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3.
BMJ Case Rep ; 17(2)2024 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-38320830

RESUMO

Ruptured renal angiomyolipoma in pregnancy is uncommon. Pregnant women may present with nonspecific symptoms such as flank or abdominal pain, contraction pain and haematuria. A thorough assessment is needed to reach the correct diagnosis. Management varies between conservative measures, radiological intervention or surgery depending on the patient's haemodynamic status and foetal condition. We present a case of a woman in her 30s, gravida 5 para 3+1 at 28 weeks of gestation, who presented with pain. The pain worsened, and she went into hypovolaemic shock. An exploratory laparotomy and emergency caesarean section were done. Retroperitoneal haematoma was found intraoperatively, but the source of bleeding was difficult to determine. An abdominal CT angiogram subsequently revealed an ongoing bleeding from a ruptured angiomyolipoma. An emergency nephrectomy was performed, and the bleeding was secured.


Assuntos
Angiomiolipoma , Hamartoma , Neoplasias Renais , Trabalho de Parto , Trabalho de Parto Prematuro , Complicações Neoplásicas na Gravidez , Feminino , Humanos , Gravidez , Angiomiolipoma/diagnóstico , Angiomiolipoma/diagnóstico por imagem , Cesárea , Hemorragia Gastrointestinal , Neoplasias Renais/diagnóstico , Neoplasias Renais/diagnóstico por imagem , Dor , Complicações Neoplásicas na Gravidez/diagnóstico por imagem , Complicações Neoplásicas na Gravidez/cirurgia , Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/cirurgia , Adulto
4.
BMC Womens Health ; 24(1): 7, 2024 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-38166995

RESUMO

BACKGROUND: In this study, the prognostic and reproductive outcomes of women who underwent excision of uterine myomas and were sutured using different techniques while undergoing a cesarean section were investigated. METHODS: A total of 299 females who underwent cesarean section between January 2015 and June 2022 due to a scarred uterus were enrolled in this study. These participants were segregated into two categories: the experimental group (comprising 155 cases) in which uterine myoma (single lesion) was excised during the cesarean procedure, and the control group (consisting of 144 cases) in which only the cesarean section was conducted. A comparison between the two groups was carried out based on the following parameters: volume of intraoperative bleeding (mL), additional measures taken for intraoperative hemostasis (n, %), percentage (%) of patients experiencing postoperative fever, duration required for the passage of gas (hours [h]), length of hospital stay (days [d]), weight of newborns (kg) and their Apgar scores, and the reproductive outcomes of the experimental group assessed two years after the surgical procedure. RESULTS: In the experimental group, the amount of bleeding during surgery, occurrence of postoperative fever among women, time taken for patients to resume passing gas, and length of hospital stay were 540.65 ± 269.12 mL, 9.03%, 15.99 ± 4.68 h, and 5.08 ± 1.18 days, respectively. In contrast, the control group had values of 409.03 ± 93.24 mL, 2.77%, 16.24 ± 4.92, and 4.47 ± 0.70 days, respectively (P < 0.05). No notable increase was observed in the need for additional intraoperative hemostasis measures, and there was no significant difference in the time it took for patients to pass gas after the surgery. All newborns had positive health status. In the experimental group, 25 patients underwent subsequent pregnancies, and 15 of them successfully reached full-term deliveries, all of which had positive outcomes. CONCLUSION: Combining myomectomy with various suture methods during cesarean delivery did not cause excessive bleeding and resulted in healthy newborns. This approach offers the advantage of avoiding additional surgeries under anesthesia and can be considered a viable option. Subsequent pregnancies after myomectomy were considered high-risk.


Assuntos
Leiomioma , Mioma , Miomectomia Uterina , Neoplasias Uterinas , Feminino , Humanos , Recém-Nascido , Gravidez , Cesárea , Leiomioma/cirurgia , Leiomioma/patologia , Prognóstico , Estudos Retrospectivos , Miomectomia Uterina/métodos , Neoplasias Uterinas/cirurgia , Neoplasias Uterinas/patologia , Complicações Neoplásicas na Gravidez/patologia , Complicações Neoplásicas na Gravidez/cirurgia
5.
Ann Ital Chir ; 94: 493-497, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38051501

