Tumor de ovario de los cordones sexuales con túbulos anulares: reporte de caso y revisión de la literatura / Ovarian sex cord tumor with annular tubules: case report and review of the literature

RESUMEN Objetivos: Reportar un caso de Tumor de Ovario de los Cordones Sexuales con Túbulos Anulares (TCSTA), hacer una revisión de la literatura acerca del diagnóstico, tratamiento y pronóstico de esta condición. Materiales y métodos: Se informa el caso de una mujer que consultó al Instituto Nacional de Cancerología, Bogotá (Colombia), con diagnóstico final de TCSTA avanzado, quien recibió tratamiento quirúrgico y quimioterapia con evolución satisfactoria a los 6 meses. Se realizó una búsqueda de la literatura en las bases de datos Medline vía PubMed, LILACS y Scielo, que incluía reportes y series de caso de mujeres con diagnóstico de TCSTA, publicados desde 1990, sin incluir rango de edad. Se extrajo información sobre el diagnóstico, tratamiento y pronóstico reportado. Se realizó resumen narrativo de los hallazgos. Resultados: Se incluyeron 14 publicaciones que incluían 26 pacientes. La edad media al diagnóstico fue de 22,5 años. Los síntomas principales fueron alteraciones de la menstruación y dolor pélvico. La tomografía computarizada fue la tecnología de imágenes más frecuentemente utilizada. El tratamiento fue quirúrgico, siempre usado, acompañado de quimioterapia (29 %); 2 casos recibieron radioterapia. Hubo recaída en el 20 % de los casos. La mortalidad fue del 12,5 %, toda en el primer año. Conclusiones: La información sobre la utilidad diagnóstica de las imágenes, marcadores tumorales y estudios de histoquímica es escasa, como también los datos sobre el pronóstico de la entidad. El tratamiento quirúrgico es el de elección, teniendo en cuenta el deseo de fertilidad de la paciente y el estadio tumoral. Se requieren más estudios que documenten de manera más detallada el manejo de esta condición.

ABSTRACT Objectives: To report a case of ovarian sex cord tumor with annular tubules (SCTAT) and conduct a literature review on diagnosis, treatment and prognosis of this condition. Material and methods: Case report of a woman with a final diagnosis of advanced SCTAT seen at the National Cancer Institute in Bogota (Colombia) who received surgical treatment and chemotherapy with a satisfactory course after 6 months. A literature search was conducted in the Medline via PubMed, LILACS and Scielo databases, including case reports and series of women diagnosed with SCTAT published since 1990, not using age ranges. Information about diagnosis, treatment and reported prognosis was retrieved. A narrative summary of the findings was prepared. Results: Fourteen publications with 26 patients were included. Mean age at diagnosis was 22.5 years. The main symptoms were menstruation abnormalities and pelvic pain. Computed tomography (CT) was the imaging technology most frequently used. Surgical treatment was used in all cases, together with chemotherapy in 29 %; 2 patients received radiotherapy. Recurrence occurred in 20 % of cases. Mortality was 12.5 %, with all deaths occurring within the first year. Conclusions: There is a paucity of information about the diagnostic utility of imaging, tumor markers and histochemical studies, as well as prognosis of this disease condition. Surgery is the treatment of choice, taking into consideration the patient's wishes regarding fertility, as well as the stage of the tumor. Further studies are needed to provide more detailed information about this condition.

Manejo con cirugía conservadora de tumor mucinoso infiltrante ovárico coexistente con tumor mucinoso borderline contralateral en gestante de 8 semanas / Conservative surgery for management of invasive mucinous ovarian tumor with concurrent borderline mucinous tumor on contralateral ovary in a woman in 8th week of pregnancy

INTRODUCCIÓN: Aproximadamente un 4% de mujeres embarazadas presentan tumoraciones anexiales en el primer trimestre de gestación, siendo la mayoría quistes anexiales simples. Solo el 1,5% persisten tras el primer trimestre y en torno al 0,9% son malignos. CASO CLÍNICO: Paciente de 31 años que consultó en urgencias por sangrado y amenorrea de 5 semanas. La ecografía transvaginal evidenció un saco gestacional intraútero y una tumoración anexial izquierda compleja de 68 mm, multilocular, sólida, de ecogenicidad mixta, con septos gruesos y un área sólida vascularizada de 40 mm, sospechosa de neoplasia de ovario. Se realizó manejo quirúrgico conservador mediante anexectomía bilateral laparoscópica en la octava semana de gestación. El diagnóstico fue de adenocarcinoma mucinoso infiltrante bien diferenciado en ovario derecho, coexistente con tumor mucinoso borderline en ovario izquierdo (etapa IC FIGO). El embarazo cursó con normalidad, a excepción de feto pequeño para la edad gestacional en la semana 39. Se finalizó la gestación en la semana 40 mediante parto vaginal. Debido al deseo de la paciente, la cirugía se realizó en el primer trimestre de embarazo en lugar de en el segundo como se recomienda. La cirugía se completó meses después del parto, con histerectomía y apendicectomía laparoscópica. DISCUSIÓN: El cáncer de ovario es el segundo tumor ginecológico más diagnosticado durante el embarazo. Suele diagnosticarse en el primer trimestre debido al cribado ecográfico gestacional. Ocurre en mujeres con baja paridad y en sus últimos años de edad reproductiva. Esto podría verse reflejado en un aumento de su incidencia debido al retraso de la edad materna al primer embarazo. Normalmente se diagnostica en etapa I, siendo entonces la supervivencia superior al 90% a los 5 años. En etapas iniciales en mujeres embarazadas, la laparoscopia es tan válida como la laparotomía.

INTRODUCTION: Approximately 4% of pregnant women present adnexal tumors in the first trimester of gestation, the majority being simple adnexal cysts. Only 1.5% persist after the first trimester and around 0.9% are malignant. CASE REPORT: 31-year-old patient who came to the emergency room because of spotting and 5-week amenorrhea. A transvaginal ultrasound revealed an intrauterine gestational sac and a 69 mm complex multiocular-solid left adnexal tumor, with thick septa and a solid vascularized area of 40 mm, with suspicion of ovarian neoplasia. Conservative surgical management was performed through laparoscopic bilateral salpingo-oophorectomy in eighth week of gestation. The diagnosis was a well-differentiated infiltrating mucinous adenocarcinoma in the right ovary, and a coexisting borderline mucinous tumor in the left ovary (FIGO stage IC). The pregnancy proceeded normally except for a small for gestational age fetus at week 39 and pregnancy was completed at week 40 by vaginal delivery. Due to the patients wishes, the surgery was performed in the 1st trimester of pregnancy instead in the 2nd as is recommended. Final surgery was completed after giving birth, with laparoscopic hysterectomy and appendectomy. DISCUSSION: Ovarian cancer is the second most diagnosed gynecological tumor during pregnancy. It is usually diagnosed during the first trimester with gestational ultrasound screening. It occurs in women with low parity and in their later years of reproductive age. This could be reflected in an increase in its incidence due to the delay in the age of first pregnancy. Normally it is diagnosed in stage I, when the survival rate is superior to 90% after 5 years. In early stages, laparoscopic surgery in pregnant women is as valid as laparotomy.

