Mulheres com síndrome do ovário policísticos que desenvolveram diabetes melitus 2 antes dos 35 anos: ansiedade, má qualidade do sono e não controle glicêmico / Women with polycystic ovarian syndrome who developed diabetes mellitus 2 before the age of 35: anxiety, poor sleep quality and lack of glycemic control / Mujeres con síndrome de ovario poliquístico que desarrollaron diabetes melitus 2 antes de los 35 años: ansiedad, mala calidad del sueño y sin control glucémico

Introdução: A síndrome dos ovários policísticos (SOP) consiste em uma desordem de origem endocrinológica de grande prevalência nas mulheres em idade fértil, sendo acometidas por ela aproximadamente de 6 a 16% da população feminina - em consonância com diversos critérios diagnósticos 1-4. Essa síndrome é associada ao hiperandrogenismo e à resistência insulínica (RI), com manifestações clínicas relacionadas a alterações reprodutivas 4, desenvolvimento de diabetes mellitus (DM2) e obesidade. Esta pesquisa objetiva compreender o perfil das mulheres com DM 2 antes dos 35 anos e os fatores que podem levar a esta condição. Metodologia: Este estudo se deu por meio de inquérito on-line feito a mulheres diagnosticadas com SOP, e com menos de 35 anos de idade. Foi desenvolvido de maneira virtualizada via plataforma GoogleForms® em função da pandemia do COVID-19. Tratou-se de um levantamento sobre presença de fatores de risco para DM 2, como sobrepeso e alimentação, sedentarismo e qualidade do sono; em grupos de mulheres com SOP diabéticas e não diabéticas, para efeito de comparação. Resultados e discussão: Um total de 198 mulheres responderam ao questionário, sendo divididas em Diabéticas (DM) e não diabéticas (NDM). O grupo DM foi o que mais apresentou IMC elevado (acima de 30), e o que mais se declarou seguir orientações nutricionais. Atividade física não diferenciou entre os grupos. O grupo DM foi o que declarou dormir mais tarde (pós 23:00) quando comparado com o grupo NDM. O sobrepeso indica ser um fator importante para o advento da DM 2 neste grupo, sendo as orientações nutricionais não tão efetivas, devido muito a dificuldade de aderir às orientações. O hábito de dormir tarde implica em alterações que levam a aumento da RI via estresse oxidativo, contribuindo para obesidade e DM 2. Conclusões: A obesidade é um fator decisivo para a precocidade da DM 2 em mulheres com SOP, e sua condição é multifatorial, associada a seguimento de orientações nutricionais, atividade física e qualidade do sono. O evitar da precocidade da DM 2 neste grupo passa por esta compreensão.

Introduction: Polycystic ovary syndrome (PCOS) is an endocrinological disorder with high prevalence in women of childbearing age, affected by approximately 6 to 16% of the female population - in line with several diagnostic criteria 1-4. This syndrome is associated with hyperandrogenism and insulin resistance (IR), with clinical manifestations related to reproductive changes 4, development of diabetes mellitus (DM2) and obesity. This research aims to understand the profile of women with DM 2 before the age of 35 and the factors that can lead to this condition. Methodology: This study was carried out through an online survey made to women diagnosed with PCOS, and under 35 years of age. It was developed in a virtualized way via the GoogleForms® platform due to the COVID-19 pandemic. This was a survey on the presence of risk factors for DM 2, such as overweight and diet, sedentary lifestyle and sleep quality; in groups of women with diabetic and non-diabetic PCOS for comparison purposes. Results and discussion: A total of 198 women answered the questionnaire, divided into Diabetic (DM) and non-diabetic (NDM). The DM group was the one with the highest BMI (above 30), and the one that most declared to follow nutritional guidelines. Physical activity did not differ between groups. The DM group was the one who reported sleeping later (after 11 pm) when compared to the NDM group. Overweight is an important factor for the advent of DM 2 in this group, and nutritional guidelines are not so effective, due to the difficulty in adhering to the guidelines. The habit of sleeping late implies changes that lead to increased IR via oxidative stress, contributing to obesity and DM 2. Conclusions: Obesity is a decisive factor for the precocity of DM 2 in women with PCOS, and its condition is multifactorial, associated with following nutritional guidelines, physical activity and sleep quality. Avoiding the precocity of DM 2 in this group involves this understanding.

Introducción: El síndrome de ovario poliquístico (SOP) es un trastorno de origen endocrinológico de alta prevalencia en mujeres en edad fértil, afectando aproximadamente entre el 6 y el 16% de la población femenina, de acuerdo con diversos criterios diagnósticos 1- 4 . Este síndrome se asocia con hiperandrogenismo y resistencia a la insulina (RI), con manifestaciones clínicas relacionadas con cambios reproductivos 4, desarrollo de diabetes mellitus (DM2) y obesidad. Esta investigación tiene como objetivo conocer el perfil de las mujeres con DM 2 antes de los 35 años y los factores que pueden conducir a esta condición. Metodología: Este estudio se realizó a través de una encuesta online realizada entre mujeres diagnosticadas con SOP y menores de 35 años. Fue desarrollado de manera virtualizada a través de la plataforma GoogleForms® debido a la pandemia de COVID-19. Se realizó una encuesta sobre la presencia de factores de riesgo para DM 2, como sobrepeso y alimentación, sedentarismo y calidad del sueño; en grupos de mujeres diabéticas y no diabéticas con síndrome de ovario poliquístico, con fines de comparación. Resultados y discusión: Respondieron al cuestionario un total de 198 mujeres, divididas en diabéticas (DM) y no diabéticas (NDM). El grupo DM fue el que presentó un IMC más elevado (superior a 30), y el que más declaró seguir las pautas nutricionales. La actividad física no difirió entre los grupos. El grupo DM fue el que reportó dormir más tarde (después de las 11:00 pm) en comparación con el grupo NDM. El sobrepeso indica que es un factor importante en la aparición de DM 2 en este grupo, siendo las pautas nutricionales no tan efectivas, en gran parte por la dificultad para cumplirlas. El hábito de dormir tarde implica cambios que conducen a un aumento de la RI vía estrés oxidativo, contribuyendo a la obesidad y la DM 2. Conclusiones: La obesidad es un factor decisivo en la aparición temprana de la DM 2 en mujeres con SOP, y su condición es multifactorial, asociado con el seguimiento de pautas nutricionales, actividad física y calidad del sueño. Evitar la precocidad de la DM 2 en este grupo requiere esta comprensión.