RESUMO

AIM: The aim of this study was to assess the postoperative results of patients who underwent myomectomy during caesarean section in a tertiary center, to investigate whether cesarean myomectomy leads to increased morbidity and to contribute to the literature. MATERIALS AND METHODS: This study was designed retrospectively and conducted to compare the preoperative and postoperative results of 121 patients who underwent myomectomy during cesarean and 149 patients who had only cesarean section in a tertiary center between 1.1.2020-1.1.2022. RESULTS: Although the study did not show a significant prolongation in terms of operative time, a significant relationship was found in the length of hospital stay. Hemoglobin levels after myomectomy were significantly lower than the group without myomectomy in the study. Additionally, preterm delivery rate was higher in the myomectomy group. CONCLUSION: As this study showed us a significant decrease in hemoglobin levels after cesarean and myomectomy, it is appropriate to perform this operation, when necessary, by experienced surgeons and in tertiary centers. KEY WORDS: Cesarean section, Myomectomy, Myomectomy during cesarean section.


Assuntos
Leiomioma , Complicações Neoplásicas na Gravidez , Miomectomia Uterina , Neoplasias Uterinas , Recém-Nascido , Humanos , Gravidez , Feminino , Miomectomia Uterina/métodos , Estudos Retrospectivos , Leiomioma/cirurgia , Neoplasias Uterinas/cirurgia , Cesárea , Centros de Atenção Terciária , Complicações Neoplásicas na Gravidez/cirurgia , Hemoglobinas
6.
Medicine (Baltimore) ; 102(30): e34521, 2023 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-37505122

RESUMO

BACKGROUND: Pregnancy luoteomas are tumor-like ovarian lesions that emerge during pregnancy and spontaneously regress after delivery. Antenatal diagnosis is infrequently reported, and unnecessary surgery appears to be common in literature reports. CASE SUMMARY: A 28-year-old primigravida with bilateral adnexal masses was discovered at 32 + 5 weeks during prenatal ultrasound evaluation. Combined with clinical presentation, auxiliary examinations including blood test, magnetic resonance imaging, gastroscopy, and consultation of multi-disciplinary team, we successfully made a diagnosis of pregnancy luteoma and provided conservative management recommendations. A cesarean section was conducted on this patient at 34 + 2 weeks of gestation due to fetal distress. The newborn was small for gestational age but normal in appearance. We performed biopsies of the adnexal masses, which were confirmed to be pregnancy luteomas using both intraoperative frozen section and final pathological diagnosis. Serum testosterone, cancer antigen 125, and alpha-fetoprotein levels gradually declined and normalized on postoperative day 28. The masses significantly decreased in size as shown by ultrasonic and magnetic resonance imaging examination on postoperative day 7, with the ovaries returning to their normal size by postoperative day 30. CONCLUSION: Prenatal diagnosis of pregnancy luteoma poses a challenge, requiring hormonal examinations, ultrasound, magnetic resonance imaging, and gastrointestinal endoscopy for identification. Caution must be exercised to avoid overtreatment. While additional cases are needed to summarize the imaging features and effects of excess hormones on the both mother and fetus, further research is necessary for a comprehensive understanding.


Assuntos
Luteoma , Cistos Ovarianos , Neoplasias Ovarianas , Complicações Neoplásicas na Gravidez , Recém-Nascido , Gravidez , Feminino , Humanos , Adulto , Luteoma/diagnóstico , Luteoma/terapia , Luteoma/patologia , Neoplasias Ovarianas/diagnóstico por imagem , Neoplasias Ovarianas/cirurgia , Cesárea , Complicações Neoplásicas na Gravidez/diagnóstico por imagem , Complicações Neoplásicas na Gravidez/cirurgia , Diagnóstico Pré-Natal
7.
JNMA J Nepal Med Assoc ; 61(265): 727-730, 2023 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-38289795

RESUMO

Immature teratoma is one of the rare malignant germ cell tumours presented in pregnancy. Here, we present 26-year-old pregnant women who had an incidental finding of left adnexal mass in an anomaly scan at 19 weeks of pregnancy. Laparotomy with peritoneal fluid cytology, left salpingo-oophorectomy and omental biopsy at 20 weeks of pregnancy revealed immature teratoma stage 1A, grade 2 in the histopathology report. However, she followed up with the metastatic mass in the pouch of Douglas at 30 weeks of pregnancy in magnetic resonance imaging despite being counselled for possible chemotherapy and surveillance. A baby with a good Apgar score and grade 3 immature teratoma in the metastatic mass was revealed following the exploratory laparotomy and cesarean section at 36 weeks of pregnancy. Fertility-sparing surgery with chemotherapy during pregnancy for high-grade tumours may result in a good prognosis. Keywords: case reports; chemotherapy; immature teratoma; pregnancy; surgery.


