Isolated fallopian tube torsion in an early adolescent / Philippine Journal of Obstetrics and Gynecology

@#Isolated fallopian tube torsion is a rare but significant gynecological cause of lower abdominal pain in adolescent females with or without risk factors. A 12-year-old female was initially treated as urinary tract infection, acute appendicitis, and a possible ovarian pathology. Intraoperatively, it was isolated fallopian tube torsion. The entity is difficult to recognize preoperatively because of its vague clinical presentation and lack of specific laboratory and imaging findings, and diagnosis is done ultimately during surgery. Isolated tubal torsion should be considered in cases of acute lower abdominal pain since awareness and early detection of the condition, especially in children and adolescents, allows early surgical intervention that may render preservation of the tubes.

Double Trouble: A case of synchronous high-grade serous carcinoma of the fallopian tube and borderline mucinous tumor of the ovary / Philippine Journal of Obstetrics and Gynecology

@#A 55‑year‑old, Gravida 2 Para 2 (2002), presented with postmenopausal vaginal bleeding. Workups pointed toward ovarian malignancy with distant metastasis (pleural effusion). Exploratory laparotomy, bilateral salpingo‑oophorectomy, surgical staging, and appendectomy were performed. On histopathological examination, synchronous high‑grade serous carcinoma of the right fallopian tube and borderline mucinous tumor of the left ovary were diagnosed. Primary fallopian tube carcinomas are very uncommon, while synchronous tumors of the female genital tract are extremely rare. Furthermore, there is a paucity of literature discussing the occurrence of synchronous primary malignancies arising from the fallopian tube and the ovary. It is crucial to differentiate primary malignancies from metastatic cancers to determine accurate staging and prognosis, as well as to assign appropriate treatment strategies. Immunohistochemistry and molecular testing play vital roles as adjunctive diagnostic tools to histologic examination in determining the origins of these tumors and distinguishing primary tumors from metastasis.

Talin1 is highly expressed in the fallopian tube and chorionic villi to promote trophoblast invasion in tubal pregnancy / 南方医科大学学报

OBJECTIVE@#To investigate the expression of Talin1 in the fallopian tube and chorionic villi in patients with tubal pregnancy and its role in regulating invasion and migration of trophoblasts.@*METHODS@#Immunohistochemistry and Western blotting were used to detect the localization and expression level of Talin1 in the fallopian tube and chorionic villi in patients with tubal pregnancy and in women with normal pregnancy. In the cell experiment, HTR-8/SVneo cells was transfected with Talin1 siRNA and the changes in cell invasion and migration were assessed using scratch assay and Transwell assay. The expressions of MMP-2, MMP-9, N-cadherin and Snail in the transfected cells were detected by qRT-PCR and Western blotting.@*RESULTS@#Positive expression of Talin1 was detected in both normal fallopian tube tissues and tissues from women tubal pregnancy, and its expression was localized mainly in the cytoplasm of cilia cells. The expression level of Talin1 was significantly higher in both the fallopian tube and chorionic villi in women with tubal pregnancy than in normal fallopian tube and chorionic villi samples (P < 0.01). In HTR-8/SVneo cells, transfection with Talin1 siRNA significantly inhibited cell invasion (P < 0.01) and migration (P < 0.05), down-regulated the expression of N-cadherin, MMP-2 and Snail (P < 0.05), and up-regulated the expression of MMP-9 in the cells (P < 0.05).@*CONCLUSION@#The expression of Talin1 in the fallopian tube and chorionic villi is significantly increased in women with tubal pregnancy, suggesting the association of Talin1-regulated trophoblast cell invasion with the occurrence of tubal pregnancy.

Quistes mesoteliales benignos con posible origen en las trompas de Falopio resecados por laparotomía / Benign mesothelial cysts with possible origin in the Fallopian tubes resected by laparotomy

Introducción. Los quistes mesoteliales benignos son una entidad poco frecuente, que ocurren especialmente en mujeres en edad reproductiva. Se deben a una proliferación anómala del mesotelio que puede ser originada en varias estructuras intraabdominales e inicialmente es asintomática. Caso clínico. Se presenta el caso de una mujer de 20 años con un cuadro sugestivo de neoplasia maligna, en quien se confirmó el diagnóstico de quiste mesotelial originado en la trompa de Falopio derecha. Se realizó tratamiento quirúrgico exitoso. Discusión. A pesar de la estrecha relación de esta entidad con el útero y los ovarios, no se encuentran reportes de quistes mesoteliales originados a partir de las trompas de Falopio. El tratamiento de los quistes mesoteliales es quirúrgico y en el caso de esta paciente se hizo con la finalidad de mejorar los síntomas y erradicar la enfermedad. Las decisiones fueron tomadas basadas en la opinión de expertos en oncología en una junta de tumores gastrointestinales. Conclusiones. Los quistes mesoteliales son neoplasias de baja incidencia, pero se deben tener en cuenta como diagnóstico diferencial de los tumores abdominales. Se presenta el caso de una paciente tratada de forma quirúrgica con resultados exitosos y seguimiento a un año sin recurrencias

