleural. Evoluiu com instabilidade hemodinâmica por derrame pleural hipertensivo à direita, sendo submetida a drenagem torácica, com citologia do líquido negativa. Após, foi submetida a laparotomia: realizada salpingo-ooforectomia esquerda. A congelação e a análise histopatológica diagnosticaram fibroma ovariano. A citologia ascítica foi negativa. CA-125 elevado, presença de derrames cavitários e exame de imagem suspeito podem mimetizar um cenário de neoplasia maligna de ovário em estágio avançado. Entretanto, na síndrome de Meigs clássica, o tratamento é cirúrgico, sendo o diagnóstico obtido por meio da análise histopatológica do tumor ovariano. O manejo da síndrome de Meigs clássica é cirúrgico e, após a remoção do tumor, o derrame pleural e a ascite desaparecem.

To describe a case of Meigs syndrome and present a narrative review of the condition. Female patient, 30 years old, nulliparous, referred to the hospital due to an adnexal mass and a previous drainage of pleural effusion. She developed hemodynamic instability due to a hypertensive right pleural effusion being submitted to chest drainage, with negative cytology of the fluid. She underwent laparotomy: Left salpingo-oophorectomy was performed and frozen section and histopathological analysis diagnosed an ovarian fibroma. Ascites cytology was negative. Elevated CA-125, presence of cavitary effusions, suspicious imaging exam can mimic a scenario of ovarian cancer at an advanced stage. However, in classical Meigs syndrome, treatment is surgical, and the diagnosis is obtained through histopathological analysis of the ovarian tumor. Classical Meigs syndrome' management is surgical. After tumor removal, pleural effusion and ascites resolve.

Post-radiotherapy hysterectomy does not benefit females with cervical adenocarcinoma.

Cervical adenocarcinoma is associated with a poor prognosis, which may be caused by the infiltrative growth pattern and metastasis of tumor cells. There is a lack of consensus on hysterectomy after radiotherapy for the improvement of selected cases. The present study aimed to assess the oncological outcome of post-radiotherapy hysterectomy in females with cervical adenocarcinoma. A total of 39 females with cervical adenocarcinoma at stages IB1 to IIIB, managed primarily with radiotherapy with complete response, and underwent extrafascial hysterectomy as consolidation therapy between 1988 to 2015 were studied. Surgery complications and residual disease were evaluated. A comparison group was constructed, comprising 41 females with cervical adenocarcinoma managed with exclusive radiotherapy or chemoradiotherapy demonstrating complete response, without surgery. Descriptive and survival analysis was performed. The groups were comparable in terms of age, cancer stage, radiotherapy (dose and duration) and follow-up, although 67% of hysterectomies were performed prior to 2002 and 46% of the radiotherapy group received chemoradiation. Late complications were similar. There were nine recurrences (23%) in the case series and 10 recurrences (24%) in the radiotherapy group. Residual disease was detected in 56% (22/39) of uterine specimens, of which 12 were up to 10 mm. Residual disease was associated with recurrence (31% vs. 6%, P=0.028). The overall survival rate was 75% for the case series vs. 88% for the radiotherapy group (P=0.579), and the disease-free survival rate was 79-80% for both. Removal of residual disease by hysterectomy did not improve the overall survival rate (P=0.283) and disease-free survival rate (P=0.072). Post-radiotherapy hysterectomy in cervical adenocarcinoma is a feasible procedure with acceptable complications, however, it did not bring relevant benefits in recurrences, disease-free survival, and overall survival rates.

[Clinically undetectable lymph node invasion in vulvar cancer]. / Invasão linfática clinicamente não detectável do câncer vulvar.

OBJECTIVE: To assess the neoplastic invasion of superficial and deep inguinal lymph nodes of women with invasive vulvar squamous carcinoma smaller than 5 centimeters with a clinically normal inguinal region. METHODS: the medical records of 59 women cared at the State University of Campinas with invasive vulvar squamous carcinoma T1 and T2 and who presented clinically normal inguinal regions (N0) were reviewed. Clinical characteristics of both tumor and patients were evaluated as well as the follow-up data. Odds ratios and Fisher's Exact Test were used to assess the correlations between the invasion of inguinal lymph nodes and tumor size, grade, relapses and clinical complications. Confidence limits of 95% were used. RESULTS: Age of the patients ranged from 34 to 91 years (mean 67 years), and follow-up time ranged from 3 days (peri-operatory death) to 252 months (mean 27 months). Clinically, 22 (37%) women had lesions T1 lesions and 37 (63%) T2. Histological analysis showed unilateral lymphatic invasion in six (10%) women and bilateral in three (5%). There was no significant association between tumor size and lymph node invasion. Also, pathologic tumor size and grade were not associated with lymph node neoplastic involvement. Relapses and late complications were not correlated with lymph node neoplastic invasion. CONCLUSIONS: Superficial and deep inguinal dissection disclosed clinically undetectable lymph node neoplastic invasion, although tumor size and histological grade, relapses and late complications were not associated with node involvement.

