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.

Tumor de células granulares de vulva: un raro tumor genital benigno / Granular cell tumor of vulva: a rare benign genital tumor

Resumen ANTECEDENTES: El tumor de células granulares de la vulva es poco común y de origen neurogénico. Afecta, principalmente, a mujeres entre 60 y 70 años y es más frecuente en la raza negra. CASO CLÍNICO: Paciente de 63 años, con una lesión vulvar indolora y no pruriginosa, en crecimiento. En la exploración se observó una lesión excrecente de 2.5 cm en la región superior del labio mayor izquierdo, dura, vascularizada y con infiltración a 2 cm de profundidad. No se palparon adenopatías sospechosas. Luego del reporte de la biopsia, sugerente de tumor de células granulares, se practicó una escisión completa, con márgenes libres. El estudio inmunohistoquímico se reportó positivo para CD68, S100 y TFE3 lo que confirmó el diagnóstico. Puesto que el índice proliferativo (Ki67) fue inferior al 5% y los márgenes quirúrgicos estaban libres, no se requirió tratamiento adyuvante. La paciente permanece en seguimiento y sin signos de recidiva. CONCLUSIÓN: Si bien los tumores de células granulares de la vulva son poco comunes y casi siempre benignos, deben incluirse en el diagnóstico diferencial de una tumoración vulvar. La inmunohistoquímica es la herramienta más útil para el diagnóstico preciso y su tratamiento de elección es la escisión local amplia, por su tendencia a la recurrencia local.

Abstract BACKGROUND: Granular cell tumor of the vulva is rare and neurogenic in origin. It mainly affects women between 60 and 70 years of age and is more frequent in black women. CLINICAL CASE: A 63-year-old woman with a painless, non-pruritic, growing vulvar lesion. Examination revealed a 2.5 cm excrescent lesion in the upper region of the left labium majus, hard, vascularized and infiltrated to a depth of 2 cm. No suspicious lymph nodes were palpated. After the biopsy report, suggestive of granular cell tumor, complete excision was performed, with free margins. The immunohistochemical study was positive for CD68, S100 and TFE3 which confirming the diagnosis. Since the proliferative index (Ki67) was less than 5% and the surgical margins were clear, adjuvant treatment was not required. The patient remains in follow-up with no signs of recurrence. CONCLUSION: Although granular cell tumors of the vulva are rare and almost always benign, they should be included in the differential diagnosis of a vulvar tumor. Immunohistochemistry is the most useful tool for accurate diagnosis and their treatment of choice is wide local excision because of their tendency for local recurrence.

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.

Incidence and univariate models for lymphatic drainage disorders following management for cervical cancer.

AIM: To clarify the incidence of lymphatic drainage disorders (LLD) after treatment for cervical cancer (CC) and to establish univariate models for their occurrence. METHODS: A total of 263 eligible patients with CC were identified between 2010 and 2019. We conducted a case-control study and divided the study population into two subsamples of 12 and 251 CC survivors based on the presence/absence of LLD, respectively. The cumulative incidence was evaluated using the Kaplan-Meier method. Univariate models based on Pearson correlation coefficient were used to evaluate associations between explanatory variables and LLD. RESULTS: The cumulative incidence of LLD began at 3.3% after the 7-month follow-up, reaching a plateau of 21.2% between 130 and 250 months of follow-up. We detected correlation between LLD and number of removed para-aortic lymph nodes (r = -0.39), number of pelvic lymphadenopathies (r = 0.16), pelvic lymphadenectomy (PL) (r = 0.16), age at diagnosis of CC (r = -0.1) and primary surgery (r = 0.1). CONCLUSION: We observed a cumulative incidence of LLD of 21.2%, which is in accord with other retrospective studies. Number of removed para-aortic lymph nodes, number of pelvic lymphadenopathies, PL, age at diagnosis of CC and primary surgery were the most influential clinical factors associated with the occurrence of LLD in CC survivors.

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.

