Possible relation between borderline ovarian cancer and endocervical adenocarcinoma: case report.

Case: The patient, a 74-year-old women was diagnosed with intestinal-type endocervical adenocarcinoma that developed after 11 years from borderline ovarian cancer. The diagnosis was based on biopsy and magnetic resonance imaging; hysterectomy with pelvic lymphadenectomy was then performed.

Colposcopy today.

A brief digression of the advent and development of colposcopy is described, along with its advantages in the prevention and diag- nosis of uterine cervical cancer.

Vacunas frente al virus del papiloma humano: actualización / Vaccine against human papillomavirus: Up-date

La vacunación frente al virus del papiloma humano (VPH) constituye una herramienta preventiva muy novedosa y de un gran impacto en la prevención primaria oncológica. El flujo de información es continuo y requiere una permanente puesta al día. Inmunogenicidad, eficacia, seguridad y eficiencia de las dos vacunas disponibles, Cervarix®, bivalente VPH 16/18, y Gardasil®, tetravalente 6/11/16/18, son actualizadas y discutidas en esta revisión (AU)

Vaccination against human papillomavirus (HPV) is a recently developed preventive tool with a major impact on primary cancer prevention. Because of the pace at which new data appear, a constant effort is required to keep up to date. The present review discusses and provides an update on the immunogenicity, efficacy, safety and efficiency of the two currently available vaccines, Cervarix®, a bivalent vaccine for the prevention of HPV 16- and 18-associated cervical cancer, and Gardasil®, a tetravalent vaccine against HPV types 6, 11, 16, and 18 (AU)

Conservative management of epithelial ovarian cancer.

We are currently faced with a progressive delay in the age at which women conceive for the first time. This raises the possibility of the appearance of gynecologic disorders that may affect fertility, including neoplasms of the ovary. Fertility-sparing surgery is defined as the preservation of ovarian tissue in one or both adnexa and/or the uterus. Borderline ovarian tumor should be treated with conservative surgery. Salpingo-oophorectomy, or even ovarian cystectomy, are the procedures of choice, with recurrence rates of 2-3% and up to 20% if a simple cystectomy is performed. Cystectomy is indicated in patients with bilateral borderline tumors or in patients with a residual ovary. Borderline tumors with invasive peritoneal implants behave as an invasive cancer in 10-30% of cases with a survival rate of 10-66% compared with 100% in borderline tumors without invasive implants. Prophylactic oophorectomy is recommended when desire of conception has been accomplished. Conservative surgery in invasive epithelial ovarian cancer is limited to Stage IA, grade 1 tumor, and in some highly selected grade 2 tumors of serous, mucinous or endometrioid type, well-encapsulated and free of adhesions. The standard oncological surgical procedure with preservation of the uterus and normal appearing ovary is recommended. This includes salpingo-oophorectomy, excision of any suspicious peritoneal lesion, multiple peritoneal biopsies, appendectomy (particularly in mucinous tumors), and pelvic and paraaortic lymphadenectomy.

Condrolipoma de la mama detectado por microcalcificaciones mamográficas / Chondrolipoma of the breast detected by microcalcifications on mammography

Se presenta el caso de una paciente de 50 años de edad, con unas microcalcificaciones mamográficas de nueva aparición y sospechosas de malignidad. La lesión se extirpó quirúrgicamente y el examen microscópico evidenció una lesión constituida por islotes maduros de tejido adiposo y cartilaginoso con focos de calcificación y osificación. El condrolipoma es un tumor benigno del que hay pocos casos descritos en la bibliografía. Se presentan los aspectos clínicos e histológicos y se discuten los diagnósticos diferenciales y la etiopatogenia del tumor

The case of a 50-year-old woman with recently developed microcalcifications on mammogram which were suspicious for malignancy is presented. The lesion was surgically removed and histological examination revealed islands of mature adipose and cartilaginous tissues with calcifications and focal ossification. Chondrolipoma is a benign tumor and only a few cases have been reported in the literature. The clinical and histological features are described, and the differential diagnosis and etiopathogenesis are discussed

Myometrial trophoblastic implant as a complication of surgically induced first-trimester termination of pregnancy.

Persistent trophoblastic tissue has been described in the abdominal cavity after surgical treatment of tubal ectopic pregnancy. More infrequently the cause of the ectopic trophoblast is linked to uterine perforation due to surgically induced termination of pregnancy (TOP). Ultrasonographic images may suggest an ectopic pregnancy. A case of myometrial trophoblastic tissue implantation following surgically induced first-trimester TOP is described.