Introduction. Benign mesothelial cysts (BMC) are a rare entity that occurs especially in women of reproductive age. It is due to an abnormal proliferation of the mesothelium that can originate from various intra-abdominal structures and it is initially asymptomatic. Clinical case. This is a case of a 20-year-old woman with a suspicious malignant neoplasia, in whom the diagnosis of a mesothelial cyst originating in the right Fallopian tube was confirmed. Successful surgical treatment was achieved. Discussion. Despite the close relationship of this entity with the uterus and ovaries, there are no reports of me-sothelial cysts originating from the Fallopian tubes. The treatment of mesothelial cysts is surgical and in the case of this patient it was performed in order to improve the symptoms and eradicate the disease. The decisions were taken based on the oncologists' expert opinion of the gastrointestinal tumor board. Conclusions. Mesothelial cysts are neoplasms of low incidence, but they should be considered as a differential diagnosis of abdominal tumors. The case of a patient treated surgically with successful results and a one-year follow-up without recurrences is presented

Hernia útero inguinal derecha atascada en mujer en edad fértil: reporte de un caso / Incarcerated right utero inguinal hernia in a woman of reproductive age: case report

Resumen Introducción: La hernia de pared abdominal es una patología habitual; la presentación más frecuente es de tipo inguinal, cercano a un 70% del total. La incidencia de un saco herniario inguinal conteniendo ovarios y trompas de Falopio, es un hecho reportado en 2,9% de los casos. Caso clínico: Se presenta una paciente, sexo femenino, de 42 años de edad, con historia de hernia inguinal derecha de larga data, ingresa por aumento de volumen doloroso e irreductible, en región inguinal derecha, no impresiona estrangulada; ingresa a pabellón de urgencia. Dentro de los hallazgos quirúrgicos destacan saco herniario que contiene útero y ambos ovarios, sin compromiso vascular. Paciente evoluciona de forma favorable egresando 2 días posterior a la cirugía.

Introduction: Abdominal wall hernia is a frequent pathology, the most frequent hernia are the inguinal type, closed to 70% of all. Although the incidence of inguinal hernial sac containing ovary and Fallopian tubes are reported on a 2.9% of the cases. Case Report: Female patient 42 years old, with a long-term history of right inguinal hernia, with sudden pain and irreducible increase of volume in the correspondent inguinal zone that doesn't look strangled; she was admitted to the emergency operating room. Among surgical findings hernia's sac content was uterus and both ovaries with no signs of vascular compromise. The patient's favorable evolved let her to be discharged from the hospital after 2 days from post operative care

Anatomia do sistema reprodutor feminino de Alouatta belzebul (Linnaeus, 1766) / [Anatomy of the female reproductive system of the Alouatta belzebul (Linnaeus, 1766)]

O conhecimento da anatomia de qualquer animal silvestre é de fundamental importância para sua preservação e proteção. Neste contexto, o presente estudo objetivou descrever a morfologia do sistema reprodutor feminino de Alouatta belzebul. Foram utilizados seis espécimes de A. belzebul, fêmeas, adultas, e livres de lesões. Observou-se macroscopicamente que os ovários têm características morfológicas em formato ovoides, com superfície lisa, e, na análise histológica na região de córtex, evidenciou-se folículos ovarianos em diferentes estágios de desenvolvimento. As tubas uterinas anatomicamente são finas e curvilíneas, apresentando uma camada mucosa, uma muscular e outra serosa. O útero possui formato simples, com fundo globoso, com um miométrio altamente vascularizado, sendo organizado em feixes de fibras musculares lisas. A estrutura anatômica da vagina apresentou-se como um tubo muscular longo de paredes finas, onde, na região vestibular, o óstio externo da uretra é marcado por uma papila uretral bilobada e, na região de vulva, em sua porção caudal, contatou-se um clitóris bem desenvolvido. No que concerne à análise histológica da vagina, verificou-se, em região de mucosa vaginal, um extrato basal composto por epitélio estratificado pavimentoso não queratinizado atrófico. As descrições morfológicas fornecem, de forma inédita, informações importantes relativas à anatomia macroscópica e microscópica do sistema reprodutor feminino dessa espécie.(AU)

Knowledge of the anatomy of any wild animal is of fundamental importance for its preservation and protection. In this context the present study aimed to describe the morphology of the female reproductive system of A. belzebul. We used 6 specimens of A. belzebul, female, adult and free of lesions. It was macroscopically observed that the ovaries are ovoid with smooth surface and the histological analysis in cortical region showed ovarian follicles in different stages of development. The fallopian tubes are anatomically thin and curvilinear, with one mucous layer, one muscular and one serous layer. The uterus was presented in a simple format with a globular fundus, with a highly vascularized myometrium, being organized in bundles of smooth muscle fibers. The anatomical structure of the vagina presented itself as a long thin-walled muscular tube where in the vestibular region the external orifice of the urethra is marked by a bilobed urethral papilla and in the caudal portion in its caudal portion a well-developed clitoris. Regarding the histological analysis of the vagina, a basal extract composed of atrophic non-keratinized stratified squamous epithelium was found in the vaginal mucosa region. The morphological descriptions provide important information regarding the macroscopic and microscopic anatomy of the female reproductive system of this species in an unprecedented way.(AU)

Disgerminoma de ovario con componente sincitiotrofoblástico en una adolescente / Ovarian dysgerminoma with syncythiotrophlastic component in a teenage woman

