Metastasizing leiomyoma during pregnancy

Uterine leiomyoma is a benign tumor of myometrial tissue which affects women of reproductive age. Its prevalence increases with age and has a peak incidence at the age of forty. The term "metastasizing leiomyoma" refers to a tumor of dense connective tissue and smooth myometrial muscle cells located outside the uterus. This group of tumors can metastasize to different organs, the lung being its main focus. We present the case report of a 33-year-old female gravida 3, para 1, abortus 1, at 11 weeks of pregnancy, with pelvic masses. The diagnosis was metastasizing leiomyoma during pregnancy.

Angioleiomioma uterino: a propósito de un caso / Uterine angioleiomyoma: report of clinical case

Resumen El angioleiomioma es un tumor benigno perivascular que raramente se localiza en el útero. Se expone el caso de un angioleiomioma de gran tamaño en una mujer de 30 años con sangrado menstrual abundante y masa abdominal palpable. La paciente fue sometida a miomectomía y diagnosticada de angioleiomioma por el estudio histológico. Ante síntomas persistentes, la angiomiomectomía o la histerectomía simple son eficaces.

Abstract Angioleiomyoma is a benign perivascular tumor that is rarely located in the uterus. This paper presents a case of a large angioleiomyoma in a 30-year-old woman with heavy menstrual bleeding and a palpable abdominal mass. The patient underwent myomectomy and was diagnosed with angioleiomyoma by histological examination. For persistent symptoms, angiomyomectomy or simple hysterectomy are effective.

Malignant uterine neoplasms attended at a brazilian regional hospital: 16-years profile and time elapsed for diagnosis and treatment / Neoplasias malignas do útero atendidas em hospital regional brasileiro: Perfil em 16 Anos e tempo dispendido até diagnóstico e tratamento

Abstract Objective The present study aims to evaluate the profile of endometrial carcinomas and uterine sarcomas attended in a Brazilian cancer center in the period from 2001 to 2016 and to analyze the impact of time elapsed fromsymptoms to diagnoses or treatment in cancer stage and survival. Methods This observational study with 1,190 cases evaluated the year of diagnosis, age-group, cancer stage and histological type. A subgroup of 185 women with endometrioid histology attended in the period from 2012 to 2017 was selected to assess information about initial symptoms, diagnosticmethods, overall survival, and to evaluate the influence of the time elapsed from symptoms to diagnosis and treatment on staging and survival. The statistics used were descriptive, trend test, and the Kaplan- Meier method, with p-values < 0.05 for significance. Results A total of 1,068 (89.7%) carcinomas (77.2% endometrioid and 22.8% nonendometrioid) and 122 (10.3%) sarcomas were analyzed, with an increasing trend in the period (p < 0.05). Histologies of non-endometrioid carcinomas, G3 endometrioid, and carcinosarcomas constituted 30% of the cases. Non-endometrioid carcinomas and sarcomas weremore frequently diagnosed in patients over 70 years of age and those on stage IV (p < 0.05). The endometrioid subgroup with 185 women reported 92% of abnormal uterine bleeding and 43% diagnosis after curettage. The average time elapsed between symptoms to diagnosis was 244 days, and between symptoms to treatment was 376 days, all without association with staging (p = 0.976) and survival (p = 0.160). Only 12% of the patients started treatment up to 60 days after diagnosis. Conclusion The number of uterine carcinoma and sarcoma cases increased over the period of 2001 to 2016. Aggressive histology comprised 30% of the patients and, for endometrioid carcinomas, the time elapsed between symptoms and diagnosis or treatment was long, although without association with staging or survival.

