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

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

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

Tumores de testículo em crianças e adolescentes / Testicular tumors in children and adolescents

OBJETIVO: Avaliar comparativamente aspectos clínicos e epidemiológicos dos tumores de testículo na infância e adolescência. MÉTODOS: Análise retrospectiva dos prontuários de pacientes com neoplasias de testículo ou paratesticulares. Foram classificados como crianças os menores de 10 anos e como adolescentes os pacientes entre 10 e 20 anos. Os resultados obtidos foram comparados por meio do teste para duas proporções: teste não paramétrico de Mann-Whitney e teste de log-rank. RESULTADOS: No período de janeiro de 1992 a julho de 2009, foram admitidos 60 pacientes: 34 crianças e 26 adolescentes com neoplasias de testículo ou paratesticulares. As principais manifestações foram tumor e dor na bolsa escrotal. A queixa de dor foi mais comum em adolescentes (p = 0,006). Estes apresentaram tempo médio de história de 4,9 meses, mais prolongado do que crianças, com 2,3 meses (p = 0,01). Os tipos histológicos encontrados foram: tumores de células germinativas em 32/60 (53 por cento), rabdomiossarcomas (RMSs) em 23/60 (38,3 por cento) e outros em 5/60 (8,3 por cento). Os adolescentes apresentaram maior frequência de RMSs, metástases em linfonodos (p = 0,003) e a distância (p = 0,035). As diferenças na sobrevida dos pacientes estudados não foram estatisticamente significantes, havendo apenas indicativo de que a sobrevida, nos casos de RMS, é maior nas crianças (p = 0,072). CONCLUSÕES: Os adolescentes com tumor testicular apresentaram maior tempo de história, tipo histológico agressivo e doença avançada ao diagnóstico quando comparados às crianças, a despeito da pequena amostra.

OBJECTIVE: To perform a comparative assessment of the clinical and epidemiological aspects of testicular tumors in childhood and adolescence. METHODS: Retrospective analysis of medical records of patients with testicular or paratesticular neoplasms. Patients under 10 years were classified as children and patients between 10 and 20 were classified as adolescents. The obtained results were compared through the two-sample test for proportions: non-parametric Mann-Whitney test and log-rank test. RESULTS: 60 patients were admitted in the period from January 1992 to July 2009: 34 children and 26 adolescents with testicular or paratesticular neoplasms. The main manifestations were testicular tumor and scrotal pain. Pain complaints were more common in adolescents (p = 0.006), who presented a mean time from disease onset to diagnosis of 4.9 months, longer than children, who presented a period of 2.3 months from disease onset to diagnosis (p = 0.01). Histological types were as follows: germ cell tumors in 32/60 (53 percent), rhabdomyosarcomas (RMSs) in 23/60 (38.3 percent), and other in 5/60 (8.3 percent). Adolescents presented a higher incidence of RMSs, lymph node metastases (p = 0.003) and distant metastases (p = 0.035). Differences in survival rates among the studied patients were not statistically significant, the only indicative being that survival in RMS cases is longer for children (p = 0.072). CONCLUSIONS: Compared to children, adolescents with testicular tumor presented longer time from disease onset to diagnosis, aggressive histological type and advanced illness at diagnosis, despite the small sample analyzed.

Retrospective and prospective study of ovarian tumours and tumour-like lesions.

Two hundred and thirty three cases of ovarian tumours and tumour like lesions were studied. Of these 233 cases, 96 cases were of ovarian tumours and 137 were tumour like lesions of the ovary. Of the 96 cases of ovarian tumours, 72.9% were benign, 4.1% were borderline and 22.9% were malignant. Histologically surface epithelial tumours were the commonest (48.8%) followed by germ cell tumours (23.9%), sex cord stromal tumours (8.3%) and metastatic tumours (2.0%). Ultrasound guided FNAC done in cases of ovarian tumours showed an accuracy of 100% for malignant lesions and 100% for benign and borderline lesions when compared with histopathological diagnosis. Of the non neoplastic lesions follicular cysts and corpus leuteal cysts were commonest (80.2%). Tuberculosis constituted (2.9%) cases and was the major cause of clinical diagnostic pitfalls for cases in which a clinical diagnosis of ovarian neoplasm was made.

