Síndrome uveomeningoencefálico Vogt Koyanagi-Harada con desprendimiento de la capa bacilar de la retina / Vogt Koyanagi-Barada uveomeningoencephalic syndrome with detachment of the bacillary layer of the retina

Introducción: El síndrome de Vogt-Koyanagi-Harada pertenece a los síndromes uveomeníngeos y es una de las principales enfermedades que amenazan la visión. Se caracteriza por una uveítis bilateral que se asocia frecuentemente con manifestaciones neurológicas, auditivas y tegumentarias. Recientemente un fenotipo particular de engrosamiento macular se ha descrito como desprendimiento bacilar asociado a esta enfermedad. Objetivo: Describir el desprendimiento bacilar de la retina mediante la tomografía de coherencia óptica de dominio espectral en un caso de Vogt Koyanagi Harada en fase uveítica. Presentación de caso: Paciente femenina de 46 años de edad atendida en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer" con disminución de agudeza visual en ambos ojos y panuveitis bilateral. Fue diagnosticada con síndrome de Vogt-Koyanagi-Harada en su fase uveítica aguda con presencia de manifestaciones neurológicas y desprendimiento de la capa bacilar de la retina identificado mediante la tomografía de coherencia óptica de dominio espectral. Conclusiones: El síndrome de Vogt-Koyanagi-Harada aguda y el desprendimiento bacilar de la capa de la retina pueden diferenciarse de otros signos mediante la tomografía de coherencia óptica de dominio espectral. Su desaparición pudiera tener una relación con la mejoría de la agudeza visual(AU)

Introduction: Vogt-Koyanagi-Harada syndrome belongs to the uveomeningeal syndromes and is one of the major vision-threatening diseases. It is characterized by bilateral uveitis, which is frequently associated with neurological, auditory and integumentary manifestations. Recently a particular phenotype of macular thickening has been described as bacillary detachment associated with this disease. Objective: To describe bacillary retinal detachment using spectral domain optical coherence tomography in a case of Vogt Koyanagi Harada in uveitic phase. Case presentation: 46-year-old female patient attended at the Cuban Institute of Ophthalmology "Ramón Pando Ferrer" with decreased visual acuity in both eyes and bilateral panuveitis. She was diagnosed with Vogt-Koyanagi-Harada syndrome in its acute uveitic phase with presence of neurological manifestations and detachment of the bacillary layer of the retina identified by spectral domain optical coherence tomography. Conclusions: Acute Vogt-Koyanagi-Harada syndrome and bacillary retinal layer detachment can be differentiated from other signs using spectral-domain optical coherence tomography. Their disappearance could be related to the improvement of visual acuity(AU)

Cistoadenofibroma seroso de ovario: experiencia de 12 años en el Hospital General Universitario de Albacete / Ovarian serous cystadenofibroma: 12-year experience at the Hospital General Universitario de Albacete

ANTECEDENTES: El cistoadenofibroma seroso de ovario es una neoplasia epitelial benigna, relativamente infrecuente, de crecimiento lento y de causa desconocida. El diagnóstico preoperatorio es complejo debido a la ausencia de síntomas y signos específicos que permitan descartar la malignidad. OBJETIVO: Analizar retrospectivamente las características clínicas, radiológicas, histopatológicas, y la atención médica de las pacientes. MATERIALES Y MÉTODOS: Análisis retrospectivo y descriptivo de pacientes con diagnóstico histopatológico de cistoadenofibroma seroso de ovario atendidas en el Hospital General de Albacete entre los años 2010 a 2022. RESULTADOS: Se analizaron 635 piezas quirúrgicas, de las que el 57.74% correspondieron a neoplasias serosas benignas, el 17.41% a neoplasias serosas fronterizas y un 24.85% a neoplasias serosas malignas. Se identificaron 20 casos de pacientes con diagnóstico de cistoadenofibroma seroso de ovario. La edad media de esas pacientes fue de 47 años, con límites de 9 y 74 años. Un caso se asoció con un tumor proliferativo seroso atípico contralateral. El tratamiento fue quirúrgico y no se identificaron recurrencias en ninguno de los casos. CONCLUSIONES: El cistoadenofibroma seroso suele manifestarse como un quiste ovárico complejo, con componentes sólidos-quísticos y tabiques irregulares; por esto a menudo se diagnostica erróneamente como tumor maligno antes de la intervención. La biopsia por congelación ayuda a confirmar su naturaleza benigna y evita una cirugía extensa innecesaria. El tratamiento consiste, principalmente, en la extirpación quirúrgica del quiste con o sin ooforectomía. El pronóstico suele ser excelente.

Abstract BACKGROUND: Serous ovarian cystoadenofibroma is a relatively rare, slow-growing, benign epithelial neoplasm of unknown cause. Preoperative diagnosis is complex due to the absence of specific symptoms and signs to rule out malignancy. OBJECTIVE: To retrospectively analyze the clinical, radiologic, histopathologic features, and medical care of the patients. MATERIALS AND METHODS: Retrospective and descriptive analysis of patients with histopathological diagnosis of ovarian serous cystoadenofibroma attended at the General Hospital of Albacete between the years 2010 to 2022. RESULTS: 635 surgical specimens were analyzed, of which 57.74% corresponded to benign serous neoplasms, 17.41% to borderline serous neoplasms and 24.85% to malignant serous neoplasms. Twenty cases of patients with a diagnosis of ovarian serous cystoadenofibroma were identified. The mean age of these patients was 47 years, with limits of 9 and 74 years. One case was associated with a contralateral atypical serous proliferative atypical tumor. Treatment was surgical and no recurrences were identified in any of the cases. CONCLUSIONS: Serous cystoadenofibroma usually manifests as a complex ovarian cyst, with solid-cystic components and irregular septa; this is why it is often misdiagnosed as a malignant tumor before surgery. Freeze biopsy helps to confirm its benign nature and avoids unnecessary extensive surgery. Treatment consists mainly of surgical removal of the cyst with or without oophorectomy. The prognosis is usually excellent.

Hallazgos genitourinarios en mujeres con tumores ováricos / Genito-urinary findings in women with ovarian tumors

Los tumores de ovario son los trastornos ginecológicos más comunes. Los tumores de ovario son el tercer tumor más común en las mujeres. Los tumores de ovario a veces son asintomáticos y tienen síntomas no específicos, lo que hace que la mayoría de los casos sean difíciles de detectar temprano. El objetivo de este estudio fue investigar las características genitourinarias del tumor ovárico en un estudio hospitalario. Se realizó un estudio observacional en Bagdad, Iraq, entre septiembre de 2018 y febrero de 2021. Las mujeres diagnosticadas con tumores ovarios a los 18 años de edad o más. Un total de cincuenta mujeres que se inscribieron en nuestro hospital. Datos clínicos y patológicos recopilados y analizados. Los datos sobre comorbilidades y resultados fueron aprobados y diagnosticados por un equipo completo de médicos ginecológicos y urológicos multidisciplinarios. La incidencia general de tumores ováricos fue 70% maligna y 30% benigna. El estudio mostró que la mayor parte del grupo de edad de tumores ováricos era superior a 55 años (62%). La mitad de los pacientes eran nuliparidades. El nivel educativo era principalmente de bajo nivel en analfabeto (20%), primario (24%), secundario (36%) en comparación con el alto nivel. Las mujeres usaron anticoncepción en 52%. La historia familiar informó en el 18% de las mujeres. El tipo histopatológico más común era el carcinoma seroso ovárico 15 (30%). Las etapas regionales eran comunes en el 50% de los pacientes. Tumores de bajo grado en 32%, intermedio en 36%y alto en 32%. Casi, el 80% de las mujeres se sometieron a TAH. Alrededor del 60% de los pacientes recibieron quimioterapia. Los resultados de salud genitourinaria adversos a largo plazo incluyeron nefritis (6%), insuficiencia renal aguda (16%), enfermedad renal crónica (18%), infección urinaria (38%), cálculo (16%), hidronefrosis (20%), Obstrucción de la vejiga (2%), estenosis ureteral (12%), retención de orina (8%), incontinencia de orina (12%), hematuria (22%), PID (14%), adhesión de órganos (8%), cervicitis (2 %), Endometriosis (2%), quiste (6%), trastornos menstruales (24%), infertilidad (2%) y dolor menopáusica (32%). En conclusión, el cáncer de ovario representa el tercer tipo de cáncer ginecológico más común. Era más común en mujeres mayores de cinco décadas. El tipo histopatológico más común es el carcinoma seroso ovárico. Observamos que los sobrevivientes de cáncer de ovario experimentaron mayores riesgos de varias enfermedades genitourinarias. Comprender los escenarios de la morbilidad múltiple para los tumores ováricos es de vital importancia para mejorar la atención clínica después del diagnóstico.

