Jorge Brañes Y

Biopsia rápida por congelación en el diagnóstico de tumores de ovario: correlación diagnóstica según diámetro y peso en tumores de origen epitelial

Background: Adequate management and treatment of ovarian carcinoma requires a complete surgical staging supported by frozen-section examination. To achieve this goal it is necessary a high level of accuracy. Aim: To evaluate the accuracy of frozen-sections in ovarian carcinoma considering the influence of tumor diameter and weight. Patients and methods: Retrospective study of frozen-sections performed in patients with ovarian tumors who underwent surgery. Frozen- and permanent- sections were divided into three categories (benign, borderline and malignant) and stratified by diameter ( 20 cm) and weight ( 1400 g). The diagnostic correlation, sensitivity, specificity, predictive values and accuracy of each frozen-section diagnosis were determined. Results: Eight hundred forty two ovarian tumors that underwent frozen-sections between January 1988 and October 1998 were studied. Final diagnosis was 86,7% benign, 2,7% low malignant potential (LMP) and 10,6% malignant. The diagnosis correlation between frozen- and permanent-sections was 98,2%. Misdiagnosis was in epithelial ovarian tumors, particularly in LMP tumors. Sensitivity, specificity, positive- and negative- predictive values and accuracy of the four hundred eighty nine epithelial tumor were 92,6%, 99,2%, 96,7%, 98,2% and 97,9%, respectively. Diagnostic correlation was higher in epithelial ovarian tumors with diameter 10 cm or weight >700 g (particularly in LMP tumors) is difficult because of the extensive sampling required. Frozen-sections diagnoses are important to determine the type and extent of surgery performed at the initial operation.

TUMOR OVARICO EN LA POSTMENOPAUSIA: CONSIDERACIONES SOBRE SU MANEJO ACTUAL

Se presenta una serie de 234 pacientes postmenopausicas mayores de 50 anos con diagnostico de tumor ovarico operadas en nuestro centro. Aproximadamente 60% de los casos fueron hallazgo del examen, ecografia o de la cirugia. Las pacientes fueron mayoritariamente abordadas por laparotomia (89%). Solo en 25 casos se realizo laparoscopia no registrandose casos de tumor maligno. En un 23% de los casos el diagnostico histologico fue el de cancer de ovario. En aquellos casos en que se realizo biopsia contemporanea (72,6%) hubo excelente concordancia (98,8%) con el diagnostico reportado en la biopsia definitiva. La tasa de complicaciones observada fue menor al 10% (con menos de un 5% de complicaciones graves). De interes resulta el que no se observaron tumores malignos en lesiones ovaricas con diametro ultrasonografico menor de 3 cm. Los hallazgos encontrados sugieren que el tumor ovarico en la postmenopausia no debe ser una indicacion perentoria de cirugia abierta. El seguimiento ecografico es factible en lesiones pequenas (menores de 3 a 5 cm), particularmente si las caracteristicas ecograficas sugieren benignidad y el CA-125 es negativo. Dada la frecuencia de tumores benignos, en casos bien seleccionados (por tamano, caracteristicas ecograficas y marcadores) y contando con biopsia contemporanea es posible realizar un abordaje por laparoscopia. En centros especializados la edad avanzada (> 70 anos) no debiese ser una contraindicacion a la cirugia

Tumor de celulas de sertoli y leydig del ovario

Se reporta el caso de una paciente de 16 anos con un tumor de celulas de Sertoli y Leydig del ovario en etapa I tratado con cirugia exclusiva. Ademas, se realiza una revision de la literatura sobre este tipo de tumor

Abordaje laparoscópico en cáncer de endometrio

SUMMARY Endometrial cancer is a relevant gynecologic neoplasm, with accelerated changes in its management. Surgery is the treatment of choice, but it can have a high rate of complications and delay in adjuvant therapies due to the surgical trauma that it inflicts. This article reviews the role of laparoscopy in the management of women with endometrial cancer, highlighting the oncologic safety, benefits and complications. Comparing laparotomy with laparoscopy, in experienced hands, it has the same results concerning to survival, recurrence and complete staging, with a lower rate of complications. Celioscopy could be the tool of the future in the management of endometrial cancer

EMBARAZO POSTERIOR A LIGADURA DE ARTERIAS HIPOGASTRICAS

El tratamiento de la metrorragia postparto contempla enfoques quirurgicos conservadores para aquellas pacientes en quienes se desea conservar la fertilidad. En ellas la ligadura de arterias hipogastricas muestra buenos resultados en el control del sangrado, ademas ha mostrado exito en lograr embarazos posteriores. Se presenta un caso clinico manejado por los autores y se analiza la literatura disponible

Carcinoma espinocelular de la vulva: caso clínico

SUMMARY Background: Squamous cell carcinoma (SCC) is a malignant epithelial neoplasm. SCC can be divided into 4 groups: non-melanoma skin cancer (NMSC), head and neck, esophageal and lung cancer. The risk for metastasis of SCC is 0.3-3.7%. Vulvar SCC is approximately 3-5% of all gynecological cancers. Case report: An 86-year old woman with a history of several years of genital pruritus and many consultations for this reason, prior treatments included valacyclovir for genital herpes; topical corticosteroids and tachrolymus for lichen sclerosus et atrophicus (LEA) with poor response. She presented with pruritus and new vulvar lesions. Physical examination showed two ulcerated nodules on the left periclitorid region and the introitus. The biopsy confirmed an infiltrating well-differentiated SCC. CT-scans discarded metastases. She received 7 weeks of radiotherapy. Due to persistence of the tumor the patient entered palliative care. Two years afterwards the patient is in good condition. Discussion: SCC represents 95% of vulvar malignancies. There are 2 types: SCC in young women, associated with high-risk human papilloma virus infection and SCC in elder women associated to the preexistence of LEA. 45-61% of vulvar SCC is associated in with preexisting

TUMOR DE LOS CORDONES SEXUALES CON TÚBULOS ANULARES DEL OVARIO NO ASOCIADO A SÍNDROME DE PEUTZ-JEGHERS: REPORTE DE UN CASO

SUMMARY A twenty years-old woman with an unusual variant of ovarian sex cord-stromal tumor, a sex cord tumor with annular tubules non-associated to Peutz-Jeghers syndrome, is reported. A review of the literature in the management of this unfrequent entity is also presented.

Tumor papilar peritoneal seroso de bajo potencial maligno.: Comunicación de un caso

Papillary serous carcinoma with low malignant potential, similar to those described in the ovary, can also originate in the peritoneum. Characteristically they show peritoneal spread without involvement of the ovary and, if present, it corresponds to a superficial implant similar to those seen in the rest of the peritoneal cavity. Histologically they correspond to a low malignant potential tumor; they are slow growing and have good prognosis. They are common in young women, usually they present few symptoms and are frequently discovered during other surgical procedures. The treatment is surgical and it can be conservative in cases of women who want to preserve their fertility, without coadjuvant therapy. We report a 34 years old woman with a primary peritoneal serous carcinoma with low malignant potential and discuss its management.