F. Tresserra

Assessment of breast cancer size: Sonographic and pathologic correlation

Accurate presurgical assessment of tumor size in breast cancer is important for choosing appropriate treatment. We retrospectively compared presurgical sonographic measurements of tumor size with postsurgical measurements of size and other variables.

Fibroadenoma phyllodes arising in vulvar supernumerary breast tissue : report of two cases

Ectopic breast tissue, found along the mammary line or sometimes outside it, can exhibit pathologic changes similar to those of the eutopic mammary gland. Fibroadenoma phyllodes, an unusual variant of mammary phyllodes tumor with stromal cellularity similar to a conventional fibroadenoma, rarely arises outside of breast. Its histogenesis is unclear; although some cases suggest an origin in cutaneous adnexa, the presence of normal breast tissue surrounding other tumors favors an ectopic mammary origin. Two cases of fibroadenoma phyllodes arising in ectopic vulvar breast tissue are described.

Tumor Size and Lymph Node Status in Multifocal Breast Cancer

Abstract:  Tumor size correlates with lymph node metastasis in breast cancer. In multifocal lesions there is controversy about considering the summation of the largest diameter of each tumor. A total of 122 patients with multifocal breast cancer were compared in a retrospective study with 177 patients with unifocal tumors, correlating tumor size with lymph node metastasis. In multifocal tumors, two sizes were considered: the diameter of the largest tumor and the combined diameter of all lesions. Relationship was established by three different logistic models using variables such as age, number of lesions, histologic type, and grade. At a same size of the largest diameter of a unifocal or multifocal lesions and the combined diameter of a multifocal lesion, the latter shows less probability of nodal metastasis indicating that combined diameter is an overestimation of the lesion size. Our results indicate that in multifocal breast cancer, only the diameter of the largest tumor breast cancer has relationship with lymph node metastasis.

Role of Color Doppler Ultrasonography in the Diagnosis of Endometriotic Cyst

We studied the role of color Doppler ultrasonography in the distinction between endometriomas and other adnexal masses. Three hundred and fifty‐two ovarian lesions were studied, comparing sonographic diagnosis with pathologic findings. On color Doppler sonography, an endometriotic cyst usually appeared as a cystic lesion with diffuse internal echoes and low vascularization. The sensitivity and specificity of color Doppler transvaginal sonography in detecting endometriotic cysts were 91.8% and 95.3%, respectively. The positive and negative predictive values were 95.5% and 91.5%, respectively. In our experience, transvaginal sonography with color Doppler interrogation is a useful technique in the diagnosis of pathologic ovarian conditions, including cystic endometriosis.

Congenital plate-like osteoma cutis of the forehead: an atypical presentation form

Cutaneous ossifications or osteoma cutis can be found in many syndromes. Primary osteoma cutis, present since birth or the first months of life, in the absence of metabolic disorders or trauma, is found in congenital plate-like osteoma cutis and progressive osseous heteroplasia, coexisting in the latter with deep connective tissue ossifications. This report documents the case of a 7-year-old female with a plate-like cutaneous ossification of the forehead causing aesthetic deformities. Other dermal ossifications in the inguinal and preauricular region, as well as the left hand and a small focus in the extraocular muscles of the left orbit, were also present. These lesions did not show progression, and most of them were present since birth. The lesion of forehead was treated surgically. The lack of progression and the fact that the orbital lesion was solitary still fits the criteria for the diagnosis of plate-like osteoma cutis. Plate-like osteoma cutis and progressive osseous heteroplasia may represent varieties of the same disorder.

Assessment of ovarian vascularization in the polycystic ovary by three-dimensional power Doppler ultrasonography

Objective. To assess whether there are differences in ovarian echogenicity and vascularization as assessed by three-dimensional power Doppler angiography (3D-PDA) between women with polycystic ovaries (PCO) and women with normal ovaries (NO). Methods. Eighty-three women were classified into two groups according to the 2003 Rotterdam consensus criteria. The NO group comprised women (n = 45) with regular menstrual cycles and proven fertility, whereas the PCO group comprised women (n = 38) with oligo-anovulation, clinical and/or biochemical features of hyperandrogenism, and polycystic ovary morphology at two-dimensional ultrasound. All women were evaluated by means of 3D-PDA. The parameters studied in both groups were follicle number per ovary (FNPO), ovarian volume (OV), mean gray value (MG) and three vascular indices: vascularization index (VI), flow index (FI) and vascularization flow index (VFI). Results. The PCO group showed a higher mean OV as well as FNPO. No differences in MG, VI, FI and VFI were found between the groups. Conclusions. 3D-PDA indices are not useful for discriminating between normal and polycystic ovaries.

