Angiomixoma agresivo pélvico: reporte de caso y revisión / Aggressive pelvic angiomyxoma: case report and revision / Angiomixoma agressivo: relato de caso e revisão

El angiomixoma agresivo pélvico es un tumor de partes blandas extremadamente raro, del cual se han reportado alrededor de 350 casos hasta la fecha. A continuación se reporta el caso clínico de una paciente que presentó dicho tumor y se describe el proceso diagnóstico y su tratamiento quirúrgico. Por otro lado, se realiza una breve revisión de la literatura disponible hasta el momento sobre el tema.

Aggressive pelvic angiomyxoma is an extremely rare soft tissue tumor, of which around 350 cases have been reported to date. This article aims at reporting the case of a patient presenting said tumor, as well as describing its diagnostic approach and its surgical treatment. On the other hand, it aims at briefly reviewing the available literature on the subject.

O angiomixoma pélvico agressivo é um tumor extremamente raro dos tecidos moles, tendo sido descritos até à data cerca de 350 casos. Relatamos o caso de uma doente que apresentava este tumor e descrevemos o processo de diagnóstico e tratamento cirúrgico. É também feita uma breve revisão da literatura disponível até à data sobre o assunto.

Imaging description of extragenital müllerian adenosarcoma: A case report / Descrição da imagem do adenosarcoma mülleriano extragenital: relato de caso

Abstract Müllerian adenosarcoma is a very rare gynecological disease, comprising 5% of uterine sarcomas. Extragenital localizations are even rarer.We report a very interesting case of a 27-year-old woman complaining of pelvic pain, with a subsequent diagnosis of extragenital Müllerian adenosarcoma. This is the first case reported in the literature with a complete and wide imaging description. Even if rare, Müllerian adenosarcoma should be hypothesized in case of young female patients presenting with suspicious pelvic mass.

Resumo O adenosarcoma Mülleriano é uma doença ginecológica muito rara, compreendendo 5% dos sarcomas uterinos. Localizações extragenitais são ainda mais raras. Relatamos um caso muito interessante de uma mulher de 27 anos queixando-se de dor pélvica com diagnóstico subsequente de adenosarcoma Mülleriano extragenital. Este é o primeiro caso relatado na literatura com uma descrição completa e ampla de imagem. Mesmo que raro, o adenosarcoma Mülleriano deve ser hipotetizado no caso de pacientes jovens do sexo feminino com massa pélvica suspeita.

Presentación tumoral de actinomicosis pélvica / Tumor Presentation of Pelvic Actinomycosis

La actinomicosis es una enfermedad crónica granulomatosa poco común causada por bacterias gram positivas, anaeróbicas, microaerófilas principalmente del género Actynomices. Se presenta el caso de una mujer de 49 años de edad, con cuadro clínico de aproximadamente 4 meses de evolución dado por estreñimiento, asociado a tenesmo rectal durante la defecación y pérdida de peso, portadora de dispositivo intrauterino desde hace 7 años. En el examen físico se encontró la presencia de una masa, de bordes mal definidos, en flanco y fosa iliaca derechos, y en hipogastrio, no dolorosa a la palpación. El ultrasonido abdominal reportó una masa en lóbulo caudado hepático y una estructura de contornos mal definidos en íntimo contacto con techo vesical y fundus uterino. La biopsia de lesión reveló actinomicosis. Se confirma la actinomicosis en una paciente con masa palpable en hipogastrio y dispositivo intrauterino colocado(AU)

Actinomycosis is an uncommon granulomatous chronic disease caused by gram-positive, anaerobic, microaerophilic bacteria, mainly of the genus Actynomices. We present the case of a 49-year-old woman with a clinical condition of approximately 4 months of evolution due to constipation, associated with rectal tenesmus during defecation and weight loss, carrier of an intrauterine device for 7 years. In the physical examination, the presence of a mass was found, with poorly defined edges, flank anda iliac fossa right, and hypogastrium, not painful on palpation. Abdominal ultrasonography reported a mass in the hepatic caudate lobe and a structure of ill-defined contours in intimate contact with the bladder roof and uterine fundus. The lesion biopsy revealed actinomycosis. It was confirmed in a patient with palpable mass in hypogastrium and intrauterine device placed(AU)

PET/MRI: a novel hybrid imaging technique. Major clinical indications and preliminary experience in Brazil / PET/RM: um novo método de imagem híbrida. Principais indicações clínicas e experiência preliminar no Brasil

ABSTRACT In recent years, medical imaging with hybrid techniques has widely accepted and employed in clinical routine. PET/MRI offers significant advantages, including excellent contrast and resolution and reduced ionizing radiation, as compared to well-established PET/CT. Therefore, PET/MRI is a promising modality for oncologic imaging of some regions, such as brain, head and neck, liver and pelvis. This article set out to analyze clinical conditions that could benefit from PET/MRI imaging based on our caseload. The potential of PET/MRI to become the imaging modality of choice for assessment of neurologic and oncologic conditions associated with soft tissues is highlighted. Clinical aspects of PET/MRI and its application to clinical cases are illustrated with examples extracted from the authors’ preliminary experience.