Assuntos
Neoplasias Ovarianas , Complicações Neoplásicas na Gravidez , Teratoma , Gravidez , Feminino , Humanos , Adulto , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/cirurgia , Cesárea , Teratoma/diagnóstico , Teratoma/terapia , Salpingo-Ooforectomia/métodos , Complicações Neoplásicas na Gravidez/diagnóstico , Complicações Neoplásicas na Gravidez/cirurgia
8.
Front Endocrinol (Lausanne) ; 13: 975954, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36325457

RESUMO

Objective: Primary hyperparathyroidism is a common disorder of the parathyroid glands. Parathyroid adenoma (PA) in pregnancy is a relatively rare disease, whose diagnosis and treatment is a challenging task. The aim of the present study is to present a new case of parathyroid adenoma during pregnancy and to give a detailed account of all reported cases of parathyroid adenoma during pregnancy in the literature. Study design: A bibliographic research was performed, and characteristics of parathyroid adenomas in pregnancy such as age, gestational week at diagnosis, ionized calcium levels, genetic testing result, symptomatology, radiological method of localization, treatment method, gestational week at operation, and maternal/fetal complications were recorded. Results: A 34-year-old woman at her 25 weeks' gestation was diagnosed with parathyroid adenoma and was referred to our Surgical Department due to contraindication for conservative treatment. A parathyroidectomy was performed, and the maternal and fetal postoperative period was uneventful. Two hundred eleven cases of parathyroid adenoma in pregnancy were recorded in the literature, and statistical analysis was performed. The median gestational week at diagnosis was 21 ± 9.61 weeks. The mean level of ionized calcium was 2.69 mmol/l [SD = 0.75 (2.55-2.84 95% CI)]. Most cases were familiar (72.4%), while surgery was the preferred treatment option (67.3%). The majority of cases were asymptomatic (21.7%), and the main radiological method applied for localization was ultrasound (63.4%). Conclusion: Parathyroid adenoma in pregnancy is a rare condition. The early diagnosis is of great importance as surgical treatment at the second trimester of pregnancy outweighs the maternal and fetal risks.


Assuntos
Adenoma , Neoplasias das Paratireoides , Complicações Neoplásicas na Gravidez , Humanos , Feminino , Gravidez , Adulto , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/diagnóstico , Neoplasias das Paratireoides/cirurgia , Cálcio , Adenoma/complicações , Adenoma/diagnóstico , Adenoma/cirurgia , Complicações Neoplásicas na Gravidez/diagnóstico , Complicações Neoplásicas na Gravidez/cirurgia , Paratireoidectomia/métodos
9.
Neurol India ; 70(Supplement): S314-S317, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36412388

RESUMO

We report the strategy of anesthesia and intraoperative neurophysiological monitoring (IONM) in a 29-year-old, 22 weeks pregnant patient posted for surgery for aggressive vertebral body hemangioma. We used propofol and fentanyl-based anesthesia for IONM. Motor-evoked potentials (MEP) and somatosensory-evoked potentials (SSEP) were used to monitor the neural tracts during surgery. Fetal heart rate monitoring was done preoperatively and postoperatively. Train of 8, 75 µs duration pulse, 250-500 Hz stimulus was used for MEP and 30 mA, 200-400 µs, 3-5 Hz was used for SSEP. No new motor or somatosensory deficits appeared. Our findings suggest that IONM can be safely done in pregnant women.


Assuntos
Anestésicos Intravenosos , Potenciais Evocados , Hemangioma , Monitorização Neurofisiológica Intraoperatória , Complicações Neoplásicas na Gravidez , Neoplasias da Coluna Vertebral , Adulto , Feminino , Humanos , Gravidez , Anestésicos Intravenosos/administração & dosagem , Cardiotocografia , Potenciais Evocados/fisiologia , Potencial Evocado Motor/fisiologia , Potenciais Somatossensoriais Evocados/fisiologia , Fentanila/administração & dosagem , Hemangioma/cirurgia , Procedimentos Neurocirúrgicos , Propofol/administração & dosagem , Estudos Retrospectivos , Neoplasias da Coluna Vertebral/cirurgia , Coluna Vertebral/cirurgia , Vias Neurais/fisiologia , Vias Neurais/fisiopatologia , Complicações Neoplásicas na Gravidez/cirurgia
10.
BMC Pregnancy Childbirth ; 22(1): 387, 2022 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-35505300