Carcinosarcoma de ovario en paciente perimenopáusica / Ovarian carcinosarcoma in a perimenopausal woman

Resumen ANTECEDENTES: El carcinosarcoma de ovario, o tumor mixto de Müller, es una neoplasia infrecuente que representa alrededor del 1 al 4% de los carcinomas ováricos epiteliales. Su histología combina componentes sarcomatosos y carcinomatosos. CASO CLÍNICO: Paciente de 55 años, con diagnóstico de carcinosarcoma de ovario. Acudió a consulta debido a un sangrado uterino irregular y dolor abdominal. En la ecografía transvaginal se encontró una formación anexial sólida y heterogénea de 11.95 x 10.6 cm, con captación Doppler. El estudio se amplió con una tomografía axial computada (TAC) abdominopélvica y de tórax en la que se observó una tumoración en el lado izquierdo de 18 x 13 cm. Los marcadores tumorales se reportaron elevados: CEA 10.60, CA 125 91.3 y CA19.9 153 U/mL, con proteína HE-4 86.8 pmol/L, ligeramente disminuida. La laparotomía exploradora se completó con una cirugía para eliminar toda la carga tumoral. Se indicó quimioterapia con paclitaxel-carboplatino. El estudio histológico definitivo informó la existencia de una tumoración sólida-quística, compatible con un carcinosarcoma en el ovario izquierdo, con amplia diseminación peritoneal. A los 3 meses de la intervención, la paciente continuaba sin signos de recidiva. CONCLUSIONES: El carcinosarcoma es un tumor ginecológico poco frecuente pero muy agresivo; por su excepcional hallazgo aún no se dispone de criterios de tratamiento. Es decisivo fomentar investigaciones futuras acerca de los factores pronósticos y biomarcadores y desarrollar tratamientos dirigidos a las características moleculares de cada paciente.

Abstract BACKGROUND: Ovarian carcinosarcoma, or mixed Müllerian tumor, is a rare neoplasm that represents about 1 to 4% of epithelial ovarian carcinomas. Its histology combines sarcomatous and carcinomatous components. CLINICAL CASE: 55-year-old female patient with a diagnosis of ovarian carcinosarcoma. She consulted due to irregular uterine bleeding and abdominal pain. Transvaginal ultrasound showed a solid and heterogeneous adnexal formation measuring 11.95 x 10.6 cm, with Doppler uptake. The study was expanded with an abdominopelvic and chest computed axial tomography (CT) scan in which a tumor was observed on the left side measuring 18 x 13 cm. Tumor markers were reported elevated: CEA 10.60, CA 125 91.3 and CA19.9 153 U/mL, with HE-4 protein 86.8 pmol/L, slightly decreased. Exploratory laparotomy was completed with R0 surgery. Chemotherapy with paclitaxel-carboplatin was indicated. The definitive histological study reported the existence of a solid-cystic tumor, compatible with a carcinosarcoma in the left ovary, with extensive peritoneal dissemination. Three months after surgery, the patient continued without signs of recurrence. CONCLUSIONS: Carcinosarcoma is a rare but very aggressive gynecologic tumor; because of its exceptional finding no treatment criteria are yet available. It is crucial to encourage future research on prognostic factors and biomarkers and to develop treatments targeted to the molecular characteristics of each patient.

Epidermoid carcinoma in the neovagina of a patient with Mayer-Rokitansky-Küster-Hauser syndrome. Case report and literature review / Carcinoma epidermoide de neovagina en paciente con síndrome de mayer- rokitansky-küster-hauser. reporte de un caso y revisión de la literatura