Fibrosarcoma primario de ovario. Reporte de una neoplasia inusual / Primary ovarian fibrosarcoma. Report of an unusual neoplasm

Introducción: El fibrosarcoma ovárico es un tumor maligno del estroma ovárico muy infrecuente, con pocos casos reportado en la literatura. Principales síntomas o hallazgos clínicos: Mujer de 56 años posmenopáusica, con sangrado vaginal escaso de varios días de evolución y dolor en fosa ilíaca derecha sin fiebre ni clínica digestiva. La exploración ginecológica era normal.Diagnósticos principales, intervenciones terapéuticas y resultados: La ecografía transvaginal mostró un endometrio homogéneo, un mioma de 2,4×1cm y una lesión sólido-quística heterogénea de tabiques gruesos de 6,4×6,8cm en el ovario izquierdo. El estudio histológico intraoperatorio se informó como: neoplasia sólida sospechosa de malignidad. Se le realizó histerectomía más doble anexectomía, omentectomía y linfadenectomía. Histológicamente la neoplasia estaba constituida por células fusiformes dispuestas en láminas y fascículos entrecruzados con apariencia difusa en espiga, con atipia nuclear moderada, áreas de necrosis y focos de hemorragia. Se identificaron 12 mitosis por 10 campos de gran aumento. Inmunohistoquímicamente las células fueron positivas para inhibina, actina 1A4, vimentina, calretinina, CD56 y CD99. El índice proliferativo con Ki-67 fue del 25%. El diagnosticó definitivo fue: fibrosarcoma primario de ovario. Un año después, la paciente se encontraba libre de enfermedad sin ninguna terapia adyuvante y continúa en seguimiento. Conclusión: El fibrosarcoma de ovario es una neoplasia maligna excepcional de mal pronóstico. En la actualidad, los tratamientos y factores pronósticos del fibrosarcoma ovárico siguen siendo discutibles. El presente caso destaca el importante papel del estudio intraoperatorio y la inmunohistoquímica para su correcto diagnóstico.(AU)

Introduction: Ovarian fibrosarcoma is an extremely rare malignant ovarian stromal tumor, with few cases reported in the literature. Main symptoms and/or clinical findings: A 56-year-old posmenopausal woman with scant vaginal bleeding of several days’ duration and pain in the right iliac fossa without fever or digestive symptoms. The gynecological examination was normal. Main diagnoses, therapeutic interventions and results: Transvaginal ultrasound showed a homogeneous endometrium, a 2.4×1cm myoma, and a heterogeneous solid-cystic lesion with thick septa measuring 6.4×6.8cm in the left ovary. An intraoperative histological study was performed, which was reported as: solid neoplasm suspicious of malignancy. Hysterectomy plus double adnexectomy, omentectomy, and lymphadenectomy were performed. Histologically, the neoplasm was made up of spindle cells arranged in sheets and intertwined fascicles with a diffuse spike-like appearance, with moderate nuclear atypia, areas of necrosis and hemorrhage foci; 12 mitoses were identified for every 10 high-power fields. Immunohistochemically the cells were positive for inhibin, actin 1A4, vimentin, calretinin, CD56 and CD99. The proliferative rate with Ki-67 was 25%. The definitive diagnosis was: primary ovarian fibrosarcoma. One year later, the patient is free of the disease without any adjuvant treatment and continues to be followed up. Conclusion: Ovarian fibrosarcoma is an exceptional malignancy with a poor prognosis. Currently, the treatments and prognostic factors for ovarian fibrosarcoma are still the subject of debate. This case highlights the important role of the intraoperative study and immunohistochemistry for its correct diagnosis.(AU)

Síndrome de ovario remanente. Revisión bibliográfica. Evidencia actual / Ovarian remnant syndrome. Literature review. The latest evidence

El síndrome de ovario remanente supone la persistencia de corteza ovárica por su resección incompleta, principalmente tras ooforectomía o anexectomía. Es una entidad infradiagnosticada que afecta de forma importante a las pacientes. Se produce principalmente en endometriosis, enfermedad pélvica inflamatoria o cirugías reiteradas. Nuestro objetivo es revisar la evidencia disponible para determinar su forma de presentación, diagnósticos diferenciales, tratamiento y estrategias preventivas. Para ello, hemos realizado una búsqueda bibliográfica de literatura a través de PubMed, Medline, Embase, BioMed Central y SciELO. Concluimos en que esta patología se debe incluir en el diagnóstico diferencial en pacientes con dolor pélvico crónico que hayan sido intervenidas de ooforectomía. Su tratamiento es principalmente quirúrgico, siendo la laparoscopia el gold standard al permitir una mayor exposición anatómica, menor pérdida sanguínea, estancia hospitalaria y tasa de complicaciones. El aislamiento en el espacio retroperitoneal del ligamento infundíbulo-pélvico durante la ooforectomía es la principal maniobra para prevenir su aparición.(AU)

Remnant ovarian syndrome is the persistence of ovarian cortex after a deficient resection, mainly after oophorectomy. It is a misdiagnosed condition that significantly affects patients. It is typical from endometriosis, pelvic inflammatory disease or previous multiple surgeries. Our objectives are to review the current evidence to determine clinic features, differential diagnosis, treatment and preventive strategies. For this, we have carried out a bibliographic literature search through the PubMed, Medline, Embase, BioMed Central and SciELO databases.We conclude that this pathology should be included in the differential diagnosis in patients with chronic pelvic pain who have undergone oophorectomy. Its treatment is surgical, being the laparoscopic approach the gold standard. It allows a better anatomic exposure, with lower blood loss, complication rate and hospital stay. Isolating the infundibulopelvic ligament in the retroperitoneal space during the oophorectomy is the main strategy to prevent this complication.(AU)

Contribución de PET/CT a la diferenciación de derrame pleural benigno y maligno en pacientes con cáncer de ovario / The contribution of PET/CT to the differentiation of benign and malignant pleural effusion in patients with ovarian carcinoma