Resumo Objetivo O presente estudo avaliou o perfil dos carcinomas endometriais e sarcomas uterinos atendidos em um centro brasileiro de câncer no período de 2001 a 2016, e avaliou o impacto do tempo decorrido entre os sintomas até o diagnóstico ou tratamento no estadiamento e sobrevida pelo câncer. Métodos Estudo observacional com 1.190 casos que analisou o ano do diagnóstico, faixa etária, estágio e tipo histológico do câncer. Um subgrupo de 185 mulheres com histologia endometrioide e atendidas no período de 2012 a 2017 foi selecionado para avaliar informações sobre sintomas iniciais, métodos de diagnóstico, sobrevida global e para analisar a relação entre o tempo decorrido a partir dos sintomas até o diagnóstico e tratamento no estadiamento e sobrevida. Foram realizadas análises estatísticas descritiva, de tendência linear e de sobrevida pelo método de Kaplan-Meier, com valores de p < 0,05 para significância. Resultados Os casos estudados de acordo com a histologia foram 1.068 (89,7%) carcinomas (77,2% endometrioides e 22,8% não endometrioides) e 122 (10,3%) sarcomas, com tendência crescente no período (p < 0,05). Histologias de carcinomas não endometrioides, G3 endometrioides e carcinossarcomas consistiram em 30% dos casos. Carcinomas não endometrioides e sarcomas forammais frequentemente diagnosticados em pacientes acima de 70 anos de idade e em estágio IV (p < 0,05). O subgrupo com185 mulheres com carcinoma endometrioide apresentou 92% de sangramento uterino anormal e 43% de diagnóstico após curetagem. O tempo médio decorrido entre os sintomas e o diagnóstico foi de 244 dias e entre os sintomas e o tratamento, 376 dias, todos sem associação com estadiamento (p = 0,976) e sobrevida (p = 0,160). Apenas 12% das pacientes iniciaram o tratamento em até 60 dias após o diagnóstico. Conclusão O número de casos de carcinomas e sarcomas uterinos aumentaram no período de 2001 a 2016. A histologia agressiva compreendeu 30% dos pacientes e, no caso dos carcinomas endometrioides, o tempo decorrido entre os sintomas e o diagnóstico ou tratamento foi longo, embora sem associação com estadiamento ou sobrevida.

Does big mean evil? Giant, but benign uterine leiomyoma: case report and review of the literature / Será que grande significa maligno? Leiomioma gigante, porém benigno: Relato de caso e revisão de literatura

Abstract Uterine leiomyoma is themost prevalent benign type of gynecological tumor. It affects more than 80% of women worldwide and, within this group, more than 50% may be asymptomatic. However, large fibroid volumes may be associated with symptoms of extrinsic compression, and most of the cases do not present atypical cells. We present the case of a 49-year-old woman who underwent a total abdominal hysterectomy of a 13.5-kg uterine leiomyoma with no malignancies at histopathology and review the literature about giant uterine leiomyomas and their clinical repercussion. We concluded that large volumes do not always pose a threat regarding malignancy; however, future molecular studies are needed to investigate giant uterine fibroids.

Resumo Leiomioma uterino é o tumor benigno ginecológico de maior prevalência. Ele afeta mais de 80% das mulheres no mundo e, deste grupo, mais de 50% podem ser assintomáticas. Contudo, miomas de grande volume podem ser associados com sintomas de compressão extrínseca, e a maioria dos casos não apresentam células atípicas. Nós apresentamos o caso de uma mulher de 49 anos que foi submetida a histerectomia total abdominal de um espécime de 13,5 quilos sem malignidades ao exame histopatológico. Também revisamos a literatura sobre leiomiomas uterinos de grande volume e sua repercussão clínica. Concluímos que grandes volumes nem sempre representam um risco relacionado à malignidade; contudo, estudos moleculares futuros são necessários para investigar leiomiomas uterinos gigantes.

A propósito de un caso: útero miomatoso gigante torsionado / Torsion of a giant miomatous uterus: report of a clinical case autores

OBJETIVO: Reportar el caso de una torsión de útero, trompas y ambos ovarios a nivel de cuello uterino. Describir la patogenia, sintomatología y tratamiento, como un caso infrecuente y potencialmente grave, en la práctica clínica diaria. MATERIAL Y MÉTODOS: Analizar el curso de esta extremadamente rara patología, en una mujer postmenopáusica de 59 años. Se trata de un caso raro de torsión uterina en un útero no gestante, reportando los hallazgos en los exámenes previos a la cirugía y los hallazgos intraoperatorios e histopatológicos postcirugía. La resonancia magnética fue fundamental en el diagnóstico de la paciente y la laparotomía realizada demostró una torsión de cuerpo uterino de 360 ° a nivel de cérvix, y un gran mioma pediculado con signos de necrosis. Hemos revisado los últimos artículos de esta rara patología RESULTADOS Y DISCUSIÓN: La paciente fue operada. Se realizó una histerectomía total mediante una laparotomía media supra e infraumbilical. Los ovarios no tenían signos de necrosis. CONCLUSIONES: Debemos tener en cuenta esta posibilidad diagnóstica, en pacientes con aumento de tamaño uterino y clínica de dolor abdominal, ya que aunque es muy infrecuente, su diagnóstico es importante, ya que puede ser peligroso para la vida de la paciente.