INTRODUCCIÓN. Los tumores de células germinales del ovario de carácter maligno son infrecuentes en la adolescencia. Los disgerminomas se caracterizan por crecimiento rápi-do, diseminación linfática, alta sensibilidad a la radioterapia y quimioterapia. OBJETIVO. Establecer la presentación clínica, métodos diagnósticos y tratamiento para el manejo del disgerminoma ovárico en una adolescente. CASO CLÍNICO. Paciente mestiza de 14 años que acudió por dolor abdominal y masa palpable en región abdominopélvica asociados a elevación de marcadores séricos tumorales. Los reportes de imagen informaron masa ane-xial derecha, sólida de bordes lobulados y bien definidos. RESULTADOS. Se realizó exére-sis del tumor con protocolo de ovario conservador. El postoperatorio describió tumor ovári-co de 20 cm, lobulado y sólido que comprometió el ovario derecho en toda su extensión. El estudio histopatológico reportó: disgerminoma en estadio patológico IA moderadamente diferenciado, con extensión tumoral a pared de la trompa uterina derecha. DISCUSIÓN. El caso coincidió con otros reportes descritos en la literatura, donde la presentación clínica fue similar y el abordaje terapéutico con un protocolo de ovario conservador más la quimio-terapia adyuvante fueron la elección más óptima para preservar la función endocrina y la fertilidad en la paciente. CONCLUSIÓN. Los exámenes complementarios para determinar el diagnóstico fueron los marcadores tumorales, la ecografía pélvica y la tomografía axial computarizada simple y contrastada de abdomen y pelvis. La cirugía conservadora abierta es gold standard complementada con quimioterapia adyuvante en la adolescente.

INTRODUCTION. Germ cells tumors of the ovary of a malignant nature are uncommon in the adolescence. Dysgerminomas are characterized by rapid growth, lymphatic disse-mination, high sensitivity to radiotherapy and chemotherapy. OBJECTIVE. Establish the clinical presentation and diagnostic methods of ovarian dysgerminoma in the pediatric age for a correct therapeutic approach. CLINICAL CASE. A mestiza female of 14 years old, who has abdominal pain and a palpable mass in the abdominal pelvic region, and also elevation of the serum tumor markers. Image reports showed right solid adnexal mass with well-defined lobed edges. RESULTS Tumor exeresis was performed with a conservative ovarian protocol. The postoperative findings described a 20 cm, lobulated, solid ovarian tumor that compromised the right ovary in its entirety. The histopathological study repor-ted: moderately differentiated pathological stage dysgerminoma IA, with tumor extension to the wall of the right uterine tube. DISCUSSION. The case agrees with other reports described in the literature where the clinical presentation was similar and the therapeutic approach with a conservative ovary protocol plus adjuvant chemotherapy were the most optimal choice to preserve endocrine function and fertility in the patient. CONCLUSION. The complementary exams to reach the diagnosis were tumor markers, pelvic ultrasound and simple and contrasted computarized axial tomography of the abdomen and pelvis. Open conservative surgery was the gold standard supplemented with adjuvant chemothe-rapy in adolescent.

Reproductive biology, morphology, and morphometry of ovaries and oviducts of Trachemys scripta elegans in Brazilian Cerrado / Biologia reprodutiva, morfologia e morfometriade ovários e ovidutos de Trachemys scripta elegans no Cerrado Brasileiro

Although Trachemys scripta elegans is an exotic species popular as a pet in Brazil, studies on reproductive biology and capacity are non-existent in the Brazilian Cerrado. This study analyzed ovarian and oviduct characteristics and the egg production capacity of T. scripta elegans grown in this biome. The findings will associate with the size of the specimens and the sexual maturity, aiming at comparisons with native and exotic populations, as well as interspecific and contributing to the understanding of its impact on the invaded ecosystems and the establishment of eradication programs. Thus, 39 females had evaluated the body biometry and the morphology and morphometry of the ovaries and oviducts. G2 (N=20): with Class I (>5-10mm) follicles, with Class I and Class II (>10-fold) follicles, 25mm) and G3 (N=9) with Class I, Class II and Class III (>25mm) follicles. Analysis of variance, Scott-Knott's test, and Pearson's correlation analysis showed that there was no significant difference between the groups in body biometry; in the mean gonadosomatic index and gonadal morphometry, only the width of the oviducts in the right antimer and the mass and width in the left antimer were higher in G3, the only one that presented eggs. There was positive and harmonic development between body mass, carapace, and plastron, and gonadal growth occurred concomitantly with body growth, indicating a higher reproductive potential and a positive relationship between the size of the litter and the female litter. The gonadosomatic index proved to be an excellent reproductive indicator, and the ovarian evaluation was a better indicator of sexual maturity than the maximum carapace length. Ovaries were irregular structures, without delimitation between the cortical and medullary regions and filled with vitelogenic follicles of different diameters, atresic follicles, and corpora lutea, which reflected the ovarian complexity of the species and the presence of follicular hierarchy. In the scarce stroma, two germinative beds were observed per ovary and the presence of gaps very close to the follicles and associated with the blood vessels. Analysis of gonadal tissue revealed three types of oocytes according to cytoplasmic characteristics: homogeneous, vesicular or vesicular in the cortex with apparent granules. Oviducts were functional and separated, joining only in the final portion to form the cloaca and subdivided into infundibulum, tuba, isthmus, uterus, and vagina. The structure of the uterine tube was composed of serosa, muscular and mucous, which was full of glands. The presence of eggs in the oviducts indicated that the specimens can reproduce in the Brazilian Cerrado. This study provides necessary and relevant information on the reproductive biology and capacity of T. scripta elegans in the Brazilian Cerrado and can contribute to the understanding of its impact on the invaded ecosystems and the establishment of eradication programs. The extraction of females with capacity can reduce the annual reproductive yield of the species and decrease its effect on local biodiversity.(AU)