Ovarian tumors are the most common gynecological disorders. Ovarian tumors are the third most common tumor in women. Ovarian tumors are sometimes asymptomatic and have non-specific symptoms, making most cases difficult to detect early. The aim of this study was to investigate genitourinary features of ovarian tumor in a hospital-based study. An observational study was conducted in Baghdad, Iraq, between September 2018 and February 2021. Women diagnosed with ovarian tumors at 18 years of age or older. A total of Fifty women who enrolled in our hospital. Clinical and pathological data collected and analyzed. Data about comorbidities and outcomes were approved and diagnosed by full team of multidisciplinary gynecological and urological doctors were recorded. Overall incidence of ovarian tumors was 70% malignant and 30% benign. The study showed that the most age group of ovarian tumors was above 55 years (62%). Half of patients were nulliparities. Educational level was mostly of low level in illiterate (20%), primary (24%), secondary (36%) compared to high level. Women used contraception in 52%. The family history reported in 18% of women. The most common histopathological type was ovarian serous carcinoma 15(30%). Regional stages were common in 50% of patients. Low grade tumors in 32%, intermediate in 36% and high in 32%. Almost, 80% of women underwent TAH. About 60% of patients received chemotherapy. The long-term adverse genitourinary health outcomes correlated included Nephritis (6%), Acute renal failure (16%), Chronic kidney disease (18%), UTI (38%), Calculus (16%), Hydronephrosis (20%), Bladder obstruction (2%), Ureteric stenosis (12%), Urine retention (8%), Urine incontinence (12%), Hematuria (22%), PID (14%), Organ adhesion (8%), Cervicitis (2%), Endometriosis (2%), Cyst (6%), Menstrual disorders (24%), Infertility (2%), and Menopausal pain (32%). In conclusion, ovarian cancer represents the third most common gynecologic cancer type. It was more common in women aged above five decades. The most common histopathological type is ovarian serous carcinoma. We observed that ovarian cancer survivors experienced increased risks of various genitourinary diseases. Understanding the multi-morbidity scenarios for ovarian tumors is of vital importance to improve clinical care after diagnosis.

Schwannoma pancreático como tumor sincrónico. Reporte de caso / Pancreatic schwannoma as a synchronous tumor. Case report

Los Schwannomas son tumores derivados de las células de Schwann de las vainas de los nervios periféricos. Se pueden localizar en cualquier región anatómica que contenga tejido nervioso periférico, siendo más frecuentes en la región craneofacial y las extremidades. Los Schwannomas pancreáticos son entidades sumamente infrecuentes de las cuales solo se han descrito 68 casos a nivel mundial. En el presente trabajo se presenta el caso de un paciente con hallazgo incidental de tres tumores sincrónicos dentro de los cuales se encuentra un Schwannoma pancreático.Caso clínico : Paciente femenino de 66 años de edad con antecedente de diabetes mellitus tipo 1 y enfermedad diverticular pancolónica quien acude presentando cuadro clínico compatible con absceso lumbar izquierdo. Se realiza TC de abdomen y pelvis con doble contraste que evidencia extensa área de colección heterogénea en región retroperitoneal que diseca hacia región lumbar y glútea izquierda, además de la presencia de tumor hipodenso de bordes lobulados en mesogastrio. Se realiza colonoscopia que reporta lesión exofítica ulcerada en unión rectosigmoidea. El resto de paraclínicos y estudios de extensión se encontraban dentro de límites normales. Se decide resolución quirúrgica mediante drenaje percutáneo de absceso y laparotomía exploradora. Informe histopatológico: cistoadenoma seroso microquístico de cuerpo de páncreas, Schwannoma de cola de páncreas y adenocarcinoma moderadamente diferenciado de colon sigmoides.Conclusión : Los Schwannomas pancreáticos son entidades sumamente infrecuentes que pueden presentarse con una amplia variedad de manifestaciones clínicas, sin embargo, deben tenerse en cuenta como posible diagnóstico diferencial ante el hallazgo de un tumor pancreático(AU)

Schwannomas, also called Neurilemmomas or Neurinomas, are tumors derived from Schwann cells of the peripheral nerve sheaths. They can be located in any anatomical region that contains peripheral nervous tissue, being more frequent in the craniofacial region and the extremities. Pancreatic Schwannomas are extremely rare entities of which only 68 cases have been described worldwide. In the present study we present the case of a patient with an incidental finding of three synchronous tumors, including a pancreatic Schwannoma.Clinical case : A 66-year-old female patient with a history of type 1 diabetes mellitus and pancolonic diverticular disease who presented with symptoms compatible with left lumbar abscess. A double-contrast CT of the abdomen and pelvis was performed, which revealed a large area of heterogeneous collection in the retroperitoneal region that dissected towards the left lumbar and gluteal region, in addition to the presence of a hypodense tumor with lobulated borders in the mesogastrium. A colonoscopy was performed, which reported an ulcerated exophytic lesion at the rectosigmoid junction. The rest of the paraclinical and extension studies were within normal limits. Surgical resolution is decided by percutaneous abscess drainage and exploratory laparotomy. Histopathological report: microcystic serous cystadenoma of the body of the pancreas, Schwannoma of the pancreas tail, and moderately differentiated adenocarcinoma of the sigmoid colon.Conclusion : Pancreatic Schwannomas are extremely rare entities that can present with a wide variety of clinical manifestations, however, they should be taken into account as a possible differential diagnosis when a pancreatic tumor is found(AU)

A propósito de un caso de desprendimiento seroso de retina en una paciente con preeclampsia severa / Apropos of a case of serous retinal detachment in a patient with severe preeclampsia

Objetivo: Presentar las características clínicas y las secuelas de un caso de desprendimiento de retina (DR) seroso en preeclampsia. Diseño del estudio: Observacional. Material y métodos: Mujer de 17 años, embarazada de 36 semanas, presentó tres días previos a la visita oftalmológica disminución de la agudeza visual de ambos ojos, así como dolor abdominal. A su llegada se diagnosticó preeclampsia con datos de gravedad, por lo que se decidió interrumpir el embarazo. Su agudeza visual de ambos ojos fue contar los dedos a 50 centímetros. El examen de fondo de ojo derecho reveló un DR inferior y temporal, también líquido que se extendía hacia la mácula. El ojo izquierdo se observa con DR superior, nasal y temporal. Se decide iniciar tratamiento con esteroides, presentando mejoría visual y anatómica al tercer día. Conclusiones: El diagnóstico oportuno y seguimiento son el pilar para tener un buen pronóstico visual en pacientes con preeclampsia.

