ABSTRACT
PURPOSE: To describe the management of dermoid cysts in a pediatric referral hospital. METHODS: Retrospective review of 115 patients with pathological diagnosis of dermoid cyst in a pediatric referral hospital between 2003 and 2019. RESULTS: One hundred fifteen patients, 51 (44.3%) males, and 64 (55.7%) females were retrospectively reviewed. There were fifty-one (44.3%) right eyes and 64 (55.7%) left eyes. Mean age at surgery was 39.15 months (5.6 months-16.4 years). One hundred four (90.4%) lesions were superficial, and 11 (9.6%) were deep. Quadrant location was 63 (54.8%) superior-temporal, 45 (39.1%) superior-nasal, 4 (3.5%) inferior-temporal, and 2 (1.7%) in the nasal inferior quadrant. Most patients only had aesthetic concerns, but 3 (2.61%) showed lacrimal drainage obstruction symptoms, 2 (1.74%) had proptosis, and 1 case spontaneously drained to the cutaneous surface. Imaging was performed in 51 (44.3%) patients. Regarding to their radiodensity, 71.9% had low density content, 28.1% high density, and only 1 patient showed full liquid content; 10.9% showed heterogeneous content; 53.1% showed bone remodeling. Every patient but 1 underwent surgery for a barely accessible asymptomatic retrobulbar cyst. Nine cysts (7.8%) were breached during surgery. Three recurrences were found (2.6%), but only 1 was related to intraoperative breach. CONCLUSIONS: Dermoid cysts are the most common benign periorbital tumors in the pediatric population. Imaging is required for evaluation of lesions in atypical locations, deep or fixed to underlying tissue. Surgical removal is the gold standard of treatment. Multidisciplinary approach may be required in the most complex cases. After surgery, few complications and recurrences were found in our series.
Subject(s)
Dermoid Cyst , Child , Dermoid Cyst/diagnosis , Dermoid Cyst/surgery , Female , Hospitals , Humans , Infant , Male , Neoplasm Recurrence, Local , Referral and Consultation , Retrospective StudiesABSTRACT
El adenosarcoma de útero es una neoplasia rara y representa aproximadamente el 8% de todos los sarcomas uterinos. Está relacionado con antecedentes de tratamiento con tamoxifeno y con radiación pélvica. La clínica más característica es la de una lesión polipoide recidivante, siendo habitual que la paciente ya haya tenido algunas biopsias previas por ese mismo motivo, en las cuales no haya podido llegarse a un diagnóstico acertado y definitivo. Incluso puede haber llegado a darse un diagnóstico erróneo, de los cuales el más frecuente es el de un pólipo cervical. La lesión consta de un componente glandular benigno creciendo inmerso en un estroma sarcomatoso. Presentamos el caso de una mujer de 53 años con una lesión polipoide uterina. Tras los estudios macroscópico, microscópico e inmunohistoquímico se llegó al diagnóstico de adenosarcoma mülleriano de útero. Se trata de una neoplasia de bajo grado y buen pronóstico, pero que recidiva en un alto porcentaje de casos (25-40%). El tratamiento es la histerectomía total simple con doble anexectomía, seguida o no de radioterapia postoperatoria, aunque en pacientes jóvenes, que no tienen el deseo genésico cumplido, al ser una neoplasia de bajo grado, se han descrito casos en los que se ha optado por un tratamiento conservador. De todas formas, no hay que olvidar que se trata de un tumor maligno y que también se han descrito casos de fallecimiento por esta entidad a causa de metástasis abdominales o de otro tipo, por lo que somos de la opinión de que la mejor y más segura opción terapéutica es la histerectomía (AU)
Uterine adenosarcoma is a rare neoplasm constituting only around 8% of all uterine sarcomas. This tumor is associated with tamoxifen therapy and pelvic radiation. The most characteristic clinical feature is a recurrent cervical polypoid lesion. Patients have often had previous biopsies for the same reason, but without an accurate diagnosis. Furthermore, a mistaken diagnosis may have been made, the most common being cervical polyp. Uterine adenosarcoma consists of neoplastic glands with a benign appearance and a sarcomatous stroma. We report the case of a 53-year-old woman with a uterine polypoid lesion. After macroscopic, microscopic and immunohistochemical studies, the diagnosis was a uterine Müllerian adenosarcoma, which is a low-grade neoplasm with good prognosis, but with a high percentage of recurrences (25%-40%). Treatment is simple hysterectomy with double adnexectomy, with the option of subsequent postoperative radiotherapy. However, because this tumor is a low-grade neoplasm, a more conservative approach has sometimes been adopted in some young patients without children. This tumor is malignant, however, and mortality from abdominal or other types of metastases has been reported. Therefore, we believe that the most appropriate and safest therapeutic option is hysterectomy(AU)