A phase 2 trial of short-course Hyperthermic IntraPeritoneal Chemotherapy (HIPEC) at interval cytoreductive surgery (iCRS) for advanced ovarian cancer / Quimioterapia Intraperitoneal Hipertérmica (HIPEC) de curta duração ao tempo da cirurgia citorredutora de intervalo (iCRS) para câncer de ovário avançado: ensaio clínico de fase 2

ABSTRACT Objective: to report the final analysis of a phase 2 trial assessing the efficacy and safety of short-course hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with advanced epithelial ovarian cancer (EOC). Methods: this was an open-label, multicenter, single-arm trial of HIPEC in patients with advanced EOC who underwent interval cytoreductive surgery (iCRS) after neoadjuvant chemotherapy (NACT). HIPEC was performed as a concentration-based regimen of platinum-based chemotherapy for 30 minutes. Primary endpoint was the rate of disease progression occurring at nine months following iCRS plus HIPEC (PD9). Secondary endpoints were postoperative complications, time to start adjuvant chemotherapy, length of hospital and ICU stay, quality of life (QoL) over treatment, and ultimately 2-year progression-free survival (PFS) and overall survival (OS). Analysis was by intention-to-treat with final database lock for survival outcomes on February 23, 2021. Results: fifteen patients with stage III EOC were enrolled between February 2015 and July 2019, in four centers. The intention to treat PD9 was 6.7%. With a median follow-up of 33 months (IQR, 24.3-46.5), the median PFS was 18.1 months and corresponding 2-year rates of PFS and OS was 33.3% and 93.3%, respectively. Three patients (20%) experienced graded III complications. Median length of hospital and ICU stay was 5 (IQR, 4-6.5) and 1 (IQR, 1-1) days, respectively. Time to restart systemic chemotherapy was 39 (IQR, 35-49.3) days and no significant difference over time in QoL was observed. Conclusions: we demonstrate preliminary efficacy and safety of short-course HIPEC in patient with advanced EOC.

RESUMO Objetivo: apresentar a análise final de ensaio clínico de fase 2 que avaliou a eficácia e a segurança da quimioterapia intraperitoneal hipertérmica (HIPEC) de curta duração em pacientes com câncer epitelial de ovário avançado (EOC). Métodos: estudo aberto, multicêntrico, de braço único avaliando a HIPEC em pacientes com EOC avançado submetidos a cirurgia citorredutora de intervalo (iCRS) após quimioterapia neoadjuvante (NACT). A HIPEC foi realizada como regime baseado na concentração de cisplatina, perfundida por 30 minutos. O desfecho primário foi a taxa de progressão da doença 9 meses após a iCRS com HIPEC (PD9). Os desfechos secundários foram complicações pós-operatórias, tempo para iniciar a quimioterapia adjuvante, tempo de internação e permanência em UTI, qualidade de vida (QoL) ao longo do tratamento e, finalmente, sobrevida cumulativa livre de progressão (PSF) e global (OS) em 2 anos. As análises foram em intenção de tratar (ITT) com fechamento dos dados para análise da sobrevida em 23 de fevereiro de 2021. Resultados: quinze pacientes com EOC em estágio III foram incluídos no estudo entre fevereiro de 2015 e julho de 2019 em quatro centros recrutadores. A PD9 por ITT foi de 6,7%. Com acompanhamento mediano de 33 meses (IQR, 24,3-46,5), a PFS mediana foi de 18,1 meses e as taxas correspondentes de PFS e OS em 2 anos foram 33,3% e 93,3%, respectivamente. Três pacientes (20%) apresentaram complicações grau III. O tempo mediano de internamento hospitalar e em UTI foi de 5 (IQR, 4-6,5) e 1 (IQR, 1-1) dias, respectivamente. O tempo para reinício da quimioterapia sistêmica foi de 39 dias (IQR, 35-49,3) e não foi observada diferença significativa na QoL ao longo do tratamento. Conclusões: demonstrou-se eficácia e segurança preliminares da HIPEC de curta duração em pacientes com EOC avançado.

CA 125 elevado en contexto de endometrioma: reporte de caso / Elevated CA 125 in the context of endometrioma: case report

Introducción: Los tumores benignos de ovario corresponden a un 60-95% de las lesiones anexiales, en edad fértil los más frecuentes corresponden a quistes foliculares y endometriomas. Sin embargo, alrededor del 15% son patología maligna de ovario. Por lo que se debe evaluar aspectos como edad, características ecográficas y la presencia de marcadores tumorales específicos como CA 125. Objetivo general: Describir un reporte de caso y caracterizar la evidencia disponible sobre el abordaje de tumores benignos de ovario. Caso Clínico: Se presenta el caso clínico de una paciente en edad fértil de 43 años, cursando con dolor abdominal asociado a masa anexial, donde destaca la elevación del marcador CA 125 en rango de malignidad, por lo que se solicita valoración por oncología y manejo quirúrgico, confirmándose una masa anexial benigna de características quísticas, sugerente de endometrioma, al descartar patología maligna se realiza quistectomía total. Discusión: La patología anexial es una entidad clínica que puede abarcar características tumorales, ya sean benignas como malignas, por ello frente a lesiones ováricas, siempre se deben descartar estas últimas. Las características ecográficas de la paciente hacían sospechar de un endometrioma, el CA 125 elevado en ella hizo que se optara por un manejo quirúrgico oncológico con biopsia rápida para descartar o confirmar malignidad. Conclusión: Ante la presencia de endometriomas, el tratamiento debe discutirse caso a caso, teniendo en cuenta la sintomatología, deseos de fertilidad futura y tamaño de las lesiones.