Objective: To present clinical characteristics and the sequelae of a case of serous retinal detachment in preeclampsia. Study design: Observational. Material and methods: We presented a 17-year old, 36-weeks pregnant, female without other ocular history, who reported 3 days previous of the ophthalmologic visit a reduction in visual acuity of both eyes, as well as abdominal pain. Upon arrival, preeclampsia was diagnosed with severity data, so was decided to terminate the pregnancy by cesarean. On examination, her visual acuity of both eyes was counting fingers at 50 centimeters. Fundus examination of the right eye revealed an inferior and temporal retinal detachment, also fluid extending into the macula. The left eye was observed with a superior, nasal and temporal detachment. It was decided to start steroid treatment, presenting visual and anatomical improvement. Conclusions: Timely diagnosis and follow-up are the pillar to have a good visual prognosis in preeclampsia

Quiste de ovario gigante y embarazo / Giant Ovarian Cyst and Pregnancy

Introducción: Los quistes en los ovarios son una afección frecuente en las mujeres en edad fértil. Objetivo: Presentar el caso de una mujer con embarazo a la que se le diagnostica un quiste gigante de ovario, de interés para los especialistas debido al tamaño y la favorable evolución. Presentación de caso: Paciente femenina de 28 años de edad, procedencia rural, con embarazo único. Se realizó captación del embarazo a las 11,4 semanas y se detectó al examen ginecológico una tumoración anexial que se corrobora por ultrasonido, donde se reporta una imagen quística que llega a la región umbilical que mide 18 centímetros, de paredes finas, multitabicada con un grosor de los tabiques de 2,3 milímetros, con vascularizazión a este nivel. Se decidió su ingreso para tratamiento quirúrgico a las 17,5 semanas de gestación, se realizó de forma electiva laparotomía exploradora. Los hallazgos operatorios fueron: quiste gigante de ovario de aproximadamente 20 centímetros. Fue dada de alta al tercer día con una evolución satisfactoria. Continúa su atención prenatal en en el consultorio del médico y la enfermera de la familia. Los resultados anatomopatológicos fue: cistodenoma seroso papilar de ovario de 20 por 20 centímetros, no se observan estigmas de malignidad. Se realiza parto eutócico a las 39,1 semanas de gestación, con un peso de 3800 gramos. Conclusiones: Se hace descripción clínico y quirúrgica del diagnóstico, la evolución, la intervención y el seguimiento de una mujer en quien coexistieron un embarazo y un cistodenoma seroso papilar de ovario, con resultados favorables(AU)

Introduction: Ovarian cysts are a frequent condition in women at fertile age. Objective: To present the case of a pregnant woman diagnosed with a giant ovarian cyst, of interest to specialists due to its size and favorable evolution. Case presentation: 28-year-old female patient, of rural origin, with a single pregnancy. During the first pregnancy consultation, at 11.4 weeks, the gynecological examination permitted to identify an adnexal tumor, a diagnosis corroborated by ultrasound imaging, reporting an 18-cm multi-septated cystic image that reaches the umbilical region, with thin walls, septa thickness of 2.3 millimeters and vascularization at this level. The patient was decided to be hospitalized for surgical treatment at 17.5 weeks of gestation; exploratory laparotomy was performed electively. The operative findings were a giant ovarian cyst of approximately twenty centimeters. She was discharged on the third day, with a satisfactory evolution. She continues to receive prenatal care in the family doctor and nurse's office. The anatomopathological results were an ovarian papillary serous cystadenoma measuring 20 per 20 cm; no stigmata of malignancy were observed. Eutocic delivery was performed at 39.1 weeks of gestation, the offspring weighing 3800 grams. Conclusions: A clinical and surgical description is made of the diagnosis, evolution, intervention and follow-up of a pregnant woman with an ovarian papillary serous cystadenoma, reporting favorable outcomes(AU)

Cistoadenoma seroso de pâncreas. por que a acurácia é baixa aos exames de imagem? / Serous cystadenoma of pancreas: why there is low accuracy in imaging exams?

RESUMO - RACIONAL: Apesar da recomendação atual que o cistoadenoma seroso deva ser tratado de forma conservadora, significativa parte dos pacientes com essa condição ainda é operada por dúvida diagnóstica. OBJETIVO: Analisar causas da baixa acurácia diagnóstica do cistoadenoma seroso. MÉTODOS: Estudo retrospectivo de portadores de cistoadenoma seroso de um banco de dados de dois ambulatórios de cirurgia hepatopancreaticobiliar entre 2006 e 2020. Foram incluídos pacientes com lesões típicas de cistoadenoma seroso aos exames de imagem (tomografia computadorizada, ressonância magnética e ecoendoscopia) e pacientes que o anatomopatológico confirmasse esse diagnóstico. RESULTADOS: 27 pacientes foram incluídos. 85,18% eram do sexo feminino. A idade média foi de 63,4 anos. Apenas um apresentava sintomas típicos de pancreatite. A Ressonância magnética foi o exame mais realizado (62,9%). A lesão era única em 88,9% e o tamanho médio foi 4 cm. O aspecto típico microcístico foi encontrado em 66,6% dos casos, os demais foram considerados atípicos. A ecoendoscopia foi realizada em 29,6%. O valor médio de antígeno carcinoembrionário nos pacientes submetidos à punção do cisto foi de 198,25 ng/mL. O tratamento cirúrgico foi realizado em 10 casos (37%). Em 7, a causa cirúrgica foi a suspeita do cistoadenoma mucinoso mediante identificação de lesões atípicas (unilocular com ou sem septos e macrocística). Em 2, a suspeita de neoplasia papilar intraductal mucinosa com "fatores preocupantes" foi a indicação cirúrgica. O último foi submetido à cirurgia por lesão de aspecto sólido e suspeita de câncer. O índice de complicações > ou = Clavien-Dindo 2 foi 30%, o índice de fístula pancreática clinicamente relevante (B e C) foi 30%. A mortalidade foi nula. CONCLUSÃO: A apresentação morfológica atípica do cistoadenoma seroso, particularmente lesões uniloculares e macrocísticas, é a principal responsável pela indicação cirúrgica. Apenas a implementação de novos, eficientes e reprodutíveis métodos diagnósticos poderá reduzir o número de cirurgias desnecessárias nesses pacientes.

ABSTRACT - BACKGROUND: Many patients with serous cystadenoma of the pancreas (SCP) underwent surgery due to diagnostic doubt. AIM: The aim of this study was to analyze the causes of low accuracy in diagnosing SCP. METHODS: This is a retrospective study of patients with SCP from a database of two hepatopancreatic biliary surgery outpatient clinics between 2006 and 2020. Patients with typical SCP lesions in imaging exams (e.g., tomography, magnetic resonance imaging [MRI], and endoscopic ultrasound [EUS]) and patients whose pathological testing confirmed this diagnosis were included. RESULTS: A total of 27 patients were included in this study. Most patients were women (85.18%), and the mean age was 63.4 years. Only one patient had typical pancreatitis symptoms. MRI was the most performed method (62.9%). The lesion was single in 88.9%, and the average size was 4 cm. The typical microcystic aspect was found in 66.6%. EUS was performed in 29.6% of cases. The mean carcinoembryonic antigen value in patients undergoing cyst puncture was 198.25 ng/mL. Surgical treatment was performed in 10 cases (37%). The cause of surgery in seven of these cases was due to a suspicion of mucinous cystadenoma based on an identification of atypical lesions (unilocular with or without septa and macrocystic) in imaging exams. A suspicion of intraductal papillary mucinous neoplasm with "worrying factors" was the indication for surgery in two cases. The last case underwent surgical treatment for a solid-looking lesion which was suspected of cancer. The complication rate ≥Clavien-Dindo 2 was 30%, and the clinically relevant pancreatic fistula rate (B and C) was 30%. Mortality was nil. CONCLUSION: The atypical morphological presentation of SCP, particularly unilocular and macrocystic lesions, is the main indication for surgery. Only the implementation of new, efficient, and reproducible diagnostic methods can reduce the number of unnecessary surgeries among these patients.