RESUMO Nos últimos anos, imagens médicas com tecnologias híbridas tornaram-se amplamente aceitas e utilizadas na prática clínica. O PET/RM possui vantagens importantes, incluindo excelentes contrastes e resolução, e menor radiação ionizante, em comparação ao PET/TC. Por isto, é uma modalidade promissora para exames de imagem de pacientes oncológicos, para avaliar o cérebro, cabeça e pescoço, o fígado e a pelve. O objetivo deste artigo foi analisar as situações clínicas que se beneficiariam de exames de PET/RM a partir de uma casuística. Destacamos o potencial desta técnica se tornar o método de imagem de escolha para doenças neurológicas e oncológicas que envolvam partes moles. Os aspectos clínicos de PET/RM e sua aplicação aos casos clínicos são ilustrados com exemplos da experiência inicial dos autores.

Unusual finding after resection of rectal adenocarcinoma: report of two cases / Achado incomum após ressecção de adenocarcinoma do reto: relato de dois casos

Pelvic recurrence after resection of rectal adenocarcinoma is a feared complication and is associated with a worse prognosis and low resectability rates. The differential diagnosis is difficult, as biopsy is seldom performed preoperatively. We report two cases of desmoid pelvic tumor after resection of rectal adenocarcinoma. Therapeutic options and literature review are described.

O aparecimento de tumor pélvico após ressecção de adenocarcinoma de reto é complicação temida e está associado à pior prognóstico e baixos índices de ressecabilidade. O diagnóstico diferencial é difícil, pois o diagnóstico histológico usualmente não é realizado no pré-operatório. São relatados dois casos em que houve o aparecimento de tumor pélvico após a ressecção de adenocarcinoma de reto, com diagnóstico histológico de tumor desmóide. As condutas adotadas e revisão da literatura são descritas.

role of gemcitabine and cisplatin as first line therapy in patients with advanced ovarian carcinoma

This study included 40 patients with histopathologically proved advanced stages III and IV ovarian carcinoma according to 1998 criteria of International Federation of Gynecology and Obstetrics [FIGO] staging system. Patients were divided into two groups: Group I: a prospectively studied group of 20 previously untreated patients, seen during the period from December 1999 to December 2000, who received cisplatin [100mg/m[2]] day I and gemcitabine [1250mg/m[2]] day and day 8 and the cycle was repeated every 21 days. Group II: a retrospectively 20 patients, fulfilling the same eligibility criteria, who received cisplatin [100mg/m[2]] and cyclophosphamide [750mg/m[2]], both in day I and the cycle was repeated every 21 days. All patients in both groups received a total of six courses of treatment and the response was determined by clinical examination as well as pelvi-abdominal ultrasound, and pelvi-abdominal computed tomography. Complete response was achieved in 35% of cases in group I vs 15% in group II, while partial response was obtained in 35% in both groups. There were no statistical significant difference between overall response rate [O.R.R] in both groups [X2 = 3.86, P 0.277]. Patients who received gemcitabine/ cisplatin combination chemotherapy showed less anemia and less renal toxicity with better tolerance than the cyclophosphamide / cisplatin arm. There were no statistical significant difference between overall survival [O.S] in both arms, however the progression free survival [P.F.S] was better in group I and reached the level of significance compared to group II [P=0.03]

Idiopathic Retroperitoneal Fibrosis Mimicking a Pelvic Tumor: a Case of Pericystitis Plastica

Retroperitoneal fibrosis was first described in 1905 by Albarran, a French urologist, who performed ureterolysis for ureteral compression produced by the disease. However, this disease became an established clinical entity by Ormond's account in the English literature in 1948. Pericystitis plastica has been used the define an extremely rare type of Idiopathic retroperitoneal fibrosis (IRF) constricting the bladder. In this study, we discussed the recovery of 29-year-old woman with pericystitis plastica who was misdiagnosed as pelvic malignancy or a chronic/subacut pelvic inflammation at the first evaluation.

Diagnostic and therapeutic value of ultrasound screening pelvic masses

To ascertain the superiority of Ultrasound screening over traditional bimanual pelvic examination in diagnosis and treatment of pelvic masses. Design: Retrospective study of 1000 consecutive patients attending the outpatient clinic for various complaints. Settings: Ultrasound clinic, a tertiary care gynae-obstetric unit in private sector, Islamabad. Subjects: One thousand consecutive patient who attended the outpatients for gynaecological checkup or first antenatal visit. Main outcome measures: Adnexal masses assessed bimanually, and with ultrasound scan and Doppler study of their blood vessels, the diagnosis then confirmed by observation, aspiration, laparoscopy or laparatomy, then follow up evaluated with ultrasound. eighty six% of adnexal pathology was missed on bimanual vaginal examination if the masses were cystic, less than 7 cms, and the patient obese and tender. Pathological changes were suspected in 230 patients at first ultrasound scan and confirmed in 100 after repeat scan in 2 weeks. 24 patients with clear cysts were aspirated under ultrasound control and aspirated fluid sent for cytology. 16 patient underwent laparoscopic evaluation and 32 were put an pituitary suppression for multiple small functional cysts. Only 28 underwent laparotomy. Ultrasound scan combined with abdominal and vaginal probes along with pulse wave Doppler is a very useful and non-ivasive tool in the diagnosis and treatment of adnexal masses and each gynecologist should aspire to have the machine besides the examination couch like the BP apparatus and the speculum, and learn to use it as recommended in the XIV FOGO World Gongress of Montreal, Canada 1994