Embora Trachemys scripta elegans seja uma espécie exótica popular como animal de estimação no Brasil, estudos sobre biologia e capacidade reprodutivas são inexistentes no Cerrado brasileiro. Este estudo analisou características ovarianas e do oviduto e a capacidade de produção de ovos em T. scripta elegans criadas neste bioma, correlacionando estes achados ao tamanho dos espécimes e a maturidade sexual, visando comparações com populações nativas e exóticas, bem como interespecíficas e contribuir para a compreensão de seu impacto nos ecossistemas invadidos e com o estabelecimento de programas de erradicação. Assim, 39 fêmeas tiveram avaliadas a biometria corporal e a morfologia e morfometria dos ovários e ovidutos. De acordo com o tamanho dos folículos ovarianos as fêmeas foram separadas em G1 (N= 10): com folículos Classe I (>5-10 mm), G2 (N= 20): com folículos Classe I e Classe II (>10-25 mm) e G3 (N= 9) com folículos Classe I, Classe II e Classe III (>25 mm). À análise de variância, teste de Scott-Knott e à análise de correlação de Pearson verificou-se que não houve diferença significativa entre os grupos na biometria corporal; no índice gonadossomático médio e na morfometria gonadal, apenas a largura dos ovidutos no antímero direito e a massa e a largura no antímero esquerdo foram maiores no G3, o único que apresentou ovos. Houve desenvolvimento positivo e harmônico entre massa corporal, carapaça e plastrão e o crescimento gonadal ocorreu concomitante ao crescimento corporal, indicando maior potencial reprodutivo e relação positiva entre o tamanho da ninhada de ovos e o da fêmea. O índice gonadossomático mostrou-se um bom indicador reprodutivo e a avaliação ovariana um melhor indicador da maturidade sexual que o comprimento máximo da carapaça. Ovários foram estruturas irregulares, sem delimitação entre a região cortical e medular e repletos de folículos vitelogênicos de diferentes diâmetros, folículos atrésicos e corpos lúteos, que refletiram a complexidade ovariana da espécie e a presença de hierarquia folicular. No estroma escasso foram observados dois leitos germinativos por ovário e a presença de lacunas muito próximas aos folículos e associadas aos vasos sanguíneos. A análise do tecido gonadal revelou três tipos de oócitos de acordo com as características do citoplasma: homogêneo, vesicular ou vesicular no córtex com grânulos aparentes. Ovidutos eram funcionais e separados, unindo-se apenas na porção final para formar a cloaca e subdividiam-se em infundíbulo, tuba uterina, istmo, útero e vagina. A estrutura da tuba uterina era constituída de serosa, muscular e mucosa, a qual era repleta de glândulas. A presença de ovos nos ovidutos indicou que os espécimes podem se reproduzir no cerrado brasileiro. Este estudo fornece informações básicas e relevantes da biologia e capacidade reprodutivas de T. scripta elegans no Cerrado brasileiro e pode contribuir com a compreensão de seu impacto nos ecossistemas invadidos e com o estabelecimento de programas de erradicação, uma vez que a extração de fêmeas com capacidade reprodutiva pode contribuir com a diminuição do rendimento reprodutivo anual da espécie e diminuir seu efeito sobre a biodiversidade local.(AU)

Prevalencia de embarazo ectópico en el Hospital Carlos Andrade Marín, 2017 a 2019 / Prevalence of ectopic pregnancy in the Carlos Andrade Marín Hospital, 2017 a 2019

RESUMEN: Objetivos: 1) Determinar la prevalencia de embarazo ectópico en el Servicio de Alto Riesgo Obstétrico del Hospital Carlos Andrade Marín. 2) Identificar los factores de riesgo asociados con esta patología. Métodos: se realizó un estudio descriptivo, de corte transversal, retrospectivo, tomando en cuenta a las pacientes ingresadas con diagnóstico de Embarazo Ectópico al Servicio de Alto Riesgo del Hospital Carlos Andrade Marín, en el periodo del 1 de enero del 2017 al 31 de mayo del 2019. Resultados: durante el período comprendido entre el 1 de enero de 2017 y el 31 de mayo de 2019, se registró un total de 7.596 nacimientos en el Servicio de Alto Riesgo Obstétrico del Hospital Carlos Andrade Marín; de ellos, hubo 117 pacientes diagnosticadas de embarazo ectópico. La prevalencia del embarazo ectópico en el Hospital Carlos Andrade Marín, entre los años 2017 y 2019, fue de 1,5%; la tasa de embarazo ectópico es de 15,40 / 1.000 gestaciones. Conclusiones: el análisis de los datos obtenidos de las historias clínicas evidenció que la tasa de prevalencia de embarazo ectópico en el Servicio de Alto Riesgo Obstétrico del Hospital Carlos Andrade Marín es similar a la reportada por diferentes estudios realizados alrededor del mundo.Palabras claves: embarazo ectópico, prevalencia, trompa de falopio, factores de riesgo