Quiste gigante de ovario / Giant cyst of ovary

Introducción: Los tumores de gran tamaño han sido descritos a través de la historia, entre ellos los ginecológicos y los de ovario cuando pesan más de 12 kg constituyen una rareza médica. Las masas tumorales en hemiabdomen inferior son causas frecuentes de consulta en cirugía general. Dentro de estas, los quistes de ovarios son los que con más frecuencia se diagnostican. Objetivo: Describir el caso de un quiste gigante de ovario en una paciente que fue atendida en consulta de cirugia general por aumento de tamaño en el abdomen de varios años de evolución. Caso clínico: Se expone el caso de una paciente femenina, con antecedentes de salud, que acude al servicio de cirugía general por aumento de volumen del abdomen, progresivo, insidioso de 2 años de evolución. Se diagnostica masa quística dependiente de ovario y en el transoperatorio se constata una tumoración quística del ovario que en el análisis histopatológico informa un cistoadenoma seroso de ovario. Conclusión: Los tumores del ovario no son tan frecuentes como los del útero y los de la mama, pero constituyen el tercer grupo de tumores benignos y malignos de la mujer. Se presentó el caso por lo infrecuente que resulta, la escasa frecuencia de reporte de estos casos lo cual aporta conocimiento a la comunidad médica sobre el tema(AU)

Introduction: Large tumors have been described throughout history, including gynecological tumors, and ovarian tumors when they weigh more than 12 kg constitute a medical rarity. Tumor masses in lower hemiabdomen are frequent causes of consultation in general surgery. Within these, ovarian cysts are the most frequently diagnosed. Objective: To describe the case of a giant ovarian cyst in a patient who was treated in a general surgery consultation due to an increase in abdomen size of several years of evolution. Clinical case: The case of a female patient, with a history of health, which goes to the general surgery service due to an increase in abdomen volume, progressive, insidious of 2 years of evolution, is presented. Ovarian-dependent cystic mass is diagnosed and a cystic tumor of the ovary is found in the transoperative period, which in the histopathological analysis reports a serous ovarian cystadenoma. Conclusion: Ovarian tumors are not as frequent as those of the uterus and those of the breast, but they constitute the third group of benign and malignant tumors of women. The case was presented because of the infrequent result, the low frequency of reporting these cases, which brings knowledge to the medical community on the subject(AU)

Quiste gigante de ovario / Giant cyst of ovary

RESUMEN Históricamente, se describen como tumores de gran tamaño aquellos que pesan más de 12 Kg, entre ellos los ginecológicos y los de ovario; sobre todo antes del advenimiento de la ecografía y en poblaciones de mala situación socioeconómica y nivel cultural, como en los países del continente africano. Se presentó un caso de quiste gigante del ovario, en una paciente de 45 años de edad, que fue atendida en el Servicio de Cirugía General del Hospital Municipal de Bocoio, provincia de Benguela, República de Angola, en el año 2015. Se presentó por un aumento de tamaño del abdomen de varios años de evolución Se le diagnosticó una masa quística dependiente de ovario, por ultrasonografía por no contar con otro medio de diagnostico imagenologico. Se confirmó a través de una laparotomía exploradora la presencia de una tumoración quística gigante del ovario de 20 kg de peso. Esta patología es poco frecuente en la actualidad debido al desarrollo de la Cirugía y de los medios de diagnósticos que permiten su detección precoz. El estudio anatomopatológico ulterior informó un cistoadenoma seroso de ovario izquierdo. La evolución de la paciente fue favorable. Se consideró un caso interesante por lo infrecuente, la poca existencia de reporte de estos casos en la literatura, sobre todo en Cuba, lo que contribuye a aportar conocimientos a la comunidad médica (AU).

ABSTRACT Through the history those tumors weighting more than 12 kg have been described as great size tumors, among them the gynecological and the ovarian ones, especially before the appearance of the ultrasonography, and among populations of bad socio-economic situation and low cultural level, like in the countries of the African continent. The authors presented the case of a giant ovarian cyst in a patient aged 45 years, who assisted in the Service of General Surgery of the Municipal Hospital of Bocolo, province of Benguela, Republic of Angola, in 1915. She arrived to the consultation due to an increase of the abdominal size of several years of evolution. By ultrasonography because there was no other mean of imaging diagnosis, the diagnosis was an ovary-dependent cystic mass. Using laparoscopy it was confirmed the presence of a giant cystic tumor of the ovary of 20 kg weight. This disease is few frequent nowadays due to the development of Surgery and diagnostic means allowing a precocious detection. The subsequent anatomopathologic study informed a serous cystadenoma of the left ovary. The patient had a satisfactory evolution. The case was considered interesting given its infrequency, the scarce existence of reports of cases like this in the literature, especially in Cuba, contributing with knowledge for the medical community (AU).

Carcinoma seroso de ovario. Serie de 14 casos y revisión de la bibliografía / Serous ovarian cancer. Report of 14 cases and review of the bibliography

Resumen OBJETIVO: Describir las características epidemiológicas, clínicas, de laboratorio, de tratamiento médico-quirúrgico y patología, en una serie de 14 pacientes con carcinoma seroso de ovario atendidas en un hospital de alta complejidad y revisión de la bibliografía con el fin de actualizar los conceptos. MATERIALES Y MÉTODOS: Estudio de serie de casos retrospectivo y descriptivo de pacientes con cáncer de ovario seroso confirmado por patología. Las pacientes se estudiaron en un hospital general de alta complejidad entre 2013 y 2016. Variables de estudio: epidemiológicas, clínicas, de laboratorio, del tratamiento médico quirúrgico, comorbilidades y patología. Revisión narrativa de la bibliografía correspondiente a la información relacionada con las variables evaluadas. RESULTADOS: Se diagnosticaron 14 mujeres, de 50 a 80 años; 3 casos con antecedente de histerectomía y 1 de salpingoclasia. Diagnóstico histológico: 10 con tumor seroso de alto grado, 2 moderadamente diferenciado, 1 seroso de bajo grado y otro no clasificado. Procedimientos quirúrgicos: histerectomía, salpingooforectomía bilateral, linfadenectomía, omentectomía en 8 casos. Clasificación en estadios: IV en 6, 3 IIIB, 2 IC, 1 IIIC y una 1 IB. Tratamiento: 10 mujeres con carboplatino y paclitaxel. Revisión de 2227 artículos encontrados, 41 seleccionados. CONCLUSIONES: El carcinoma seroso de ovario se clasifica, actualmente, en bajo y alto grado (más frecuente y agresivo). Este tipo fue el más frecuente, los factores de riesgo encontrados, por el número reducido de pacientes, no permiten emitir conclusiones.