Invasão linfática clinicamente não detectável do câncer vulvar / Clinically undetectable lymph node invasion in vulvar cancer

OBJETIVO: Avaliar em mulheres com carcinoma escamoso da vulva menor que 5 cm e clinicamente sem comprometimento inguinal a invasão por neoplasia nos linfonodos inguinais superficiais e profundos. MÉTODOS: Foram avaliados os dados de 59 mulheres atendidas entre outubro de 1982 e janeiro de 2004 na Universidade Estadual de Campinas, em decorrência de carcinoma escamoso invasivo da vulva T1 ou T2 e com linfonodos inguinais clinicamente livres de invasão neoplásica (N0). Foram levantadas características clínicas do tumor e das pacientes e os dados do seguimento. Foram calculados os odds ratio e teste exato de Fisher para as associacões entre a invasão dos linfonodos inguinais com o tamanho do tumor, grau histológico, recidivas e complicacões. A confianca estatística foi de 95 por cento. RESULTADOS: A idade das mulheres variou de 34 a 91 anos (média de 67 anos), com tempo de seguimento entre três dias (óbito perioperatório) e 252 meses (média de 27 meses). Clinicamente, 22 (37 por cento) mulheres apresentavam tumores T1 e 37 (63 por cento) T2. Após análise histológica, seis (10 por cento) mulheres apresentavam invasão unilateral e três (5 por cento) bilateral, não havendo associacão entre o tamanho do tumor e a invasão dos linfáticos inguinais. Também o tamanho do tumor à avaliacão patológica e seu grau histológico não se mostraram associados à invasão nos linfonodos inguinais. Recidivas e complicacões tardias não se correlacionaram com a invasão neoplásica inguinal. CONCLUSÕES: A disseccão inguinal superficial e profunda revelou invasão neoplásica clinicamente não detectável em 15 por cento das mulheres estudadas, apesar de que tamanho e grau histológico do tumor, recidivas e complicacões tardias não estiveram associadas com a invasão nos linfonodos.

Risk-of-malignancy index in preoperative evaluation of clinically restricted ovarian cancer.

CONTEXT: There is no adequate preoperative method for differentiating between benign and malignant pelvic masses. Evaluations of CA 125 serum levels, ultrasonography findings and menstrual state have been tested in isolation as diagnostic methods. The evaluation of these three methods in association with each other could improve diagnostic performance. OBJECTIVE: To evaluate the risk-of-malignancy index by combining serum CA 125 levels, ultrasound score and menopausal status in preoperative diagnoses for women with pelvic masses clinically restricted to the ovaries and without clear evidence of malignancy. DESIGN: Cross-sectional study. SETTING: Centro de Atenção Integral à Saúde da Mulher, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil. PARTICIPANTS: 158 women admitted between January 1996 and March 1998 for surgical exploration of pelvic masses. PROCEDURES: The risk-of-malignancy index was calculated as US x M x CA 125, performed preoperatively. Ultrasound findings were classified according to the shape, size, multiplicity, presence of wall expansion involvement or ascites, using a score system (US). Menopausal status was considered as 1 for premenopausal and 3 for postmenopausal (M), and CA 125 serum levels were considered in absolute values. STATISTICAL ANALYSIS: Most relevant variables were included in a logistic multiple regression model, fitted using the ultrasound score, the serum CA 125 level and the menopausal status. The model was used for evaluating the performance of each individual predictor in determining the malignancy of these tumors and identifying the risk-of-malignancy index. RESULTS: The best individual performance was found in CA 125 levels (sensitivity of 78%, specificity of 75%), followed by ultrasound score (sensitivity of 75%, specificity of 73%) and menopausal status (sensitivity of 73%, specificity of 69%). The performance obtained for the risk-of-malignancy index at the cut-off point of 150 was a sensitivity and specificity of 79%. The area under the ROC curve for the risk-of-malignancy index was 0.90, which was greater than the area for CA 125 levels (0.83) or ultrasound score (0.79). CONCLUSION: The risk-of-malignancy index using ultrasound morphological score, serum CA 125 levels and menopausal status might be of value in the preoperative assessment of ovarian carcinomas.

