Cáncer sincrónico de carcinosarcoma uterino y carcinoma seroso tubárico. A propósito de un caso y revisión de la bibliografía / A synchronous diagnosis of uterine carcinosarcoma and serous tubal carcinoma. A case report and literature review

Exponemos el caso de una paciente de 74 años que consultó por sangrado posmenopáusico y finalmente se diagnosticó de carcinosarcoma uterino y carcinoma seroso tubárico, sincrónico.En la exploración se objetivó una formación polipoidea a través del cérvix y se visualizó en la ecografía transvaginal una imagen heterogénea intracavitaria.El resultado del estudio histológico de ambos hallazgos fue de carcinosarcoma.Tanto la resonancia magnética como la tomografía axial computarizada describieron una lesión en cuerpo uterino indicativa de mioma sin descartar degeneración sarcomatosa, además de una lesión cervical con características similares.Ante la sospecha de un carcinoma de endometrio tipo ii, se realizó, por vía laparoscópica, una histerectomía, una doble anexectomía, una omentectomía y una linfadenectomía pélvica y paraaórtica. Con el siguiente resultado anatomopatológico: carcinosarcoma uterino de 5cm con infiltración miometrial <50% y afectación del estroma cervical, con márgenes libres. Ambos anejos y tejido peritoneal presentaban infiltración por carcinoma seroso de alto grado de origen tubárico. Las linfadenectomías pélvica y paraaórtica sin evidencia de malignidad.Se concluye un estadificación de carcinosarcoma uterino estadio ii y carcinoma seroso tubárico estadio iiiB sincrónico.Se trata de una rara entidad; tenemos conocimiento de un único caso clínico similar documentado, siendo nuestro propósito presentar el manejo y tratamiento realizado.

We report a rare case of uterine carcinosarcoma involving a 74-year-old woman. The patient complained of posmenopausal bleeding. The disease was eventually diagnosed as simultaneous uterine carcinosarcoma and high-grade serous tubal carcinoma.Clinical examination found a cervical tumour and transvaginal ultrasound showed a heterogeneous intrauterine image. The histological result of both findings was carcinosarcoma.The computed tomography scan and magnetic resonance imaging reported similar findings for intrauterine and cervical tumour, with the same features as a possible myoma or mass with sarcomatous degeneration.Given the suspicion of a high-risk variant of endometrial adenocarcinoma, the primary management of carcinosarcoma is surgery. Complete surgical staging included total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, pelvic and para-aortic lymph node dissection.The pathological findings revealed a uterine carcinosarcoma tumour, invading less than half the myometrium and the stromal connective tissue of the cervix but not extending beyond the uterus. The histopathological studies of bilateral adnexectomy and the peritoneal biopsy demonstrated the presence of high-grade serous tubal carcinoma. The lymph study was negative for malignancy.We concluded a synchronous diagnosis of uterine carcinosarcoma stage II and high-grade serous tubal carcinoma stage IIIB.A detailed literature search and management of this entity are discussed.

Aspiration cytology of 147 adnexal cysts with histologic correlation.

OBJECTIVE: To assess the usefulness of cytology in the diagnosis of 147 histologically established adnexal cysts. STUDY DESIGN: Retrospective, macro-microscopic study based on fluid aspirated from 132 ovarian and 15 extraovarian cysts and projected as a cytohistologic correlation. RESULTS: Typical macroscopic features were identified in 76% of endometriotic cysts, in 53% of mucinous neoplasms and in 67% of dermoid cysts. Cytology helped to identify 67% of nonneoplastic and 56% of neoplastic cysts. The lowest diagnostic sensitivities were observed in functional cysts and benign serous neoplasms (50%), while the highest were shown by endometriotic cysts (76%) and malignant epithelial neoplasms (71%). Inadequate samples were obtained from all types of cysts, even malignant ones (two mucinous cystadenocarcinomas). Diagnostic cytology was useless in extraovarian cysts (33% sensitivity). An adult granulosa cell tumor was erroneously diagnosed as a follicular cyst by cytologic examination. CONCLUSION: Examination of the cyst fluids obtained by aspiration demonstrated low sensitivity, with 43% of inadequate samples obtained from all types of cysts. Malignant cystic neoplasms may be overlooked in inadequate samples. Our study also revealed that specificity in this type of analysis is high in inadequate samples, provided that the technique is carried out correctly.

Intrauterine growth retardation at term: association between anthropometric and endocrine parameters.

OBJECTIVE: To investigate the endocrine profile of the intrauterine growth retardation newborns and its association with anthropometric parameters at birth. STUDY DESIGN: This is a case-control study of 76 full term gestations, of which 31 were diagnosed as intrauterine growth retardation (IUGR) confirmed at birth, and 45 as normal births. Insulin, insulin-like growth factor I (IGF-I), growth hormone (GH), thyroid stimulating hormone (TSH), hydrocortisone, prolactin and 15 metabolic parameters were measured in maternal blood antepartum, amniotic fluid and umbilical cord blood at birth. RESULTS: Blood taken from the umbilical cord in the IUGR group had statistically significant lower levels of IGF-I, insulin and TSH, but higher levels of GH. In amniotic fluid and maternal blood, IUGR babies had lower levels of cortisol. The changes in GH and glucose levels in cord blood of IUGR babies were independently associated to birth weight variability (Adjusted regression coefficient-squared=0.09 and 0.17 respectively). Ponderal index (weight/length3) among IUGR babies was independently associated with metabolic changes in amniotic fluid (Adjusted regression coefficient-squared=0.35). CONCLUSIONS: The endocrine profile of IUGR fetus would be: hypoinsulinemic, hypothyrotropinemic, hypoglycemic, hypoalbuminemic, hypocholesterolemic and hypermagnesemic with lower IGF-I levels, yet higher than normal group GH levels at birth. Triglycerides in amniotic fluid; GH, Glucose and Mg changes in cord blood of IUGR babies were independently associated with birth weight variability.

Fine needle aspiration cytology of primary epithelioid sarcoma of the vulva. A case report.

The cytopathologic features of the fine needle aspiration cytology of the local recurrence of a vulvar epithelioid sarcoma were documented. The cytologic findings included round polygonal cells with abundant eosinophilic cytoplasm and an eccentrically located nucleus. Despite their epithelioid aspect, the cells in the smears had a sarcomatous arrangement, consisting of isolated cells and loosely cohesive groups. The cytologic findings correlated well with the histologic features of the tumor, which consisted of nodules of eosinophilic epithelioid cells. We discuss the clinical characteristics and prognostic factors in this unusual, vulvar location of this soft tissue sarcoma.