Introduction: Benign ovarian tumors correspond to 60-95% of adnexal lesions, in childbearing years the most frequent correspond to follicular cysts and endometriomas. However, about 15% are malignant ovarian pathology. Therefore, aspects such as age, ultrasound characteristics and the presence of specific tumor markers such as CA 125 must be evaluated. General objective: Describe a case report and characterize the available evidence on benign ovarian tumors. Case report: A case of a 43 year old female of childbearing age, presents abdominal pain associated with an adnexal mass, where CA 125 elevations are found in the range of malignancy, for which an oncology evaluation and surgical management. A benign adnexal mass with cystic characteristics is confirmed, suggestive of endometrioma, when malignant pathology is ruled out, a total cystectomy is performed. Discussion: Adnexal pathology is a clinical entity that can include tumor characteristicas, whether benign or malignant, therefore, in the face of ovarian lesions, these should always be ruled out. The sonographic characteristics of the patient made one suspect an endometrioma, the elevated CA 125 in it led to an oncological surgical management with rapid biopsy to rule out or confirm malignancy. Conclusions: In the presence of endometriomas, treatmentshould be discussed individually, taking into account the symptoms, wishes for future fertility, and size of the lesions. Keywords: Ca-125 antigen, Endometriosis, Ovarian neoplasms

Tumor de células de Sertoli-Leydig: a propósito de un caso y revisión de la literatura reciente / Ovarian Sertoli-Leydig cell tumour: a clinical case and recent basic literature review

INTRODUCCIÓN: Los tumores de células de Sertoli-Leydig son neoplasias de ovario infrecuentes, lo que dificulta su diagnóstico y tratamiento. OBJETIVO: Revisar y sintetizar el manejo actual de los tumores de células de Sertoli-Leydig. MÉTODO: Se realizó una revisión de la literatura reciente sobre tumores de células de Sertoli-Leydig, a propósito de un caso en nuestro centro. RESULTADOS: Los tumores de las células de Sertoli-Leydig son infrecuentes, con mayor incidencia en edades tempranas. Ante una paciente joven con una lesión anexial unilateral y signos de virilización deberán considerarse estos tumores dentro del diagnóstico diferencial. En los estadios iniciales y en pacientes jóvenes podrá plantearse un tratamiento quirúrgico que preserve la fertilidad, y la asociación de tratamiento adyuvante dependerá de la diferenciación y del estadiaje del tumor.

INTRODUCTION: Sertoli-Leydig cell tumors are infrequent ovarian neoplasms, which difficults their diagnosis and treatment. Objective: To review and synthesize the current management of the Sertoli-Leydig cell tumor. METHOD: A review of the recent literature regarding the Sertoli-Leydig cell tumor was carried out, regarding a case in our center. RESULTS: Sertoli-Leydig cell tumors are an infrequent entity, with a higher incidence in early ages. In a young patient with a unilateral adnexal lesion and signs of virilization, these tumors should be considered within the differential diagnosis. In early stages and young patients, a surgical treatment that preserves fertility may be considered, and the association of adjuvant treatment will depend on the differentiation and staging of the tumor.

Presentación inusual de teratomas ováricos bilaterales en gemelas / Bilateral ovarian mature teratomas in twins: an unsual presentation

RESUMEN Los teratomas maduros son los tumores ováricos más frecuentes en edad pediátrica. A la fecha, se han descrito escasos reportes sobre su aparición en gemelas. Se presenta el caso de teratomas ováricos bilaterales en gemelas bicoriales, tratadas con tumorectomía laparoscópica. A los 45 días post-operatorios, ambas presentan recurrencia bilateral con marcadores tumorales negativos. Se realiza una nueva tumorectomía laparoscópica, cuyo estudio histopatológico confirma teratomas maduros. Presentan segunda recurrencia evidenciada en control imagenológico a los 2 meses post-quirúrgicos. Se plantea la posible asociación genética y/o familiar en la aparición de teratomas ováricos, la cual, hasta el momento, es prácticamente desconocida.

ABSTRACT Mature cystic teratomas are the most frequent ovarian tumor in children. There are few reports describing mature teratoma in twins to date. We present a case of bicorial twins with bilateral ovaric mature cystic teratoma treated with laparoscopic tumorectomy. 45 days after surgery, both present bilateral recurrence with negative tumor markers. The patients underwent a new laparoscopic tumor resection, where histopathological diagnosis confirms mature teratomas. Ultrasound control describes second recurrence 2 months after surgery. There is a possible genetic and/or family association in the presentation of ovarian teratomas, which currently, is unknown.

Tumores ováricos en pediatría: revisión de los casos en un servicio de pediatría durante 10 años / Pediatric ovarian tumors: a 10-year review in a pediatric service

Los tumores ováricos, a diferencia de lo que sucede en la edad adulta, son infrecuentes en la población pediátrica. Predomina la estirpe germinal, con altas tasas de supervivencia. El objetivo de este estudio es presentar la epidemiología, clínica, diagnóstico y tratamiento de las pacientes de 0-15 años con diagnóstico, entre 2007 y 2017, de tumor ovárico en nuestro centro. Fueron 8 los casos encontrados de 171 tumores diagnosticados (el 4,7 %), con edad media de presentación de 12,5 años. Predominaban, al momento del debut, alteraciones menstruales, dolor abdominal y aumento de perímetro abdominal. Fueron de tipo germinal 6/8, y el teratoma maduro fue el más frecuente. Todas se diagnosticaron con ecografía abdominal, y se confirmó el diagnóstico en 7/8 con resonancia magnética. Se intervinieron todos los casos; predominó la salpingo-ooforectomía, y una paciente precisó quimioterapia adyuvante. La supervivencia libre de enfermedad fue del 100 %.

Unlike adults, ovarian tumors are infrequent in the pediatric population, predominating the germ line at this age, with high survival rates. The objective is to present the epidemiological, clinical, diagnosis and therapeutic characteristics of 0 to 15-year-old patients diagnosed with ovarian tumor in our center between 2007 and 2017.Eight cases out of 171 diagnosed tumors (4.7 %) were found, with a mean age of presentation of 12.5 years. At the moment of diagnosis, menstrual disturbances, abdominal pain and an increase in abdominal circumference predominated. Six out of eight were germ cell tumors, being the mature teratoma the most frequent one. All cases were diagnosed with abdominal ultrasound scan, confirmed in 7/8 cases with magnetic resonance imaging. All cases underwent surgery, predominating salpingo-oophorectomy with one patient requiring adjuvant chemotherapy. Disease-free survival was 100 %.