RESUMEN Objetivo: presentar el caso de una paciente con síndrome de Mayer-Rokitansky-Küster-Hauser, con diagnóstico de carcinoma escamoso en neovagina, y realizar una revisión de la literatura del tratamiento y pronóstico de las neoplasias o la infección por VPH de tejidos neovaginales en mujeres transgénero o con síndrome MRKH. Materiales y métodos: mujer de 56 años de edad que consulta en un hospital universitario regional de la ciudad de Sevilla (España). Tras la exploración clínica se aprecia una tumoración exofítica en fondo de vagina, con resultado de biopsia de carcinoma escamoso y cultivo positivo para virus del papilloma humano (VPH) tipo 16. Se realizó una búsqueda bibliográfica en la base de datos Medline vía PubMed, con los términos: "congenital abnormalities"; "mullerian aplasia"; "neovagina"; "vaginal neoplasms"; "squamous carcinoma"; "HPV infection", de reportes y series de caso, y estudios observacionales publicados desde el año 2000 hasta octubre de 2019 en inglés y español. Resultados: se incluyeron 14 estudios; de estos, siete correspondieron a carcinoma escamocelular, tres a adenocarcinoma y cuatro informan infección solo por VPH. Todos los carcinomas escamocelulares presentaban estadios avanzados por compromiso local o linfático y recibieron radioterapia con quimioterapia concomitante o cirugía radical. El pronóstico fue malo en tres de los casos. Las pacientes con adenocarcinoma también presentaron lesiones avanzadas con compromiso local, el tratamiento fue quirúrgico, con quimioterapia concomitante en dos de los casos. Solo una paciente tuvo seguimiento mayor a cinco años. La infección por VPH es frecuente en mujeres sometidas a construcción de neovagina. Conclusiones: las pacientes con neovagina son susceptibles de desarrollar carcinomas escamosos si se utilizaron injertos cutáneos, o adenocarcinomas en aquellas en las que se reconstruyó la vagina a partir de injertos tisulares intestinales. Dado que al momento del diagnóstico presentan compromiso local, a menudo requieren tratamientos radicales o combinados. Se debe investigar cuáles son las mejores estrategias de tamizaje de VPH, cáncer escamoso y adenocarcinoma en este tipo de pacientes.

ABSTRACT Objective: To present the case of a squamous carcinoma in the neovagina of a patient with Mayer-Rokitansky-Küster-Hauser syndrome and review of the literature related to treatment and prognosis of vaginal neoplasms or HPV infection in transgender women or with MRKH syndrome. Materials and methods: A 56-year-old woman consulted to the Hospital Universitario of Sevilla (Spain). During the clinical examination, a exophytic tumor at the bottom of the vagina was found and the biopsy reported squamous carcinoma and positive nucleic acid amplification test for human papilloma (HPV) type 16. A literature search of case reports, case series and observational studies published from 2000 to October 2019 in English and Spanish was performed in Medline via PubMed, with the following terms: "congenital abnormalities"; "Mullerian aplasia"; "neovagina"; "Vaginal neoplasms"; "Squamous carcinoma"; "HPV infection" was performed. Results: 14 studies were finally included; seven corresponded to squamous cell carcinoma, three to adenocarcinoma and four reported HPV infection only. All of the squamous cell carcinomas were at advanced stages due to local or lymphatic compromise and received radiotherapy with concomitant chemotherapy or radical surgery. The prognosis was bad in three of the cases. Patients with adenocarcinoma also presented with advanced lesions due to local extensión and received surgical treatment and two cases received concomitant chemotherapy. Only one patient was followed-up for five years or more. HPV infection is common in women who underwent neovagina reconstruction. Conclusions: Patients with neovagina are susceptible to develope squamous carcinomas or adenocarcinomas depending if skin or intestinal tissue grafts are used. According to local compromise at the time of diagnosis, radical or combined treatments are required. Which screening strategies for HPV, squamous cell carcinomas and adenocarcinoma is to be investigated.