The role of colposcopy in modern gynecology.

UNLABELLED: The purpose of this review is to demonstrate that colposcopy, introduced in 1925--which is, notably before the development of great technological advances in modern gynecology--continues to be a valid technique without essential innovations to the original method described at the beginning of the last century. Colposcopy was developed in Germany during the rise of Nazism with the Second World War being an important barrier for the spread and diffusion of the technique. Colposcopy, however, continued to progress in a few countries such as Spain, Italy, Brazil, France and Switzerland. When colposcopy was introduced in the United States during the 70s, its use was mostly restricted to specialists who were almost exclusively dedicated to cervical pathology and knowledgeable about cytopathology, anatomic pathology, and colposcopy and who were competent both in the diagnosis and treatment of cervical lesions. These circumstances were completely different from what happened in the majority of European countries where colposcopists were trained as gynecologists and their histocytological knowledge, which was focused on the lower genital tract, was somewhat more extensive than that acquired by specialists in gynecology. There are two clearly different trends in relation to the use of colposcopy with characteristic geographic distribution: countries with an Anglo-Saxon influence in which colposcopy is performed selectively, and countries with a German medical inheritance in which colposcopy is carried out routinely during a standard general gynecological consultation. However, this difference is not restrictive and by no means can it be stated that colposcopy is systematically being used by all European or Latin American gynecologists for reasons related to training in the colposcopic technique. In 1977, we introduced the concept of dynamic colposcopy with the aim of differentiating it from the descriptive immobility of the original classification of Hinselmann (1954) that had remained almost unchanged by his immediate followers. Briefly, the objective was to turn colposcopy into a diagnostic tool able to identify the pathological substrate corresponding to traditional colposcopic images. We established ten differential signs that allow us to classify an ATZ area as subsidiary or not to be biopsied. The classification system proposed in Rome (International Federation of Cervical Pathology and Colposcopy [IFCPC], 1990) supports our original concept because by identifying major or minor changes in the original images, a diagnosis of the severity of the lesion can be established. With regard to specificity, the figures range between 48% and 10% with 96% for sensitivity. Obviously, a wide range of colposcopic specificity must be related to the expected efficacy of the method. When after biopsy of an atypical colposcopic image, only a low-grade lesion is detected, should this be considered a false positive colposcopic result? Although histopathologic findings are accepted as the "gold standard"...it is well known that a certain degree of subjectivity can be present. Inter- and intra-observer differences (when the same pathologist is reviewing the diagnosis after a certain time lapse) may be present. It has been argued that microbiopsy under colposcopic control gives rise to a wide error range and that it cannot be considered representative of the lesion. It is likely that this situation may occur when colposcopy-guided biopsy is performed by inexperienced hands or when biopsy is limited to small and insufficient sampling. A very important colposcopic sign, such as complete visual inspection of the squamocolumnar junction is frequently missed. Any lesion with boundaries in the endocervix, cannot be simply assessed by means of microbiopsies from the ectocervix unless there is no doubt regarding the severity of the lesions. Microcolpohysteroscopy (MCH) may be of great value in these cases by showing the limits of endocervical involvement. CONCLUSIONS: According to the evidence presented here, it can be concluded that "colposcopy is in good health" and that probably the popularity of this technique in the field of gynecology would increase if cytopathologists and gynecologists' tasks were limited to their own fields rather than turning them into improvised specialists for their counterpart disciplines. The coordinating role of the gynecologist as a specialist for integral women's health should continue to be defended and in this respect, colposcopy should be considered a routine technique in daily practice.

Factores de riesgo, pronóstico y screening en el carcinoma de ovario / Risk factors, prognostic and screening in ovarian cancer

Objetivo: Revisar la epidemiología, factores de riesgo y pronóstico del carcinoma de ovario, así como el estado actual de screening de esta enfermedad.Fuentes: Literatura médica hasta abril del año 2000 a través del Medline.Conclusiones: Hoy por hoy los dos factores pronósticos más importantes siguen siendo el estadio de la enfermedad en el momento del diagnóstico y la radicalidad de la cirugía. El análisis del verdadero valor de los múltiples factores de 'riesgo' permitiría la identificación de los que exigirían un control exhaustivo de las pacientes y quizá el tan deseado diagnóstico precoz o temprano de la enfermedad (AU)