A challenge for colorectal surgeons: pathogenesis, progression and management of the secondary tumors of the ovary / 中华胃肠外科杂志

A common clinical problem encountered by colorectal surgeons is the secondary tumors of the ovary (STO), particularly in young female patients. Most STO are from the digestive tract, and the known possible metastatic mechanisms include lymphatic, hematogenous, and intraperitoneal spreading. The molecular and histopathological characteristics of STO from different sites are diverse. It is particularly important to correctly identify the origin and feature of STO, which should be clarified by combining medical history, histopathology, immunohistochemistry, molecular biology, imaging and other means. The prognosis of patients with STO is poor in general. Comprehensive therapies based on surgical resection can benefit some patients. There is no specific treatment for STO at present, but not giving up easily on these patients is the right choice that every surgeon should understand.

Preoperative differentiation of benign and malignant non-epithelial ovarian tumors: clinical features and tumor markers / Diferenciação pré-operatória de tumores ovarianos não epiteliais benignos e malignos: características clínicas e marcadores tumorais

Abstract Objective To evaluate the role of clinical features and preoperativemeasurement of cancer antigen 125 (CA125), human epididymis protein(HE4), and carcinoembryonic antigen (CEA) serum levels in women with benign and malignant non-epithelial ovarian tumors. Methods One hundred and nineteen consecutive women with germ cell, sex cordstromal, and ovarian leiomyomas were included in this study. The preoperative levels of biomarkers were measured, and then surgery and histopathological analysis were performed. Information about the treatment and disease recurrence were obtained from the medical files of patients. Results Our sample included 71 women with germ cell tumors (64 benign and 7 malignant), 46 with sex cord-stromal tumors (32 benign and 14 malignant), and 2 with ovarian leiomyomas. Among benign germ cell tumors, 63 were mature teratomas, and, amongmalignant, fourwere immatureteratomas. Themost common tumors in the sex cordstromal group were fibromas (benign) and granulosa cell tumor (malignant). The biomarker serum levels were not different among benign andmalignant non-epithelial ovarian tumors. Fertility-sparing surgeries were performed in 5 (71.4%) women with malignant germ cell tumor. Eleven (78.6%) patients with malignant sex cord-stromal tumors were treated with fertility-sparing surgeries. Five women (71.4%) with germ cell tumors and only 1 (7.1%) with sex cord-stromal tumor were treated with chemotherapy. One woman with germ cell tumor recurred and died of the disease and one woman with sex cord-stromal tumor recurred. Conclusion Non-epithelial ovarian tumors were benign in the majority of cases, and the malignant caseswere diagnosed at initial stages with good prognosis. Themeasurements of CA125, HE4, and CEA serum levels were not useful in the preoperative diagnosis of these tumors.

Resumo Objetivo Avaliar o papel das características clínicas e a medida pré-operatória dos níveis séricos de CA125, HE4, e CEA em mulheres com tumores de ovário não epiteliais benignos e malignos. Métodos Cento e dezenovemulheres consecutivas comtumores ovarianos de células germinativas, do cordão sexual-estroma, e miomas ovarianos foram incluídas neste estudo. Os níveis pré-operatórios dos biomarcadores foram medidos, a cirurgia e a análise histopatológica foram realizadas. Informações sobre tratamento e recorrência da doença foram obtidas dos prontuários médicos das pacientes. Resultados Nossa amostra incluiu 71 mulheres com tumores de células germinativas (64 benignos e 7 malignos), 46 com tumores do cordão sexual-estroma (32 benignos e 14 malignos), e 2 com leiomiomas ovarianos. Entre os tumores benignos de células germinativas, 63 eram teratomas maduros, e, entre os malignos, quatro eram teratomas imaturos. Os tumores mais comuns do grupo do cordão sexual-estroma foram fibromas (benignos) e tumores de células da granulosa (malignos). Os níveis séricos dos biomarcadores não diferiram entre os tumores de ovário não epiteliais benignos e malignos. A cirurgia preservadora de fertilidade foi realizada em 5 (71,4%) mulheres com tumores malignos de células germinativas. Onze (78,6%) mulheres com tumores do cordão sexual-estromamalignos foram tratadas comcirurgia preservadora de fertilidade. Cinco (71,4%)mulheres com células germinativas e apenas 1 (7,1%) com tumor do cordão sexual-estroma foram tratadas com quimioterapia. Uma mulher com tumor de células germinativas recidivou e morreu da doença. Uma mulher com tumor do cordão sexual-estroma recidivou. Conclusão Os tumores de ovário não epiteliais foram benignos namaioria dos casos e os malignos foram diagnosticados em estágios iniciais, com bom prognóstico. A medida dos níveis séricos de CA125, HE4, e CEA não foram úteis no diagnóstico préoperatório desses tumores.

Practical recommendations for the management of benign adnexal masses / Recomendações práticas para o tratamento de massas anexiais benignas

Abstract Objective To performa comprehensive review to provide practical recommendations regarding the diagnosis and treatment of benign adnexal masses, as well as information for appropriate consent, regarding possible loss of the ovarian reserve. Methods A comprehensive review of the literature was performed to identify the most relevant data about this subject. Results In total, 48 studies addressed the necessary aspects of the review, and we described their epidemiology, diagnoses, treatment options with detailed techniques, and perspectives regarding future fertility. Conclusions Adnexal masses are extremely common. The application of diagnosis algorithms is mandatory to exclude malignancy. A great number of cases can bemanaged with surveillance. Surgery, when necessary, should be performed with adequate techniques. However, even in the hands of experienced surgeons, there is a significant decrease in ovarian reserves, especially in cases of endometriomas. There is an evident necessity of studies that focus on the long-term impact on fertility.

Resumo Objetivo Realizar uma revisão abrangente para fornecer recomendações práticas sobre o diagnóstico e tratamento demassas anexiais benignas, bemcomo informações para um consentimento adequado com relação à possível perda da reserva ovariana. Métodos Uma revisão abrangente da literatura foi realizada para identificar os dados mais relevantes sobre o assunto. Resultados No total, 48 estudos abordaram os aspectos necessários da revisão, e descrevemos sua epidemiologia, diagnósticos, opções de tratamento com técnicas detalhadas, e perspectivas sobre fertilidade futura. Conclusões As massas anexiais são extremamente comuns. A aplicação de algoritmos de diagnóstico é obrigatória para excluiramalignidade. A maioria dos casos pode ser manejada conservadoramente. A cirurgia, quando necessária, deve ser realizada com técnicas adequadas. No entanto, mesmo nas mãos de cirurgiões experientes, há diminuição significativa da reserva ovariana, principalmente nos casos de endometriomas. Há uma evidente necessidade de estudos que enfoquemo impacto das massas anexiais benignas na fertilidade em longo prazo.