Malignant ovarian germ cell tumor in King Chulalongkorn Memorial Hospital.

OBJECTIVES: To determine the frequency, characteristics, treatment and outcome of patients with malignant ovarian germ cell tumor (MOGCT) in King Chulalongkorn Memorial Hospital during the period January 1992 - December 2000. STUDY DESIGN: Retrospective descriptive study MATERIAL AND METHOD: All patients with malignant ovarian germ cell tumor in King Chulalongkorn Memorial Hospital during the period January 1992 - December 2000 were analyzed by the characteristics of patients, treatment and outcome. RESULTS: Sixty-six patients with MOGCT were demonstrated in that period with a mean age of 22.6 years old. Most of the patients were nulliparous and premenopausal status. Primary surgery was done in all patients. Forty-two patients (63.6%) received conservative surgery. Eight patients received no adjuvant treatment after surgery due to stage 1A dysgerminoma and immature teratoma stage I grade I. Fifty-six patients received chemotherapy for adjuvant treatment. VAC regimen was given in 27 cases (40.9%) and PVB regimen was given in 25 cases (37.9%). Salvage therapy in the patients with persistent and recurrent disease was treated in 9 patients, who received a platinum-base of regimen. Two-year survival was 88% with the median time to follow up 24 months. Overall five-year survival in the present study was 85%. CONCLUSION: MOGCT in King Chulalongkorn Memorial Hospital had clinical characteristics similar to other studies in malignant ovarian germ cell tumor Treatment by VAC regimen still has benefit in selected group.

Epidemiología de los tumores derivados de las células germinales en la edad pediátrica / Epidemiology of the germ cell tumors in children

Objetivo. Revisión de la literatura para conocer los aspectos epidemiológicos relacionados con los tumores de células germinales (TCG), en niños. Fuente de datos. Revisión del Medline hasta febrero de 1995. La información se contrastó con la experiencia obtenida en la institución donde laboran los autores. Se obtuvieron las fotocopias de los artículos aparecidos en los últimos 15 años. Se analizó y sintetizó la información de cada artículo, presentado en este documento la información de mayor interés. Conclusiones. De los informes publicados los TCG representan menos de 2 por ciento de los tumores que se presentan en hombre y menos de 4 por ciento de los que padecen las mujeres. Su localización más frecuente es la región sacrococcígea. Los TCG gonadales son más frecuentes en hombres de 0-4 años, mientras que las mujeres habitualmente lo presentan en el inicio de la segunda década de la vida. los tumores extragonadales ocurren en ambos sexos, habitualmente antes de los cinco años de edad. No se apreció que hubiese alguna tendencia a aumentar su incidencia. Los principales factores de riesgo para TCG es el testículo criptorquídico y la susceptibilidad aumentada al cáncer en los diversos síndromes genéticos y de deficiencias inmunitarias. Se consideran necesarios mayores estudios epidemiológicos para un mejor conocimiento de los factores de riesgo y para poder establecer otras asociaciones

Estudio estadístico de los quistes embrionarios del cuello / Statistical study of embryonal cysts of the neck

Se realiza un estudio estadístico sobre los quistes embrionarios del cuello en el servicio de Cirugía Maxilofacial del Hospital Provincial Clínicoquirúrgico Docente "Saturnino Lora" de Santiago de Cuba, durante el periodo comprendido desde el 1ro. de enero de 1972 hasta el 31 de diciembre de 1982, en el cual se computaron 60 historias clínicas con diagnósticos histológicos de las afecciones enmarcadas en la investigación. El quiste más común fue el tirogloso y en el grupo etario, la tercera década fue la más afectada, con predominio del sexo femenino. Como localización más frecuente se halló la línea media del cuello