RESUMO
Exponemos el caso de una paciente de 74 años que consultó por sangrado posmenopáusico y finalmente se diagnosticó de carcinosarcoma uterino y carcinoma seroso tubárico, sincrónico.En la exploración se objetivó una formación polipoidea a través del cérvix y se visualizó en la ecografía transvaginal una imagen heterogénea intracavitaria.El resultado del estudio histológico de ambos hallazgos fue de carcinosarcoma.Tanto la resonancia magnética como la tomografía axial computarizada describieron una lesión en cuerpo uterino indicativa de mioma sin descartar degeneración sarcomatosa, además de una lesión cervical con características similares.Ante la sospecha de un carcinoma de endometrio tipo ii, se realizó, por vía laparoscópica, una histerectomía, una doble anexectomía, una omentectomía y una linfadenectomía pélvica y paraaórtica. Con el siguiente resultado anatomopatológico: carcinosarcoma uterino de 5cm con infiltración miometrial <50% y afectación del estroma cervical, con márgenes libres. Ambos anejos y tejido peritoneal presentaban infiltración por carcinoma seroso de alto grado de origen tubárico. Las linfadenectomías pélvica y paraaórtica sin evidencia de malignidad.Se concluye un estadificación de carcinosarcoma uterino estadio ii y carcinoma seroso tubárico estadio iiiB sincrónico.Se trata de una rara entidad; tenemos conocimiento de un único caso clínico similar documentado, siendo nuestro propósito presentar el manejo y tratamiento realizado.
We report a rare case of uterine carcinosarcoma involving a 74-year-old woman. The patient complained of posmenopausal bleeding. The disease was eventually diagnosed as simultaneous uterine carcinosarcoma and high-grade serous tubal carcinoma.Clinical examination found a cervical tumour and transvaginal ultrasound showed a heterogeneous intrauterine image. The histological result of both findings was carcinosarcoma.The computed tomography scan and magnetic resonance imaging reported similar findings for intrauterine and cervical tumour, with the same features as a possible myoma or mass with sarcomatous degeneration.Given the suspicion of a high-risk variant of endometrial adenocarcinoma, the primary management of carcinosarcoma is surgery. Complete surgical staging included total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, pelvic and para-aortic lymph node dissection.The pathological findings revealed a uterine carcinosarcoma tumour, invading less than half the myometrium and the stromal connective tissue of the cervix but not extending beyond the uterus. The histopathological studies of bilateral adnexectomy and the peritoneal biopsy demonstrated the presence of high-grade serous tubal carcinoma. The lymph study was negative for malignancy.We concluded a synchronous diagnosis of uterine carcinosarcoma stage II and high-grade serous tubal carcinoma stage IIIB.A detailed literature search and management of this entity are discussed.
Assuntos
Feminino , Idoso , Ciências da Saúde , Neoplasias Uterinas , Carcinoma , Carcinossarcoma , Neoplasias dos Genitais Femininos , ÚteroRESUMO
OBJECTIVE: To assess the usefulness of cytology in the diagnosis of 147 histologically established adnexal cysts. STUDY DESIGN: Retrospective, macro-microscopic study based on fluid aspirated from 132 ovarian and 15 extraovarian cysts and projected as a cytohistologic correlation. RESULTS: Typical macroscopic features were identified in 76% of endometriotic cysts, in 53% of mucinous neoplasms and in 67% of dermoid cysts. Cytology helped to identify 67% of nonneoplastic and 56% of neoplastic cysts. The lowest diagnostic sensitivities were observed in functional cysts and benign serous neoplasms (50%), while the highest were shown by endometriotic cysts (76%) and malignant epithelial neoplasms (71%). Inadequate samples were obtained from all types of cysts, even malignant ones (two mucinous cystadenocarcinomas). Diagnostic cytology was useless in extraovarian cysts (33% sensitivity). An adult granulosa cell tumor was erroneously diagnosed as a follicular cyst by cytologic examination. CONCLUSION: Examination of the cyst fluids obtained by aspiration demonstrated low sensitivity, with 43% of inadequate samples obtained from all types of cysts. Malignant cystic neoplasms may be overlooked in inadequate samples. Our study also revealed that specificity in this type of analysis is high in inadequate samples, provided that the technique is carried out correctly.