Carcinoma endometrioide sincrónico de ovario y endometrio / Ovarian and endometrial synchronous endometrioid carcinoma

ANTECEDENTES: existe una asociación demostrada entre endometriosis y algunas histologías del carcinoma epitelial de ovario. Por otra parte, se ha observado que hasta un 30% de las neoplasias de ovario se presentan de forma concomitante a neoplasias del endometrio. Para considerar la sincronicidad entre estos tumores, estos deben cumplir criterios anatomopatológicos estrictos como los descritos por scully. OBJETIVO: presentar un caso clínico de carcinoma endometrioide sincrónico de ovario y endometrio sobre focos de endometriosis, así como su diagnóstico y manejo. CASO CLÍNICO: paciente de 27 años que consulta por spotting intermenstrual. En la ecografía endocavitaria se observa un pólipo endometrial. Además, se describe un tumor anexial izquierdo de 42mm, trilobulado, con un polo sólido de 17×15mm. Se somete a una polipectomía histeroscópica y quistectomía ovárica laparoscópica. Asimismo, se reseca implante sospechoso en el fondo de saco posterior. El resultado anatomopatológico de las piezas quirúrgicas fue: pólipo endometrial con hiperplasia compleja con atipias y focos de adenocarcinoma endometrioide grado I; el tumor quístico ovárico izquierdo consistente con quiste endometriósico con focos de adenocarcinoma endometrioide. La lesión peritoneal corresponde a un implante de adenocarcinoma endometrioide grado I. El estudio de las características anatomopatológicas y la presencia del implante peritoneal sugieren el diagnóstico de un carcinoma endometrioide ovárico con origen en una lesión endometriósica sincrónico con un carcinoma endometrioide endometrial. CONCLUSIÓN: el diagnóstico diferencial entre la sincronicidad o diseminación de los tumores de ovario y endometrio de estirpe endometrioide supone un reto para el clínico y es fundamental para el correcto manejo de estas neoplasias.

BACKGROUND: there is a demonstrated association between endometriosis and some epithelial ovarian carcinoma histologies. On the other hand, it has been observed that up to 30% of ovarian neoplasms present concomitantly with endometrial neoplasms. To consider synchronicity between these neoplasms, they must meet strict pathological criteria such as those described by scully. OBJECTIVE: to introduce a case of an ovarian and endometrial synchronous endometrioid carcinoma implanted on endometriosis sites, as well as its diagnosis and management. CLINICAL CASE: a 27-year-old patient who consulted because of an intermenstrual spotting. The ultrasound image showed an endometrial polyp. Furthermore, a 42 mm left adnexal trilobal tumor with a 17×15mm solid pole was described. She underwent a hysteroscopic polypectomy and laparoscopic ovarian cystectomy. Likewise, resection of a suspicious implant in the posterior vaginal fornix was done. The pathological result of the surgical pieces was: endometrial polyp with complex hyperplasia with atypia and focal points of grade I endometrioid adenocarcinoma; the left ovarian cystectomy: endometriotic cyst with focal points of endometrioid adenocarcinoma. The peritoneal lesion corresponded to a grade I endometrioid adenocarcinoma implant. The study of the pathological characteristics and the presence of the peritoneal implant suggest the diagnosis of endometrioid ovarian carcinoma originated in a synchronous endometriotic lesion with endometrial endometrioid carcinoma. CONCLUSION: differential diagnosis between the synchronicity or spread of ovarian and endometrial endometrioid cell line carcinomas, is a great challenge and it is essential for the correct management of these neoplasms

Quality of life in a phase 2 trial of short-course hyperthermic intraperitoneal chemotherapy (HIPEC) at interval debulking surgery for high tumor burden ovarian cancer / Avaliação da qualidade de vida em ensaio clínico de fase 2 envolvendo quimioterapia intraperitoneal hipertérmica (HIPEC) de curta duração no momento da citorredução de intervalo em pacientes com câncer de ovário de grande volume tumoral

ABSTRACT Introduction: to evaluate the effect of short-course (i.e.: 30 minutes) HIPEC on health-related quality of life (HRQoL) in our feasibility study; NCT02249013. Methods: a prespecified secondary end-point of our open-label, multicenter, single-arm, phase 2 trial on safety and efficacy was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30, version 3.0). Patients were required to complete the HRQoL questionnaire at baseline, after HIPEC, and after the end of the treatment. Changes of HRQoL over time were assessed by median scores for each domain and analyzed by Friedman`s test at a significant two-sided level of 0.05. Results: fifteen patients with high tumor burden EOC were recruited from our public health system between February 2015 and July 2019. A baseline EORTC QLQ-C30 questionnaire and at least one follow-up questionnaire was received from all of the patients. No significant difference over time in the QLQC30 summary scores was observed (p>0.05). The transitory impairment on patients HRQoL immediately after the short-course HIPEC trended to return to baseline at the end of the multimodal treatment. Conclusions: we found no significant impairment of short-course HIPEC on patients HRQoL into the context of our comprehensive treatment protocol.

RESUMO Objetivo: avaliar o impacto da quimioterapia intraperitoneal hipertérmica (HIPEC) de curta duração (i.e.: 30 minutos) na qualidade de vida (QoL) relacionada à saúde (HRQoL) no contexto de ensaio clínico terapêutico piloto; NCT02249013. Métodos: avaliou-se o desfecho secundário predeterminado de HRQoL em ensaio clínico de fase 2 de segurança e eficácia, aberto, multicêntrico, de braço único, utilizando-se o questionário European Organization for Research and Treatment of Cancer Quality of Life (EORTC QLQ-C30, versão 3.0). As pacientes foram solicitadas a responder o questionário de HRQoL antes do tratamento, após a HIPEC, e ao fim do tratamento interdisciplinar. As variações da HRQoL ao longo do tempo foram avaliadas pelas medianas dos escores de cada domínio e analisadas pelo teste de Friedman, considerando-se nível de significância estatística bicaudal de 5%. Resultados: quinze pacientes com câncer de ovário de grande volume tumoral foram recrutadas do sistema de saúde pública (i.e.: SUS) entre fevereiro de 2015 e julho 2019. Um questionário basal e pelo menos um questionário de acompanhamento foram coletados de todas as pacientes. Não se observou diferença significativa ao longo do tempo na HRQoL em nenhum dos domínios ou sintomas estudados (p> 0,05). O comprometimento transitório da HRQoL imediatamente após a HIPEC de curta duração tendeu a retornar à linha de base ao final do tratamento multimodal. Conclusões: não se observou impacto significativo da HIPEC de curta duração sobre a HRQoL no contexto deste protocolo de tratamento interdisciplinar.