RESUMO

BACKGROUND: To evaluate pregnancy outcomes and the risk of adverse obstetrical outcomes of cesarean myomectomy (CM) compared with cesarean section (CS) only, and to investigate the trend of surgeons in choosing CM. METHODS: A retrospective cohort study was performed on all patients who underwent CS complicated by leiomyoma at two university hospitals between January 2010 and May 2020. All patients were categorized into the CM (341 women) or CS-only (438 women) group. We analyzed the demographic factors, obstetric factors, surgical outcomes, and possible risk factors for adverse outcomes between the two groups. RESULTS: Women who underwent CS only were significantly more likely to have a previous myomectomy and multiple leiomyoma history than women who underwent CM. The gestational age at delivery and pregnancy complications were significantly higher in the CS-only group. The mean size of the leiomyomas was larger in the CM group than in the CS-only group (5.8 ± 3.2 cm vs. 5.2 ± 3.1 cm, P = 0.005). The operation time and history of previous CS and preterm labor were higher in the CM group. The leiomyoma types differed between the two groups. The subserosal type was the most common in the CM group (48.7%), and the intramural type was the most common in the CS-only group. Patients in the CM group had fewer than three leiomyomas than those in the CS-only group. Preterm labor and abnormal presentation were relatively higher in the CM group than in the CS-only group, concerning leiomyoma presence. There were no significant differences in the preoperative and postoperative hemoglobin levels. The size of the leiomyoma (odds ratio [OR] = 1.162; 95% confidence interval [CI]: 1.07-1.25; P < 0.001) and operation time > 60 min (OR = 2.461; 95% CI: 1.45-4.15) were significant independent predictors of adverse outcomes after CM. CONCLUSIONS: CM should be considered a reliable and safe approach to prevent the need for another surgery for remnant leiomyoma. Herein, surgeons performed CM when uterine leiomyomas were large, of the subserosal type, or few. Standardized treatment guidelines for myomectomy during CSs in pregnant women with uterine fibroids should be established.


Assuntos
Leiomioma , Trabalho de Parto Prematuro , Complicações Neoplásicas na Gravidez , Miomectomia Uterina , Neoplasias Uterinas , Cesárea/efeitos adversos , Feminino , Humanos , Recém-Nascido , Leiomioma/cirurgia , Masculino , Trabalho de Parto Prematuro/etiologia , Gravidez , Complicações Neoplásicas na Gravidez/epidemiologia , Complicações Neoplásicas na Gravidez/etiologia , Complicações Neoplásicas na Gravidez/cirurgia , Estudos Retrospectivos , Miomectomia Uterina/efeitos adversos , Neoplasias Uterinas/epidemiologia , Neoplasias Uterinas/cirurgia
11.
Z Geburtshilfe Neonatol ; 226(4): 274-277, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35609870

RESUMO

BACKGROUND: Chorioangioma is a vascular neoplasm of the placenta with the potential to cause heart failure, hydrops, and even death. CASE: A 30-year-old patient was referred owing to a large placental chorioangioma and fetal hydrops at 28 weeks of gestation. The patient underwent ultrasound-guided interstitial laser ablation. Ten days later, fetal blood transfusion was performed and at 31 weeks of gestation, and the patient delivered a female infant by cesarean section. The newborn was discharged from the neonatal intensive care unit without any complication. CONCLUSION: According to our case, large placental chorioangioma may have a favorable outcome with interstitial laser ablation and fetal transfusion.


Assuntos
Hemangioma , Terapia a Laser , Doenças Placentárias , Complicações Neoplásicas na Gravidez , Adulto , Cesárea , Feminino , Hemangioma/diagnóstico por imagem , Hemangioma/cirurgia , Humanos , Recém-Nascido , Placenta/diagnóstico por imagem , Placenta/cirurgia , Doenças Placentárias/diagnóstico por imagem , Doenças Placentárias/cirurgia , Gravidez , Complicações Neoplásicas na Gravidez/diagnóstico por imagem , Complicações Neoplásicas na Gravidez/cirurgia , Ultrassonografia Pré-Natal
12.
J Obstet Gynaecol Res ; 48(1): 244-250, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34729873

RESUMO

A 35-year-old woman presented with abdominal discomfort at 26 weeks gestation. The magnetic resonance imaging demonstrated a huge unilocular cystic mass with mural nodules originated from body and tail of pancreas. There was also a cystic mass in the left ovary with suppressed intensity on fat saturated image. One week later, she complained of worsening left lower abdominal pain and dyspnea as a new symptom. Hence, distal pancreatectomy with splenectomy and left ovarian cystectomy were performed. The huge cystic mass of pancreas was compressing the diaphragm, and left tubo-ovarian torsion was observed. This is the second case wherein an MCN of the pancreas with mature cystic teratoma of the ovary caused different symptoms. The management of MCNs in pregnant women should consider multiple aspects such as the malignancy potential of imaging findings, severity of symptoms, and fetal well-being.