Abstract OBJECTIVE: To describe the epidemiological, clinical, laboratory, surgical medical management and pathology characteristics in a series of 14 patients with serous ovarian carcinoma in a highly complex hospital and review of the literature in order to update the concepts. MATERIALS AND METHODS: Retrospective and descriptive case series study of a patient with serous ovarian cancer confirmed by pathology. The patients were studied in a highly complex general hospital between 2013 and 2016. Study variables: Epidemiological, clinical, laboratory surgical medical treatment, comorbidities, and pathology. Narrative review of the bibliography corresponding to information related to the evaluated variables. RESULTS: Fourteen women between the ages of 50 and 80 were diagnosed, 3 with a history of hysterectomy and 1 with tubal ligation. Histological diagnosis: 10 with high-grade serous tumor, 2 moderately differentiated, 1 low-grade serous and one not classified. Surgical procedures: hysterectomy, bilateral salpinges-oophorectomy, lymphadenectomy, omentectomy in 8 cases. They classified into states: IV in 6, 3 IIIB, 2 IC, 1 IIIC and 1 IB. Treatment 10 women with carboplatin and paclitaxel. Review 2227 articles were found, 41 sectioned. CONCLUSIONS: Serous ovarian carcinoma is currently classified as low and high grade (more frequent and aggressive). This type was the most frequent, the risk factors found by the reduced number do not allow conclusions to be drawn.

Carcinoma intraepitelial tubárico seroso como hallazgo posquirúrgico de endometriosis y útero miomatoso. Reporte de un caso / Seuous tubal intraepithelial carcinoma as a post-surgical finding of endometriosis and myomatous uterus. A case report

Resumen: ANTECEDENTES: El carcinoma intraepitelial tubárico seroso es una lesión precursora del carcinoma invasivo de las trompas de Falopio que con frecuencia se diagnostica en el contexto de una salpingooforectomía bilateral profiláctica por patología ginecológica benigna. CASO CLÍNICO: Paciente nulípara, de 51 años, con cuadro clínico de dolor abdominal y elevación de marcadores tumorales CA-125 y CA-19.9, diagnosticada con útero polimiomatoso y sospecha de endometrioma en el ovario derecho. Después de la histerectomía subtotal con anexectomía bilateral, el estudio histológico de la pieza tubárica extirpada reportó focos microscópicos de carcinoma intraepitelial tubárico seroso, sin signos de invasión estromal. Por los hallazgos se solicitaron pruebas de imagen mamarias y el estudio genético de mutación BRCA 1 y 2. CONCLUSIÓN: La salpingooforectomía bilateral profiláctica es un procedimiento que reduce el riesgo de carcinomas peritoneales, tubáricos y serosos de ovario. Las pacientes con carcinoma intraepitelial tubárico seroso deben tener seguimiento basado en controles ecográficos, pruebas de imagen mamarias, determinación de marcadores tumorales y estudios genéticos, debido a su asociación con mutaciones en los genes BRCA 1 y 2.

Abstract: BACKGROUND: Serous tubal intraepithelial carcinoma (STIC) is a precursor lesion of invasive high-grade tubal and serous carcinoma of the ovary, frequently diagnosed in the context of prophylactic bilateral salpingoophorectomy for benign gynecological pathology. The objective of this work is to carry out a literature review on the most relevant aspects of the follow-up of this injury, after its incidental diagnosis in gynecological surgery. CLINICAL CASE: A 51-year-old nulliparous patient who, in the context of a clinical situation of abdominal pain with elevation of tumor markers CA125 and CA19.9, was diagnosed with polymomatous uterus and suspected endometrioma in the right ovary. After a subtotal hysterectomy with bilateral adnexectomy, the histological study of the excised tubal specimen found microscopic foci of STIC without signs of stromal invasion. Given this finding, breast imaging tests and a genetic study of the BRCA 1/2 mutation was requested. CONCLUSION: Prophylactic bilateral salpingoophorectomy in gynecological surgery is a procedure that can reduce the risk of developing peritoneal, tubal, and serous ovarian carcinomas. Patients diagnosed with STIC should be subsidiaries of follow-up based on ultrasound controls, mammary imaging tests, tumor markers, and genetic studies, due to their association in many cases with mutations in the BRCA 1/2 genes. It is necessary to establish a series of standardized clinical protocols for the management of patients with STIC and to continue advancing our understanding of this pathology and its subsequent evolution to high-grade serous carcinoma.

Brain metastasis in papillary serous adenocarcinoma of the endometrium / Metástase cerebral do adenocarcinoma seroso-papilífero do endométrio

Abstract Background Most endometrial cancers (75%) are diagnosed in early stages (stages I and II), in which abnormal uterine bleeding is the most frequent clinical sign.When the diagnosis is performed in stage IV, the most common sites of metastasis are the lungs, liver and bones. Central nervous system (CNS)metastasis is a rare condition. The aim of this study is to describe a case of uterine papillary serous adenocarcinoma of the endometrium that progressed to brain and bone metastases. Case Report We present the case of a 56-year-old woman with abnormal uterine bleeding and endometrial thickened echo (1.8 cm). A hysteroscopy with biopsy was performed, which identified poor differentiated serous adenocarcinoma of the endometrium. A total abdominal hysterectomy, with pelvic and para-aortic lymphadenectomy, was performed. Analysis of the surgical specimen revealed a grade III uterine papillary serous adenocarcinoma. Adjuvant radio/chemotherapy (carboplatin and paclitaxel-six cycles) was indicated. Sixteen months after the surgery, the patient began to complain of headaches. Brain magnetic resonance imaging demonstrated an expansile mass in the right parietal lobe, suggesting a secondary hematogenous implant subsequently confirmed by biopsy. She underwent surgery for treatment of brain metastasis, followed by radiotherapy. She died 12 months after the brain metastasis diagnosis due to disease progression. Conclusion Uterine papillary serous adenocarcinoma of the endometrium has a low propensity to metastasize to the brain. To the best of our knowledge, this is the fifth documented case of uterine papillary serous adenocarcinoma of the endometrium with metastasis to the CNS.

Resumo Fundamentos A maioria dos cânceres de endométrio (75%) é diagnosticada em estágios iniciais (estágios I e II), nos quais o sangramento uterino anormal é o sinalclínico mais frequente. Quando o diagnóstico é realizado no estágio IV, os locais mais comuns de metástase são os pulmões, o fígado e os ossos. A metástase para o sistema nervoso central (SNC) é uma condição rara. O objetivo deste estudo é descrever um caso de adenocarcinoma seroso-papilífero do endométrio que progrediu para metástases cerebral e óssea. Relato de Caso Apresentamos o caso de uma mulher de 56 anos com sangramento uterino anormal e eco endometrial espessado (1,8 cm). Foi realizada histeroscopia com biópsia que identificou adenocarcinoma seroso-papilífero pouco diferenciado do endométrio. Uma histerectomia abdominal total, com linfadenectomia pélvica e para-aórtica, foi realizada. A análise da peça cirúrgica revelou adenocarcinoma seroso-papilífero do endométrio grau III. Radioterapia adjuvante/quimioterapia (carboplatina e paclitaxel- seis ciclos) foi indicada.Dezesseismeses após a cirurgia, a paciente começou a se queixar de dores de cabeça. A ressonância magnética cerebral demonstrou uma massa expansiva no lobo parietal direito, sugerindo um implante hematogênico secundário posteriormente confirmado por biópsia. A paciente foi submetida a cirurgia para tratamento de metástase cerebral, seguida de radioterapia. A paciente morreu 12 meses após o diagnóstico de metástase cerebral devido à progressão da doença. Conclusão O adenocarcinoma seroso-papilífero do endométrio tem uma baixa propensão a metastizar para o cérebro. Até onde sabemos, este é o quinto caso documentado de adenocacinoma seroso-papilífero do endométrio com metástase para o SNC.