Adenosarcoma de alto grado de endocérvix y cavidad endometrial con componente heterólogo de rabdomiosarcoma. Reporte de caso y revisión de la literatura / High grade adenosarcoma of endocervix and endometrial cavity with a heterologous component of rhabdomyosarcoma. Case report and review of the literature

Objective: To present the case of a patient diagnosed with high grade adenosarcoma of the endocervix and the endometrial cavity, with a heterologous component, and to conduct a review of the literature focusing on the diagnosis and therapeutic management of this disease condition. Materials and methods: We present the case of a 31-year-old female patient who came to Virgen Macarena University Hospital of Seville, a Level III regional institution, complaining of genital bleeding arising from an endocervical polypoid mass. The biopsy of the mass revealed a high grade, poorly differentiated leiomyosarcoma of the endocervix. The patient was taken later to total abdominal hysterectomy. The study of the surgical specimen provided the following result: adenosarcoma of the endocervix and endometrial cavity with a heterologous rhabdomyosarcoma component. A search was conducted in the Medline database via Pubmed using the terms "adenosarcoma," "endocervical," "cervix," "uterus," "heterologous." The search in- cluded literature review articles, case reports and clinical case series describing aspects of cervical adenosarcoma and the heterologous rhabdomyosar- coma component, published in English and Spanish since 1974. Results: Six articles corresponding to literature reviews, case reports or case series in which the most relevant aspects of the diagnosis and treatment of this disease condition are described were retrieved. Conclusions: This condition is characterized, on occasions, by rapid and aggresive growth, hence the importance of early diagnosis and optimal treatment based on a combination of surgery, radiation therapy and chemotherapy. However, due to its low prevalence, further studies are needed in order to confirm these data.

Objetivo: presentar el caso de una paciente con diagnóstico de adenosarcoma de alto grado de en- docérvix y de cavidad endometrial, con componente heterólogo, y hacer una revisión de la literatura con especial atención al diagnóstico y manejo terapéutico de esa patología. Materiales y métodos: Se presenta el caso de una paciente de 31 años, que consulta al Hospital Universitario Virgen Macarena de Sevilla, institución regional de tercer nivel, por presentar san grado genital originado por una masa polipoidea endocervical que se llevó a biopsia con resultado de un leiomiosarcoma poco diferenciado de alto grado de endocérvix. Posteriormente fue llevada a histerectomía total abdominal. En el estudio de la pieza quirúrgica el resultado fue: adenosarcoma de endocérvix y cavidad endometrial, con componente heterólogo de rabdomiosarcoma. Con los términos: "adenosarcoma", "endocervical", "cérvix", "uterus", "heterologous", en las bases de datos Medline vía PubMed se realizó una búsqueda de artículos de revisión bibliográfica, reportes y series de casos clínicos que describían aspectos del adenosarcoma cervicouterino y del componente heterólogo de rabdomiosarcoma, en inglés y español, publicados desde 1974. Resultados: se hallaron seis artículos correspondientes a revisiones de la literatura, reportes o series de casos, donde se describen los aspectos más importantes referentes al diagnóstico y tratamiento de esta patología. Conclusiones: esta patología se caracteriza, en ocasiones, por un crecimiento rápido y agresivo, donde es importante el diagnóstico precoz y el tratamiento óptimo, basado en una combinación de cirugía, radioterapia y quimioterapia, aunque dada su baja prevalencia se necesitan aún más estudios para poder confirmar estos datos.

High grade adenosarcoma of endocervix and endometrial cavity with a heterologous component of rhabdomyosarcoma. Case report and review of the literature / Adenosarcoma de alto grado de endocérvix y cavidad endometrial con componente heterólogo de rabdomiosarcoma. reporte de caso y revisión de la literatura