Objetivo En nuestro estudio el objetivo fue investigar la contribución de los hallazgos de la tomografía por emisión de positrones (PET)/tomografía computarizada (TC) en la diferenciación no invasiva entre el derrame pleural (DP) de origen benigno (DPB) y maligno (DPM) en pacientes diagnosticadas de un carcinoma de ovario (CO). Material y método Se incluyeron en el estudio a 32 pacientes diagnosticadas de CO con DP. Se efectuó análisis comparativo entre el DPB y el DPM para los siguientes parámetros: SUVmáx. del DP, índice objeto/fondo (TBRp: target/background ratio) del DP, dividiendo el SUVmáx. del DP por el SUVmedio del flujo sanguíneo mediastínico (MBP: medistinal blood pool), engrosamiento pleural, adenopatías supradiafragmáticas, DP unilateral o bilateral, diámetro del DP, edad de la paciente y niveles de CA125. Resultados La edad media de las 32 pacientes fue de 57±2,8 años. Se observó mayor frecuencia significativa de un TBRp>1,1, engrosamiento pleural y ganglios linfáticos supradiafragmáticos en el DPM respecto al DPB. Aunque no se detectó ningún nódulo pleural en las pacientes con DPB, estos estuvieron presentes en 7 pacientes con DPM. En la distinción DMP-DBP la sensibilidad del TBRp fue del 95,2% y la especificidad del 72,7%, la sensibilidad del engrosamiento pleural fue del 80,9%, y la especificidad del 81,8%, la sensibilidad de los ganglios linfáticos supradiafragmáticos fue del 38% y la especificidad del 90,9%, y la sensibilidad del nódulo pleural fue del 33,3% y la especificidad del 100%. No hubo diferencias significativas entre los 2 grupos respecto al resto de factores. Conclusión El engrosamiento pleural y el valor de TBRp determinados en la PET/TC pueden contribuir a la diferenciación entre DMP y DBP, especialmente en aquellas pacientes con CO en estadio avanzado y mal estado general, o que no son tributarias de ser sometidas a tratamiento quirúrgico (AU)

Objective The present study investigates the ability of non-invasive contribution of positron emission tomography (PET)/computed tomography (CT) to distinguish between benign pleural effusions (BPE) and malignant pleural effusions (MPE) in patients diagnosed with ovarian carcinoma (OC). Material and method Included in the study were 32 OC patients with a PE diagnosis. The cases with BPE and MPE were compared in terms of the PE maximum standardized uptake value (SUVmax), PE SUVmax/mean standardized uptake (SUVmean) value of the mediastinal blood pool (TBRp), the presence of pleural thickening, the presence of supradiaphragmatic lymph node, unilateral or bilateral PE, pleural effusion diameter, patient age and CA125 value. Results The mean age of the 32 patients was 57±2.8 years. TBRp>1.1, pleural thickening and supradiaphragmatic lymph node were observed significantly more frequently in the MPE than the BPE cases. While no pleural nodules were detected in patients with BPE, they were present in 7 of the patients with MPE. The rates of distinction between the MPE and BPE cases were as follows: the sensitivity of the TBRp value was 95.2% and specificity was 72.7%; the sensitivity of pleural thickness was 80.9% and specificity was 81.8%; the sensitivity of supradiaphragmatic lymph node was 38% and specificity was 90.9%; and the sensitivity of the pleural nodule was 33.3% and specificity was 100%. There were no significant differences between two groups in any other factors. Conclusion Pleural thickening and TBRp values ascertained through PET/CT may aid the distinction between MPE-BPE, especially in patients with advanced stage OC with a poor general condition, or those who cannot undergo surgery (AU)

Systemic Inflammatory Patterns in Ovarian Cancer Patients: Analysis of Cytokines, Chemokines, and Microparticles / Padrões inflamatórios sistêmicos em pacientes com câncer de ovário: Análise de citocinas, quimiocinas e micropartículas

Abstract Objective To compare the patterns of systemic inflammatory response in women with epithelial ovarian cancer (EOC) or no evidence of malignant disease, as well as to evaluate the profile of systemic inflammatory responses in type-1 and type-2 tumors. This is a non-invasive and indirect way to assess both tumor activity and the role of the inflammatory pattern during pro- and antitumor responses. Materials and Methods We performed a prospective evaluation of 56 patients: 30 women without evidence of malignant disease and 26 women with EOC. The plasma quantification of cytokines, chemokines, and microparticles (MPs) was performed using flow cytometry. Results Plasma levels of proinflammatory cytokines interleukin-12 (IL12), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α) interleukin-1 beta (IL-1β), and interleukin-10 (IL-10), and C-X-C motif chemokine ligand 9 (CXCL-9) and C-X-C motif chemokine ligand 10 (CXCL-10) were significantly higher in patients with EOC than in those in the control group. Plasma levels of cytokine interleukin-17A (IL-17A) and MPs derived from endothelial cells were lower in patients with EOC than in the control group. The frequency of leukocytes and MPs derived from endothelial cells was higher in type-2 tumors than in those without malignancy. We observed an expressive number of inflammatory/regulatory cytokines and chemokines in the cases of EOC, as well as negative and positive correlations involving them, which leads to a higher complexity of these networks. Conclusion The present study showed that, through the development of networks consisting of cytokines, chemokines, and MPs, there is a greater systemic inflammatory response in patients with EOC and a more complex correlation of these biomarkers in type-2 tumors.

Resumo Objetivo Comparar os padrões de resposta inflamatória sistêmica em mulheres com câncer epitelial de ovário (CEO) ou sem evidência de doença maligna, bem como avaliar o perfil de respostas inflamatórias sistêmicas em tumores dos tipos 1 e 2. Esta é uma forma não invasiva e indireta de avaliar tanto a atividade tumoral quanto o papel do padrão inflamatório durante as respostas pró- e antitumorais. Métodos Ao todo, 56 pacientes foram avaliados prospectivamente: 30 mulheres sem evidência de doença maligna e 26 mulheres com CEO. A quantificação plasmática de citocinas, quimiocinas e micropartículas (MPs) foi realizada por citometria de fluxo. Resultados Os níveis plasmáticos das citocinas pró-inflamatórias interleucina-12 (IL12), interleucina-6 (IL-6), fator de necrose tumoral alfa (tumor necrosis factor alpha, TNF-α, em inglês), interleucina-1 beta (IL-1β), e interleucina-10 (IL-10), e da quimiocina de motivo C-X-C 9 (CXCL-9) e da quimiocina de motivo C-X-C 10 (CXCL-10) foram significativamente maiores em pacientes com EOC do que nos controles. Os níveis plasmáticos da citocina interleucina-17A (IL17A) e MPs derivados de células endoteliais foram menores em pacientes com CEO do que no grupo de controle. A frequência de leucócitos e de MPs derivadas de células endoteliais foi maior nos tumores de tipo 2 do que naqueles sem malignidade. Observou-se um número expressivo de citocinas e quimiocinas inflamatórias/regulatórias nos casos de CEO, além de correlações negativas e positivas entre elas, o que leva a uma maior complexidade dessas redes. Conclusão Este estudo mostrou que, por meio da construção de redes compostas por citocinas, quimiocinas e MPs, há maior resposta inflamatória sistêmica em pacientes com CEO e correlação mais complexa desses biomarcadores em tumores de tipo 2.

