Comparison of Ultrasound Scores in Differentiating between Benign and Malignant Adnexal Masses.

Subjective ultrasound assessment by an expert examiner is meant to be the best option for the differentiation between benign and malignant adnexal masses. Different ultrasound scores can help in the classification, but whether one of them is significantly better than others is still a matter of debate. The main aim of this work is to compare the diagnostic performance of some of these scores in the evaluation of adnexal masses in the same set of patients. This is a retrospective study of a consecutive series of women diagnosed as having a persistent adnexal mass and managed surgically. Ultrasound characteristics were analyzed according to IOTA criteria. Masses were classified according to the subjective impression of the sonographer and other ultrasound scores (IOTA simple rules -SR-, IOTA simple rules risk assessment -SRRA-, O-RADS classification, and ADNEX model -with and without CA125 value-). A total of 122 women were included. Sixty-two women were postmenopausal (50.8%). Eighty-one women had a benign mass (66.4%), and 41 (33.6%) had a malignant tumor. The sensitivity of subjective assessment, IOTA SR, IOTA SRRA, and ADNEX model with or without CA125 and O-RADS was 87.8%, 66.7%, 78.1%, 95.1%, 87.8%, and 90.2%, respectively. The specificity for these approaches was 69.1%, 89.2%, 72.8%, 74.1%, 67.9%, and 60.5%, respectively. All methods with similar AUC (0.81, 0.78, 0.80, 0.88, 0.84, and 0.75, respectively). We concluded that IOTA SR, IOTA SRRA, and ADNEX models with or without CA125 and O-RADS can help in the differentiation of benign and malignant masses, and their performance is similar to the subjective assessment of an experienced sonographer.

Conservative management of patients with early endometrial carcinoma: a systematic review.

OBJECTIVE: To know the characteristics of endometrial adenocarcinoma in young patients and to review the published experience in patients with endometrial adenocarcinoma that were conservatively managed with hormonal therapy to spare their fertility. METHODS: We carried out a search in the Survey conducted by the Section of Oncologic Gynecology of SEGO (Spanish Society of Gynecologists) to identify the characteristics of young patients with endometrial adenocarcinoma. In addition we searched MEDLINE and other databases for English-language articles describing patients with endometrial adenocarcinoma who were treated with hormonal therapy. The search included articles published between January 1966 and January 2007. RESULTS: Endometrial carcinoma in patients under 45 years old is an unusual condition that shows a more favourable pattern than in older patients. One hundred and thirty-three patients were found in the search. The average duration of hormonal therapy was approximately six months. The average response time was 12 weeks; 76% of patients treated with hormonal therapy had a complete response and the other 24% never responded to treatment. Of those who initially responded, 66% percent did not show recurrence of disease. The other 34% had a relapse. There have been 4 published deaths of conservatively managed patients. CONCLUSION: A conservative approach in these patients can offer reasonable oncological security and the opportunity of fulfilling their maternal desires in selected cases. However, consideration should be taken regarding the potential adverse outcomes that have been recently published in the literature.

Gigantomastia durante el embarazo / Gigantomasty during pregnancy

La gigantomastia, o hipertrofia mamaria masiva, es una entidad muy rara de etiología desconocida, que quizás se deba a una estimulación hormonal excesiva o a una hipersensibilidad del órgano diana. El tratamiento durante el embarazo es de soporte y farmacológico. En el posparto la mayoría de las pacientes requiere una reducción mamaria y una reconstrucción quirúrgica. Presentamos el caso de una paciente con un rápido crecimiento mamario bilateral durante el embarazo, a la que se tuvo que realizar una cesárea en la semana 32 de gestación por el gran riesgo materno que suponía mantener el embarazo. En un segundo tiempo se realizó una reducción mamaria bilateral

Gigantomastia, or massive breast hypertrophy, is a rare condition of unknown etiology that may be due to hormonal overproduction or hypersensitivity of the target organ. Treatment during pregnancy is supportive and pharmacologic. Most patients require reduction mammoplasty. We present the case of a patient with rapid and massive bilateral breast enlargement during pregnancy. Premature labour at 32 weeks was followed by delivery of a normal infant by caesarean section. In a second intervention, a reduction mammoplasty was carried out