[The first Mexican consensus of endometrial cancer. Grupo de Investigación en Cáncer de Ovario y Tumores Ginecológicos de México]. / Primer consenso Mexicano de cancer de endometrio.

INTRODUCTION: Endometrial cancer (EC) is the second most common gynecologic malignancy worldwide in the peri and postmenopausal period. Most often for the endometrioid variety. In early clinical stages long-term survival is greater than 80%, while in advanced stages it is less than 50%. In our country there is not a standard management between institutions. GICOM collaborative group under the auspice of different institutions have made the following consensus in order to make recommendations for the management of patients with this type of neoplasm. MATERIAL AND METHODS: The following recommendations were made by independent professionals in the field of Gynecologic Oncology, questions and statements were based on a comprehensive and systematic review of literature. It took place in the context of a meeting of four days in which a debate was held. These statements are the conclusions reached by agreement of the participant members. RESULTS: Screening should be performed women at high risk (diabetics, family history of inherited colon cancer, Lynch S. type II). Endometrial thickness in postmenopausal patients is best evaluated by transvaginal US, a thickness greater than or equal to 5 mm must be evaluated. Women taking tamoxifen should be monitored using this method. Abnormal bleeding in the usual main symptom, all post menopausal women with vaginal bleeding should be evaluated. Diagnosis is made by histerescopy-guided biopsy. Magnetic resonance is the best image method as preoperative evaluation. Frozen section evaluates histologic grade, myometrial invasion, cervical and adnexal involvement. Total abdominal hysterectomy, bilateral salpingo oophorectomy, pelvic and para-aortic lymphadenectomy should be performed except in endometrial histology grades 1 and 2, less than 50% invasion of the myometrium without evidence of disease out of the uterus. Omentectomy should be done in histologies other than endometriod. Surgery should be always performed by a Gynecologic Oncologist or Surgical Oncologist, laparoscopy is an alternative, especially in patients with hypertension and diabetes for being less morbid. Adjuvant treatment after surgery includes radiation therapy to the pelvis, brachytherapy, and chemotherapy. Patients with Stages III and IV should have surgery with intention to achieve optimal cytoreduction because of the impact on survival (51 m vs. 14 m), the treatment of recurrence can be with surgery depending on the pattern of relapse, systemic chemotherapy or hormonal therapy. Follow-up of patients is basically clinical in a regular basis. CONCLUSIONS: Screening programme is only for high risk patients. Multidisciplinary treatment impacts on survival and local control of the disease, including surgery, radiation therapy and chemotherapy, hormonal treatment is reserved to selected cases of recurrence. This is the first attempt of a Mexican Collaborative Group in Gynecology to give recommendations is a special type of neoplasm.

[Benign breast diseases: clinical, radiological and pathological correlation]. / Patología mamaria benigna: correlación clínica, radiológica y patológica.

INTRODUCTION: Benign lesions of the breast are common; however, benign pathological states have always been neglected in comparison to cancer even though they account for as much as 90 percent of the clinical presentations related to breast. A useful classification system for benign breast disease has been described by Love and colleagues and is based on symptoms and physical findings, six general categories have been identified, which include physiological swelling and tenderness, nodularity, mastalgia, dominant lumps, nipple discharge, and inflammation. Another classification system developed by Page and coworkers separates the various types of benign breast lesions into three clinically relevant groups: non-proliferative lesions, proliferative lesions without atypia, and proliferative the histopathological evaluation of the biopsy specimen in order to determine the subsequent risk of developing carcinoma if the lesions represents atypia of lobules or ductal epithelium. OBJECTIVE: The study was made to evaluate the clinical, radiological and pathological correlation of the benign breast lesions. METHODS: We studied women aged 40 years or less that went to the Foundation Rodolfo Padilla Padilla by mastalgia or the presence of a mass. We determined the Kappa coefficient in order to identify the agreement between the three observers according to different pathologies: fibroadenoma, abscess, cyst, mastitis, fibrosis, and cancer. RESULTS: We made 698 breast Ultrasounds in women younger 40 years, we found 52% ultrasound normal and 48% were reported with benign breast pathology: fibroadenomas 38%, cyst 27%, dilated ducts 24%, benign nodule 4%, mastitis 3%, ectasia 2%, and abscess 2%. The correlation was made to 58 patients, finding the following coefficients kappa. Fibroadenoma: when evaluating the clinical examination versus ultrasound: K = 50%. Cysts: when evaluating clinical examination versus ultrasound: K = 17%, when evaluating ultrasound versus pathology: K = 3%. Fibrosis: when evaluating clinical examination versus ultrasound: K = 56%, when evaluating ultrasound versus pathology: K = 50%, when evaluating ultrasound versus pathology: K = 50%. CONCLUSION: The benign breast pathology must be studied carefully because the clinical and ultrasonic evaluation is not conclusive, and the histopathological evaluation of the biopsy specimens sometimes is necessary to discard malignancy.