Cistoadenofibroma de ovario / Ovarian cystadenofibroma

El cistoadenofibroma ovárico es un tumor benigno poco frecuente y se caracteriza por un patrón bifásico compuesto por componentes epiteliales y estromales; actualmente se desconocen los factores de riesgo asociados, aunque las mujeres obesas y las menopáusicas que consumen terapia de reemplazo hormonal tienen un mayor riesgo. Se presentó una adolescente de 17 años de edad, evaluada en consulta externa dos años antes, por un quiste de ovario izquierdo; recibió tratamiento hormonal sin resultados satisfactorios. Se le practicaron exámenes de analítica sanguínea y estudios de imagen. Con la administración de anestesia regional epidural continua se realizó anexectomía izquierda, se confirmó mediante estudio histológico, un cistoadenofibroma seroso de ovario. El objetivo del tratamiento en estas pacientes es la remoción quirúrgica completa de la lesión ante el riesgo de malignización; este tratamiento quirúrgico fue fundamental y la evolución fue favorable, tuvo un periodo de recuperación de corta duración y muy positivo.

Ovarian cystadenofibroma is a rare benign tumour characterized by a biphasic pattern made up of epithelial and stromal components; associated risk factors are currently unknown, although obese and menopausal women taking hormone replacement therapy are at increased risk. We present a 17-year-old female adolescent who was evaluated in an outpatient clinic two years earlier due to a left ovarian cyst. She received hormonal treatment without satisfactory results. She underwent blood analysis tests and imaging studies. Left adnexectomy was performed with the administration of continuous epidural regional anesthesia, and a serous ovarian cystadenofibroma was confirmed by histological study. The goal of treatment in these patients is the complete surgical removal of the lesion given the risk of malignancy; this surgical treatment was fundamental and the evolution was favourable. She had a short and very positive recovery period.

Diagnóstico y tratamiento del síndrome de ovario poliquístico

El síndrome de ovario poliquístico es un trastorno endocrino-genético-ginecológico que afecta principalmente a mujeres en edad fértil, con manifestaciones de hiperandrogenismo e infertilidad en etapas tempranas de la vida. Este trabajo tiene por objetivo describir el diagnóstico y tratamiento del síndrome de ovario poliquístico. cuya fisiopatología no ha sido del todo comprendida, de ahí que su diagnóstico continúe siendo por exclusión. Los criterios del consenso de Rotterdam han logrado mejorar la uniformidad diagnóstica; sin embargo, se hace necesario un diagnóstico individualizado, en el cual debe incluirse el estudio de la morfología de los ovarios. Aunque la literatura sugiere la asociación de esta entidad con la presencia de obesidad, resistencia a la insulina e hiperinsulinismo, no se incluyen como parte de los criterios diagnósticos actualmente. El tratamiento incluye cambios en los estilos de vida, unidos a inhibidores de la producción de andrógenos por los ovarios, inhibidores de la acción de los andrógenos y los sensibilizadores a la insulina; se establecerá según los intereses reproductivos de la paciente.

Polycystic ovary syndrome is an endocrine-genetic-gynecological disorder that mainly affects women of childbearing age, with manifestations of hyperandrogenism and infertility in early stages of life. This work aims to describe the diagnosis and treatment of polycystic ovary syndrome whose pathophysiology has not been fully understood, hence its diagnosis continues to be by exclusion. The Rotterdam consensus criteria have managed to improve diagnostic uniformity; however, an individualized diagnosis is necessary, which must include the study of the morphology of the ovaries. Although the literature suggests the association of this entity with the presence of obesity, insulin resistance and hyperinsulinism, they are not currently included as part of the diagnostic criteria. Treatment includes changes in lifestyle, together with inhibitors of androgen production by the ovaries, inhibitors of androgen action and insulin sensitizers; It will be established according to the patient´s reproductive interests.

Concept of opportunistic bilateral salpingectomy in a sample of Mexican gynecologists. What should residents be trained on? / Concepto de salpingectomía bilateral oportunista en una muestra de ginecólogos mexicanos. ¿En qué se debe capacitar a los residentes?

Background: Ovarian cancer is the fifth deadliest cancer among women. There is no effective screening method. It has been suggested that ovarian cancer originates from precursor lesions in the fimbriae of the fallopian tubes. Objective: The aim of this study was to determine the level of knowledge of opportunistic bilateral salpingectomy by gynecologists. Methods: A cross-sectional study was carried out and a survey was sent electronically to gynecologists and gynecology residents. Demographic characteristics as well as questions of interest related to clinical practice and indication for surgery were included. Results: 52 subjects were included, 21 women and 31 men, with a mean age of 40.7 years. Thirty-five board certified gynecologists, as well as 17 gynecology residents, were included as part of the total survey group. Thirty-six individuals (69.2%) reported performing elective salpingectomy. The motivation they had to perform salpingectomy as a method of sterilization was: “reduction in the risk of ovarian cancer in the future” (55.6%). The indication for elective salpingectomy while performing other procedures was: “to prevent ovarian cancer” (61.1%). Certified gynecologists (42.9%) as well as residents (41.1%) considered “transvaginal ultrasound screening” as the best primary prevention method for ovarian cancer in low-risk women. Conclusions: Opportunistic bilateral salpingectomy is safe and cost-effective. However, when gynecologists are interviewed to find out their level of knowledge, there is poor acceptance of opportunistic bilateral salpingectomy in Mexico. A training strategy should be designed in the gynecology residency in order to motivate ovarian cancer prevention.(AU)