ABSTRACT: Objective: To determine the prevalence of ectopic pregnancy in the high-risk obstetric service of the Carlos Andrade Marín Hospital and to know the associated risk factors. Methods: A descriptive, cross-sectional, retrospective study was carried out, taking into account patients admitted with a diagnosis of ectopic pregnancy to the high-risk service of the Carlos Andrade Marín Hospital, from January 1, 2017 to May 31 of 2019. Results: During the period from January 1, 2017 to May 31, 2019, a total of 7596 births were recorded in the High Obstetric Risk Service of Hospital Carlos Andrade Marín. Of all of them, a total of 117 patients were registered diagnosis of ectopic pregnancy. The prevalence of ectopic pregnancies in the Hospital Carlos Andrade Marín in a period between 2017 and 2019 was 1.5%, with an ectopic pregnancy rate of 15.40 per 1000 pregnancies. Conclusions: When performing an analysis of the data obtained from the medical records it was possible to obtain similar results of prevalence rates of ectopic pregnancy in the High Risk Obstetric Service of the Hospital Carlos Andrade Marín in relation to the data obtained by different studies conducted around of the world.Keywords:ectopic pregnancy, prevalence, fallopian tube, risk factors

Potential predictors for chemotherapeutic response and prognosis in epithelial ovarian, fallopian tube and primary peritoneal cancer patients treated with platinum-based chemotherapy

3.38, PLR >210, CA125 >365, advanced stage, suboptimal disease, serous type, and ascites were significant predictive factors for platinum resistance. However, only NLR >3.38 and advanced stage were independent predictive factors with an adjusted odds ratio of 1.880 and 3.333, respectively. Regarding factors associated with poor survival outcomes, only PLR >210 and advanced stage were independent factors, with a hazard ratio of 1.578 and 3.994, respectively.CONCLUSION: High NLR and advanced stage were potential independent predictive factors for platinum resistance, whereas high PLR and advanced stage were potential independent predictive factors for poor survival outcomes.

Endosalpingiosis de cicatriz operatoria de Pfannenstiel: reporte de caso / Endosalpingiosis of Pfannenstiel incision scar: a case report

Introducción: la endosalpingiosis es una enfermedad benigna caracterizada por el crecimiento ectópico del epitelio de la trompa de Falopio, siendo su presencia en cicatrices operatorias excepcional, habiéndose reportado cuatro casos en la literatura internacional. Caso clínico: se presenta el caso de una paciente de 40 años que consultó por dolor sobre incisión de Pfannenstiel y tumoración a dicho nivel. La misma se resecó y el estudio anatomopatológico informó endosalpingiosis. Discusión: el diagnóstico de endosalpingiosis cutánea es posoperatorio y realizado luego del estudio de la pieza de resección. Con su extirpación completa, se resuelve definitivamente la sintomatología y en los pocos casos publicados en la literatura no se ha reportado recidiva.

Introducion: endosalpingiosis is a benign disease characterized by the ectopic growth of the epithelium in the Fallopian tube, being it exceptional in surgical scars, four cases having been reported by international literature. Clinical case: the study presents the clinical case of a 40 year old female patient who consulted for pain in the Pfannenstiel incision and a tumour on the site. After resection, pathological study revealed endosalpingiosis. Discussion: the diagnosis of cutaneous endosalpingiosis occurs after surgery and upon the analysis of the resected piece. Complete removal results in the final solution of symptoms and no relapse has been reported in cases published in literature.

Introdução: a endossalpingiose é uma condição benigna que se caracteriza pelo crescimento ectópico do epitélio da trompa de Falópio; sua presença em cicatrizes operatórias é excepcional sendo que somente quatro casos foram encontrados na literatura internacional. Caso clínico: apresenta-se o caso clínico de uma paciente de 40 anos de sexo feminino que consultou por dor e tumoração na incisão de Pfannenstiel. O laudo de anatomia patológico da tumoração ressecada foi endossalpingiose. Discussão: o diagnóstico de endossalpingiose cutânea é pós-operatório e é feito pelo exame da peça de ressecção. Sua extirpação completa soluciona definitivamente a sintomatologia; os poucos casos publicados na literatura não informam recidivas.

Gestação heterotópica associada a torção de anexo contralateral em gestação não planejada / Heterotopic management associated with the torment of contralateral apparatus in unplugged management

A gestação heterotópica se define como uma gravidez intra e uma extraútero, nesse caso, a gravidez que se encontra extraútero, em tuba uterina. Foi descoberta após a paciente apresentar dor abdominal, ainda não relatando atraso menstrual e sem a paciente apresentar desejo de engravidar. O diagnóstico foi feito por meio do exame de ultrassonografia com a visualização de massa anexial íntegra à esquerda. A torção de ovário, que é definida pela rotação parcial ou total do pedículo vascular ovariano, causando estase circulatória que pode causar progressivamente edema e gangrena e progredir para necrose, causando danos irreversíveis aos ovários, também foi descoberta por meio do exame de ultrassom e dos sintomas da paciente. A clínica apresentou-se por abdome agudo. No intraoperatório, foi feito o diagnóstico de gestação heterotópica e também apresentou torção de ovário contralateral, caso esse sobre o qual, em conjunto, não há relatos na literatura.(AU)

Heterotopic gestation is defined as an intrauterine pregnancy and an extrauterine pregnancy, in this case the extrauterine pregnancy in the uterine tube. It was discovered after the patient presented abdominal pain, still not reporting menstrual delay and without the patient presenting desire to become pregnant. The diagnosis was made through the ultrasound examination with the visualization of complete adnexal mass on the left. Ovarian torsion, which is defined by partial or total rotation of the ovarian vascular pedicle, causing a circulatory stasis that can progressively cause edema, gangrene and progress to necrosis, causing irreversible damage to the ovaries, was also discovered by ultrasound examination and of the patient's symptoms. The clinic presented with an acute abdomen. n the intraoperative period, the diagnosis of heterotopic gestation was made and also presented contralateral ovary torsion, in which case, there are no reports in the literature.(AU)