Assuntos
Neoplasias Ovarianas , Neoplasias Pancreáticas , Complicações Neoplásicas na Gravidez , Adulto , Feminino , Humanos , Pancreatectomia , Neoplasias Pancreáticas/cirurgia , Gravidez , Complicações Neoplásicas na Gravidez/diagnóstico por imagem , Complicações Neoplásicas na Gravidez/cirurgia , Esplenectomia
13.
J Matern Fetal Neonatal Med ; 35(25): 8767-8777, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34822317

RESUMO

Purpose: Meningioma is a benign tumor, more frequent in female population. During pregnancy, distinguishing a meningioma from other common conditions presenting with similar symptoms (headache, vomiting, visual impairment) is challenging. Moreover, the management must consider not only maternal but also fetal health. The rarity of the condition does not allow to define the features to which look in order to stratify the risk for the need of surgery during pregnancy. We reported three cases of meningioma in pregnant women treated at our department and reviewed those previously reported in the literature. The aim of this review is to evaluate which factors are more determinant in such management.Methods: Electronic databases were searched from year 2000 until June 2020, to identify clinical studies on management of meningioma diagnosed during pregnancy. The primary outcome was surgical timing. Secondary outcomes were delivery methods, maternal and neonatal outcomes.Results: Surgery after pregnancy is more frequently performed in PR + tumor (p-value 0.038) and with HA (p-value 0.0445), as well as in meningioma diagnosed during the third trimester, compared to those diagnosed before (p-value 0.0012). Surgery during pregnancy was more frequent in patients with visual loss (p-value 0.006). No significant differences were found in surgical management, according to age, WHO grade, tumor location, lesion diameter and ER positivity. Delivery method is independent from both hormonal receptor status and main symptoms, but women who had neurosurgery during pregnancy delivered more frequently with spontaneous vaginal delivery (p-value <0.01).Conclusion: The decision regarding surgical timing of meningioma diagnosed during pregnancy depends on PR + and impending symptoms as visual loss or headache. It seems that timing of neurosurgery does not affect the delivery method. A multidisciplinary approach is always useful to perform a rapid and appropriate diagnosis and to better evaluate pros and cons of surgery during pregnancy and following management both for maternal and fetal wellness.


Assuntos
Neoplasias Meníngeas , Meningioma , Complicações Neoplásicas na Gravidez , Recém-Nascido , Feminino , Humanos , Gravidez , Meningioma/diagnóstico , Meningioma/cirurgia , Meningioma/complicações , Complicações Neoplásicas na Gravidez/diagnóstico , Complicações Neoplásicas na Gravidez/cirurgia , Parto Obstétrico , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/cirurgia , Neoplasias Meníngeas/complicações , Cefaleia
14.
Cancer Rep (Hoboken) ; 5(7): e1542, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-34528406

RESUMO

BACKGROUND: Although cervical cancer is one of the most common malignancies in pregnancy, its management mainly follows the guidelines for nonpregnant disease state. Within the limited time, patients, and healthcare workers must make difficult decisions to either delay treatment until documented fetal maturity or start immediate treatment based on the disease stage. CASE: The patient was a 37-year-old woman: gravida 1, para 0. Her cervical cytology revealed a high-grade squamous intraepithelial lesion at 8 weeks' gestation. Moreover, invasive squamous cell carcinoma was suspected based on the findings of uterine cervix biopsy. Cervical conization was performed at 11 weeks' gestation, confirming a histopathological diagnosis of squamous cell carcinoma, pT1b2. Cervical cytology findings continued to be negative for intraepithelial lesion or malignancy from 2 weeks after conization until 2 weeks before a cesarean section. In addition, we performed abdominal pelvic lymphadenectomy at 16 weeks' gestation to determine whether the patient could continue her pregnancy. No lymph node metastasis or local recurrence was observed. Finally, a cesarean section and modified radical hysterectomy were performed at 35 weeks' gestation. There was no carcinoma invasion or metastasis. A baby girl weighing 2056 g was delivered with 1- and 5-min Apgar scores of 8 and 9, respectively. Five years postoperatively, there was no evidence of cancer recurrence. CONCLUSION: Management of cervical cancer during pregnancy by using a combination strategy of deep conization and pelvic lymphadenectomy could be an effective strategy for carefully and safely assessing risks of recurrence and metastasis.