OBJECTIVE: To report a case of torsion of the uterus, fallopian tubes and both ovaries around the uterine collum and the symptomatology, pathogenesis and treatment of this uncommon pathology. MATERIAL AND METHODS: The article analyses the course of this extremely rare pathology in a postmenopausical woman of 59 years. It is a rare case like a non gravid uterine torsion in a postmenopausical woman. We have the exams previous to the surgery, the finds intraoperative and the histolopathological reports postsurgery. RMN was the most important in diagnosis and the laparotomy showed a 360° an uterus increased on size and a big pedunculated myoma with signs of necrosis We have reviewed the latest articles on this strange pathology RESULTS AND DISCUSSION: The patient was operated. A infra-supra medium laparotomy was practiced and a total hysterectomy was made. Ovarians had not signs of necrosis. CONCLUSIONS: We must take into account, in patients with pathologies that increase uterine size and abdominal pain, the possibility of uterine torsion. Although it is a very infrequent pathology, its diagnosis is important, since it can be dangerous for the life of the patient

Teste de micronúcleo para detecção de instabilidade genômica em lesão cervical por papilomavírus humano / Prueba de micronúcleo para detectar inestabilidad genómica en lesión cervical por virus del papiloma humano / Micronucleus test to detect genomic instability in cervical lesion by human papillomavirus

Objetivo: analisar a produção científica acerca do teste de micronúcleo como instrumento para detecção de instabilidade genômica e dos fatores de risco para lesão intraepitelial cervical em pacientes com papilomavírus humano. Método: revisão integrativa de publicações dos últimos 10 anos, realizada no período de agosto de 2017 a junho de 2018, através da Medical Literature Analysis and Retrieval System, Literatura Latino-americana e do Caribe em Ciências da Saúde e PubMed Central. Resultados: quatro artigos foram analisados em que o teste de micronúcleo foi utilizado para detectar instabilidade genômica e risco de lesão intraepitelial cervical e seis artigos como biomarcador em diferentes estágios pré-neoplásicos, neoplásicos em lesões intraepiteliais e fatores de risco para o câncer cervical. Conclusões: o teste de micronúcleo é um método simples, rápido, barato e importante para detectar instabilidade genômica em células intraepiteliais cervicais que apresentam lesão sugestiva para o câncer de colo uterino.(AU)

Objective: to analyze the scientific production about the micronucleus test as an instrument for detecting genomic instability and risk factors for cervical intraepithelial injury in patients with human papillomavirus. Method: integrative review of publications from the last 10 years, carried out from August 2017 to June 2018, through Medical Literature Analysis and Retrieval System, Latin American and Caribbean Literature in Health Sciences and PubMed Central. Results: four articles were analyzed in which the micronucleus test was used to detect genomic instability and risk of cervical intraepithelial injury and in six articles as a biomarker in different pre-neoplastic stages, neoplastic in intraepithelial injuries and risk factors for cervical cancer. Conclusions: the micronucleus test is a simple, fast, inexpensive and important method to detect genomic instability in cervical intraepithelial cells that present lesions suggestive of cervical cancer.(AU)

Objetivo: analizar la producción científica sobre la prueba de micronúcleos como instrumento para detectar la inestabilidad genómica y los factores de riesgo de lesión intraepitelial cervical en pacientes con virus del papiloma humano. Método: revisión integradora de publicaciones de los últimos 10 años, realizada desde agosto de 2017 hasta junio de 2018, a través de la Medical Literature Analysis and Retrieval System, Literatura Latinoamericana y del Caribe en Ciencias de la Salud y PubMed Central. Resultados: se analizaron cuatro artículos en los que se utilizó la prueba de micronúcleos para detectar la inestabilidad genómica y el riesgo de lesión intraepitelial cervical y en seis artículos como biomarcador en diferentes etapas preneoplásicas, neoplásico en lesiones intraepiteliales y factores de riesgo de cáncer cervical. Conclusiones: la prueba de micronúcleos es un método simple, rápido, económico e importante para detectar la inestabilidad genómica en células intraepiteliales cervicales que presentan lesiones sugestivas de cáncer cervical.(AU)

Differential expression, diagnostic and prognostic significance of stathmin-1 and CD147 in various uterine smooth muscle tumors / Expresión diferencial, diagnóstico y significado de pronóstico de stathmin-1 y CD147 en diferentes tumores del músculo liso uterino