Antecedentes: El cáncer de ovario es el quinto cáncer más mortal entre las mujeres. No existe un método de detección eficaz. Se ha sugerido que el cáncer de ovario se origina a partir de lesiones precursoras en las fimbrias de las trompas de Falopio. Objetivo: Determinar el nivel de conocimiento de los ginecólogos sobre la salpingectomía bilateral oportunista. Métodos: Se envió una encuesta por vía electrónica a médicos ginecólogos y residentes de Ginecología. Se incluyeron características demográficas, así como preguntas de interés relacionadas con la práctica clínica y la indicación de cirugía. Resultados: Se incluyeron 52 sujetos, 21 mujeres y 31 hombres, con una edad media de 40,7 años. Treinta y cinco ginecólogos certificados, así como 17 residentes de ginecología, se incluyeron como parte del grupo total. Treinta y seis individuos (69,2%) informaron haber realizado salpingectomía electiva. La motivación que tuvieron para realizar la salpingectomía como método de esterilización fue: «reducción del riesgo de cáncer de ovario en el futuro» (55,6%). La indicación de salpingectomía electiva mientras se realizaban otros procedimientos fue: «para prevenir el cáncer de ovario» (61,1%). Los ginecólogos certificados (42,9%) y los residentes (41,1%) consideraron la «detección con ultrasonido transvaginal» como el mejor método de prevención primaria para el cáncer de ovario en mujeres de bajo riesgo. Conclusiones: Cuando entrevistamos a los ginecólogos detectamos poca aceptación de la salpingectomía bilateral oportunista en México. Se debe diseñar una estrategia de formación en la residencia de Ginecología para motivar la prevención del cáncer de ovario.(AU)

Sclerosing stromal tumor of the ovary: Two case reports and literature review / Tumor estromal esclerosante de ovario: reporte de 2 casos clínicos y revisión de la literatura

Introduction: Sclerosing stromal tumors (SSTs) are rare benign ovarian tumors. They represent 6% of sex cord stromal tumors. Its preoperative diagnosis is often a challenge due to its similarity to malignant tumors on ultrasound imaging. We present two cases of SSTs to emphasize the consideration of this type of tumors in the differential diagnosis of solid adnexal masses in young women. A review of the literature on the typical ultrasound features, clinical presentation, and management of SSTs was performed. Main symptoms and/or clinical findings: Pelvic pain was the main symptom in both cases. In the first case, transvaginal ultrasound revealed an unilocular solid adnexal mass of 59mm×44mm×45mm with cystic areas and marked peripheral and central vascularization. MRI (magnetic resonance imaging) revealed a 50mm×50mm heterogeneous adnexal mass with a solid peripheral component and a cystic-necrotic center. In the second case, pelvic ultrasound showed a solid cystic adnexal mass of 103mm×77mm with marked peripheral vascularity. Main diagnoses: Postoperative anatomopathological diagnosis in both cases was an ovarian SST.Therapeutic interventions and results. Unilateral laparoscopic salpingo-oophorectomy and oophorectomy, respectively, was performed without incidents. There has been no recurrence during follow-up.Conclusion: It is important to consider SSTs in the differential diagnosis of young women with a unilateral solid-cystic adnexal mass with a high degree of peripheral and central vascularization. Laparoscopic approach together with fertility-sparing techniques should be considered the treatment of choice.(AU)

Introducción: Los tumores esclerosantes del estroma (SST) son tumores benignos raros del ovario. Representan un 6% de los tumores del estroma de los cordones sexuales. Su diagnóstico preoperatorio suele ser un desafío por su similitud ecográfica con los tumores malignos. Presentamos 2 casos de SST para enfatizar la consideración de este tipo de tumores en el diagnóstico diferencial de masas anexiales sólidas en mujeres jóvenes. Se realizó una revisión de la literatura sobre las características ecográficas típicas, la presentación clínica y el manejo de los SST. Principales síntomas y/o hallazgos clínicos: El dolor pélvico fue el síntoma principal en ambos casos. En el primer caso, la ecografía transvaginal reveló una masa anexial unilocular sólida de 59×44×45mm con áreas quísticas y marcada vascularización periférica y central. La resonancia magnética nuclear reveló una masa anexial heterogénea de 50×50mm con componente sólido periférico y un centro quístico-necrótico. En el segundo caso, la ecografía pélvica mostró una masa anexial sólido quística de 103×77mm con marcada vascularización periférica. Diagnósticos principales: El diagnóstico anatomopatológico postoperatorio en ambos casos fue de un SST de ovario.Intervenciones terapéuticas y resultados: Se realizó ooforectomía y salpingooforectomía unilateral laparoscópica, respectivamente, sin incidencias. No se ha producido recidiva durante el seguimiento. Conclusión: Es importante considerar los SST en el diagnóstico diferencial ante mujeres jóvenes con una masa anexial sólido-quística unilateral con un alto grado de vascularización periférica y central. El abordaje laparoscópico junto con técnicas preservadoras de fertilidad deben ser consideradas el tratamiento de elección.(AU)

Fallo ovárico, una problemática para las mujeres en edad reproductiva y su relación genética / Ovarian failure, a problem for women in reproductive age and its genetic relationship

La insuficiencia ovárica primaria es una condición en la que las mujeres menores de 40años experimentan oligomenorrea o amenorrea durante 4meses o más; esta pérdida temprana de la función ovárica puede estar relacionada con una serie de etiologías, incluidos trastornos genéticos, autoinmunes, infecciones o causas iatrogénicas; no obstante, del 74 al 90% son idiopáticas. A pesar de ser una alteración poco prevalente, es de gran importancia clínica, ya que afecta en múltiples aspectos de la vida a todas las mujeres. En la actualidad se están desarrollando diferentes estudios con el fin de encontrar nuevos blancos moleculares para establecer nuevas terapias para el tratamiento de esta patología.(AU)

Primary ovarian failure is a condition in which women under 40 experience oligomenorrhea or amenorrhea for 4months or longer; this early ovarian function loss may be related to a series of etiologies, including genetic disorders, autoimmune diseases, infections or iatrogenic causes; however 74%-90% are idiopathic. Despite being a less prevalent disorder, it is of great clinical importance since it affects all women in multiple aspects of life. At present, different studies are being developed in order to find new molecular targets to establish new therapies for the treatment of this pathology.(AU)

Desfechos reprodutivos e de sobrevida em adolescente tratada com cirurgia preservadora de fertilidade por tumor borderline de ovário em estádio avançado: relato de caso e revisão da literatura / Reproductive and survival outcomes in an adolescent treated with fertility- sparing surgery for advanced stage borderline ovarian tumor: case report and review of the literature

Existem poucos dados na literatura sobre os resultados obstétricos e oncológicos de adolescentes com tumores borderline de ovário em estádio avançado trata- das com cirurgia preservadora da fertilidade. Uma adolescente de 15 anos com diagnóstico de tumor borderline de ovário estádio IIIc foi inicialmente tratada com tumorectomia ovariana bilateral e quimioterapia adjuvante com esquema de platina/taxano (seis ciclos). Durante o seguimento, foi submetida a outras três tumorectomias devido a tumor borderline de ovário (duas vezes) e cistadenoma ovariano (uma vez). Outra recidiva de tumor borderline de ovário ocorreu seis anos após o diagnóstico inicial, quando ela estava grávida; foi tratada com tumorecto- mia realizada durante a cesariana. Em sua última consulta ambulatorial, a mulher de 27 anos não apresentava evidência da doença e tinha um filho saudável. Mesmo em estádio avançado, a cirurgia de preservação da fertilidade foi segura e factível nessa paciente com tumor borderline de ovário.