RESUMEN Objetivo: presentar el caso de una paciente con diagnóstico de adenosarcoma de alto grado de endocérvix y de cavidad endometrial, con componente heterólogo, y hacer una revisión de la literatura con especial atención al diagnóstico y manejo terapéutico de esa patología. Materiales y métodos: Se presenta el caso de una paciente de 31 años, que consulta al Hospital Universitario Virgen Macarena de Sevilla, institución regional de tercer nivel, por presentar san grado genital originado por una masa polipoidea endocervical que se llevó a biopsia con resultado de un leiomiosarcoma poco diferenciado de alto grado de endocérvix. Posteriormente fue llevada a histerectomía total abdominal. En el estudio de la pieza quirúrgica el resultado fue: adenosarcoma de endocérvix y cavidad endometrial, con componente heterólogo de rabdomiosarcoma. Con los términos: "adenosarcoma", "endocervical", "cérvix", "uterus", "heterologous", en las bases de datos Medline vía PubMed se realizó una búsqueda de artículos de revisión bibliográfica, reportes y series de casos clínicos que describían aspectos del adenosarcoma cervicouterino y del componente heterólogo de rabdomiosarcoma, en inglés y español, publicados desde 1974. Resultados: se hallaron seis artículos correspondientes a revisiones de la literatura, reportes o series de casos, donde se describen los aspectos más importantes referentes al diagnóstico y tratamiento de esta patología. Conclusiones: esta patología se caracteriza, en ocasiones, por un crecimiento rápido y agresivo, donde es importante el diagnóstico precoz y el tratamiento óptimo, basado en una combinación de cirugía, radioterapia y quimioterapia, aunque dada su baja prevalencia se necesitan aún más estudios para poder confirmar estos datos.

ABSTRACT Objective: To present the case of a patient diagnosed with high grade adenosarcoma of the endocervix and the endometrial cavity, with a heterologous component, and to conduct a review of the literature focusing on the diagnosis and therapeutic management of this disease condition. Materials and methods: We present the case of a 31-year-old female patient who came to Virgen Macarena University Hospital of Seville, a Level III regional institution, complaining of genital bleeding arising from an endocervical polypoid mass. The biopsy of the mass revealed a high grade, poorly differentiated leiomyosarcoma of the endocervix. The patient was taken later to total abdominal hysterectomy. The study of the surgical specimen provided the following result: adenosarcoma of the endocervix and endometrial cavity with a heterologous rhabdomyosarcoma component. A search was conducted in the Medline database via Pubmed using the terms "adenosarcoma," "endocervical," "cervix," "uterus," "heterologous." The search included literature review articles, case reports and clinical case series describing aspects of cervical adenosarcoma and the heterologous rhabdomyosarcoma component, published in English and Spanish since 1974. Results: Six articles corresponding to literature reviews, case reports or case series in which the most relevant aspects of the diagnosis and treatment of this disease condition are described were retrieved. Conclusions: This condition is characterized, on occasions, by rapid and aggressive growth, hence the importance of early diagnosis and optimal treatment based on a combination of surgery, radiation therapy and chemotherapy. However, due to its low prevalence, further studies are needed in order to confirm these data.

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.

Epidermoid carcinoma in the neovagina of a patient with Mayer-Rokitansky-Küster-Hauser syndrome. Case report and literature review / Carcinoma epidermoide de neovagina en paciente con síndrome de Mayer-Rokitansky-Küster-Hauser. Reporte de un caso y revisión de la literatura

Objective: To present the case of a squamous carcinoma in the neovagina of a patient with Mayer-Rokitansky-Küster-Hauser syndrome and review of the literature related to treatment and prognosis of vaginal neoplasms or HPV infection in transgender women or with MRKH syndrome. Materials and methods: A 56-year-old woman consulted to the Hospital Universitario of Sevilla (Spain). During the clinical examination, a exophytic tumor at the bottom of the vagina was found and the biopsy reported squamous carcinoma and positive nucleic acid amplification test for human papilloma (HPV) type 16. A literature search of case reports, case series and observational studies published from 2000 to October 2019 in English and Spanish was performed in Medline via PubMed, with the follow- ing terms: "congenital abnormalities"; "Mullerian aplasia"; "neovagina"; "Vaginal neoplasms"; "Squamous carcinoma"; "HPV infection" was performed. Results: 14 studies were finally included; seven corresponded to squamous cell carcinoma, three to adenocarcinoma and four reported HPV infection only. All of the squamous cell carcinomas were at advanced stages due to local or lymphatic compro- mise and received radiotherapy with concomitant chemotherapy or radical surgery. The prognosis was bad in three of the cases. Patients with adenocarcinoma also presented with advanced lesions due to local extensión and received surgical treatment and two cases received concomitant chemotherapy. Only one patient was followed-up for five years or more. HPV infection is common in women who underwent neovagina reconstruction. Conclusions: Patients with neovagina are susceptible to develope squamous carcinomas or adenocarcinomas depending if skin or intestinal tissue grafts are used. According to local compromise at the time of diagnosis, radical or combined treatments are required. Which screening strategies for HPV, squamous cell carcinomas and adenocarcinoma is to be investigated.

