Virilización en mujer menopáusica: limitaciones de la ecografía ginecológica en la detección de tumores ováricos / Virilization in menopausal women: limitations of gynecologic ultrasound for detection of ovarian tumors

Presentamos un caso de una mujer menopáusica de 56 años con clínica de hirsutismo progresivo severo de 7 meses de evolución. Entre otras pruebas, se realizó una ecografía transvaginal en el que se observaron unos anejos estrictamente normales. Ante la sospecha de patología ovárica debido a la ausencia de patología suprarrenal y test de frenación con análogos de la GnRh positivo, se solicitó una RMN pélvica que identificó una pequeña tumoración sugestiva de tumor del estroma ovárico. Se realizó una ooforectomia bilateral laparoscópica. El estudio anatomopatológico informó de tumor de células esteroideas (Tumor de células de Leydig). La clínica de virilización mejoró progresivamente después de la intervención

We report the case of a menopausal 56-year-old woman with severe progressive hirsutism with 7 months of evolution. Among other tests, a transvaginal Doppler Ultrasound was performed, revealing strictly normal ovaries. Due to the absence of suprarenal pathology and that the results of the gonadotropin-releasing hormone agonist test turned out positive, suggesting ovarian pathology, a Pelvic MRI was ordered. The results showed a small tumour suggestive of ovarian tumour stroma, so surgery was performed. The results of anatomical pathology reported Leydig cells tumour. Symptoms of virilisation improved progressively after the surgery

Nueva propuesta quirúrgica para úteros miomatosos grandes: histerectomía asistida inversa / New surgical approach for large fibroid uterus. Reverse assisted hysterectomy

Objetivo: describir una nueva técnica que combina la vía vaginal y la laparoscopia en caso de úteros grandes y con poca movilidad permitiendo evitar la vía laparotómica. Material y métodos: se realiza un estudio descriptivo y retrospectivo entre marzo de 2011 y abril de 2013. Se recogen 15 casos realizados con esta técnica en el Hospital de Mataró. Se analizan la edad, la paridad, número de cesáreas u otras cirugías anteriores ya fuesen abdominales o vaginales, estado hormonal de la paciente, tamaño uterino clínico y por ecografía, prolapso uterino, incontinencia de orina, hemoglobina pre y post quirúrgicas, sangrado durante la cirugía, peso por anatomía patológica, diagnóstico anatomopatológico y días de hospitalización. Resultados: la media de edad de las pacientes fue de 46,7 años. El motivo de consulta en el 53,3% de los casos fue por metrorragia y en el 46,7% por tumoración abdominal. El peso medio de las piezas quirúrgicas fue de 705 g y no hubo complicaciones importantes asociadas a la cirugía. La media de tiempo operatorio fue de 122 minutos. Conclusiones: si bien los avances en la vía laparoscópica han permitido realizar histerectomías de úteros miomatosos con éxito, dejando en un segundo plano la vía abdominal, todavía existen casos de úteros grandes con poca movilidad lateral que nos obligan a realizar un abordaje abdominal. Para estas situaciones, nuestro grupo, realiza una traquelectomía simple vía vaginal con posterior histerectomía subtotal vía laparoscópica. Se trata de una alternativa viable, segura, con una baja tasa de complicaciones y con una estancia hospitalaria reducida, por lo que parece una opción razonable en casos seleccionados (AU)

Objective: To describe a new technique that combines vaginally and laparoscopy approach for large and no-mobil uteri allowing to avoid laparotomy. Material and methods: A descriptive and retrospective study was performed between March 2011 and April 2013. 15 cases performed with this procedure in Mataró Hospital are collected. We analize age, parity , number of caesarean section or other previous surgeries (abdominal or vaginal), hormonal status of the patient, uterine size clinical and by ultrasound , uterine prolapse, urinary incontinence, pre and post surgical hemoglobin, bleeding during surgery, weight pathology, pathological diagnosis and hospital stay. Results: The average age of the patients was 46.66 years. The main reason for consultation in 53.33% of cases was for menorrhagia and in 46.66% of abdominal tumor. The average weight of the surgical specimens was 705 g and there were no major complications related to surgery. The mean operative time was 122 minutes. Conclusions: Despite of advances in laparoscopic approach for hysterectomies that have allowed us to perform successfully fibroid uterus, leaving in the background the abdominal route, there are still cases of large uteri with minimum lateral mobility that would make us think of a better abdominal approach. For these situations we propose the vaginal trachelectomy with subsequent laparoscopic subtotal hysterectomy is a feasible and safe alternative, with a low complication rate and a reduced hospital stay, it seems a reasonable option in selected cases (AU)

Influence of the in situ component in 389 infiltrating ductal breast carcinomas.