Intraoperative ultrasound leads to conservative management of benign ovarian tumors: A retrospective, single-center study / Ultrassom intraoperatório leva ao manejo conservador de tumores ovarianos benignos: Um estudo retrospectivo e monoinstitucional

Abstract Objective To evaluate whether the use of intraoperative ultrasound leads to more conservative surgeries for benign ovarian tumors. Methods Women who underwent surgery between 2007 and 2017 for benign ovarian tumors were retrospectively analyzed. The women were classified into two groups: those who underwent intraoperative ultrasound (group A) and those who did not (group B). In group A, minimally-invasive surgery was performed for most patients (a specific laparoscopic ultrasound probe was used), and four patients were submitted to laparotomy (a linear ultrasound probe was used). The primary endpoint was ovarian sparing surgery (oophoroplasty). Results Among the 82 cases identified, only 36 met the inclusion criteria for the present study. Out of these cases, 25 underwent intraoperative ultrasound, and 11 did not. There were no significant differences in arterial hypertension, diabetes, smoking history, and body mass index for the two groups (p=0.450). Tumor diameter was also similar for both groups, ranging from 1 cm to 11 cm in group A and from 1.3 cm to 10 cm in group B (p=0.594). Tumor histology confirmed mature teratomas for all of the cases in group B and for 68.0% of the cases in group A. When the intraoperative ultrasound was performed, a more conservative surgery was performed (p<0.001). Conclusion The use of intraoperative ultrasound resulted in more conservative surgeries for the resection of benign ovarian tumors at our center.

Resumo Objetivo Avaliar se o uso do ultrassom intraoperatório leva a cirurgias mais conservadoras para tumores ovarianos benignos. Métodos Mulheres que foram submetidas a cirurgia entre 2007 e 2017 por tumores ovarianos benignos foram analisadas retrospectivamente. As mulheres foram classificadas em dois grupos: aquelas que foram submetidas ao ultrassom intraoperatório (grupo A), e aquelas que não o foram (grupo B). No grupo A, foi realizada cirurgia minimamente invasiva na maioria das pacientes (foi usada sonda ultrassonográfica laparoscópica específica), e quatro pacientes foram submetidas a laparotomia (foi usada sonda ultrassonográfica linear). O desfecho primário foi a cirurgia preservadora do ovário (ooforoplastia). Resultados Entre os 82 casos identificados, somente 36 atenderam aos critérios de inclusão para este estudo. Destes, 25 pacientes foram submetidas ao ultrassom intraoperatório, e 11 não o foram. Não houve diferenças significantes em relação à pressão arterial, diabetes, tabagismo e índice de massa corporal entre os dois grupos (p=0.450). O diâmetro do tumor também foi similar entre os dois grupos, variando de 1cm a 11cm no grupo A, e de 1,3cma 10cm no grupo B (p=0.594). A histologia dos tumores confirmou teratoma maduro para todos os casos do grupo B, e para 68,0% dos casos do grupo A. Mais cirurgias conservadoras foram realizadas quando o ultrassom intraoperatório foi realizado (p<0.001). Conclusão O uso do ultrassom intraoperatório resultou em mais cirurgias conservadoras na ressecção de tumores benignos do ovário em nossa instituição.

Rare case of sarcomatoid squamous cell carcinoma arising in an ovarian mature teratoma / Caso raro de carcinoma espinocelular sarcomatoide que surge em um teratoma ovariano maduro

Abstract Although mature cystic teratoma (MCT) is benign, malignant transformation (MT) occurs in ~ 1% to 2% of all cases, and usually consists of squamous cell carcinoma (SCC), which accounts for ~ 80% of the cases. Spindle-cell (sarcomatoid) carcinoma (SCSC) is an uncommon type of SCC, comprising up to 3% of all cases. The lack of characteristic symptoms and specific imaging findings may lead to preoperative misdiagnosis. Moreover, the clinicopathologic characteristics, the treatment, the prognostic factors and the mechanism of MT have not yet been well understood due to the rarity of such tumors, especially in women of reproductive age. The authors present a case of a 34- year-old patient with 14 weeks of gestation who was diagnosed with an adnexal mass suggestive of ovarian teratoma. A laparoscopy salpingo-oophorectomy was performed after 6 months of delivery, and the histological exam revealed a sarcomatoid SCC in the MCT.

Resumo Embora o teratoma cístico maduro (MCT) seja benigno, a transformação maligna (MT) ocorre em cerca de 1% a 2% dos casos, e geralmente apresenta-se sob a forma de carcinoma espinocelular (CEC), responsável por cerca de 80% dos casos. O carcinoma (sarcomatoide) de células fusiformes (CSCF) é um tipo incomum de CEC, compreendendo até 3% de todos os casos. A falta de sintomas característicos e achados imagiológicos específicos pode levar a erros diagnósticos pré-operatórios. Além disso, as características clinico-patológicas, o tratamento, os fatores prognósticos e o mecanismo da MT ainda não são bem compreendidos devido à raridade de tais tumores, principalmente em mulheres em idade reprodutiva. Os autores apresentam um caso de uma paciente de 34 anos com 14 semanas de gestação que foi diagnosticada comumamassa anexial sugestiva de teratoma do ovário. A anexectomia laparoscópica foi realizada após 6 meses do parto, e o exame histológico revelou um CEC sarcomatoide tendo como origem um MCT.

