Ovarian Sertoli-Leydig cell tumours: How typical is their typical presentation?

Ovarian Sertoli-Leydig cell tumours (OSLCT) are rare and typically present with androgenic manifestations in women of the 2nd-3rd decade. Out of 228 diagnoses of ovarian sex cord-stromal tumours recorded at an academic institution during a 14-year period, eight women were surgically treated for OSLCT. Patient mean age was 54.8 years (range 19-81), five women being in the postmenopausal stage (62.5%). Only one woman presented with androgenic manifestations (12.5%), four with abnormal/postmenopausal uterine bleeding (50%), and three with abdominal pain (37.5%). Fertility sparing or radical surgery was performed depending on patient age and stage of disease. The only patient with an advanced disease (FIGO stage IV) was referred to palliative care postoperatively. The other seven were at FIGO stage I. Five of them were free from disease at a mean follow-up of 67 months, while the remaining two were lost at follow-up. The youngest woman of the series, treated with fertility-preserving unilateral salpingo-oophorectomy at the age of 19, had two spontaneous pregnancies and deliveries of healthy babies during a 10-year follow-up period. In conclusion, our single institution 14-year experience demonstrates that the diagnosis of OSLCT is particularly challenging since many patients are older than expected and lack androgenic manifestations. Impact statement • What is already known on this subjectOvarian Sertoli-Leydig cell tumours (OSLCT) are rare and are thought to typically present with androgenic manifestations in women of the 2nd-3rd decade. • What the results of this study addOur single institution 14-year experience shows that a high proportion of women with ovarian Sertoli-Leydig cell tumours may not present with androgenic manifestations, and many of them also are in the postmenopausal stage. Most patients have a good prognosis and fertility-preserving surgery in younger women can lead to spontaneous pregnancies and deliveries of healthy children after treatment. • What are the implications of these findings for clinical practice and/or further researchThe diagnosis of OSLCT is particularly challenging and therefore not reached before surgery in most of the cases. However, while hysterectomy with bilateral salpingo-oophorectomy and surgical staging are recommended for women with higher stage or no fertility wish, fertility-sparing surgery should be considered in younger women with early disease. Therefore, further research should focus on non-invasive diagnosis possibly by means of laboratory or imaging techniques.

Degeneración cerebelosa paraneoplásica asociada a teratoma ovárico maduro / Paraneoplastic cerebellar degeneration associated with mature ovarian teratoma

La degeneración cerebelosa paraneoplásica es uno de los síndromes paraneoplásicos más frecuentemente asociados al cáncer, sobre todo a tumores de alta agresividad como los carcinomas de células pequeñas pulmonares, cánceres de ovarios y linfomas Hodgkin. Su fisiopatología parece deberse a una reacción inmunológica frente a las células de Purkinje del tejido cerebeloso. En la bibliografía científica actual no existen referencias a casos acontecidos en el contexto de teratomas benignos ováricos como el que presentaremos a continuación (AU)

Paraneoplastic cerebellar degeneration is one of the most frequent paraneoplastic syndromes associated with aggressive tumors such as small-cell lung cancer, gynecological cancer and Hodgkin’s lymphoma. The physiopathologic basis of this syndrome appears to be an immune response against Purkinje cells. Currently, there are no references in the scientific literature to cases associated with mature ovarian teratomas, as in the case presented herein (AU)

Un modelo de gestión de consultas en un centro de especialidades: implicación y comunicación de los profesionales como claves del éxito / A management model of consultations in speciality center. Implication and communication of professionals as keys for the success

El objetivo de la asistencia sanitaria pública es proveer al ciudadano, en el nivel asistencial más adecuado y de la forma más eficiente posible, de aquellos servicios que mejor preserven o restauren su estado de salud. Para ello, la interacción de clínicos y gestores se hace necesaria, y un buen entendimiento por ambas partes debe ser un punto de partida elemental para desarrollar un modelo de organización de consultas que busca una asistencia sanitaria de calidad. Varios son los elementos de los que depende la calidad de la atención sanitaria, entre ellos destacamos: a) continuidad asistencial, b) participación de los profesionales en la gestión de las consultas y c) participación de los pacientes en las decisiones clínicas. Probablemente, el elemento más importante es entender los servicios sanitarios como una responsabilidad de todos, considerando siempre, como principal objetivo la satisfacción del ciudadano

The purpose of public health care is to provide the residents the best health care as efficiently as possible of those services that best preserve or restore his/her health condition. To do so, interaction between the clinicians and the managers is necessary and good understanding between them should be a fundamental starting point to develop an organization model of consultations that seeks quality health care. Quality of public health care depends on several elements, standing out among them: a) health care continuity, b) participation of the professionals in the management of the consultations, and c) participation of the patients in the clinical decisions. The most important element is probably understanding the public health care services as a responsibility of all, always considering the resident's satisfactions as the primary objective