TITULO: CARCINOMA EPIDERMOIDE DE NEOVAGINA EN PACIENTE CON SÍNDROME DE MAYER- ROKITANSKY-KÜSTER-HAUSER. REPORTE DE UN CASO Y REVISIÓN DE LA LITERATURA. Objetivo: Presentar el caso de una paciente con síndrome de Mayer-Rokitansky-Küster-Hauser, con diagnóstico de carcinoma escamoso en neovagina, y realizar una revisión de la literatura del tratamiento y pronóstico de las neoplasias o la infección por VPH de tejidos neovaginales en mujeres transgénero o con síndrome MRKH. Materiales y métodos: Mujer de 56 años de edad que consulta en un hospital universitario regional de la ciudad de Sevilla (España). Tras la exploración clínica se aprecia una tumoración exofítica en fondo de vagina, con resultado de biopsia de carcinoma escamoso y cultivo positivo para virus del papilloma humano (VPH) tipo 16. Se realizó una búsqueda bibliográfica en la base de datos Medline vía PubMed, con los términos: "congenital abnormalities"; "mullerian aplasia"; "neovagina"; "vaginal neoplasms"; "squamous carcinoma"; "HPV infection", de reportes y series de caso, y estudios observacionales publicados desde el año 2000 hasta octubre de 2019 en inglés y español. Resultados: Se incluyeron 14 estudios; de estos, siete correspondieron a carcinoma escamocelular, tres a adenocarcinoma y cuatro informan infección solo por VPH. Todos los carcinomas escamocelulares presentaban estadios avanzados por compromiso local o linfático y recibieron radioterapia con quimioterapia concomitante o cirugía radical. El pronóstico fue malo en tres de los casos. Las pacientes con adenocarcinoma también presentaron lesiones avanzadas con compromiso local, el tratamiento fue quirúrgico, con quimioterapia concomitante en dos de los casos. Solo una paciente tuvo seguimiento mayor a cinco años. La infección por VPH es frecuente en mujeres sometidas a construcción de neovagina. Conclusiones: Las pacientes con neovagina son susceptibles de desarrollar carcinomas escamosos si se utilizaron injertos cutáneos, o adenocarcinomas en aquellas en las que se reconstruyó la vagina a partir de injertos tisulares intestinales. Dado que al momento del diagnóstico presentan compromiso local, a menudo requieren tratamientos radicales o combinados. Se debe investigar cuáles son las mejores estrategias de tamizaje de VPH, cáncer escamoso y adenocarcinoma en este tipo de pacientes.

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)

Torsión aislada de trompa de Falopio en paciente sometida a bloqueo tubárico bilateral / Isolated Fallopian tube torsion in a patient with bilateral tube blockage

La torsión aislada de la trompa de Falopio es un motivo infrecuente de consulta en Ginecología. La clínica que produce es sumamente inespecífica, dificultando mucho la realización de un diagnóstico de sospecha y de un tratamiento precoz (AU)

Isolated torsion of the fallopian tube is a rare reason for seeking consultation in gynaecology. Symptoms are non-specific, which hampers its presumptive diagnosis and early treatment (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)

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)

Técnicas de imagen en la evaluación de las manifestaciones sistemáticas de las vasculitis / Imaging techniques for the evaluation of systemic manifestations of vasculitis