Causes of misdiagnosis in assessing tubal patency by transvaginal real-time three-dimensional hysterosalpingo-contrast sonography

SUMMARY OBJECTIVE This study aims to investigate the causes of misdiagnosis in assessing tubal patency by transvaginal real-time three-dimensional hysterosalpingo-contrast sonography (TVS RT-3D-HyCoSy), in order to improve the diagnostic efficiency of TVS RT-3D-HyCoSy. METHODS A total of 162 oviducts of 83 infertility patients were examined by TVS RT-3D-HyCoSy. These results were compared with the gold standard for laparoscopic dye studies, and the misdiagnosed cases were analyzed. RESULTS TVS RT-3D-HyCoSy revealed that 68 oviducts were unobstructed and 94 obstructed. The results for the 144 oviducts were in line with the gold standard, while those for 18 oviducts were not. The accuracy rate of the TVS RT-3D-HyCoSy was 88.9%, and the misdiagnosis rate was 11.1%. The main causes of misdiagnosis included contrast medium countercurrent and diffusion, oviduct spasm, abnormal shape or position of the oviduct, pelvic adhesion, and poor imaging operation. CONCLUSION TVS RT-3D-HyCoSy can well-evaluate tubal patency, and understand and improve the cause of misdiagnosis. Furthermore, the diagnostic efficiency of TVS RT-3D-HyCoSy can still be further improved.

RESUMO OBJETIVO Este estudo tem como objetivo investigar as causas do diagnóstico equivocado na avaliação da patência tubária por meio da ultrassonografia de contraste histerosalpingo em tempo real transvaginal (TVS RT-3D-HyCoSy), a fim de melhorar a eficiência diagnóstica das TVS RT-3D-HyCoSy. MÉTODOS Um total de 162 ovidutos em 83 pacientes da infertilidade foi examinado por TVS RT-3D-HyCoSy. Esses resultados foram comparados com o padrão ouro para estudos de tintura laparoscópica, e os casos diagnosticados erroneamente foram analisados. RESULTADOS TVS RT-3D-HyCoSy revelaram que 68 ovidutos foram desobstruídos e 94 ovidutos foram obstruídos. Os resultados para os 144 ovidutos estavam em consonância com o padrão ouro, enquanto que aqueles para os 18 ovidutos, não. A taxa de acurácia do TVS RT-3D-HyCoSy foi de 88,9%, e a taxa de erro de diagnóstico foi de 11,1%. As principais causas de erro de diagnóstico incluíram contraponto e difusão do meio de contraste, espasmo do oviduto, forma ou posição anormal do oviduto, adesão pélvica e má operação de imagem. CONCLUSÃO TVS RT-3D-HyCoSy pode bem avaliar a patência tubária, e compreender e melhorar a causa do erro de diagnóstico. Além disso, a eficiência diagnóstica do TVS RT-3D-HyCoSy ainda pode ser melhorada.

Femoral hernia containing the right fallopian tube: a rare finding / Hérnia femoral contendo a trompa de falópio direita: um achado raro

Abstract Femoral hernias comprise a small proportion of all groin hernias. They are more common in women and have a high rate of incarceration and strangulation, leading to emergency repair. A 61-year-old female patient was admitted to the emergency department complaining of a 2-day painful lump in the right groin, that had become more intense in the last 24 hours. Physical examination suggested the presence of a strangulated femoral hernia, and the patient underwent emergency surgical repair. Intraoperatively, the right fallopian tube was observed in the hernia sac. Since there were no signs of ischemia, the tube was reduced back into the pelvic cavity and the hernia was repaired. The postoperative period was uneventful, and the patient was discharged without complications, 3 days after surgery.

Resumo As hérnias femorais representamuma pequena fração de todas as hérnia da região inguinal. Elas são mais comuns entre as mulheres e estão associadas a elevadas taxas de complicações, como encarceramento e estrangulamento, com necessidade de cirurgia urgente. Uma paciente do sexo feminino, de 61 anos, recorreu ao serviço de emergência por quadro de dor e tumefação da região inguinal direita com 2 dias de evolução e agravamento nas últimas 24 horas. O exame objetivo sugeria a presença de uma hérnia femoral encarcerada, e a paciente foi submetida a cirurgia urgente. Intraoperatoriamente, confirmou-se o diagnóstico de hérnia femoral encarcerada, que continha a trompa de falópio direita no interior do saco herniário. Uma vez que a que a trompa não apresentava sinais de isquemia, o conteúdo da hérnia foi reduzido, e procedeu-se à sua reparação. O período pós-operatório decorreu sem intercorrências, e a paciente teve alta no 3° dia após a cirurgia.

Tumor adenomatoide de tubas uterinas, reporte de un caso y revisión de la literatura / Adenomatoid uterine tube tumor, case report and literature review

Resumen Los tumores adenomatoides del tracto genital son neoplasias poco frecuentes, de comportamiento benigno; debido a sus características histológicas se confunden fácilmente con tumores de estirpe vascular. Estudios recientes demuestran que los tumores adenomatoides del tracto genital femenino están genéticamente definidos por la mutación TRAF7 que activa la expresión aberrante de la vía NFkB. Presentamos el caso de una mujer de 27 años, asintomática, a quien se le realiza salpingectomía bilateral como método de anticoncepción definitivo; en el examen macroscópico de la tuba derecha se encuentra formación quística que por sus características microscópicas es diagnosticada como tumor adenomatoide de la tuba uterina. Finalmente se realiza una revisión de la literatura.

