Muerte materna asociada a una malformación arteriovenosa uterina / Maternal death associated with uterine arteriovenous malformation

La malformación arteriovenosa uterina (MAVU), para algunos autores considerada como fístula arteriovenosa, representa entre el 1 y 2% de la hemorragia genital e intraperitoneal como resultado de la rotura vascular espontánea o provocada posterior a una intervención quirúrgica.Exponemos un caso de muerte materna ocurrida durante una caminata sobre una pendiente, presentando metrorragia y desvanecimiento con desenlace letal. La autopsia médico legal demostró un útero gestante con hemorragia del miometrio y múltiples coágulos hemáticos, diagnosticada anatomopatológicamente como MAVU.La muerte materna es un problema de salud pública multifactorial en los países subdesarrollados, la MAVU es una causa poco frecuente, sin embargo, algunos autores la consideran subdiagnosticada; han aumentado el reporte de casos en los últimos años y en los países en desarrollo puede ser letal. (AU)

Uterine arteriovenous malformation (UAMM) for some authors, considered an arteriovenous fistula, represents between 1% and 2% of genital and intraperitoneal hemorrhage as a result of spontaneous or provoked vascular rupture after a surgical intervention.We present a case of maternal death that occurred during a walk on a slope, presenting metrorrhagia and fainting with a fatal outcome. The medico-legal autopsy showed a pregnancy uterus with myometrial hemorrhage and multiple blood clots, diagnosed pathologically as a uterine arteriovenous malformation.Maternal death is a multifactorial public health problem in underdeveloped countries. Uterine arteriovenous malformation is a rare cause, however some authors consider it underdiagnosed; reported cases have increased in recent years and in developing countries it can be lethal. (AU)

Tumor de colisión en el ovario, con fibrotecoma. Reporte de un caso / Collision tumor in the ovary, with fibrothecoma. Case report

Resumen ANTECEDENTES: La coincidencia temporo-espacial de dos o más neoplasias benignas, malignas o combinadas, que afectan a un mismo órgano o tejido es lo que define al tumor de colisión, con diferencias conductuales, genéticas e histológicas. Los tumores de colisión ovárica son un subtipo raro. CASO CLÍNICO: Paciente de 53 años, que acudió al servicio de Urgencias debido a un dolor intermitente de siete meses de evolución que, en las últimas semanas, se intensificó y se agregaron náuseas y vómitos. Durante la exploración abdominal se detectó un aumento de volumen en el área pélvica, sin irritación peritoneal. Los marcadores tumorales: CA-125, CA 19-9 y antígeno carcinoembrionario se reportaron en parámetros normales. La ecografía pélvica informó la existencia de una imagen quística simple y compleja, con componente sólido. El examen de anatomía patológica diagnosticó: tumor de colisión en el ovario izquierdo. CONCLUSION: Los tumores de colisión en el ovario son poco frecuentes según lo reportado en la bibliografía. El diagnóstico anatomopatológico minucioso y el seguimiento clínico-radiológico adecuado son necesarios para descartar los tumores de colisión.

Abstract BACKGROUND: The temporal-spatial coincidence of two or more benign, malignant or combined neoplasms that affect the same organ or tissue is what defines the collision tumor, with behavioral, genetic and histological differences. Ovarian collision tumors are a rare subtype. CLINICAL CASE: A 53-year-old patient, who came to the Emergency Department due to intermittent pain of seven months' evolution, which, in recent weeks, intensified and nausea and vomiting were added. During abdominal examination, an increase in volume was detected in the pelvic area, without peritoneal irritation. Tumor markers: CA-125, CA 19-9 and carcinoembryonic antigen were reported in normal parameters. Pelvic ultrasound reported the existence of a simple and complex cystic image, with a solid component. Pathological anatomy examination diagnosed: collision tumor in the left ovary. CONCLUSION: Collision tumors in the ovary are rare according to reports in the literature. A thorough pathological diagnosis and adequate clinical-radiological follow-up are necessary to rule out colliding tumors.

Comparing cytology, colposcopy and human papillomavirus cervical intraepithelial lesion screening methods in women with systemic lupus erythematosus.

OBJECTIVE: To compare the performance of cytology, colposcopy and human papillomavirus in detecting cervical intraepithelial lesions in women with systemic lupus erythematosus. METHODS: Papanicolaou smears (normal, low-grade squamous intraepithelial lesion, high grade squamous intraepithelial lesion), colposcopy findings, human papillomavirus and co-testing (Papanicolaou smear + human papillomavirus) were compared with cervical biopsy findings in women with systemic lupus erythematosus. Sensitivity, specificity, false-positive and false-negative rates, positive and negative predictive values and likelihood ratios of cytologic smears, colposcopy findings, human papillomavirus and co-testing were determined. RESULTS: Cytology and colposcopy were performed in 170 systemic lupus erythematosus women (mean age and disease duration of 43.7±12.1 years and 9.7±5.3 years, respectively) and biopsies were performed in 55 patients (38.2% normal, 60.0% low-grade squamous intraepithelial lesion and 1.8% high grade squamous intraepithelial lesion). The sensitivity, specificity, positive predictive value and negative predictive value of cytology were 14.7% (95% confidence interval 5.5-31.8%), 95.2% (95% confidence interval 74.1-99.7%), 83.3% (95% confidence interval 36.4-99.1%) and 40.8% (95% confidence interval 27.3-55.7%), respectively. The sensitivity, specificity and positive predictive value of colposcopy findings were 100.0% (95% confidence interval 87.3-100.0%), 0.0% (95% confidence interval 0.0-19.2%) and 61.8% (95% confidence interval 47.7-74.2%), respectively. The sensitivity and specificity of co-testing were 8.0% (95% confidence interval 1.3-27.5%) and 100.0% (95% confidence interval 71.6-100.0%). The positive predictive value and negative predictive values were 100.0% (95% confidence interval 19.7-100.0%) and 36.1% (95% confidence interval 33.5-38.8%), respectively. CONCLUSIONS: In systemic lupus erythematosus patients, colposcopy impressions were more sensitive than cytology and co-testing. However, cytology and co-testing were the most specific tests. The results should be interpreted with caution due to the small sample size.