Bilateral Ovarian Collision Tumours: Serous Carcinomas and Fibrothecomas / Tumores de colisión ováricos bilaterales: carcinomas serosos y fibrotecomas

ABSTRACT A patient had both ovaries affected by clearly demarcated colliding tumour masses of different gross appearance, histological features and immunohistochemical profiles, corresponding to bilateral collision papillary serous high-grade adenocarcinoma and fibrothecoma. Despite the applied chemotherapy, it led to a lethal outcome for the patient nearly a year after the surgery. Bilateral ovarian tumours raise the question of whether they are primary tumours or metastases. Simultaneous bilateral occurrence of surface epithelial tumours with other types of ovarian tumours is rare. Therefore, it poses a great challenge in proper differential diagnostics.

RESUMEN Una paciente tenía ambos ovarios afectados por masas tumorales en colisión, claramente demarcadas. Las mismas mostraban diferente aspecto macroscópico, y diferentes rasgos histológicos y perfiles inmunohistoquímicos, correspondientes a fibrotecomas y adenocarcinomas serosos papilares bilaterales de alto grado en colisión. A pesar de la quimioterapia aplicada, la condición condujo a un resultado fatal para la paciente, casi un año después de realizada la cirugía. Los tumores ováricos bilaterales plantean la cuestión de si se trata de tumores primarios o metástasis. La ocurrencia bilateral simultánea de tumores epiteliales superficiales con otros tipos de tumores ováricos es rara, y por tanto, plantea un gran desafío a la hora de realizar un diagnóstico diferencial adecuado.

Desprendimiento de retina seroso bilateral como presentación inusual de insuficiencia renal crónica terminal en un paciente pediátrico

Introducción: El desprendimiento de retina (DR) seroso, se define como una elevación de la retina producida por la acumulación de líquido su retiniano sin tracción vítrea significativa o ruptura de la misma. Se encuentra asociado a patologías oculares y sistémicas como la Insuficiencia renal crónica (IRC). Es necesario determinar la enfermedad de base para brindar el tratamiento específico Caso clínico: Se presenta el caso de una niña de 13 años, sin antecedentes previos, que fue derivada al Servicio de Oftalmología, por desprendimiento de retina (DR) bilateral, constándose DR seroso, por lo que fue remitida al Servicio de Urgencias Pediátricas para detección de la patología causal. Se constató al examen físico hipertensión arterial, palidez de piel y mucosas y edema bipalpebral y de miembros inferiores; en los estudios laboratoriales anemia y caída de filtración glomerular y en la ecografía, riñones de tamaño pequeño con aumento de la ecogenicidad con lo que se hizo el diagnóstico de IRC. Se realizó tratamiento antihipertensivo y hemodialítico crónico con mejoría progresiva del DR, sin llegar a agudeza visual normal. Conclusión: La pérdida brusca de la visión en un paciente sin datos patológicos previos, puede deberse a una enfermedad sistémica como la IRC, por lo que estos pacientes deben ser sometidos a un riguroso control laboratorial dado que los hallazgos oftalmológicos pueden ser la imagen en espejo de alteraciones metabólicas no controladas.

Introduction: Serous retinal detachment (RD) is defined as an elevation of the retina produced by the accumulation of fluid in the sub-retina without significant vitreous traction or rupture. It is associated with ocular and systemic pathologies such as chronic renal failure (CRF). It is necessary to determine the underlying disease in order to provide specific treatment. Case report: We present the case of a 13-year-old girl, with no previous medical history, who was referred to the Ophthalmology Service due to bilateral retinal detachment (RD), consisting of serous RD. She was subsequently referred to the Pediatric Emergency Department for detection of the underlying pathology. The physical examination showed arterial hypertension, pale skin and mucous membranes, as well as bilateral palpebral and lower limb edema; laboratory studies showed anemia and a decrease in the glomerular filtration rate. Ultrasound showed small-sized kidneys with increased echogenicity and the diagnosis of CRF was made. Chronic antihypertensive and hemodialysis treatment was performed with progressive improvement of the RD, without achieving normal visual acuity. Conclusion: The sudden loss of vision in a patient without previous pathology may be due to a systemic disease such as CRF, so these patients must undergo a rigorous laboratory control since ophthalmological findings may be a sign. of uncontrolled metabolic alterations.

Tratamento cirúrgico de lesões císticas do pâncreas: uma experiência unicêntrica / Surgical management of cystic lesions of the pancreas: a single-centre experience

ABSTRACT BACKGROUND: Cystic lesions of the pancreas represent a group of pancreatic diseases with great histological heterogeneity, varying from benign lesions, some of them with malignant potential, to overt malignant lesions. OBJECTIVE: To describe the cases of cystic lesions of the pancreas which underwent surgical intervention at a tertiary university hospital. METHODS: This is a retrospective population-based study (historical cohort) which was carried out enrolling individuals attended at the Outpatient service of Pancreas Surgery of the Hospital de Clínicas of Unicamp. The individuals underwent surgical procedures performed from January 2012 through December 2016. RESULTS: In the period evaluated, 39 cases of cystic lesions of the pancreas which underwent surgery were identified, 26 (66.6%) of which were female. The average age at diagnosis was 47.4±16.4 years (range, 18-73). In regards to symptoms, 35 (89.7%) were symptomatic. The average length of hospital stay was 10 days (range 4-76). Surgeries performed to treat the lesions depended on the localization and type of the lesions: cystojejunostomy (41%), distal pancreatectomy (36%), pancreaticoduodenectomy (15.4%), drainage of ruptured and/or infected pseudocyst (5.2%) and central pancreatectomy (2.6%). CONCLUSION: Cystic lesions of the pancreas are a group of lesions with a highly varying presentation and diagnostic approach and may require an also highly variable surgical treatment. An appropriate preoperative imaging diagnosis is essential for their management.

RESUMO CONTEXTO: As lesões císticas do pâncreas representam um grupo de doenças pancreáticas com grande heterogeneidade histológica, variando desde lesões benignas, algumas com potencial pré-maligno, até outras degeneradas para formas malignas. OBJETIVO: Descrever os casos de LCPs submetidos à intervenção cirúrgica em um hospital universitário terciário. MÉTODOS: Trata-se de um estudo retrospectivo populacional (coorte histórica) realizado com a participação de indivíduos atendidos no Ambulatório de Cirurgia do Pâncreas do Hospital de Clínicas da Unicamp. Os indivíduos foram submetidos a procedimentos cirúrgicos realizados no período de janeiro de 2012 a dezembro de 2016. RESULTADOS: No período avaliado, foram identificados 39 casos de lesões císticas do pâncreas operados, sendo 26 (66,6%) do sexo feminino. A idade média no diagnóstico foi de 47,4±16,4 anos. Em relação aos sintomas, 35 (89,7%) eram sintomáticos. O tempo médio de internação foi de 10 dias (variação de 4-76). As cirurgias realizadas para o tratamento das lesões dependeram da localização e do tipo das lesões: derivação pseudocisto-jejunal (41%), pancreatectomia distal (36%), pancreaticoduodenectomia (15,4%), drenagem de pseudocistos rotos e/ou infectados (5,2%) e pancreatectomia central (2,6%). CONCLUSÃO: As lesões císticas do pâncreas são um grupo de lesões cuja apresentação e abordagem diagnóstica são altamente heterogêneas e que podem requerer um tratamento cirúrgico altamente complexo e variável. Um diagnóstico pré-operatório adequado é essencial para definir o seu tratamento.