Risk-of-Malignancy Index in preoperative evaluation of clinically restricted ovarian cancer

CONTEXT: There is no adequate preoperative method for differentiating between benign and malignant pelvic masses. Evaluations of CA 125 serum levels, ultrasonography findings and menstrual state have been tested in isolation as diagnostic methods. The evaluation of these three methods in association with each other could improve diagnostic performance. OBJECTIVE: To evaluate the risk-of-malignancy index by combining serum CA 125 levels, ultrasound score and menopausal status in preoperative diagnoses for women with pelvic masses clinically restricted to the ovaries and without clear evidence of malignancy. DESIGN: Cross-sectional study. SETTING: Centro de Atençäo Integral à Saúde da Mulher, Universidade Estadual de Campinas, Campinas, Säo Paulo, Brazil. PARTICIPANTS: 158 women admitted between January 1996 and March 1998 for surgical exploration of pelvic masses. PROCEDURES: The risk-of-malignancy index was calculated as US x M x CA 125, performed preoperatively. Ultrasound findings were classified according to the shape, size, multiplicity, presence of wall expansion involvement or ascites, using a score system (US). Menopausal status was considered as 1 for premenopausal and 3 for postmenopausal (M), and CA 125 serum levels were considered in absolute values. STATISTICAL ANALYSIS: Most relevant variables were included in a logistic multiple regression model, fitted using the ultrasound score, the serum CA 125 level and the menopausal status. The model was used for evaluating the performance of each individual predictor in determining the malignancy of these tumors and identifying the risk-of-malignancy index. RESULTS: The best individual performance was found in CA 125 levels (sensitivity of 78 percent, specificity of 75 percent), followed by ultrasound score (sensitivity of 75 percent, specificity of 73 percent) and menopausal status (sensitivity of 73 percent, specificity of 69 percent). The performance obtained for the risk-of-malignancy index at the cut-off point of 150 was a sensitivity and specificity of 79 percent. The area under the ROC curve for the risk-of-malignancy index was 0.90, which was greater than the area for CA 125 levels (0.83) or ultrasound score (0.79). CONCLUSION: The risk-of-malignancy index using ultrasound morphological score, serum CA 125 levels and menopausal status might be of value in the preoperative assessment of ovarian carcinomas

Tumores de células da granulosa do ovário: estadiamento e tratamento / Granulosa cell tumors of the ovary: staging and treatment

O objetivo deste trabalho foi o de analisar a importância dos achados cirúrgicos e histólogicos para a definiçäo dos estadiamento e tratamento dos tumores de células da camada granulosa do ovário. Foram avaliados o estadiamento e os resultados do tratamento de 11 pacientes, atendidas entre janeiro de 1990 e dezembro de 1994, no Centro de Atençäo Integral + Saúde da Mulher, da Universidade Estadual de Campinas, no Estado de Säo Paulo. O seguimento foi atualizado em agosto de 1996. A idade das pacientes variou de 18 a 67 anos, com média de 46 anos. Duas pacientes foram submetidas à salpingo-ooforectomia bilateral, histerectomia total, apendicectomia e omentectomia e, em sete, acrescentou-se a linfadenectomia retroperitoneal. Em dois casos a doença era irressecável. Cinco pacientes encontravam-se com tumor em estádio IIIC; uma, em estádio IC; e cinco, em estádio IA. A revisäo histopatológica revelou 10 neoplasias do tipo adulto e uma do tipo juvenil. Em todos os casos encontrou-se mais de um tipo histopatológico de tumor de células granulosas, sendo dominante o tipo sólido (7/11 casos). O tratamento complementar com antiblásticos - seis ciclos de carboplatina (300 mg/m²) e ciclofosfamida (500 mg/m²) - foi aplicado nas pacientes com doença em estádios IC e IIIC. No último controle, com um seguimento variando de 20 a 71 meses, todas as pacientes com tumores no estádio inicial encomtravam-se sem doença; contudo, das cinco pacientes com neoplasia em estádio IIIC, três apresentavam progressäo da doença apesar do tratamento antiblástico.

Estudo radiológico ósseo de mulheres climatéricas e menopausadas / Bone radiology study on climacteric and menopausal women

Quinhentas e três mulheres admitidas no Ambulatório de Menopausa do Centro de Atençåo Integral à Saúde da Mulher da Universidade de Campinas em 1992 e 1993 foram submetidas a raios-X simples de tórax, fêmur, måos e punhos e coluna vertebral. Os dados para estudo foram obtidos através de revisåo retrospectiva dos laudos do exame radiológico fornecidos pelo Setor de Radiologia desta instituiçåo. A idade média das pacientes foi de 51,8 +-8,4 anos. O local mais freqüentemente acometido foi a coluna vertebral. Sinais sugestivos de osteoartrose e osteoporose foram mais prevalentes em coluna lombar. Também observou-se desvios acentuados da coluna vertebral em 53,3 por cento dos casos, a presença de ateromas aórticos calcificados em 26 por cento e lesöes radiodensas pulmonares em 9,6 por cento das pacientes. Concluiu-se que a avaliaçåo radiológica de pacientes menopausadas e climatéricas é de grande valor, sobretudo quando nåo existe a disponibilidade de procedimentos mais sofisticados para a avaliaçåo de massa óssea