SUMMARY: Uterine smooth muscle tumors (USMT) are common, behavior-distinct gynecological tumors; including: leiomyoma (ULM), leiomyosarcoma (ULMS), and smooth muscle tumors of undetermined malignant potential (STUMP). Pre-operative distinction is difficult, thus diagnosis relies on histopathology. Immunohistochemistry (IHC) had been used to help in distinction. We studied two markers (stathmin-1 and CD147) to demonstrate whether they have diagnostic/ prognostic assist. Sixty seven USMT are studied. Age, follow up, and recurrence/metastasis data were collected. Representative slides were stained and Histologic score (HS) calculated as stain intensity (SI) X percentage of positive tumor cells (PP). Results were grouped as low expression (LE) and high expression (HE); then correlated to tumor types, and risk of recurrence/ metastasis. Statistical analysis (P < 0.05); Sensitivity, specificity, positive and negative predictive values and confidence intervals in diagnosing ULMS were calculated. Stathmin-1 HS (p= 0.000) and HE (p=0.002) were different among groups. Same as for CD147 HS and HE (both p=0.000), with a gradient increase from LM to STUMP to ULMS. Sensitivity, specificity, positive and negative predictive values and confidence intervals in diagnosing ULMS were as following: For stathmin-1 HS: 92 %; 20 %; 42 %; and 80 % (CI= 44-96 %). For Stathmin-1 HE: 80 %; 66 %; 60 %; and 84 % (CI=66-94 %). For CD147 HS: 85 %; 22 %; 41 %; and 69 %. For CD147 HE: 58 %; 49 %; 42 %; and 65 % (CI= 45-80 %), respectively. Recurrence / metastasis were documented in 6 cases (4 ULMS; 2 STUMP) with follow up ranging from 6 months to 102 months. 5 tumors had stathmin-1 HE (p=0.099); 2 had CD147 HE (p=0.393) in the primary tumors. STMN1 and CD147 are helpful diagnostic tests for USMT sub-typing, especially for ULMS. Gradient increase of expression from LM, to STUMP, to ULMS may indicate a role in malignant transformation in USMT, and in increased risk of recurrences/metastasis.

RESUMEN: Los tumores del músculo liso uterino (USMT, por sus siglas en inglés) son tumores ginecológicos comunes y de comportamiento distinto; incluyendo: leiomioma (ULM), leiomiosarcoma (ULMS) y tumores de músculo liso de potencial maligno indeterminado (STUMP). La distinción preoperatoria es difícil, por lo que el diagnóstico se basa en la histopatología. La inmunohistoquímica (IHQ) se había utilizado para ayudar en la distinción. Estudiamos dos marcadores (stathmin-1 y CD147) para demostrar si había efecto diagnóstico / pronóstico. Se estudiaron 67 USMT. Se recopilaron los datos de edad, seguimiento y recurrencia / metástasis. Las muestras representativas se tiñeron y la puntuación histológica (HS) se calculó como la intensidad de la tinción (IS) x porcentaje de células tumorales positivas (PP). Los resultados se agruparon como expresión baja (EB) y expresión alta (EA); luego se correlacionaeon con los tipos de tumores y el riesgo de recurrencia / metástasis. Análisis estadístico (P <0,05); se calcularon la sensibilidad, la especificidad, los valores predictivos positivos y negativos y los intervalos de confianza en el diagnóstico de ULMS. Stathmin-1 HS (p = 0,000) y HE (p = 0,002) fueron diferentes entre los grupos. Igual que para CD147 HS y HE (ambos p = 0,000), con un aumento de gradiente de LM a STUMP a ULMS. La sensibilidad, la especificidad, los valores predictivos positivos y negativos y los intervalos de confianza en el diagnóstico de ULMS fueron los siguientes: Para stathmin-1 HS: 92 %; 20 %; 42 %; y 80 % (IC = 44-96 %). Para Stathmin-1 HE: 80 %; 66 %; 60 %; y 84 % (IC = 66-94 %). Para CD147 HS: 85 %; 22 %; 41 %; y el 69 %. Para CD147 HE: 58 %; 49 %; 42 %; y 65 % (IC = 45-80 %), respectivamente. La recurrencia / metástasis se documentaron en 6 casos (4 ULMS; 2 STUMP) con un seguimiento que osciló entre 6 meses y 102 meses. Cinco tumores tenían stathmin-1 HE (p = 0,099); dos tenían CD147 HE (p = 0,393) en los tumores primarios. STMN1 y CD147 son pruebas de diagnóstico útiles para la subclasificación de USMT, especialmente para ULMS. El aumento en el gradiente de la expresión de LM, a STUMP, a ULMS puede indicar un papel en la transformación maligna en USMT y en un mayor riesgo de recurrencias / metástasis.