Clinical features and management of women with borderline ovarian tumors in a single center in Brazil / Características clínicas e manejo de mulheres com tumores borderline de ovário em um hospital no Brasil

Abstract Objective The aim of the present study was to describe and analyze data of 57 women with borderline ovarian tumors (BOTs) regarding histological characteristics, clinical features and treatment management at the Department of Obstetrics and Gynecology of the Universidade Estadual de Campinas (Unicamp, in the Portuguese acronym). Methods The present retrospective study analyzed data obtained from clinical and histopathological reports of women with BOTs treated in a single cancer center between 2010 and 2018. Results A total of 57 women were included, with a mean age of 48.42 years old (15.43- 80.77), of which 30 (52.63%) were postmenopausal, and 18 (31.58%) were < 40 years old. All of the women underwent surgery. A total of 37 women (64.91%) were submitted to complete surgical staging for BOT, and none (0/57) were submitted to pelvic or paraortic lymphadenectomy. Chemotherapy was administered for two patients who recurred. The final histological diagnoses were: serous in 20 (35.09%) cases, mucinous in 26 (45.61%), seromucinous in 10 (17.54%), and endometrioid in 1 (1.75%) case. Intraoperative analyses of frozen sections were obtained in 42 (73.68%) women, of which 28 (66.67%) matched with the final diagnosis. The mean follow-up was of 42.79 months (range: 2.03-104.87 months). Regard ingthe current status of the women, 45(78.95%) are alive without disease, 2(3.51%) arealive with disease, 9 (15.79%) had their last follow-up visit > 1 year beforethe performanceof the present study but arealive, and 1 patient(1.75%) died of another cause. Conclusion Women in the present study were treated according to the current guidelines and only two patients recurred.

Resumo Objetivo O objetivo do presente estudo foi descrever uma série de 57 mulheres com tumores borderline de ovário (TBO) em relação às características histológicas, clínicas, e ao manejo do tratamento realizado no Departamento de Obstetrícia e Ginecologia da Universidade Estadual de Campinas (Unicamp). Métodos O presente estudo retrospectivo analisou dados obtidos dos registros clínicos e histopatológicos de mulheres com TBO tratadas em um único centro oncológico de 2010 a 2018. Resultados Um total de 57 mulheres foram incluídas, com uma média de idade de 48,42 anos (15,43-80,77), das quais 30 (52,63%) eram menopausadas, e 18 (31,58%) tinham < 40 anos. Todas as mulheres foram operadas. Um total de 37 mulheres (64,91%) foram submetidas a cirurgia de estadiamento completo para TBO, e nenhuma foi submetida a linfadenectomia pélvica ou paraórtica. O tratamento com quimioterapia foi administrado em duas pacientes que recidivaram. Os diagnósticos histológicos finais foram: seroso em 20 mulheres (35,09%), mucinoso em 26 (45,61%), seromucinoso em 10 (17,54%) e endometrióide em 1 (1,75%). A avaliação histológica intraoperatória foi realizada em 42 (73,68%) das mulheres, das quais 28 (66,67%) foram compatíveis com os diagnósticos finais. O tempo médio de seguimento foi de 42,79 meses (variando de 2,03 a 104,87 meses). Em relação ao status atual das mulheres, 45 (78.95%) estão vivas sem doença, 2 (3,51%) estão vivas com doença, 9 (15.79%) tiveram a última consulta de seguimento há > 1 ano antes da realização do presente estudo, mas estão vivas, e 1 paciente faleceu por outra causa. Conclusão As mulheres do presente estudo foram tratadas de acordo com as recomendações atuais e apenas duas mulheres apresentaram recorrência.

Tumor ovárico virilizante en mujer postmenopáusica: reporte de caso / Ovarian virilizing tumor in postmenopausal woman: case report

Ovarian steroid-producing tumors are infrequent entities and are potentially malignant. Testosterone is the hormone that rises more frequently and is associated mostly with signs of virilization. We present the clinical case of a 67-year-old postmenopausal woman who came to the clinic for alopecia, with high levels of testosterone and ovarian mass by ultrasound. Surgical treatment was indicated. The main diagnostic aspects are presented.

Los tumores productores de esteroides ováricos constituyen entidades infrecuentes y son potencialmente malignos. La testosterona es la hormona que se eleva con más frecuencia y se asocia en su mayoría a signos de virilización. Se presenta el caso clínico de una mujer postmenopáusica de 67 años que acude a consulta por alopecia, con niveles elevados de testosterona y masa ovárica por ecografía. Se indicó tratamiento quirúrgico. Se presentan los principales aspectos diagnósticos.

Frozen section in the management of ovarian and uterine tumors: the past 5 years in a tertiary centre / Exame de congelação no tratamento de tumores uterinos e do ovário: experiência de 5 anos em um centro terciário

Abstract Objective Intraoperative frozen section (IFS) is a valuable resource, and its use in gynecological pathology has not been sufficiently emphasized. The main goal of the present study is to evaluate the reliability and agreement rates between IFS and the final paraffin section (PS) and determine how reliable IFS is. Methods A retrospective study of all IFSs performed on uterine tumors and suspicious adnexal masses between January 2012 and December 2016 (excluding metastases) at the department of obstetrics and gynecology of the Centro Hospitalar Tondela Viseu. Frozen versus permanent section diagnosis were compared regarding the histologic type of the tumor, and the depth of myometrial invasion. Results A total of 286 cases were eligible for the present study, including 102 (35.7%) IFSs of uterine tumors, and 184 (64.3%) IFSs of ovarian tumors. The overall rate of deferred cases was 5.2% (15/286). The accuracy of the diagnosis in cases of endometrial carcinoma was 96.25% (77/80). Among the ovarian tumors, misdiagnoses occurred in 2 cases (1.1%), corresponding to a borderline tumor (serous type) and a clear cell intracystic adenocarcinoma. Conclusion The IFS analysis plays an important role in selected situations and is associated to a high sensitivity and specificity in cases of ovarian and endometrial tumors. Its high accuracy is almost universally associated with the possibility of obtaining an optimal surgical treatment at the time of the first surgical approach.