Las vasculitis provocan un proceso inflamatorio vascular que determina distintas manifestaciones orgánicas que dependen del calibre del vaso afectado y de su localización. Las técnicas de imagen desempeñan un papel importante en la caracterización y detección de las vasculitis de vasos grandes y medianos, pues son capaces de detectar el edema parietal y de monitorizar la respuesta para el tratamiento. En las vasculitis de vasos pequeños las técnicas de imagen son necesarias para estudiar las diferentes repercusiones orgánicas o sistémicas, ya que en el momento actual ninguna técnica de imagen tiene la resolución espacial suficiente para visualizarlos de forma directa (AU)

Vasculitides create a local inflammatory process in the vessel wall, which determines the different organic manifestations according to vessel size and location. Imaging techniques play a key role in the characterization and detection of large and medium size vessel vasculitides. Imaging is able to detect the vessel wall edema and to monitor the therapeutic response. In small vessel vasculitis, imaging can indirectly analyse the organic and/or systemic manifestations, because at present, none of the imaging techniques has the necessary spatial resolution to directly visualize small vessels (AU)

[Imaging techniques for the evaluation of systemic manifestations of vasculitis]. / Técnicas de imagen en la evaluación de las manifestaciones sistemáticas de las vasculitis.

Vasculitides create a local inflammatory process in the vessel wall, which determines the different organic manifestations according to vessel size and location. Imaging techniques play a key role in the characterization and detection of large and medium size vessel vasculitides. Imaging is able to detect the vessel wall edema and to monitor the therapeutic response. In small vessel vasculitis, imaging can indirectly analyse the organic and/or systemic manifestations, because at present, none of the imaging techniques has the necessary spatial resolution to directly visualize small vessels.

[Seminal vesicle cyst with renal agenesis associated with vascular anomalies. Case report]. / Quiste de vesícula seminal con agenesia renal asociado a malformaciones vasculares. Presentación de un caso.

OBJECTIVE: We report a case of seminal vesicle cyst with ipsilateral renal agenesis associated wit abnormalities of the abdominal great vessels, not described previously in the bibliography. METHODS: 33 year-old-male with history of abdominal pain and fever. This case was evaluated by ultrasound, IV urography, CT scan and MRI. RESULTS/CONCLUSIONS. Congenital cystic disease of the seminal vesicle is an uncommon disorder. It is associated with genitourinary anomalies, often renal agenesis, and even anomalies of the lower spine. However, anomalies of the abdominal great vessels have not been described previously. CT scan provided excellent demonstration of associated anomalies.

Quiste de vesícula seminal con agenesia renal asociado a malformaciones vasculares. Presentación de un caso / Seminal vesicle cyst with renal agenesis associated with vascular anomalies. Case report

Objetivo: Presentamos un caso de malformación quística de vesícula seminal con agenesia renal ipsilateral asociada a alteraciones vasculares en aorta y cava, no descrito previamente en la literatura. Métodos: Varón de 33 años de edad con historia de dolor abdominal y fiebre. Se realiza ecografía, urografía, TAC y RMN. Resultados/Conclusiones: La enfermedad quística de la vesícula seminal es poco frecuente. Se asocia a otras anomalías genitourinarias como la agenesia renal e incluso a alteraciones de la columna vertebral. Sin embargo, no se han descrito anomalías vasculares. El TAC es fundamental para determinar anomalías asociadas (AU)

Objective: We report a case of seminal vesicle cyst with ipsilateral renal agenesis associated wit abnormalities of the abdominal great vessels, not described previously in the bibliography. Methods: 33 year-old-male with history of abdominal pain and fever. This case was evaluated by ultrasound, IV urography, CT scan and MRI. Results/Conclusions: Congenital cystic disease of the seminal vesicle is an uncommon disorder. It is associated with genitourinary anomalies, often renal agenesis, and even anomalies of the lower spine. However, anomalies of the abdominal great vessels have not been described previously. CT scan provided excellent demonstration of associated anomalies (AU)