Hematoma de Morel Lavallée gigante en la rodilla derecha: reporte de un caso / Giant Morel Lavallée hematoma in the right knee: case report

RESUMEN Se presenta el caso del paciente de 36 años de edad, con antecedentes de acondroplasia que desde hace 7 meses sufrió una lesión traumática no de gravedad en la rodilla derecha. La cual comienza a aumentar de volumen con contenido líquido fluctuante. Fue puncionado en dos ocasiones obteniéndose líquido serohemático; al no resolver y continuar aumentando de tamaño, se le plantea que es portador de un hematoma seroso de Morel Lavallée, que se produce por la fricción entre el tejido celular subcutáneo y la fascia. Su localización es infrecuente en la rodilla por lo que se decide presentar el caso ya que en la literatura revisada; no aparece ningún caso descrito. Por lo que constituye el objetivo principal de este trabajo, describir su proceder y la eficacia del tratamiento quirúrgico, con el que se obtuvo resultado satisfactorio (AU).

ABSTRACT We present the case of a patient aged 36 years, with antecedents of achondroplasia who 7 months ago suffered a non serious traumatic lesion in the right knee. The volume of the lesion began to increase with a fluctuant fluid contain. It was punctured twice draining serohematic fluid; it did not solve and the size increased more and more, so the patient was said that he had a serous Morel Lavallée hematoma, produced by the friction between the subcutaneous cell tissue and fascia. Its location in the knee is infrequent and it was not found any case like this in the reviewed literature; therefore we decided to present the case. The main objective of our work was describing it, showing the procedure and efficacy of the surgical that gave a satisfactory result (AU).

Identificação de microRNAs diferencialmente expressos em carcinomas serosos de alto grau de pacientes com distintas evoluções clínicas / Identification of microRNAs differentially expressed in high grade serous carcinomas of patients with different clinical evolutions

Introdução: O tratamento do câncer epitelial de ovário é baseado na combinação de cirurgia e quimioterapia (principalmente carboplatina e paclitaxel). Embora o tratamento seja eficiente em 80% dos casos, a taxa de sobrevida de 5 anos é baixa devido à alta taxa de recorrência e resistência ao tratamento medicamentoso. Os processos moleculares que influenciam na resposta terapêutica e mecanismos que acarretam na sobrevida das pacientes ainda não são completamente compreendidos, e por este motivo, torna-se necessário a identificação de moléculas que possibilitem a melhor compreensão. Muitos estudos relatam a importância dos miRNAs no desenvolvimento e progressão do câncer de ovário, entretanto, tendo em vista a heterogeneidade do câncer ovariano, este estudo se diferencia por selecionar uma casuística clinicamente homogênea. Neste contexto, o objetivo do presente estudo foi caracterizar o perfil da expressão de miRNAs em amostras clinicamente homogêneas de adenocarcinoma seroso de alto grau, a fim de identificar miRNAs que estão envolvidos no processo de resistência ao tratamento quimioterápico e capazes de diferenciar pacientes com distintas evoluções clínicas. Metodologia: Foram selecionadas trinta e três amostras de adenocarcinoma seroso de ovário de alto grau, provenientes do banco de tumores do A.C.Camargo Cancer Center, oriundas de cirurgia com ressecção ótima cujas pacientes tinham estadiamento III e passaram por acompanhamento clínico mínimo de 2 anos. Destas 25 amostras foram provenientes de tumor primário, 8 de metástases primárias pareadas de pacientes que apresentaram recidiva e 5 amostras de epitélio de tuba de falópio de pacientes sem histórico de câncer como controle normal. A identificação dos miRNAs diferencialmente expressos nas pacientes com distintos desfechos clínicos foi realizada através da plataforma de larga escala de expressão de miRNAs humanos (G4870A ­ ID 031181; 8x60K, Agilent Tecnologies). As probes foram filtradas e normalizadas utilizando o software BRB ArrayTool (v. 4.4.0). Os alvos foram preditos usando miRWalk 2.0 (http://www.umm.uni-heidelberg.de/apps/zmf/mirwalk/custom.html), em quatr diferentes algoritmos (miRWalk, RNA22, miRanda and Targetscan). Para a análise do perfil entre miRNAs e transcritos codificadores, 415 amostras foram obtidas do The Cancer Genome Atlas (TCGA) (http://tcga-data.nci.nih.gov/tcga/) e essa interação foi submetida a um teste de correlação de Pearson. Os miRNAs diferencialmente expressos em diferentes desfechos clínicos foram validados pela técnica de in situ hybridization (ISH) em 114 amostras de adenocarcinoma seroso de alto grau incluídas no TMA proveniente do departamento de Anatomina Patologica do Hospital AC Camargo e em diferentes amostras provenientes do TCGA. Os alvos dos miRNAs validados foram associados a sobrevida global e livre de doença em amostras do TCGA e confirmados em amostras contidas no TMA da casuística interna através da técnica de Imuno-histoquímica. Resultados: A análise de comparação da expressão diferencial de miRNAs entre controle normal e de seroso de alto grau seroso demonstrou que 365 miRNAs foram diferencialmente expressos e foram encontradas 613 interações inversamente correlacionadas. Os miRNAs miR-934 e miR-143 foram associados a pior sobrevida global em nossa casuística, o miR-503-5p com resistência a quimioterapia. Apenas o miR-934 foi validado no TCGA e pela técnica de ISH. O alvo FZD3 foi predito para o miR-934 e miR-143 e foi negativamente correlacionado com ambos miRNAs em células tumorais de ovário. A expressão da proteína FZD3 por imuno-histoquímica demonstrou que esse receptor não foi expresso na membrana celular e sim no citoplasma e núcleo nos tumores de alto grau seroso. Conclusão: Diversos miRNAs tem participação na progressão do tumor de ovário. O miR-934 foi encontrado aumentado nas amostras metastática e em tumores primários e foi associado a pior sobrevida global, bem como o aumento citoplasmático de FZD3, alvo do miR-934, contudo este não foi associado a expressão de Beta-catenina. Sugere-se assim que outras vias de sinalização possam estar envolvidas neste contexto (AU)