Abstract The adenomatoid tumors of the genital tract are rare neoplasms, with benign behavior; due to their histological characteristics, they are easily confused with tumors of vascular origin. Recent studies show that adenomatoid tumors of the female genital tract are genetically defined by the TRAF7 mutation that activates the aberrant expression of the NFkB pathway. We present the case of a 27-year-old woman, asymptomatic, who underwent bilateral salpingectomy as a method of definitive contraception; In the macroscopic examination of the right tuba, cystic formation is found which, due to its microscopic characteristics, is diagnosed as an adenomatoid tumor of the uterine tube. Finally, a review of the literature is made

Expresión de p53 en ovario y trompa uterina de tumores malignos epiteliales primarios del ovario / Ovary and fallopian tube expression of p53 in primary epithelial ovarian cancer

Introducción: la mutación en el gen TP53 se ha asociado con la oncogénesis de los tumores de ovario tipo II. Se ha propuesto que las mutaciones de p53 se inician en las células de la trompa uterina y después migran al ovario. El objetivo de este estudio es establecer la frecuencia de la expresión de p53 en ovario y trompa uterina en carcinoma epitelial primario de ovario. Materiales y métodos: estudio de corte transversal en tumores primarios epiteliales de ovario. Se evaluó la expresión de p53 por inmunohistoquímica en el ovario y en las trompas uterinas. Resultados: se incluyeron 45 pacientes con edad media de 55 años. Se estudiaron 24 casos de carcinomas serosos, 6 endometrioides, 5 mixtos, 3 de células claras, 3 carcinosarcomas, 2 carcinomas mucinosos y 2 indiferenciados. Se observó positividad fuerte y difusa en 68% de los tumores tipo II. En 52 hubo positividad en trompa uterina y ovario, 92% con compromiso bilateral. En 3 de estos casos se reconoció carcinoma intraepitelial tubárico con positividad de p53 en el área tumoral, no tumoral y en el carcinoma seroso. Conclusión: como se ha observado en estudios previos, el gen TP53 está involucrado en la oncogénesis de los tumores tipo II y se ha demostrado que existe una relación entre una mutación inicial de p53, seguida por STIL, STIC, evolucionando a un carcinoma seroso de ovario.

Introduction: a TP53 gene mutation has been associated with the oncogenesis of type II ovary tumors. Mutations of the p53 gene in the fallopian tube cells which migrate to the ovary have been proposed as an alternative origin. This study focuses on establishing the frequency of p53 ovary and uterine tube expression in primary epithelial ovarian cancer. Materials and Methods: a cross-sectional study on primary epithelial ovarian tumors. Expression of p53 in the ovary and uterine tubes was assessed using immunohistochemistry. Results: 45 patients, median age 55 years, were included. Twenty-four (24) cases of serous carcinomas, 6 endometrioid carcinomas, 5 mixed carcinomas, 3 clear-cell carcinomas, 3 carcinosarcomas, 2 mucinous carcinomas and 2 undifferenciated tumors were studied. Positivity was strong and diffuse in 68% of type II tumors. Positivity was detected in the tubes and ovaries in 52 cases, 92% with bilateral compromise. Intraepithelial tube carcinoma was recognized in 3 cases with p53 positivity in the tumor, outside the tumor and in the serous carcinoma. Conclusion: as observed in previous studies, TP53 gene is involved in the oncogenesis of type II tumors and a correlation between the initial p53 mutations followed by STIL, STIC progressing to an ovary serous carcinoma has been demonstrated.

Serous Adenocarcinoma of Fallopian Tubes: Histological and Immunohistochemical Aspects

BACKGROUND: Although primary cancer of the fallopian tubes is a relatively rare type of tumor in female reproductive organs, its mortality is quite high. It is important to identify molecular and biological markers of this malignancy that determine its specific phenotype. METHODS: The study was carried out on samples received from 71 female patients with primary cancer of the fallopian tubes. The main molecular and biological properties, including hormone status (estrogen receptor [ER], progesterone receptor [PR]), human epidermal growth factor receptor (HER2)/neu expression, proliferative potential (Ki-67), apoptosis (p53, Bcl-2), and pro-angiogenic (vascular endothelial growth factor) quality of serous tumors were studied in comparison with clinical and morphological characteristics. RESULTS: ER and PR expression is accompanied by low grade neoplasia, early clinical disease stage, and absence of lymphogenic metastasis (p < .001). HER2/neu expression is not typical for primary cancer of the fallopian tubes. Ki-67 expression is characterized by an inverse correlation with ER and PR (p < .05) and is associated with lymphogenic metastasis (p < .01). p53+ status correlates with high grade malignancy, tumor progression, metastasis, negative ER/PR (p < .001), and negative Bcl-2 status (p < .05). Positive Bcl-2 status is positively correlated with ER and PR expression and low grade malignancy. CONCLUSIONS: Complex morphologic (histological and immunohistochemical) study of postoperative material allows estimation of the degree of malignancy and tumor spread to enable appropriate treatment for each case.