Leiomiosarcoma primario vaginal en el embarazo. A propósito de un caso / Primary vaginal leiomyosarcoma in pregnancy. About A case

RESUMEN Los sarcomas primarios de vagina son extremadamente raros especialmente durante la gestación. Se presenta el caso de una gestante de 25+2 semanas que acude a urgencias con clínica de sangrado vaginal objetivándose a la exploración una formación nodular dependiente de pared vaginal derecha. Dada la clínica se reseca en quirófano con el hallazgo histopatológico de leiomiosarcoma. A la gestante se le realiza sin incidencias una cesárea en la semana 34 de gestación, previa maduración pulmonar fetal, completándose en el puerperio inmediato el estudio de extensión sin encontrarse ningún hallazgo relevante. Finalmente, se somete a la paciente a una histerectomía y salpinguectomía bilateral con preservación ovárica. El seguimiento y los controles sucesivos de la gestante en los meses posteriores muestran ausencia de enfermedad.

ABSTRACT Primary sarcomas of the vagina are extremely rare, especially during pregnancy. We report a case of a 25-week-pregnant who came to emergency room complaining of vaginal bleeding. Pelvic examination revealed a globular mass located on the right vaginal wall. Given the persistent bleeding, resection of the mass was performed. The specimen was sent to pathology and confirmed to be a leiomyosarcoma. At 34-weeks of pregnancy after fetal lung maturation a cesarean section is done. It was completed the extension study during immediate postpartum without any relevant finding. Finally, she had a totally hysterectomy and bilateral salpingectomy with ovarian preservation. Clinical follow-up over the following months shows no evidence of disease.

[Lower gastrointestinal bleeding; a case report]

A 40-year-old woman was referred to our health center with a bulky rectorrhagia. The patient was treated with meropenem and vancomycin for an enterococcal meningitis one week earlier. A colonoscopy was performed at a different center, which was unsuccessful due to high blood volume in the colon and poor vision. The patient underwent angiography of the superior and inferior mesenteric arteries and the rectum artery, but the origin of the bleeding was not known. A polypoid mass with ulcer and bleeding from the site was seen in repeated colonoscopy of the left colon reagion. Due to the severity of the bleeding, the patient was transferred to the operating room and a large uterine mass that had transmitted to the lobes of the sigmoid colon was observed. Due to the diagnosis of uterine tumor, hysterectomy and oophorectomy were performed, and the descending colon was removed as a colostomy from the abdominal wall. In the pathological examination, diffuse endometriosis was found, which had involved the left ovary, the left fallopian tube, and both parametrium and sigmoid to the submucosal layer. On the 26th day, the patient was discharged with a good general condition and full vigilance

Uterine Fibroid Symptom - Quality of Life questionnaire translation and validation into Brazilian Portuguese / Tradução e validação para língua portuguesa do questionário Uterine Fibroid Symptom - Quality of Life

Abstract Purpose To translate into Portuguese, culturally adapt and validate the Uterine Fibroid Symptom - Quality of Life (UFS-QoL) questionnaire for Brazilian women with uterine leiomyoma. Methods Initially, the UFS-QoL questionnaire was translated into Brazilian Portuguese in accordance with international standards, with subsequent cultural, structural, conceptual and semantic adaptations, so that patients were able to properly answer the questionnaire. Fifty patients with uterine leiomyoma and 19 patients without the disease, confirmed by abdominal pelvic examination and/or transvaginal ultrasound, were selected at the outpatient clinics of the Department of Gynecology of the Universidade Federal de São Paulo (Unifesp). The UFS-QoL questionnaire was administered to all women twice on the same day, with two different interviewers, with an interval of 15 minutes between interviews. After 15 days, the questionnaire was readministered by the first interviewer. Reliability (internal consistency and test-retest), construct and discriminative validity were tested to ratify the questionnaire. Results The reliability of the instrument was assessed by Cronbach’s α coefficient with an overall result of 0.97, indicating high reliability. The survey results showed a high correlation (p= 0.94; p 0.001). Conclusion The UFS-QoL questionnaire was successfully adapted to the Brazilian Portuguese language and Brazilian culture, showing reliability and validity.

