RESUMO
BACKGROUND: Adenoma malignum of the cervix (also referred to as minimal deviation adenocarcinoma) is a rare malignancy. Although previous reports have described adenoma malignum presenting with mucinous vaginal discharge, no reports to our knowledge have described a presentation with profound hyponatremia due to fluid losses. CASE: We present a case of adenoma malignum in a 52-year-old woman who presented with substantial watery vaginal discharge and profound hyponatremia. CONCLUSION: Despite being a rare cervical tumour, adenoma malignum should be considered in the differential diagnosis of watery vaginal discharge. This tumour can present with severe electrolyte disturbances.
Contexte : L'adénome malin du col utérin (aussi connu sous le nom d'adénocarcinome à déviation minime) constitue une tumeur maligne rare. Bien que des signalements précédents aient indiqué que l'adénome malin s'accompagnait d'un écoulement vaginal mucineux, nous n'avons trouvé aucun signalement décrivant la présence concomitante d'une profonde hyponatrémie attribuable à des pertes liquidiennes. Cas : Nous présentons un cas d'adénome malin chez une femme de 52 ans qui connaissait un écoulement vaginal aqueux substantiel et une profonde hyponatrémie. Conclusion : Bien qu'il s'agisse d'une tumeur cervicale rare, l'adénome malin devrait être pris en considération dans le diagnostic différentiel de l'écoulement vaginal aqueux. Cette tumeur peut s'accompagner de graves perturbations de l'équilibre électrolytique.
Assuntos
Adenocarcinoma/complicações , Hiponatremia/etiologia , Neoplasias do Colo do Útero/complicações , Descarga Vaginal/etiologia , Adenocarcinoma/diagnóstico , Adenocarcinoma/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/cirurgiaRESUMO
OBJECTIVE: To survey all gynaecologists in Canada to determine the number who perform or offer the laparoscopic myomectomy (LM) procedure, the barriers that deter gynaecologists from performing or offering LM, and to understand the perceptions and attitudes of Canadian gynaecologists with respect to LM. METHODS: A survey was developed, pre-tested, and distributed to all 1279 obstetrician-gynaecologists on the SOGC mailing list in April 2007. RESULTS: A total of 529 obstetrician-gynaecologists participated in the survey a response rate of 41.4%. Of the 485 respondents who practised gynaecology, 119 (24.5%) performed LM, but only 15 (3.1%) stated that more than 50% of their myomectomies were performed laparoscopically. Two hundred twelve gynaecologists (44.3%) admitted to having referred a patient to another gynaecologist for LM. Laparoscopic surgeons felt the principal barrier to performing LM was lack of training in the procedure (70.7%). Gynaecologists felt the principal barrier to referring to another gynaecologist for LM was their uncertainty about who offered the procedure (33%). The majority of gynaecologists believed that LM has faster recovery time. The majority of respondents, however, were unsure which procedure is superior with respect to blood loss, adhesion formation, fertility rate post-procedure, uterine rupture rate in subsequent pregnancy, and cost-effectiveness. CONCLUSION: Despite existing evidence that indicates that LM is comparable to abdominal myomectomy with respect to complication rates and fertility, only one quarter of Canadian gynaecologists who responded to this survey performed the procedure. Barriers to performing LM included lack of training and barriers to referral included uncertainty about who offered the procedure.