There are few data in the literature regarding obstetric and oncological outcomes of adolescents with advanced-stage borderline ovarian tumors treated with fertility spa- ring surgery. A 15 years old adolescent who was diagnosed with a stage IIIc borderline ovarian tumor, was treated with bilateral ovarian tumorectomies and adjuvant chemotherapy with platinum/taxane regimen (six cycles). During follow up she was submitted to other three tumorectomies due to borderline ovarian tumor(twice) and ovarian cysta- denoma (once). Another borderline ovarian tumorrecurren- ce occurred six years after initial diagnosis, when she was pregnant; treated with tumorectomy performed during ce- sarean section. At her last outpatient visit, the 27-year-old woman had no evidence of disease and a had healthy child. Even at an advanced stage, fertility sparing surgery was safe and feasible in this patient with borderline ovarian tumor.

Linfoma no Hodgkin difuso de células B grande como linfoma primario de ovario. Presentación de caso / Diffuse large B-cell non-Hodgkin's lymphoma as primary ovarian lymphoma. Case presentation

Fundamento: Los linfomas primarios de ovario son poco frecuentes; el 1 % de estos se presenta en ovario y el 1.5 % de los tumores malignos de ovario son linfomas. Los tipos histológicos más frecuentes es el linfoma no Hodgkin difuso de células B grande y el BurKitt; el tratamiento consiste en cirugía combinada con quimioterapia. Objetivo: Reportar un caso de un linfoma no Hodgkin difuso de células B grande primario de ovario. Presentación de caso: Se presentó el caso de una paciente de 39 años de edad, con antecedentes patológicos personales de salud; la cual fue al cuerpo de guardia de ginecología por presentar dolor abdominal difuso que no se aliviaba con analgésicos. En la exploración física presentaba dolor a la palpación superficial y profunda en hipocondrio y fosa ilíaca derecha con masa tumoral palpable. Ecografía hacia proyección anexial derecha se observó una imagen de baja ecogenicidad y en la laparoscopia de urgencia se concluyó como una formación de aspecto tumoral que parecía corresponderse con ovario derecho. Se le realizó una histerectomía con doble anexectomía. El diagnóstico anatomopatológico fue un linfoma no Hodgkin primario de ovario. Conclusiones: La paciente del caso presentado tuvo una clínica oligosintomática y la confirmación de la enfermedad fue a partir de una muestra quirúrgica, lo que expresa que el diagnóstico del linfoma no Hodgkin de células B es difícil y aunque es poco frecuente siempre se debe tener en cuenta en el diagnóstico diferencial de las tumoraciones unilaterales de ovario.

Background: Primary ovarian lymphomas are uncommon, 1% of these malignancies occur in the ovary, and 1.5% of all ovarian malignancies are lymphomas. The most common histologic types are diffuse large B-cell non-Hodgkin's lymphoma and BurKitt's lymphoma; treatment consists of surgery combined with chemotherapy. Objective: To report a case of primary ovarian diffuse large B-cell non-Hodgkin lymphoma. Case presentation: A 39-year-old female case is presented, with a personal pathological history; she went to the gynecology emergency service because she presented diffuse abdominal pain that was not relieved by analgesics. Physical examination revealed superficial and deep pain on palpation in the hypochondrium and right illiac fossa with a palpable tumor mass. Right adnexal ultrasound showed an image of low echogenicity and at the emergency laparoscopy, it was diagnosed as a tumor-like formation that appeared to correspond to the right ovary. She underwent a hysterectomy with double adnexectomy. The anatomopathologic diagnosis was primary ovarian non-Hodgkin's lymphoma. Conclusions: The patient in the presented case had an oligosymptomatic clinical presentation. Confirmation of the disease was obtained from a surgical sample, which means that B-cell non-Hodgkin's lymphoma is difficult to diagnose and although it is uncommon, it should always be considered in the differential diagnosis of unilateral ovarian tumors.

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.

Frecuencia de la sintomatología del síndrome de ovario poliquístico y el síndrome premenstrual, relacionado con el estrés académico en estudiantes de medicina de una Universidad Privada del Perú

Introducción: El síndrome de ovario poliquístico y el síndrome premenstrual son prevalentes. Objetivo: Determinar la frecuencia de la sintomatología del síndrome de ovario poliquístico y del síndrome pre menstrual y su relación con el estrés en estudiantes de medicina. Material y métodos: Estudio analítico transversal. La población de estudio fue de 322 estudiantes de medicina del primer al sexto año, elegidas por conveniencia de una universidad privada de Trujillo. Mediante un formulario de google se aplicó el cuestionario "SPM", "el inventario SISCO del Estrés académico", y "el cuestionario sobre ovario poliquístico"; previo conocimiento informado, tuvo la aprobación del Comité de Bioética de la universidad. Resultados: El SOP presentó una probabilidad alta de 5,28%, media de 46,58% y baja de 48,13%. La frecuencia del SPM en los niveles, leve, moderado y alto fueron de 47,52%, 25,47% y 4,04% respectivamente. Los niveles de estrés fueron: leve, moderado y profundo de 4,35%, 65,22% y 30,43%, respectivamente. Se encontró asociación altamente significativa entre el estrés y SPM; estrés y SOP; p= 0,000915106 y p= 1.8589E-25 respectivamente. Conclusiones: La frecuencia de SPM, la probabilidad alta de SOP y los niveles de estrés fueron altos y existe asociación significativa entre el estrés, SPM y SOP.