Resumo Objetivo Traduzir para o português, adaptar culturalmente e validar o questionário Uterine Fibroid Symptom - Quality of Life (UFS-QoL) para as mulheres brasileiras com leiomioma uterino. Métodos Inicialmente, o questionário UFS-QoL foi traduzido para o português brasileiro, em conformidade com as normas internacionais, com adaptações culturais, estruturais, conceituais e semânticas subsequentes, de modo que as pacientes fossem capazes de responder o questionário de forma adequada. Cinquenta pacientes com leiomioma uterino e 19 pacientes sem a doença, confirmada por exame pélvico abdominal e/ou ultrassonografia transvaginal, foram selecionados nos ambulatórios do Departamento de Ginecologia da Universidade Federal de São Paulo (Unifesp). A todas as mulheres foi administrado o questionário UFS-QoL por duas vezes no mesmo dia, por dois entrevistadores diferentes, com um intervalo de 15 minutos entre as entrevistas. Após 15 dias, o questionário foi novamente administrado pelo primeiro entrevistador. Confiabilidade (consistência interna e teste-reteste), constructo e validade discriminativa foram testados para ratificar o questionário. Resultados A confiabilidade do instrumento foi avaliada pelo coeficiente α de Cronbach com um resultado global de 0,97, indicando alta confiabilidade. Os resultados da pesquisa mostraram uma correlação elevada (p= 0,94; p 0,001). Conclusão O questionário UFS-QoL foi adaptado com sucesso para a língua portuguesa e cultura brasileira, mostrando confiabilidade e validade.

A Rare Case of Intra-Endometrial Leiomyoma of Uterus Simulating Degenerated Submucosal Leiomyoma Accompanied by a Large Sertoli-Leydig Cell Tumor

A 50-year-old peri-menopausal woman presented with hard palpable mass on her lower abdomen and anemia from heavy menstrual bleeding. Ultrasonography showed a 13x12 cm sized hypoechoic solid mass in pelvis and a 2.5x2 cm hypoechoic cystic mass in uterine endometrium. Abdomino-pelvic computed tomography revealed a hypodense pelvic mass without enhancement, suggesting a leiomyoma of intraligamentary type or sex cord tumor of right ovary with submucosal myoma of uterus. Laparoscopy revealed a large Sertoli-Leydig cell tumor of right ovary with a very rare entity of intra-endometrial uterine leiomyoma accompanied by adenomyosis. The final diagnosis of ovarian sex-cord tumor (Sertoli-Leydig cell), stage Ia with intra-endometrial leiomyoma with adenomyosis, was made. Considering the large size of the tumor and poorly differentiated nature, 6 cycles of chemotherapy with Taxol and Carboplatin regimen were administered. There is neither evidence of major complications nor recurrence during 20 months' follow-up.

Lipoleiomioma uterino: un hallazgo inusual / Uterine lipoleiomyoma: an unusual finding

Los tumores lipomatosos uterinos son lesiones generalmente benignas, de patogenia incierta y muy baja incidencia. Habitualmente se presentan en mujeres posmenopáusicas y el diagnóstico preoperatorio es difícil debido a que se confunden clínicamente y ecográficamente con leiomiomas. Usualmente son asintomáticos pero pueden manifestarse con metrorragia, dolor pélvico y masa palpable. El tumor lipomatoso uterino más frecuente es el lipoma mixto cuya denominación dependerá de las proporciones de tejido adiposo y conectivo que lo constituyan. El manejo puede ser conservador o quirúrgico dependiendo del tamaño y sintomatología de la paciente. Se presenta el caso de una mujer de 50 años, con un tumor uterino diagnosticado preoperatoriamente como leiomioma y con diagnóstico histopatológico de lipoleiomioma.

The uterine lipomatous tumors are usually benign lesions, of uncertain pathogenesis and very low incidence. They are often presented in postmenopausal women and the preoperative diagnosis is difficult because they are confounded clinically and sonographically with leiomyomas. They are frequently asymptomatic but may present with metrorrhagia, pelvic pain and palpable mass. The most common uterine lipomatous tumor is the mixed lipoma whose denomination depends on the proportions of fat and connective tissue. The conservative or surgical management will depend on the size of the tumor and the patient symptoms. We present a case report of a 50 year- old woman with a uterine tumor diagnosed preoperatively as leiomyoma and whose histopathological diagnosis was lipoleiomyoma.

Prognostic impact of lymphadenectomy in uterine clear cell carcinoma / 부인종양

OBJECTIVE: The aim of this study was to estimate the survival impact of lymphadenectomy in patients diagnosed with uterine clear cell cancer (UCCC). METHODS: Patients with a diagnosis of UCCC were identified from Surveillance, Epidemiology, and End Results (SEER) program from 1988 to 2007. Only surgically treated patients were included. Statistical analysis using Student t-test, Kaplan-Meier survival methods, and Cox proportional hazard regression were performed. RESULTS: One thousand three hundred eighty-five patients met the inclusion criteria; 955 patients (68.9%) underwent lymphadenectomy. Older patients (> or =65) were less likely to undergo lymphadenectomy compared with their younger cohorts (64.3% vs. 75.9%, p10 nodes removed) were 32% (HR, 0.68; 95% CI, 0.56 to 0.83; p<0.001) and 47% (HR, 0.53; 95% CI, 0.43 to 0.65; p<0.001) less likely to die, respectively. CONCLUSION: The extent of lymphadenectomy is associated with an improved survival of patients diagnosed with UCCC.

