Prognosis and treatment-selection criteria for patients with high-grade stage IIIc-IV serous ovarian, fallopian tube or peritoneal cancer / Pronóstico y selección de tratamiento en pacientes con cáncer seroso de ovario, de trompas de Falopio o peritoneal de alto grado, estadio IIIc-IV

Objective: To determine the impact of implementing strict treatment-selection criteria on the overall outcome of women with high-grade serous advanced stage ovarian, fallopian tube, or primary peritoneal carcinoma. Material and methods: We included patients treated for high-grade serous advanced stage ovarian, fallopian tube, or primary peritoneal carcinoma at our Institution from January 2007 to March 2015. All other non-serous, low-grade histology tumors and secondary cytoreductions were excluded. strict treatment-selection criteria was used to decide on primary cytoreductive surgery versus neoad-juvant chemotherapy and type of adjuvant therapy. Collected data included patient and tumor characteristics, preoperative diagnostic procedures, surgical treatment, perioperative complications, and neoadjuvant and adjuvant chemotherapies. Appropriate statistical tests were used and survival analysis performed. Results: We identified 71 eligible patients. Mean age was 58.5 ± 11.8 years, 28.2% received neoadjuvant chemotherapy, and 77.5% had optimal cytoreductive surgery to < 1 cm residual disease. Major complications were observed in 16.9% of women, with no significant difference between neoadjuvant chemotherapy and primary cytoreductive surgery groups. With a median follow-up of 35.7 months, median overall survival was not achieved and 57.2% of patients were alive 54 months after surgery. A total of 24 out of 71 (33.8%) died of disease, 11 (45.8%) within two years after surgery. Median progression-free survival was 19.5 months (95% CI 14.8-24.3). Conclusions: Applying strict treatment-selection criteria for patients with high-grade serous advanced stage ovarian, fallopian tube, or primary peritoneal carcinoma ensures few surgical complications and excellent survival rates for the majority of these women

Objetivo: determinar el impacto de la implementación de criterios estrictos de selección de tratamiento sobre el pronóstico de las mujeres con carcinoma seroso de ovario, trompa de Falopio o peritoneal primario en estadio avanzado y de alto grado. Material y métodos: entre enero de 2007 y marzo de 2015 se incluyeron pacientes tratadas por carcinoma ovárico seroso avanzado de alto grado, trompa de Falopio o carcinoma peritoneal primario en nuestro hospital. Se utilizaron criterios estrictos de selección de tratamiento para decidir sobre la cirugía citorreductora primaria versus quimioterapia neoadyuvante y el tipo de tratamiento adyuvante. Los datos recogidos incluyeron características del paciente y del tumor, procedimientos diagnósticos preoperatorios, tratamiento quirúrgico, complicaciones perioperatorias y quimioterapias neoadyuvantes y adyuvantes. Se utilizaron pruebas estadísticas adecuadas y se realizó un análisis de supervivencia. Resultados: se incluyeron 71 pacientes. La edad media fue de 58,5 ± 11,8 años, el 28,2% recibió quimioterapia neoadyuvante y el 77,5% tuvo una cirugía citorreductora óptima (< 1 cm de enfermedad residual). Se observaron complicaciones mayores en el 16,9% de las mujeres, sin diferencias significativas entre los grupos de quimioterapia neoadyuvante y de cirugía citorreductora primaria. Con una mediana de seguimiento de 35,7 meses, no se alcanzó la mediana de supervivencia global y el 57,2% de los pacientes estaban vivas 54 meses después de la cirugía. Un total de 24 de 71 (33.8%) murieron de enfermedad, 11 (45.8%) en los dos años después de la cirugía. La mediana de supervivencia libre de progresión fue de 19,5 meses (IC del 95%: 14,8-24,3). Conclusiones: la aplicación de criterios estrictos de selección de tratamiento para pacientes con carcinoma seroso ovárico, de trompa de Falopio o carcinoma peritoneal primario en estadio avanzado de alto grado asegura pocas complicaciones quirúrgicas y buenas tasas de supervivencia para la mayoría de estas pacientes

Preoperative diagnosis of atypical pelvic leiomyoma and sarcoma: the potential role of diffusion-weighted imaging.