Introduction: The treatment of epithelial ovarian cancer is based on the combination of surgery and chemotherapy (mainly carboplatin and Plactaxel). Although treatment is effective in 80% of cases, the 5 year survival rate is low due to the high recurrence rate and drug treatment resistance. The molecular processes that influence the therapeutic response and mechanisms that lead to the patient's survival are not yet fully understood, and for this reason, it becomes necessary to identify molecules that allow the best understanding. Many studies report the importance of miRNAs in the development and progression of ovarian cancer, however, in view of the heterogeneity of ovarian cancer, this study differs by selecting a clinically homogeneous casuistic. In this context, the objective of the present study was to characterize the profile of the expression of miRNAs in clinically homogeneous samples of high-grade serous adenocarcinoma, in order to identify miRNAs that are involved in the process of resistance to chemotherapic treatment and able to differentiate patients with different clinical developments. Methodology: A total of 33 specimens of high-grade ovary adenocarcinoma were selected from the tumor Bank of the A C Camargo Cancer Center, extracted from surgery with optimal resection whose patients had staging III and passed through clinical accompaniment of at least 2 years. Of these 25 samples were derived from primary tumor, 8 from primary metastasis of relapsed patients (paired) and 5 samples from fallopian epithelium tube of patients with no history of cancer as normal control. The identification of MiRNAs differentially expressed in patients with different clinical outturns was performed through the large-scale human miRNAs expression platform (G4870A ­ ID 031181; 8x60K, Agilent Technologies). The probes have been filtered and normalized using the BRB ArrayTool Software (v. 4.4.0). The targets were predicted using MiRWalk 2.0 (http://www.umm.uni-heidelberg.de/apps/zmf/mirwalk/custom.html), in four different algorithms (MiRWalk, RNA22, MiRanda and Targetscan). For the profile analysis between MiRNAs and transcribed coders, 415 samples were obtained from the Cancer Genome Atlas (TCGA) (http://tcga-data.nci.nih.gov/tcga/) and this interaction was subjected to a Pearson correlation test. The MiRNAs differentially expressed in different clinical outcomes were validated by the in situ hybridization (ISH) technique in 114 samples of high-grade serous adenocarcinoma included in the TMA from the Department of Anatomina Patologica A.C.Camargo Hospital and in different samples from the TCGA. The targets of the validated miRNAs were associated with global survival and disease-free in samples of the TCGA and confirmed in samples contained in the TMA of the internal casuistic through the technique of Imunohistoquimica. Results: The comparison analysis between normal control and high degree serous demonstrated that 365 miRNAs were differentially expressed and were found 613 interactions inversely correlated. The MiRNAs mir-934 and mir-143 were associated with worse global survival in our casuistic, the mir-503-5p with chemotherapy resistance. Only the MiR-934 was validated in TCGA and ISH technique. The FZD3 target was predicted for the mir-934 and mir-143 and was negatively correlated with both miRNAs in ovarian tumor cells. The expression of the FZD3 protein by Imunohistoquimica demonstrated that this receptor was not expressed in the cellular membrane but in the cytoplasm and nucleus in the high-degree serous tumors. Conclusion: Several miRNAs have participation in the ovarian tumor progression. The mir-934 was found increased in the metastatic samples and in primary tumors and was associated with worse global survival, as well as the cytoplasmic increase of FZD3, target of the MiR-934, however this was not associated with the expression of Beta-catenin. It is suggested, thus, that other pathways may be involved in this context (AU)

Adenocarcinoma sincrónico de alto grado de endometrio y ovario; a propósito de un caso clínico / Synchronous high-grade adenocarcinoma of the endometrium and ovary; about a clinical case

RESUMEN El cáncer sincrónico endometrial y ovárico (SEOC) representa alrededor de un 5-10% de las neoplasias de endometrio y ovario. Cuando no existe extensión locorregional y presentan un patrón histológico de bajo grado, actúan como si fueran dos tumores primarios independientes, en lugar de comportarse como un cáncer en estadio avanzado. Los mecanismos para diferenciar si su origen es metastásico o por el contrario, son tumores primarios independientes conlleva una gran dificultad y ha generado una importante controversia dentro del estudio de este tipo de neoplasias. En este artículo, exponemos el caso clínico de una paciente de 46 años que presenta un tumor sincrónico de endometrio y ovario en estadio IA, desconocido hasta el estudio histológico de la pieza quirúrgica.

ABSTRACT Endometrial and ovarian synchronous cancer (SEOC) accounts for about 5-10% of endometrial and ovarian neoplasms. When there is no local extension and they present a low-grade histological pattern, they act as if they were two independent primary tumours, instead of behaving as an advanced stage cancer. Therefore, the differentiation of its origin (metastatic or independent primary tumours) is fraught with difficulty and has generated a significant controversy in the study of this type of neoplasms. In this article, we present the clinical case of a 46-year-old patient presenting a synchronous tumor of the endometrium and ovary in IA stage, unknown until the histological study of the surgical sample.

Desprendimiento seroso macular asociado a foseta papilar congénita y coloboma de papila: ¿Qué opciones terapéuticas tenemos? / Macular serous detachment associated to congenital papillary pit and papillary coloboma: What treatment options do we have?

La foseta papilar es una rara anomalía congénita que forma parte del espectro de las anormalidades congénitas del disco óptico. Se trata de invaginaciones intrapapilares que suelen localizarse en el margen del disco óptico. La mayoría se localiza a nivel temporal; en torno al 20 por ciento son de localización central seguidas por las fosetas superiores, inferiores o nasales. La bilateralidad se estima en un 10-15 por ciento y su incidencia se ha establecido en torno al 0,19 por ciento. Suelen ser asintomáticas, aunque en aproximadamente el 50 por ciento de los casos se produce afectación macular por el paso de fluido procedente desde la foseta papilar hacia las diferentes capas retinianas, lo que afecta secundariamente la agudeza visual y es, por tanto, el motivo de consulta. Hasta el momento se han descrito múltiples alternativas terapéuticas para el tratamiento de los desprendimientos de retina serosos asociados a foseta de papila, pero ninguna de estas alternativas se ha impuesto sobre el resto. El tratamiento de esta enfermedad consiste en cerrar la comunicación entre la foseta y el espacio subretiniano con diversas opciones terapéuticas como: la fotocoagulación láser, la neumoretinopexia, la indentación escleral posterior, la fenestración del nervio óptico, la vitrectomía o alguna combinación de las anteriores. La actual revisión bibliográfica se propone profundizar en el tema, sobre la base de pacientes en consulta con dicha afección retiniana(AU)

Papillary pit is a rare congenital anomaly that is part of the congenital optic disc anomaly spectrum. It deals with intrapapillary invaginations that may be located at the border of the optic disc. Most of them is located at temporal level, around 20 percent are located centrally followed by upper, lower and nasal pits. Bilateral pits are estimated to be 10-15 percent and their incidence has been set at 0.19 percent. They are asymptomatic although 50 percent of cases suffer macular damage due to the passing of fluid from the papillary pit to the different retinal layers, which affecgs in a secondary way the visual acuity and thus it is the reason to go to the ophthalmologist. Multiple therapeutic alternatives for the treatment of papillary pit-associated serous retinal detachments have been described but none of them has predominated over the others. The treatment of this disease consists of closing the communication between the pit and the subretinal space with several therapeutic options such as laser photocoagulation, pneumoretinopexia, posterior scleral indentation, optic nerve fenestration, vitrectomy or any combination of the above-mentioned methods(AU)

Quiste de ovario intraligamentario gigante y miomatosis uterina / Giant intraligamentary ovary cyst and uterine myomatosis

Se presenta el caso de una paciente de 55 años de edad con quiste gigante de ovario. Fue atendida por integrantes de la Brigada Médica Cubana en la consulta de Ginecología del Hospital Regional de New Ámsterdam de la República de Guyana en el mes agosto de 2016 por presentar aumento de tamaño del abdomen, de aproximadamente dos años de evolución. El diagnóstico fue sospechado por ultrasonografía y tomografía axial computarizada. Se confirmó una tumoración quística gigante del ovario derecho a través de una laparotomía exploradora con dimensiones extraordinarias 48 cm de diámetro y peso 12,5 kg; además, miomatosis uterina. Se le realizó histerectomía total con doble anexectomía. El estudio histológico concluyó ser un cistoadenoma seroso de ovario y miomatosis uterina(AU)

We present the case of a 55-year-old female with giant ovarian cyst. She was attended in the gynecology consultation by members of the Cuban Medical Brigade, at the Regional Hospital of New Amsterdam in the Republic of Guyana during August, 2016. She presented a size increase abdomen, of approximately two years of evolution. The diagnosis was suspected by ultrasonography and computerized axial tomography. An exploratory laparotomy confirmed a giant cystic tumor in the right ovary of extraordinary dimensions (48 cm in diameter and 12.5 kg in weight), beside uterine myomatosis. A total hysterectomy was performed with double annexectomy. The histological study concluded that it was a serous cystadenoma of ovary and uterine myomatosis(AU)