Embarazo ectópico molar tubárico: a propósito de un caso clínico / Tubal ectopic pregnancy molar: a case report

Introducción: La incidencia de gestación ectópica es 20/1000 embarazos. La mola hidatiforme ocurre en 1/1000 embarazos. Los casos de mola hidatiforme en embarazos ectópicos albergados en las trompas de Falopio constatados en la literatura mundial son excepcionales. Objetivo: Presentamos un caso clínico de embarazo ectópico molar tubárico y revisión de la literatura. Conclusión: La enfermedad trofoblástica gestacional asociada a embarazo ectópico es un entidad extremadamente rara que debe tenerse en cuenta por su trascendencia.

Introduction: The incidence of ectopic pregnancy is 20/1000 pregnancies. The hidatidyform mole occurs in about 1/1000 pregnancies. The cases of hidatidyform mole in ectopic pregnancies located in the Fallopian tube collected in world literature are exceptional. Objective: We present a clinical case of an ectopic molar pregnancy in the tubes and a literature review. Conclusion: The trophoblastic pregnancy disease associated to an ectopic pregnancy is an extremely rare entity that should be considered because of its transcendence.

Lipoleiomyoma associated to uterine prolapse: a case report / Lipoleiomioma associado a prolapso uterino: relato de caso

Lipoleiomyoma is a rare benign tumor of the uterus, with an incidence ranging between 0.03 por cento and 0.2 por cento. DESCRIPTION: the authors report a case of lipoleiomyoma diagnosis in an 82-year-old woman with a totally prolapsed uterus. DISCUSSION: lipoleiomyoma is most common among postmenopausal women and is associated with ordinary leiomyomas. Histologically it is composed of smooth muscle, adipocytes and fibrous tissue. In general asymptomatic, the diagnosis usually involves imaging studies such as ultrasound and computed tomography of the pelvis...

Lipoleiomioma é um raro tumor benigno do útero, com uma incidência variando entre 0,03 percent e 0,2 percent. DESCRIÇÃO: os autores relatam um caso de diagnóstico ocasional de lipoleiomioma ocorrido em uma mulher de 82 anos e com prolapso uterino total. DISCUSSÃO: o lipoleiomioma é mais frequente entre mulheres pós-menopáusicas associado a leiomiomas comuns. Histologicamente é composto por músculo liso, adipócitos e tecido fibroso. Em geral assintomático, o diagnóstico envolve normalmente estudos de imagem como ultrassom e tomografia computadorizada da pelve...

Prevalência de diagnóstico médico auto-relatado de miomas uterinos em população brasileira: Padrões demográficos e socioeconômicos no Estudo Pró-Saúde / Prevalence of self-reported medical diagnosis of uterine leiomyomas in a Brazilian population: Demographic and socioeconomic patterns in the Pro-Saúde Study

Introdução: Os miomas uterinos (MU) são considerados os tumores mais comuns do sistema reprodutor feminino; no entanto, existem poucos estudos epidemiológicos sobre essa condição no Brasil. Objetivo: Estimar as prevalências de história auto-relatada de MU segundo características demográficas, socioeconômicas e de acesso a serviços de saúde. Métodos: Foram analisados dados de 1.733 trabalhadoras de universidade no Rio de Janeiro, participantes da linha de base do Estudo Pró-Saúde (1999-2001), em relação a três desfechos: (1) diagnóstico médico de MU, (2) MU com sintomas prévios ao diagnóstico e (3) casos que realizaram histerectomia pelo tumor. As prevalências e seus intervalos de 95% de confiança (IC 95%) foram estimadas em relação a estratos de variáveis demográficas (idade, cor/raça), socioeconômicas (escolaridade, renda) e marcadoras de acesso a serviços de saúde (teste Papanicolaou , exame de mama, plano de saúde). Resultados: A prevalência de diagnóstico médico de MU foi de 23,3% (IC 95% - 21,3; 25,2); a de MU com sintomas prévios ao diagnóstico, de 13,3% (IC 95% - 11,7; 15,0) e a de histerectomia pelo tumor, de 8,4% (IC 95% - 7,5; 10,3). Entre participantes abaixo de 45 anos de idade, foram observadas prevalências mais elevadas nos estratos de piores condições socioeconômicas e de cor/raça preta. Entre aquelas com 45 anos ou mais, foram encontradas maiores prevalências entre mulheres com melhor acesso a serviços de saúde. Conclusão: Entre as mulheres brasileiras investigadas, os MU constituem problema relevante de saúde, com prevalências ...