Assuntos
Carcinoma de Células Escamosas , Complicações Neoplásicas na Gravidez , Neoplasias do Colo do Útero , Adulto , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/cirurgia , Cesárea , Feminino , Humanos , Estadiamento de Neoplasias , Gravidez , Complicações Neoplásicas na Gravidez/diagnóstico , Complicações Neoplásicas na Gravidez/patologia , Complicações Neoplásicas na Gravidez/cirurgia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgia
15.
Rev. chil. obstet. ginecol. (En línea) ; 86(6): 573-582, dic. 2021. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-1388699

RESUMO

Resumen El manejo del tumor anexial en embarazadas sigue siendo un desafío. El objetivo del siguiente trabajo es realizar una revisión bibliográfica, en la que se abordarán las diferentes alternativas en cuanto a diagnóstico y manejo del tumor anexial en embarazadas, así como también indicaciones de abordaje quirúrgico y recomendaciones para una cirugía segura. Los tumores anexiales en embarazadas son poco frecuentes, y la mayoría son benignos y tipo funcionales. La ecografía ha sido fundamental para lograr diferenciar su carácter benigno o maligno. El manejo puede ser expectante o quirúrgico. El manejo quirúrgico se reserva para ciertas características de las lesiones anexiales. En cuanto a la vía operatoria, la literatura apoya la laparoscopia mostrando que existen múltiples beneficios al compararla con la laparotomía. Para el abordaje quirúrgico existen opciones en cuanto a la técnica, siendo estas anexectomía o quistectomía. Resulta fundamental tener consideraciones especiales en la técnica debido a los cambios fisiológicos de las embarazadas, como por ejemplo la altura uterina y el tamaño del tumor anexial. A modo de conclusión, el manejo de los tumores anexiales en el embarazo sigue siendo controversial y se extrapola principalmente basándose en la literatura de pacientes no gestantes u otros procedimientos quirúrgicos en embarazadas.


Abstract Nowadays the management of the adnexal tumors in pregnant women is still a challenge. The purpose of this article is to perform a bibliographic review and present the differential diagnosis, management, and surgical approaches for the women in this condition. Adnexal tumors in pregnant women are rare, most of them are benign corresponding to functional cysts. In order to differentiate benign from malignant tumors, Ultrasonography has been one of the most important imaging advances. The management can be either expectant or surgical. Surgical management is referred for tumors with certain specific characteristics. In relation to surgical management, the literature supports laparoscopy, showing greater benefits in comparison to laparotomy. There are different options for this kind of approach. Its mandatory to have special considerations in the technique due to the physiological changes in pregnant women, some examples are the uterine and the tumor size. The management of the adnexal tumors in pregnancy is still controversial, its based on studies of non-pregnant patients or other kinds of surgeries in pregnant women.


Assuntos
Humanos , Feminino , Gravidez , Complicações Neoplásicas na Gravidez/cirurgia , Doenças dos Anexos/cirurgia , Laparoscopia/métodos , Complicações Neoplásicas na Gravidez/diagnóstico por imagem , Doenças dos Anexos/complicações , Doenças dos Anexos/diagnóstico por imagem , Ultrassonografia
16.
BMC Pregnancy Childbirth ; 21(1): 744, 2021 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-34732155

RESUMO

INTRODUCTION: A retrospective study was conducted to investigate the effectiveness and feasibility of fibroid enucleation in the anterior wall of the uterus by transverse uterine incision during cesarean section. METHODS: The medical history, surgical data, preoperative and postoperative changes in the blood system, and complications of 90 pregnant women who underwent myomectomy of the anterior uterine wall during cesarean section at the second Department of Maternal and Child Health Hospital of Fujian Province were analyzed retrospectively. RESULTS: No significant differences were noted in the leiomyoma number, pathological type, preoperative and postoperative hemoglobin level, perioperative bleeding incidence, blood transfusion frequency, postoperative fever incidence, and duration of lochia between the study and control groups. The proportion of large fibroids was slightly higher in the study group than in the control group (p < 0.05), and the operation time and average hospitalization time were slightly longer in the study group than in the control group (p < 0.05). The distribution of type III-V fibroids was slightly more in the study group than in the control group (p < 0.05), and the distribution of type VI fibroids in the study group was less than that in the control group (p < 0.05). CONCLUSION: Fibroid enucleation is safe and effective in the anterior wall of the uterus through the lower uterine transverse incision in cesarean section. It has the potential to reduce the risk of pelvic and intrauterine adhesions in the future.