Introduction: Polycystic ovarian syndrome and premenstrual syndrome are prevalent. Objective: to determine the frequency of the symptoms of polycystic ovarian syndrome and premenstrual syndrome and its relationship with stress in medical students. Methods: Cross-sectional analytical study. The study population was 322 medical students from the first to the sixth year, chosen for convenience from a private university in Trujillo. Using a google form, the "SPM" questionnaire, "the SISCO inventory of academic stress", and "the polycystic ovary questionnaire" were applied; prior informed knowledge, it had the approval of the Bioethics Committee of the university. Results: The SOP presented a high probability of 5.28%, a medium of 46.58% and a low of 48.13%.The frequency of PMS at the levels, mild, moderate and high were 47.52%, 25.47% and 4 04% respectively.The levels of stress were: mild, moderate and deep of 4.35%, 65.22% and 30.43%, respectively.A highly significant association was found between stress and SPM, stress and PCOS, p = 0.000915106 and p= 1.8589E-25 respectively. Conclusions: The frequency of PMS, the high probability of SOP and the stress levels were high and there is a significant association between stress, SPM and SOP.

The Efficacy of Metformin and Exenatide in Polycystic Ovary Syndrome (PCOS) Patients / La eficacia de metformina y exenatida en pacientes con síndrome de ovario poliquístico (SOP)

Introducción: El Síndrome del Ovario Poliquístico (SOP) es un trastorno hormonal que afecta al 5-10% de las mujeres que se encuentran en edad reproductiva. este metanálisis tiene como objetivo evaluar la eficacia de la metformina y la exenatida, respectivamente, y comparar la eficacia de ambos fármacos utilizando el Índice de Masa Corporal (IMC), el colesterol de lipoproteínas de baja densidad (LDL-C), el colesterol de lipoproteínas de alta densidad (HDL-C) y los niveles de testosterona. Método: En este estudio se consultaron Scopus, Science Direct, Oxford Journal, Wiley Online Library y Medline a través del motor de búsqueda PubMed. El análisis estadístico de los estudios incluidos se realizó mediante el software RevMan 5.4. Resultados: Hubo 6 estudios incluidos en el análisis del estudio. Hubo una reducción significativa en el IMC de las pacientes con SOP con exenatida frente a metformina (diferencia de medias = 0,51; intervalo de confianza (IC) del 95 % = 0,07; 0,96; I 2 = 52 %; p = 0,02). También hubo una reducción significativa en el nivel de testosterona de los pacientes con SOP con exenatida frente a metformina (diferencia de medias = 0,15; intervalo de confianza (IC) del 95 % = 0,07; 0,22;I 2 = 0 %; p = 0,0002). No hubo efecto sobre la media de LDL-C y de HDL-C cuando se comparó entre metformina y exenatida. Este muestra que la exenatida es eficaz para reducir el IMC y los niveles de testosterona en pacientes con SOP. Conclusiones: Hubo una reducción significativa en el IMC y los niveles de testosterona de los pacientes con SOP cuando se usó exenatida en comparación con metformina. Sin embargo, no hubo efecto sobre la media de los niveles de LDL-C y HDL-C de las pacientes con SOP. (AU)

Introduction: Polycystic Ovary Syndrome (PCOS) is a hormonal disorder that affects 5-10% of women who are their reproductive age. This meta-analysis aims to evaluate the efficacy of metformin and exenatide, respectively, and to compare the efficacy of both drugs using Body Mass Index (BMI), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and testosterone level. Method: Scopus, Science Direct, Oxford Journal, Wiley Online Library, and Medline (through the PubMed search engine) were used in this study. Statistical analysis of the included studies was done using the RevMan 5.4 software. Results: There were 6 studies included in the analysis of the study. There was a significant reduction in BMI of PCOS patients with exenatide versus metformin (mean difference = 0.51; 95% confidence interval (CI)= 0.07, 0.96, I 2= 52%; p=0.02). There was also a significant reduction in the testosterone level of PCOS patients with exenatide versus met-formin (mean difference = 0.15; 95% confidence interval (CI)= 0.07, 0.22, I 2= 0%; p=0.0002). There was no effect on the mean of LDL-C and of HDL-C when compared between metformin and exenatide This meta-analysis shows that exenatide is effective in reducing BMI and testosterone levels in PCOS patients. Conclusions: There were a significant reduction in BMI and testosterone levels of PCOS patients when exenatide was used as compared to metformin. However, there was no effect on the mean of the LDL-C and HDL-C levels of the PCOS patients. (AU)

La visión de los profesionales sanitarios del proceso diagnóstico de las mujeres con cáncer de ovario en Catalunya: estudio cualitativo / Health professionals’ perspective about women's experiences during the diagnostic process of ovarian cancer in Catalonia: Qualitative study

Objetivo: Identificar las oportunidades perdidas en el diagnóstico del cáncer de ovario (CO) en el sistema sanitario público de Catalunya mediante el análisis de la visión de los profesionales sobre el relato de las experiencias de las pacientes con CO. Diseño: Estudio cualitativo exploratorio-descriptivo, con dos grupos focales. Emplazamiento: Atención primaria, noviembre de 2017. Participantes: Treinta y cuatro profesionales en base a un muestreo teórico: 21médicos de familia, 8profesionales de centros de salud sexual y reproductiva y 5ginecólogos de hospital. Métodos: Los participantes debatieron sobre diferentes itinerarios de procesos diagnósticos de mujeres con CO mediante la exposición de tres flujogramas elaborados a partir de los relatos obtenidos en entrevistas a pacientes. Se realizó un análisis de contenido temático. Resultados: Se identificaron tres temas con diversos subtemas: a)falta de sospecha diagnóstica (desconocimiento de los síntomas, obviar la anamnesis y la exploración física, fragmentación de la atención y sesgos y prejuicios); b)dificultades para activar el proceso diagnóstico (acceso limitado a pruebas, accesibilidad desigual a ginecología y falta de seguimiento), y c)ausencia de circuitos rápidos preestablecidos. Conclusiones: Los resultados ofrecen una visión de las dificultades del diagnóstico precoz del CO en nuestro ámbito. Creemos que su identificación permitirá la elaboración de estrategias para mejorar la precisión diagnóstica y la calidad de la atención en las mujeres con CO en nuestro medio.(AU)

Objective: To identify missed opportunities in the diagnosis of ovarian cancer (OC) in the public health system of Catalonia, through the analysis of the perceptions of health professionals on the stories's experiences of OC patients. Design: Qualitative exploratory-descriptive study, with two focus groups. Setting: Primary Care, November 2017. Participants: Thirty-four professionals based on theoretical sampling: 21 family doctors, 8 professionals from sexual and reproductive health centres and 5 hospital gynaecologists. Methods: Participants discussed the different diagnostic pathways for women with OC through the presentation of flowcharts which were developed with three storie's and experiences of OC patients. Results: Three themes with various sub-themes were identified as follow: a)lack of cancer diagnostic suspicion (lack of knowledge of symptoms of OC, anamnesis and physical examination overlooked, fragmentation of patient's care and bias and prejudice); b)difficulties in activating the diagnostic process (limited access to tests, unequal accessibility to gynaecology and lack of follow-up); and c)absence of fast-track referral system.Conclusions: The results offer insight into the difficulties of early diagnosis of OC in our setting. We believe that their identification will allow the development of strategies to improve diagnostic accuracy and quality of care for women with OC in our setting.(AU)

The contribution of PET/CT to the differentiation of benign and malignant pleural effusion in patients with ovarian carcinoma.