Molecular markers derived from ovarian cancer and its correlation with the types of oviductal epithelial lesions / 中南大学学报(医学版)

To explore the role of P53, pairing box gene 8 antibody (PAX8), and calcium omentum protein (Calretinin) in the origin of epithelial ovarian cancer.
 Methods: A total of 63 tissue samples of ovarian tumor and fallopian tubes were collected. Immunohistochemistry methods were used to analyze the expression of P53, PAX8, and Calretinin. The relationship between these protein levels and the classification of ovarian tumors was evaluated.
 Results: In epithelial ovarian cancer, the P53 or PAX8 was correlated with the occurrence of high-grade carcinoma, while the calretinin was correlated with the occurrence of low-grade carcinoma (P<0.05). The combination of PAX8 with Calretinin was correlated with the grade of ovarian tumor (P<0.05). The combination of P53 with Calretinin was correlated with the grade of tumor (P<0.05). The combination of P53 with PAX8 was correlated with the grade of tumor (P<0.05). The expression of P53 in fallopian tubes was correlated with the malignant degree of epithelial ovarian cancer (P<0.05). The degree of fallopian tube lesions in patients with ovarian cancer was correlated with epithelial ovarian cancer. The malignant lesions of tubal epithelium was correlated with high-grade carcinoma, while the normal or atypical hyperplasia of tubal epithelium was correlated with low-grade carcinoma (P<0.05).
 Conclusion: P53 and Calretinin combined with PAX8 show a synergistic effect on the differentiation of epithelial ovarian cancer grade. The morphology of HE and the expression of TP53 in the fallopian tube epithelium play an auxiliary role in the diagnosis of epithelial ovarian cancer.

Development and Validation of Ovarian Symptom Index-18 and Neurotoxicity-4 for Korean Patients with Ovarian, Fallopian Tube, or Primary Peritoneal Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study was to develop Korean versions of the National Comprehensive Cancer Network/Functional Assessment of Cancer Therapy (NCCN-FACT) Ovarian Symptom Index-18 (NFOSI-18) and FACT/Gynecologic Oncology Group (FACT-GOG) Neurotoxicity 4-item (NTX-4), evaluating their reliability and reproducibility. MATERIALS AND METHODS: In converting NFOSI-18 and NTX-4, the following steps were performed: forward translation, backward translation, expert review, pretest of preliminary format, and finalization of Korean versions (K-NFOSI-18 and K-NTX-4). Patients were enrolled from six institutions where each had completed chemotherapy for ovarian, tubal, or peritoneal cancer at least 1 month earlier. In addition to demographics obtained by questionnaire, all subjects were assessed via K-NFOSI-18, K-NTX-4, and a Korean version of the EuroQoL-5 Dimension. Internal structural validity and reliability were evaluated using item internal consistency, item discriminant validity, and Cronbach's α. To evaluate test-retest reliability, K-NFOSI-18 and K-NTX-4 were readministered after 7-21 days, and intraclass correlation coefficients (ICCs) were calculated. RESULTS: Of the 250 women enrolled during the 3-month recruitment period, 13 withdrew or did not respond, leaving 237 (94.8%) for the analyses. Mean patient age was 54.3±10.8 years. Re-testing was performed in 190 patients (80.2%). The total K-NFOSI-18 and K-NTX-4 scores were 49 (range, 20 to 72) and 9 (range, 0 to 16), respectively, with high reliability (Cronbach's α=0.84 and 0.89, respectively) and reproducibility (ICC=0.77 and 0.84, respectively) achieved in retesting. CONCLUSION: Both NFOSI-18 and NTX-4 were successfully developed in Korean with minimal modification. Each Korean version showed high internal consistency and reproducibility.

Relationship between the precursors of high grade serous ovarian cancer and patient characteristics: decreased incidence of the p53 signature in pregnant women / 부인종양

OBJECTIVE: To investigate the relationship between the precursors of high grade serous ovarian cancer (HGSOC) and the characteristics of patients with a low HGSOC risk in terms of the effects of pregnancy. METHODS: We prospectively examined consecutive cases in which the bilateral fallopian tubes were removed during benign gynecological or obstetric surgery and assessed the relationship between the patient characteristics, including parity and pregnancy, and the incidence of HGSOC precursors. All the fallopian tubes were examined by applying the Sectioning and Extensively Examining the Fimbriated End (SEE-FIM) Protocol. RESULTS: Of the 113 patients enrolled, 67 were gynecological and 46 were obstetric. The p53 signature was identified in 21 patients. No other precursors were identified. In a comparison of the p53 signature-positive and negative groups, parous women and pregnant women were significantly fewer in the p53 signature-positive group (53% vs. 86%, p=0.002, 10% vs. 47%, p=0.001, respectively). Current pregnancy was also associated with a significantly lower incidence of the p53 signature after multivariate adjustment (odds ratio [OR]=0.112; 95% confidence interval [95% CI]=0.017–0.731; p=0.022). Among gynecological patients, parous women were fewer in the p53 signature-positive group on univariate (47% vs. 73%, p=0.047) and multivariate analysis (OR=0.252; 95% CI=0.069–0.911; p=0.036). No other characteristics were associated with p53 signature positivity. CONCLUSIONS: The incidence of the p53 signature was significantly lower in parous women and pregnant women. This decreased incidence of early phase serous carcinogenesis may be one of the possible mechanisms underlying HGSOC risk reduction among parous women.