Assuntos
Cesárea/métodos , Leiomioma/cirurgia , Complicações Neoplásicas na Gravidez/cirurgia , Miomectomia Uterina/métodos , Neoplasias Uterinas/cirurgia , Adulto , China/epidemiologia , Feminino , Humanos , Gravidez , Estudos Retrospectivos
17.
Obstet Gynecol ; 138(4): 565-573, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34623068

RESUMO

OBJECTIVE: To evaluate outcomes of the first pregnancy after fertility-sparing surgery in patients with early-stage cervical cancer. METHODS: We performed a population-based study of women aged 18-45 years with a history of stage I cervical cancer reported to the 2000-2012 California Cancer Registry. Data were linked to the OSHPD (California Office of Statewide Health Planning and Development) birth and discharge data sets. We included patients with cervical cancer who conceived at least 3 months after a fertility-sparing surgery, which included cervical conization or loop electrosurgical excision procedure. Those undergoing trachelectomy were excluded. The primary outcome was preterm birth. Secondary outcomes included growth restriction, neonatal morbidity, stillbirth, cesarean delivery, and severe maternal morbidity. We used propensity scores to match similar women from two groups in a 1:2 ratio of case group participants to control group participants: population individuals without cancer and individuals with cervical cancer (women who delivered before their cervical cancer diagnosis). Wald statistics and logistic regressions were used to evaluate outcomes. RESULTS: Of 4,087 patients with cervical cancer, 118 (2.9%) conceived after fertility-sparing surgery, and 107 met inclusion criteria and were matched to control group participants. Squamous cell carcinoma was the most common histology (63.2%), followed by adenocarcinoma (30.8%). Patients in the case group had higher odds of preterm birth before 37 weeks of gestation compared with both control groups (21.5% vs 9.3%, odds ratio [OR] 2.7, 95% CI 1.4-5.1; 21.5% vs 12.7%, OR 1.9, 95% CI 1.0-3.6), but not preterm birth before 32 weeks. Neonatal morbidity was more common among the patients in the case group relative to those in the cervical cancer control group (15.9% vs 6.9%, OR 2.5, 95% CI 1.2-5.5). There were no differences in rates of growth restriction, stillbirth, cesarean delivery, and maternal morbidity. CONCLUSION: In a population-based cohort, patients who conceived after surgery for cervical cancer had higher odds of preterm delivery compared with control groups.


Assuntos
Colo do Útero/cirurgia , Conização/métodos , Preservação da Fertilidade/métodos , Resultado da Gravidez/epidemiologia , Neoplasias do Colo do Útero/cirurgia , Adolescente , Adulto , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Colo do Útero/patologia , Cesárea/estatística & dados numéricos , Estudos de Coortes , Feminino , Retardo do Crescimento Fetal/epidemiologia , Número de Gestações , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Gravidez , Complicações Neoplásicas na Gravidez/cirurgia , Nascimento Prematuro/epidemiologia , Pontuação de Propensão , Natimorto/epidemiologia , Traquelectomia/métodos , Adulto Jovem
18.
Am J Case Rep ; 22: e933639, 2021 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-34644286

RESUMO

BACKGROUND Cervical cancer is the most common gynecologic malignancy diagnosed in pregnancy. When cervical cancer is diagnosed late in pregnancy, pelvic lymphadenectomy is avoided. Advanced imaging adds an alternative way to assess nodal involvement. The aim of this case report is to demonstrate how magnetic resonance imaging (MRI) can contribute to the clinical staging of cervical cancer and inform treatment decisions when diagnosis is made late in pregnancy. We report the case of a woman in the third trimester who was diagnosed with advanced-stage squamous cell cervical carcinoma by MRI and biopsy. CASE REPORT A 33-year-old woman at 33 weeks of gestation was admitted to our hospital for recurrent vaginal bleeding. Examination revealed a large cervical mass. A gynecologic oncologist was consulted, an examination under anesthesia was performed, and cervical biopsy samples were obtained. Pathology results revealed squamous cell carcinoma of the cervix. A clinical stage of IB3 was assumed. MRI revealed a 5.2×5.8-cm cervical mass and an enlarged left pelvic lymph node. These findings upstaged the patient to IIIC1. Instead of undergoing a radical cesarean hysterectomy, the patient had a cesarean delivery and pelvic lymph node dissection. Four weeks later, she began chemotherapy and pelvic radiation. CONCLUSIONS There is significant value in advanced imaging for cervical cancer staging. This is especially relevant in pregnancy, where the under-staging of disease is a concern. This case report demonstrates the value of MRI in cervical cancer staging, particularly in pregnant women, in whom treatment and the timing of treatment should be individualized.