OBJECTIVE: The present study investigates the ability of non-invasive contribution of positron emission tomography (PET)/computed tomography (CT) to distinguish between benign pleural effusions (BPE) and malignant pleural effusions (MPE) in patients diagnosed with ovarian carcinoma (OC). MATERIAL AND METHODS: Included in the study were 32 OC patients with a PE diagnosis. The cases with BPE and MPE were compared in terms of the PE maximum standardized uptake value (SUVmax), PE SUVmax/mean standardized uptake (SUVmean) value of the mediastinal blood pool (TBRp), the presence of pleural thickening, the presence of supradiaphragmatic lymph node, unilateral or bilateral PE, pleural effusion diameter, patient age and CA125 value. RESULTS: The mean age of the 32 patients was 57±2.8 years. TBRp>1.1, pleural thickening and supradiaphragmatic lymph node were observed significantly more frequently in the MPE than the BPE cases. While no pleural nodules were detected in patients with BPE, they were present in 7 of the patients with MPE. The rates of distinction between the MPE and BPE cases were as follows: the sensitivity of the TBRp value was 95.2% and specificity was 72.7%; the sensitivity of pleural thickness was 80.9% and specificity was 81.8%; the sensitivity of supradiaphragmatic lymph node was 38% and specificity was 90.9%; and the sensitivity of the pleural nodule was 33.3% and specificity was 100%. There were no significant differences between two groups in any other factors. CONCLUSIONS: Pleural thickening and TBRp values ascertained through PET/CT may aid the distinction between MPE-BPE, especially in patients with advanced stage OC with a poor general condition, or those who cannot undergo surgery.

[Health professionals' perspective about women's experiences during the diagnostic process of ovarian cancer in Catalonia: Qualitative study]. / La visión de los profesionales sanitarios del proceso diagnóstico de las mujeres con cáncer de ovario en Catalunya: estudio cualitativo.

OBJECTIVE: To identify missed opportunities in the diagnosis of ovarian cancer (OC) in the public health system of Catalonia, through the analysis of the perceptions of health professionals on the stories's experiences of OC patients. DESIGN: Qualitative exploratory-descriptive study, with two focus groups. SETTING: Primary Care, November 2017. PARTICIPANTS: Thirty-four professionals based on theoretical sampling: 21 family doctors, 8 professionals from sexual and reproductive health centres and 5 hospital gynaecologists. METHODS: Participants discussed the different diagnostic pathways for women with OC through the presentation of flowcharts which were developed with three storie's and experiences of OC patients. RESULTS: Three themes with various sub-themes were identified as follow: a)lack of cancer diagnostic suspicion (lack of knowledge of symptoms of OC, anamnesis and physical examination overlooked, fragmentation of patient's care and bias and prejudice); b)difficulties in activating the diagnostic process (limited access to tests, unequal accessibility to gynaecology and lack of follow-up); and c)absence of fast-track referral system. CONCLUSIONS: The results offer insight into the difficulties of early diagnosis of OC in our setting. We believe that their identification will allow the development of strategies to improve diagnostic accuracy and quality of care for women with OC in our setting.

Leiomioma ovárico primario

El leiomioma es un tumor mesenquimal benigno común que puede desarrollarse allí donde haya músculo liso; raro como tumor ovárico primario, su origen aún es controversial. El leiomioma ovárico primario es uno de los tumores benignos más raros del ovario, representa 0,5% a 1% de los tumores benignos y suele observase en mujeres entre 20 y 65 años. Generalmente, son asintomáticos y se les encuentra de forma incidental durante el examen pélvico o la cirugía por otra causa, pero en ocasiones puede manifestarse por dolor abdominal y masa palpable. El diagnóstico definitivo es difícil antes de la extirpación quirúrgica. Debido a que no existen síntomas patognomónicos ni tiene imágenes características, los principales diagnósticos diferenciales incluyen fibroma, tecoma, tumor estromal esclerosante y leiomiosarcoma. La tinción inmunohistoquímica es fundamental para el diagnóstico preciso y debe considerarse en el diagnóstico diferencial de los tumores ováricos de células fusiformes. Se presenta un caso de leiomioma ovárico primario.

Leiomyoma is a common benign mesenchymal tumor that can develop wherever smooth muscle is present; rare as a primary ovarian tumor, its origin is still controversial. Primary ovarian leiomyoma is one of the rarest benign ovarian tumors, accounting for 0.5% 1% of benign tumors and is usually seen in women between 20 and 65 years of age. They are usually asymptomatic and appear incidentally during a pelvic examination or surgery for another cause but can occasionally manifest by abdominal pain and palpable mass. Definitive diagnosis is difficult before surgical removal. Because there are no pathognomonic symptoms and no characteristic imaging, the main differential diagnoses include fibroma, thecoma, sclerosing stromal tumor and leiomyosarcoma. Immunohistochemical staining is essential for accurate diagnosis and should be considered in the differential diagnosis of ovarian spindle cell tumors. A case of primary ovarian leiomyoma is presented.

Carcinosarcoma ovárico asociado a carcinoma seroso intraepitelial tubárico

El carcinosarcoma primario ovárico es una neoplasia de baja incidencia, que suele ser diagnosticado en estadios avanzados y cursa con un mal pronóstico. Se comunica el caso de una paciente de 64 años con una tumoración abdominopélvica de 15 cm. El examen histológico evidenció una neoplasia maligna bifásica ovárica asociada a un carcinoma seroso intraepitelial tubárico, hallazgo que estaría en relación con la patogénesis de esta neoplasia.

Primary ovarian carcinosarcoma is a low incidence neoplasm that is usually diagnosed in advanced stages and has a poor prognosis. We report the case of a 64-yearold female patient with a 15 cm abdominopelvic tumor. Histological examination revealed a malignant ovarian biphasic malignancy associated with a serous tubal intraepithelial carcinoma, a finding that would be related to the pathogenesis of this neoplasm.