Endometrial hyperplasia with secretory changes

OBJECTIVE Secretory changes in endometrial hyperplasia are uncommon. The aim of this study is to review the morphologic and clinical findings of 24 cases of endometrial hyperplasia with secretory changes. METHODS In 24 patients diagnosed with endometrial hyperplasia with secretory changes during 6 years, clinical characteristics such as menopausal status and hormone treatment were correlated with morphological features. A matched age control group of 24 women with conventional endometrial hyperplasia was used to compare the hormonal effect. RESULTS Nineteen patients were premenopausal. Nine women showed simple hyperplasia without atypia and 15 complex hyperplasia, 7 of them with atypia. Seventeen women were under hormonal treatment at the time of diagnosis, 10 of them with progestins. In 7 patients endometrial adenocarcinoma could be seen, 5 coexisting with endometrial hyperplasia with secretory changes and in 2 appearing after 1 and 4 months. In control group only 2 patients were undergoing progestin hormonal treatment. CONCLUSIONS Secretory changes can be found in hyperplastic endometrium, particularly in premenopausal women under hormonal treatment with progestins, with the risk of misdiagnosis.

Impact of Surgery on the Evolution of Uterine Sarcomas

STUDY OBJECTIVE To identify the characteristics of uterine sarcomas and assess the impact of morcellation on prognosis. DESIGN Case-control study. (Canadian Task Force classification II-2). SETTING Hospital Quiron-Dexeus, an academic hospital. PATIENTS Patients with uterine sarcoma histologically diagnosed and treated in our center between 1987 and 2013. INTERVENTION All descriptive data, including type of surgery and clinical and pathological data, were reviewed. Survival analysis was performed comparing patients with hysterectomy/myomectomy without any type of morcellation and patients with morcellation during surgery. MEASUREMENTS AND MAIN RESULTS A total of 37 sarcomas were diagnosed during the study period. The most common symptom was metrorrhagia (50%). The indication for surgery was related to myoma growth in 40% of cases and to metrorrhagia in 37.1% of cases. Open surgery was performed in 23 patients (62.2%), and laparoscopy was performed in 9 (24.3%). Myomectomy was performed in 14 patients (37.8%), and 23 patients (62.1%) underwent hysterectomy as initial surgery. Morcellation for tumor extraction was done in 8 cases (21.6%). Survival analysis by surgical approach showed increased disease-free survival (DFS) in the laparotomy group compared with the laparoscopy group (median, 70.3 months vs 10.4 months; p = .018). Median DFS according to type of surgery was 6.3 months in morcellation cases, 11.9 months in vaginal fragmentation cases, and 149.9 months in nonmorcellated cases (p < .002). The median time to progression was shorter in morcellated cases (laparocopic and vaginal) compared with nonmorcellated cases (11.9 vs 14.9 months; p < .001). No statistically significant differences in prognosis were related to myomectomy versus hysterectomy; however, there were significants difference between morcellation and nonmorcellation cases. CONCLUSION Taking into account the negative impact of morcellation in sarcomas, the use of this technique should be reconsidered in cases of myoma with atypical clinical presentation or symptomatology. Patients must be informed about the possibility of a nonidentified sarcoma and the possible impact on prognosis resulting from its morcellation.

Myometrial trophoblastic implant as a complication of surgically induced first‐trimester termination of pregnancy

Persistent trophoblastic tissue has been described in the abdominal cavity after surgical treatment of tubal ectopic pregnancy. More infrequently the cause of the ectopic trophoblast is linked to uterine perforation due to surgically induced termination of pregnancy (TOP). Ultrasonographic images may suggest an ectopic pregnancy. A case of myometrial trophoblastic tissue implantation following surgically induced first‐trimester TOP is described. Copyright

OC21.07: Ultrasonographic features of Fallopian tube cancer

Objectives: Controversy exists for role of transvaginal ultrasound (TVS) in the follow up of ovarian cancer and BOT. The aim of this study was to assess the diagnostic value of TVS in the follow up of patients submitted to cystectomy (CYS), unilateral salpingo-oophorectomy (USO) or bilateral salpingo-oophorectomy with/without total hysterectomy (radical surgery, RS) for BOT. Methods: Patients with previous surgery for BOT, at least 2 scan after surgery and a follow up period of more than 12 months were included in this study. TVS findings especially ovarian lesions, tumor recurrences, site and sonographic characteristics of recurrences were evaluated. Results: 35 patients treated surgically for BOT underwent TVS follow up. The median duration of follow-up was 59 months (range 12 120) with a mean number of scan of 5.2 (2–15). 18 patients had serous, 13 mucinous, 2 endometriod, 1 clear cell and 1 serous/ mucinous borderline tumors. 8 patients underwent CYS, 18 USO, and 10 RS. 4 patients in the CYS group (50%), 3 in the USO group (18%), and 2 (20%) in RS showed a lesion at TVS suggestive for recurrence. In all cases the relapse was confirmed by histology. Disease free interval, was a mean of 48 months (range 12–96), 4 recurrences occurs after 5 years from surgery. In 7 of the 9 patients with BOT recurrences, the relapsed lesions showed similar sonographic features to the histological type of the previous removed BOT. 2 recurrences showed malignant transformation. Conclusions: TVS seems to be a reliable diagnostic tool for the monitoring women treated for BOT. We observed a total recurrence rate of 26% which was significantly higher in patients who underwent only to CYS (50%). Sonographic characteristics of the recurrence are similar to the previous BOT histological type. We suggest for patients treated for BOT a TVS follow up every 6 months.