Assuntos
Carcinoma de Células Escamosas , Complicações Neoplásicas na Gravidez , Neoplasias do Colo do Útero , Adulto , Biópsia , Carcinoma de Células Escamosas/patologia , Células Epiteliais/patologia , Feminino , Humanos , Histerectomia , Imageamento por Ressonância Magnética , Estadiamento de Neoplasias , Gravidez , Complicações Neoplásicas na Gravidez/diagnóstico por imagem , Complicações Neoplásicas na Gravidez/cirurgia , Terceiro Trimestre da Gravidez , Neoplasias do Colo do Útero/diagnóstico por imagem
19.
Gynecol Oncol ; 163(2): 385-391, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34561098

RESUMO

OBJECTIVE: The purpose of this study is to compare ultrasonographic ovarian mass scoring systems in pregnant women. STUDY DESIGN: This multicenter study included women with an ovarian mass during pregnancy who were evaluated using ultrasound and underwent surgery in 11 referral hospitals. The ovarian mass was evaluated and scored using three different scoring systems(International Ovarian Tumor Analysis Assessment of Different NEoplasias in the adnexa[IOTA ADNEX], Sassone, and Lerner). The final diagnosis was made histopathologically. Receiver operating characteristic(ROC) curves were generated for each scoring system. RESULTS: During the study period, 236 pregnant women underwent surgery for an ovarian mass, including 223 women(94.5%) with a benign ovarian mass and 13 women(5.5%) with a malignant ovarian mass. Among 10 ultrasound image findings, six findings were different between benign and ovarian masses(maximal diameter of mass, maximal diameter of solid mass, wall thickness of mass, inner wall structure, thickness of septations, and papillarity). In all three scoring systems, the ovarian mass scores were significantly higher in malignant masses than in benign masses, with the highest area under the ROC curve(AUROC) in the Sassone scoring system(AUROC: 0.831 for Sassone, 0.710 for Lerner vs 0.709 for IOTA ADNEX; p < 0.05, between the Sassone and Lerner/ IOTA ADNEX). A combined model was developed with the six different ultrasound findings, and the AUROC of the combined model was 0.883(p = not significant between the combined model and Sassone). CONCLUSION: In pregnant women, malignant ovarian tumors can be predicted with high accuracy using either the Sassone scoring system or the combined model.


Assuntos
Neoplasias Ovarianas/epidemiologia , Ovário/diagnóstico por imagem , Complicações Neoplásicas na Gravidez/epidemiologia , Adulto , Feminino , Humanos , Idade Materna , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Ovário/patologia , Ovário/cirurgia , Gravidez , Complicações Neoplásicas na Gravidez/diagnóstico , Complicações Neoplásicas na Gravidez/patologia , Complicações Neoplásicas na Gravidez/cirurgia , Prognóstico , Estudos Retrospectivos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Ultrassonografia/estatística & dados numéricos
20.
Gan To Kagaku Ryoho ; 48(8): 1069-1071, 2021 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-34404079

RESUMO

This report describes the case of a 36-year-old woman with stage ⅠB1 cervical adenocarcinoma that was diagnosed when her fetus was at 19 weeks of gestation. Both she and her family strongly hoped that her pregnancy could continue. After approval by the Ethics Committee of our hospital, she was treated with paclitaxel and carboplatin. At 32 weeks of gestation, the patient delivered a 1,518 g female newborn via cesarean section. A radical hysterectomy with pelvic lymphadenectomy was performed after delivery. The newborn had Apgar scores of 3 at 1 minute and 5 at 5 minutes. No external malformations were observed. The Kyoto Scale of Psychological Development 2001 was used for cognitive assessment. Although the Language-Social Developmental Quotient score was 65 and developmental delay was observed at 1 year 8 months, the score improved to 98 at 3 years 5 months. The child was followed up until the age of 6 years 2 months and showed no developmental delay. Presentation of this case is important because there are few reports in Japan about the development of children of cancer patients who are exposed to anticancer drugs during pregnancy.


Assuntos
Complicações Neoplásicas na Gravidez , Neoplasias do Colo do Útero , Adulto , Cesárea , Criança , Desenvolvimento Infantil , Feminino , Humanos , Histerectomia , Gravidez , Complicações Neoplásicas na Gravidez/tratamento farmacológico , Complicações Neoplásicas na Gravidez/cirurgia , Neoplasias do Colo do Útero/cirurgia
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