Chylous Ascites Secondary to Retroperitoneal Para-Aortic Lymphadenectomy: A Case Report.

Chylous ascites is caused by an accumulation of lymphatic fluid in the peritoneal cavity secondary to a rupture or obstruction of the abdominal lymphatic ducts. It has a milky appearance and is rich in triglycerides. The most frequent etiologies are neoplasms, liver cirrhosis, and ruptured lymphatic vessels after abdominal surgery. Clinically, it manifests as abdominal distention and increased abdominal girth. The presence of triglycerides in ascites fluid is the most useful diagnostic criterion. Treatment consists of a high-protein diet with fat restriction and medium-chain triglyceride supplements. Surgery is reserved for refractory cases. We present the case of a 66-year-old patient with a diagnosis of chylous ascites secondary to retroperitoneal lymphadenectomy.

Uterine Primitive Neuroectodermal Tumor.

Uterine primitive neuroectodermal tumors (PNETs) are rare entities, with only around 70 cases published in the literature. Most of them are diagnosed in advanced stages with rapid progression and poor prognosis. Herein, we present a case of a 71-year-old patient with postmenopausal metrorrhagia and an ultrasound finding of endometrial thickening. The pathological diagnosis after an endometrial biopsy showed PNET. In the study of extension, possible distant dissemination with infiltration of the sigmoid and liver was observed. Chemotherapy treatment was proposed, but not begun due to the rapid progression of the disease. Four months after the initial diagnosis, the patient died of multiple organ failure. While there is no optimal chemotherapy treatment regimen for PNET, some studies have reported encouraging results. It is necessary to publish more studies emphasizing the follow-up and survival of the disease to establish which may be the best treatment option and thus improve the current poor prognosis.

A propósito de un caso: disgenesia gonadal pura 46XY o síndrome de Swyer / On the subject of a case: 46XY pure gonadal dysgenesis or Swyer’s syndrome

La disgenesia gonadal es la primera causa de amenorrea primaria. Se define como una falta de correlación entre el fenotipo sexual manifestado y el genotipo. Las principales etiologías por su mayor frecuencia corresponden al síndrome de Turner y síndrome de Swyer. Se presenta el caso de una paciente que consulta por una amenorrea primaria a los 17 años. En primer lugar, se realiza una anamnesis descartando cuadros similares en su familia. A la exploración física destaca un aspecto femenino normal, aunque el desarrollo de los caracteres sexuales secundarios no es completo observándose unas mamas en estadio I de Tanner y escaso vello axilar y púbico. A la exploración ginecológica se observan genitales externos femeninos normales sin signos de hipoestrogenismo. Se realiza un tacto bimanual en el que impresiona que el útero está en anteversoflexión, de pequeño tamaño y no es posible tactar los ovarios en las zonas anexiales. Se realiza una ecografía transvaginal en la que se objetiva un útero pequeño y no se distinguen estructuras compatibles con ovarios en ambas zonas anexiales. Se solicita un cariotipo que es informado como 46XY. El juicio diagnóstico es síndrome de Swyer. Se realiza una gonadectomía profiláctica vía laparoscópica. Intraoperatoriamente se objetiva un útero de aspecto hipoplásico y los ovarios se encuentran sustituidos por cintillas fibrosas de color blanco nacarado. Histológicamente están compuestas por tejido similar a la cortical ovárica sin distinguirse folículos primordiales, datos característicos de la disgenesia gonadal. Tras la intervención la paciente ha recibido tratamiento con terapia de reemplazo hormonal (AU)

Gonadal dysgenesis is the leading cause of primary amenorrhea. It is defined as a lack of correlation between the sexual phenotype and genotype said. The main etiologies for their most frequently correspond to Turner syndrome and Swyer syndrome. It is described the case of a patient who complains of primary amenorrhea at age 17. First, a thorough history is made by ruling similar pictures in your family. A physical examination revealed a normal female appearance, although the development of secondary sexual characteristics is not fully, observed a breast Tanner stage I and low axillary and pubic hair. A pelvic examination showed normal female external genitalia, no evidence of hypoestrogenism. A two-hand touch in which the uterus is impressive in anteversoflexión, is small and can not be tactar ovaries in adnexal areas is performed. Transvaginal ultrasound in which a small uterus objective and non-compatible structures with ovarian adnexal differ in both areas is performed. A karyotype which is reported as 46XY is requested. The diagnosis judgment is Swyer syndrome. Prophylactic gonadectomy performed laparoscopically. Intraoperatively was observed a hypoplastic uterus stayed in pelvis and ovaries are substituted by fibrous tracts of pearly white. From the histological point of view these slips are composed similar to the cortical tissue without distinguishing ovarian primordial follicles ovarian, data compatible with the characteristics of gonadal dysgenesis. After the intervention the patient has been treated with hormone replacement therapy (AU)