Resumo Objetivo O diagnóstico intraoperatório por congelação é umrecurso importante cujo uso empatologia ginecológica não tem sido suficientemente enfatizado. O objetivo do presente estudo foi avaliar as taxas de concordância entre o diagnóstico intraoperatório por congelação e o estudo anatomopatológico definitivo e determinar o quanto o diagnóstico intraoperatório por congelação é um método confiável. Métodos Um estudo retrospectivo de todos os diagnósticos intraoperatórios por congelação realizados em tumores uterinos e massas anexiais suspeitas entre janeiro e 2012 e dezembro de 2016 (excluindo metástases) no serviço de ginecologia e obstetrícia do Centro Hospitalar Tondela Viseu. Comparação do diagnóstico intraoperatório por congelação com o resultado do estudo definitivo em relação ao tipo histológico do tumor e profundidade de invasão miometrial. Resultados Um total de 286 casos foram elegíveis para o estudo, incluindo 102 (35.7%) tumores uterinos e 184 (64.3%) tumores ovarianos. A taxa global de casos deferidos foi de 5.2% (15/286). Entre os tumores uterinos, a acuidade de diagnóstico nos casos de carcinoma endometrial foi de 96.25% (77/80). Entre os tumores ovarianos, não se verificou concordância em 2 casos (1.1%), correspondendo a um tumor borderline do tipo seroso e a um adenocarcinoma de células claras intracístico. Conclusão O diagnóstico intraoperatório por congelação apresenta-se com um importante papel em situações selecionadas, sendo acompanhado de elevada taxa de sensibilidade e especificidade para tumores endometriais e ovarianos. A sua elevada acuidade diagnóstica encontra-se associada à possibilidade de obter um tratamento cirúrgico adequado na primeira abordagem cirúrgica

Tumores ováricos en niñas y adolescentes / Ovarían masses in infant-juvenile age

Introducción. El tratamiento quirúrgico adecuado para las pacientes pediátricas con lesiones ováricas es heterogéneo, y en las niñas es conveniente conservar los ovarios. El objetivo de este estudio es analizar los hallazgos relacionados con un grupo de pacientes a las que se operó por lesiones ováricas. Pacientes y métodos. Un estudio retrospectivo realizado durante 13 años con 56 pacientes menores de 17 años. Estas pacientes se dividieron en 3 grupos según el diagnóstico de patología ovárica: 25 tenían lesiones funcionales (quistes y torsión), 18 tenían lesiones ováricas epiteliales y 13 tenían tumores germinales. Se comparó a estos tres grupos en términos de menarquia, torsión, edad, duración, tamaño, dolor, tumor, vómitos, menstruación irregular, ubicación y tipo de operación. Resultados. Enestosgrupos,fueronmásfrecuentes los quistes foliculares, los cistoadenomas serosos y los teratomas. La media de edad de las pacientes fue de 12,18 ± 4,84 años. Los síntomas y signos más frecuentes fueron dolor (85,7%) e hinchazón (37,5%) en la región abdominopélvica. Se observó torsión en 21 pacientes (37,5%); la media del tamaño del tumor fue de 10,46 ± 6,55 cm. Se realizó una salpingoovariectomía (SO, por sus siglas en inglés) en 38 pacientes y una resección del quiste (CE, por sus siglas en inglés) en 18 pacientes. Se observaron más casos de torsión en las pacientes premenárquicas que en las menárquicas y en el grupo de lesiones funcionales. Se realizaron más resecciones quirúrgicas en el grupo de lesiones funcionales, y más SO en los grupos de lesiones epiteliales y tumores germinales. Conclusión. Se considera que la torsión y las patologías ováricas funcionales son frecuentes en la edad premenstrual, y las lesiones malignas son muy raras en todos los grupos etarios, por lo que se recomienda preservar la fertilidad en la cirugía.

Introduction. The appropraite surgical treatment to pediatric patients with ovarian lesions are heterogeneous and ovarian preservation is desirable in children. The aim of this study is to the discuss findings related to a set of patients who were operated on for ovarian lesions. Patients and methods. A retrospective study carried out in 13 years on 56 patients under the age of 17. These patients were divided into 3 groups according to ovarian pathologic diagnosis: 25 with functional (cyts and torsion), 18 with epithelial ovarian lesions and 13 with germ cell tumours. These three groups were compared in terms of menarche, torsion, age, duration, size, pain, mass, vomiting, irregular menstruation, location and operation type. Results. Follicle cysts, serous cyst adenomas and teratomas were the most common in these groups. The mean age of the patients was 12.18+4.84 years. The most common symptoms and signs were abdominal-pelvic pain (85.7%) and swelling(37.5%). Torsion was seen in 21 patients (37.5%), mean mass size was found to be 10.46+6.55 cm. A salpingo-oophorectomy (SO) was performed in 38 patients and cyst excision (CE) was performed in 18 patients. In premenarcheal cases, torsion was seen more in menarcheal cases and in the functional lesion group. CE was performed more often in the functional and t SO was performed often in the epithelial and germ cells groups. Conclusion. Torsion and functional ovarian pathologies are thought to be common in premenstrual ages and malign lesions are very rare in all age groups so we recommend ovarian protective surgery should be preferred.

Costo efectividad de la cirugía reductora de riesgo en trompas y ovarios en casos con mutación del gen BRCAI en Colombia / Cost-effectiveness of risk-reducing salpingo-oophorectomy in cases of BRCA1 gene mutation in Colombia

RESUMEN Objetivo Evaluar la utilidad de la cirugía reductora de riesgo en trompas y ovarios en casos con mutación del gen BRCA1 en Colombia Material y Métodos Análisis de costo-efectividad en el que se incorporan tres procesos: a. Pacientes con pruebas de tamización para cáncer de mama y ovario. b. cirugía reductora de riesgo en trompas y ovarios c. cirugía reductora de riesgo en trompas y ovarios con mastectomía bilateral. Se evalúa como desenlace la ganancia en años de supervivencia. Resultados La cohorte con cirugía reductora de riesgo en trompas y ovarios y mastectomía bilateral es la de mayor ganancia con 13 años mientras que la cirugía reductora de riesgo en trompas y ovarios gana 4,95 años con respecto al grupo de seguimiento. Conclusiones Las tres opciones evaluadas son aceptables, pero de ellas la de mayor ganancia en la supervivencia es la combinación de cirugía reductora de riesgo en trompas y ovarios con mastectomía bilateral.(AU)

ABSTRACT Objective To assess the usefulness of risk reduction salpingo-oophorectomy in cases with mutation of the BRCA1 gene in Colombia. Material and Methods Cost-effectiveness analysis in which three processes are incorporated: a. Patients with screening tests for breast and ovarian cancer. b. Risk reduction surgery in the fallopian tubes and ovaries c. Reductive surgery in the fallopian tubes and ovaries with bilateral mastectomy. The outcome is evaluated as the gain in years of survival. Results The cohort with risk reduction surgery in the fallopian tubes and ovaries and bilateral mastectomy is the one with the highest gain with 13 years, while the risk reduction surgery in the fallopian tubes and ovaries gain 4.95 years with respect to the follow-up group. Conclusions The three options evaluated are acceptable, but of them the one with the greatest gain in survival is the combination of risk-reducing surgery in the fallopian tubes and ovaries with bilateral mastectomy.(AU)