Introduction: Uterine leiomyomas (UL) are considered the most common tumors of the female reproductive system. However, there are few epidemiological studies about this condition in Brazil. Aim: To estimate the prevalence of self-reported history of UL according to demographic and socioeconomic characteristics, and to markers of access to health care. Methods: We analyzed data from 1,733 university employees who participated at the baseline waves of the Pro-Saude Study (1999-2001), in relation to three outcomes: (1) self-reported medical diagnosis of UL, (2) UL with symptoms prior to diagnosis, and (3) cases with hysterectomy due to UL. Prevalence and 95% confidence intervals (95% CI) were estimated in relation to strata of variables related to demographic (age, color/race) and socioeconomic characteristics (education, income) and of markers of access to health care (Pap smear, breast clinical exam and private health insurance status). Results: The prevalence of medically-diagnosed UL was 23.3% (95% CI - 21.3, 25.2), the UL with symptoms prior to diagnosis of 13.3% (95% CI - 11.7, 15.0) and hysterectomy due to UL, 8.4% (95% CI - 7.5, 10.3). Among participants younger than 45 years old, higher prevalence was observed among women with worse socioeconomic conditions and of black color/race. Among those with 45 years or more, there was higher prevalence among women with better access to health care. Conclusion: In this study population of Brazilian women, UL is a relevant health problem, and its prevalence and associated socio-demographic gradients are similar to those observed in other countries. .

Leiomioma uterino atípico: a propósito de un caso / Atypical uterine leiomyoma: a case report

Los leiomiomas son tumores benignos compuestos principalmente por células musculares lisas, pero con cantidad variable de tejido conectivo fibroso. Son las neoplasias más habituales del tracto genital femenino, estando presentes en 77% de las piezas de histerectomías realizadas por cualquier indicación. Además de los leiomiomas uterinos usuales y los leiomiosarcomas, existe un grupo de tumores intermedios o borderline. Presentar un caso infrecuente. Descripción del caso y revisión bibliográfica. Femenina de 47 años, quien presenta aumento de volumen circunferencia abdominal y dolor pélvico de 2 años de evolución, al examen físico presenta abdomen globoso, ascítico, lesión de ocupación de espacio palpable en hipogastrio que se extiende hasta mesogastrio, al examen ginecológico se palpa lesión que ocupa fondo de saco, altacto rectal tumor que ejerce compresión extrínseca sobre el recto. Tanto al ultrasonido como tomografía se evidencia lesión para uterina izquierda y ascitis sin otras alteraciones. La colonoscopia confirma compresión extrínseca sobre cara anterior del recto, sin infiltración. Es llevada a mesa operatoria encontrando como hallazgos líquido ascítico, tumor de 30 cm x 20 cm que aparenta originarse de la cara posterior del cuerpo uterino e implante peritoneal en parietocólico izquierdo. Se realiza histerectomía total abdominal más ooforosalpingectomía bilateral, muestreo ganglionar pélvico y muestreo peritoneal. Los leiomiomas atípicos son un grupo de neoplasias cuyo diagnóstico y tratamiento representan un reto, debido a su comportamiento y a la poca información que existe publicada.

Leiomyomas are benign tumors composed mainly of smooth muscle cells, but with varying amounts of fibrous connective tissue. They are the most common malignancies of the female genital tract, being present in 77% of the parts of hysterectomies performed for any indication. Besides the usual uterine leiomyomas and leiomyosarcomas, there is a group of intermediate or borderline tumors. In this work we presentan unusual case. Analysis of case report and literature review. We view and examined a patient women’s of 47 years, who presented increased abdominal volume concomitant pelvic pain, physical examination presents abdomen globosely, ascites, a space occupying lesion palpable in the hypogastrium extending to the mesogastrium, the gynecologic examination shows that space occupying for tumor lesion in the fornix, the rectal touch space occupying for tumor and extrinsic compression exerted on the rectum. Both the ultrasound and tomography is evidence of parauterine left space occupying lesion and ascites without other alterations. Colonoscopy confirmed extrinsic compression on anterior rectum without infiltration. Operative finding as ascites fluid findings, tumor side 30 cm x 20 cm, appears to originate from the back of the uterine body and left parietocolic peritoneal implant. Total abdominal hysterectomy is performed more oophorectomy bilateral, pelvic lymph node and peritoneal sampling. The atypical leiomyomas are a group of neoplasms whose diagnosis and treatment represent a challenge because of their behavior and that there is little published information.