The objective of our study was to determine the utility of diffusion-weighted magnetic resonance (DWMR) to differentiate the atypical uterine leiomyomas and sarcomas, establishing a cut-off value of the apparent diffusion coefficient (ADC) to rule out the malignancy. We performed a diagnostic accuracy retrospective study including 10 patients with pelvic sarcomas and 17 patients with leiomyomas. Atypical morphological features in magnetic resonance (MR) studies occurred in 58.8% of the patients, leading to a significant number of indeterminate diagnoses. In contrast, ADC values were consistent for leiomyomas, sarcomas, primary tumours, recurrences, intrauterine and in the extrauterine pelvic locations. The ADC cut-off value was set in 1 (×10-3 mm2/s). Thus, the ADC values equal or superior to 1 × 10-3 mm2/s were always associated with a leiomyoma. The structural MR accuracy was 66.7%, reaching 100% when using DWMR with dichotomised ADC values. Diffusion-weighted imaging with the quantitative measurement of ADC may be considered a useful preoperative test for the differentiation of atypical leiomyomas from sarcomas. Impact statement What is already known on this subject? Papers reporting the utility of a diffusion-weighted MR for the diagnosis of uterine sarcomas are scarce and consist of a small series. However, the published results are consistent with our study, with the decreased ADCs in the case of malignancy. What do the results of this study add? The main differential characteristic of our study is that we selected only the atypical leiomyomas: they share sonographic and MR features with sarcomas, which often leads to an inaccurate diagnosis. This is also the first paper reporting on the role of DWMR with ADC for these types of tumours in extrauterine pelvic locations. We demonstrated a consistent relationship between dichotomised ADC values in leiomyomas/sarcomas for these particular cases and in recurrent tumours, with no overlap between both the groups, as a difference with the previous reports. What are the implications of these findings for clinical practice and/or further research? Our study can be considered as a proof of concept supporting DWMR with ADC measurement as a useful tool to enhance the diagnostic accuracy of MR, highlighting its value to rule out malignancy. Hence, DWMR seems to be a potential useful test to include in the preoperative evaluation of clinically atypical uterine tumours.

Update on intravenous leiomyomatosis: report of five patients and literature review.

The objective of this study was to review management and results of surgical therapy of intravenous leiomyomatosis (IVL). A retrospective review of five patients treated at the Mayo Clinic between 2002 and 2012 and a literature review from 1970 to the present were performed. IVL is a rare condition, often overlooked, misdiagnosed or inadequately treated. Despite its benign histological features, invasion of large vessels and cardiac extension can occur and be fatal. Appropriate diagnosis and a radical surgical approach to IVL provide optimal outcomes. Incomplete resection and/or microscopic foci of IVL can lead to recurrence. Surgery should always aim for complete tumor excision and include hysterectomy and bilateral salpingoophorectomy. Radical parametrectomy and intravenous tumor resection may be necessary.

Desgarro rectovaginal con esfínter anal íntegro: una complicación obstétrica infrecuente / Rectovaginal tear with intact anal sphincter: an uncommon obstetric complication

El desgarro rectovaginal aislado es una complicación de baja incidencia en el ámbito de la obstetricia. Existen pocas publicaciones al respecto, factor que contribuye a la ausencia de consenso en cuanto a su manejo. En el presente artículo, describimos la ocurrencia de dos lesiones de este tipo en nuestro hospital (1.800 partos/año) en el curso de 10 años. Mediante revisión bibliográfica exponemos factores de riesgo y principios de tratamiento. Resulta fundamental la detección precoz de la lesión, así como su reparación quirúrgica minuciosa. En cuanto a la prevención, el fórceps parece ser el principal factor asociado, por lo que resulta conveniente optar por instrumentos menos lesivos, especialmente en pacientes añosas, primíparas o fetos macrosómicos (AU)

The incidence of isolated rectovaginal tear is low in obstetrics and the scarcity of publications on the subject contributes to the lack of consensus on its management. The present article describes the occurrence of two such injuries in our hospital (1800 births / year) over the course of 10 years. Through a literature review, we discuss the risk factors and principles of treatment. Early detection of the injury is essential, as well as meticulous surgical repair. Forceps seems to be the main causative factor and therefore choice of less harmful instruments is advisable, especially in the elderly, primiparous patients, and macrosomic fetuses (AU)