[Pheochromocytoma and pregnancy. A case report]. / Feocromocitoma y embarazo. Reporte de un caso.

BACKGROUND: Pheochromocytoma is a tumor originating in the chromaffin cells. These tumors secrete catecholamines which act on target organs and cause hypertensive crises. They are rare during pregnancy, and a differential diagnosis must be carried out mainly with pregnancy-induced hypertension. CLINIC CASE: A 22-year-old patient in week 11.5 of pregnancy presented at the Hospital General Dr. Miguel Silva in Morelia, Michoacán with hypertension that had existed for more than two years with poor adherence to treatment. At the time of referral to our unit she presented a hypertensive crisis that had been unresponsive to all antihypertensive treatments. Following the establishment of a study protocol, a diagnosis of posterior left adrenal pheochromocytoma was made. After subsequent pharmacological treatment with alpha and beta blockers, a left adrenalectomy was performed. The patient did not require antihypertensive treatment following surgery. The histopathological report indicates the presence of a nodular and vascularized left adrenal gland weighing 25 g and measuring 5 x 4 x 3.5 cm. Gland consistency was soft, and the presence of cystic lesions in parenchymal tissue was noted. A yellowish-brown color and sponge-like appearance were also present. Such features support a diagnosis of pheochromocytoma. The pregnancy continued normally until week 32, when the patient presented to our department with active-phase preterm labor. A Cesarean section was performed with the delivery of a live female weighing 1400 gr. The infant is currently alive and well. CONCLUSION: Thus, it is important that obstetrician knows this disease and its management during pregnancy; so we present this case report.

[Genital tuberculosis and pregnancy to term. Case report]. / Tuberculosis genital y embarazo a término. Reporte de caso.

Tuberculosis continues to be a worldwide public health issue, known as "the great pretender" resembling many diseases. Overall 1% of women infected with Mycobacterium species develop genital tuberculosis (GT) which is widespread more commonly during their fertility age, 20-40 years old. GT is the second most common cause of extra pulmonary tuberculosis. One of the clinical manifestations in these patients is Infertility; with a poor prognosis of a successful pregnancy even with a correct diagnosis, medical and/or surgical treatment. Most pregnancies result in ectopic pregnancies or abortions. In low income countries GT may account for 5-20% of infertility cases. It was widely believed that pregnancy represented a period of risk to women infected with tuberculosis; and actually abortion is suggested. We report a case of a 21 year old female patient who came to the General Hospital Dr. Miguel Silva in the city of Morelia, Michoacán with the diagnosis of late puerperium postpartum complicated with retained placental tissue to perform a uterine curettage. The patient had fever and anemia for which we had to perform a laparotomy exploration of the doubt of uterin perforation; the surgical findings were pathognomonic of GT for which we continue to realize Hysterectomy. The macro and microscopically pathologic findings consists in GT, confirming the diagnosis with Ziehl-Neelsen acid stain. GT findings must always be differentiated from ovarian cancer.

[Pelvic retroperitoneal teratoma. A case report]. / Teratoma pélvico retroperitoneal. Reporte de un caso.

Teratomas are congenital tumors comprising of tissues arising from pluripotent embryonic cells. Their common sites of occurrences are ovary, testis, mediastinum and retroperitoneum. Retroperitoneal teratomas are extremely rare in adults but occur in 3% of children. The presence of a cystic or complex adnexal mass during pregnancy is common with mature teratoma reported in approximately 30-50% of pregnancies. The ultrasound is the number one method of detection. The use of tumor markers is limited because it alters its value during pregnancy. We report a case of a 18 year old female patient who came to the General Hospital Dr. Miguel Silva in Morelia, Michoacán with a gestation age of 10.2 weeks and a recent diagnosis of an asymptomatic adnexal mass. Using the transvaginal approach, the ultrasound reported an irregular gestational sac with the absence of cardiac activity in the embryo. A diffusely echogenic adnexal mass with oval appearance, wall regularity and homogeneous internal echos of 12.96 x 8.99 cm. Exploratory laparotomy was performed finding normal uterus and ovaries, with the posterior retroperitoneal resection of the 15 cm multi-lobed tumor. The surgical specimen measured 13 x 12 x 8 cm, had a brownish color, wall irregularity, soft consistency, multi-lobed, and a yellowish interior greasy material. Microscopically the tumor is delimited with a firm capsule composed of a hyaline-fibrous tissue, lined by squamous keratinized epithelium, with multiple layers of keratin. This anato-pathologic finding is diagnostic of retroperitoneum mature teratoma.

[Angiomiofibroblastoma of the vulva. Report of case]. / Angiomiofibroblastoma de la vulva. Reporte de caso.

Angiomyofibroblastoma is a benign mesenchymal tumor of the lower genital tract described in 1992 by Fletcher and his group. Must be differentiated mainly from aggressive angiomyxoma, which has a high local recurrence rate. We report the case of a 21 year old patient who attended the General Hospital Dr. Miguel Silva, in Morelia, Michoacan, because post-term pregnancy of 41.1 weeks gestation, with a bulky vulvar tumor, asymptomatic with four years of evolution. Cesarean section and vulvar tumor resection were performed. The surgical specimen measured 14 x 10 x 5 cm, had a polypoid aspect, multilobulated, with nodules of varying size. From a microscopic point of view the tumor was well defined, formed by loose connective tissue septa, with stromal fusiform cells and benign characteristics, between collagen fibers, with abundant vessels. The histochemical studies were positive for desmin and vimentin. These anatomopathological findings are diagnostic of vulvar angiomyofibroblastoma, benign course tumor, does not resort nor does it generate metastases after simple surgical resection; however, recurrence in the vagina is reported. Must be differentiated from other mesenchymal neoplasms of the genital tract.