ABSTRACT
BACKGROUND: Mullerian adenosarcoma is a rare gynecological malignancy with a low malignant potential, with biphasic growth, consisting of a benign epithelial element and a malignant mesenchymal element. It occurs in all ages predominating in postmenopausal women. Cervical localization of Mullerian adenosarcomas is rare; however, it is associated with a presentation in young women. The diagnosis is made by anatomopathological study of the lesion and immunohistochemistry. The prognosis is generally good although the recurrence rate is high. CLINICAL CASE: We present the case of a 27-year-old patient who attended a gynecological consultation with bleeding and transvaginal flow. During the gynecological examination, a polypoid lesion originating in the cervix was identified, which was removed by torsion and was diagnosed as Mullerian cervical adenosarcoma. Subsequently, a cervical cone was performed because the patient refused hysterectomy. CONCLUSIONS: Mullerian cervical adenosarcoma is a rare neoplasm with a recurrence rate that can reach up to 50% of cases, so close follow-up is necessary. A local excision can be considered in patients without poor prognosis factors and who wish to preserve their fertility.
ANTECEDENTES: El adenosarcoma mulleriano (AM) es una neoplasia ginecológica rara, de bajo potencial maligno, con crecimiento bifásico, constituida por un elemento epitelial benigno y otro mesenquimatoso maligno. Se presenta en todas las edades, pero predomina en mujeres posmenopáusicas. La localización cervical de los AM es poco frecuente; sin embargo, se asocia a una presentación en mujeres jóvenes. El diagnóstico se realiza mediante estudio anatomopatológico de la lesión e inmunohistoquímica. El pronóstico es generalmente bueno, aunque la tasa de recidiva es alta. CASO CLÍNICO: Presentamos el caso de una paciente de 27 años que acudió a consulta ginecológica con sangrado y flujo transvaginal. En la exploración ginecológica se identificó una lesión polipoide originada en el cérvix, la cual se extirpó por torsión y fue diagnosticada como AM cervical. Posteriormente se realizó conización cervical debido a que la paciente rechazó la histerectomía. CONCLUSIÓN: El AM cervical es una neoplasia poco frecuente que tiene una tasa de recidiva que puede llegar hasta al 50% de los casos, por lo que es necesario un seguimiento estrecho. La escisión local puede ser considerada en pacientes sin factores de mal pronóstico y que deseen conservar su fertilidad.
Subject(s)
Adenosarcoma/therapy , Uterine Neoplasms/therapy , Adult , Conservative Treatment , Female , HumansABSTRACT
PURPOSE: Epidemiologic studies have suggested that higher levels of circulating vitamin D may reduce breast cancer risk, but no studies have investigated this association among women in developing countries, and very few studies have further investigated this association according to menopausal status. METHODS: A population-based case-control study in Mexico with 1,000 incident breast cancer cases aged 35-69 years, enrolled shortly after diagnosis (0-6 days) and frequency-matched to 1,074 controls on age, region, and health care system, was used to assess the association between serum 25-hydroxyvitamin D [25(OH)D] levels with overall, pre- and postmenopausal breast cancer risk. 25(OH)D concentration was measured on a random sub-sample of women (573 cases and 639 matched controls) using a liquid chromatography/tandem mass spectrometry method. Odds ratios (ORs) and 95 % confidence intervals (CIs) were estimated from multivariable conditional logistic regression models. RESULTS: Serum 25(OH)D concentration (per 10 ng/mL increase) showed a strong inverse association with risk of breast cancer among all (p(trend) = 0.001), pre- (p(trend) = 0.006) and postmenopausal women (p(trend) = 0.0001). Compared with a predefined lower concentration of 25(OH)D (<20 ng/mL), higher levels (>30 ng/mL) were associated with lower overall (OR = 0.53, 95 % CI: 0.28-1.00; p(trend) = 0.002), pre- (OR = 0.60, 95 % CI: 0.16-2.17; p(trend) = 0.07) and postmenopausal (OR = 0.37, 95 % CI: 0.16-0.82; p(trend) = 0.004) breast cancer risk. CONCLUSIONS: The results of this large population-based case-control study indicate an inverse association between circulating vitamin D levels and breast cancer risk among pre- and postmenopausal Mexican women.