BACKGROUND: Our aim was to evaluate and compare lymph node involvement, as well as disease-free survival (DFS) and overall survival (OS), between infiltrating ductal carcinoma with (group 1) and without (group 2) intraductal carcinoma component in order to determine the prognostic value of the intraductal component. METHODS: Data from 389 cases of infiltrating ductal carcinoma of the breast were included in the study by means of reviewing medical charts and pathology slides. RESULTS: There was no statistically significant difference between both groups regarding node status. The 5-year DFS rate was 90.7% in group 1 and 81.8% in group 2 (p = 0.014), with a median follow-up of 73.2 months (95% CI 68.3-77.4). There was no statistically significant difference in 5-year OS between groups (98% group 1 vs. 93% group 2) with a median global survival of 134 months (95% CI 131-137). CONCLUSIONS: The presence of intraductal component in the infiltrating carcinoma seems to increase DFS and may be an independent and favorable prognostic factor for breast cancer.

[Node status in 454 ductal breast cancers cases according to the association with in situ component]. / Afectación ganglionar en 454 casos con carcinoma ductal infiltrante de mama según el hallazgo de componente intraductal asociado.

BACKGROUND: Studies have shown that breast infiltrating ductal carcinoma develops from precursor lesions or pre-invasive. It is accepted that the risk of invasive ductal carcinoma increased slightly in hyperplasia, but especially in cases of atypical hyperplasia and intraductal carcinoma. OBJECTIVES: To evaluate and compare the nodal status between ductal breast cancer with in situ component (group 1) or without it (group 2). MATERIAL AND METHOD: Descriptive and retrospective study that included 454 ductal breast cancers. Data concerning clinical and pathological variables was collected. All data was compared between both groups. RESULTS: Among all cases, 176 (38.8%) showed positive lymph nodes, 136 patients (39.5%) from group 1 and 40 cases (36.4%) from group 2. Among group 1 cases, high-grade subgroup showed higher positive lymph node rate (82 cases, 55.4%) than the extensive in situ carcinomas subgroup (84 cases, 49.7%). Both of them had a significant higher rate than group 2 cases (p = 0.003 y p = 0.028, respectively). Moreover, the low-grade in situ carcinomas without cellular necrosi had positive lymph nodes just in 30 cases (24%), significantly lower (p = 0.034) than group 2. CONCLUSIONS: We did not find overall statistical differences between groups depending on in situ associated component. But when we analyzed in situ subgroups, we found differences with higher positive lymph node rate in high grade carcinomas and extensive in situ carcinomas subgroups, while lower affectation rates were observed in low grade carcinomas (without cellular necrosis), compared to the group of breast cancers without in situ component associated.

Rotura uterina. Diagnóstico y consecuencias en una gestante de 30 semanas / Uterine rupture. Diagnosis and repercussions at 30 weeks of pregnancy

La rotura uterina es una complicación obstétrica infrecuente con una morbimortalidad maternofetal alta. Su diagnóstico temprano y tratamiento inmediato son importantes factores pronósticos, tanto para la madre como para el feto. Presentamos el caso de una paciente gestante de 30 semanas que presentó una rotura uterina espontánea en la zona de una cicatriz de miomectomía laparoscópica anterior, lo que dio lugar a un hemoperitoneo materno y a la muerte fetal intraútero. Se practicó un tratamiento quirúrgico de urgencia mediante una histerectomía subtotal por vía abdominal (AU)

Uterine rupture is an infrequent obstetric complication with high morbidity and mortality for both the mother and fetus. Early diagnosis and treatment of this entity are important prognostic factors. We report the case of woman at 30 weeks of pregnancy with spontaneous uterine rupture in a previous scar from a laparoscopic myomectomy, giving rise to maternal hemoperitoneum and intrauterine fetal death. Emergency surgery was performed with subtotal abdominal hysterectomy (AU)