Descripción de un caso de un leiomioma quístico gigante que simula una tumoración ovárica / A case report of giant cystic leiomyoma mimicking an ovarian tumour

Paciente de 73 años remitida por hallazgo casual de una gran masa abdominal. En la ecografía abdominal se observó una tumoración mixta de predominio quístico que ocupaba todo el abdomen, desde la pelvis hasta el apéndice xifoides. La TC abdómino-pélvico informó de una masa quística que ocupaba todo el abdomen en relación con cistoadenoma/cistoadenocarcinoma mucinoso ovárico, por lo que se indicó tratamiento quirúrgico y el diagnóstico definitivo fue un leiomioma dependiente del útero con degeneración hidrópica. Los miomas uterinos son tumoraciones frecuentes en la mujer, sin embargo si presentan cambios degenerativos, puede ser difícil su diagnóstico inicial, al simular patología anexial (AU)

A 73-year-old woman was referred to our service due to incidental discovery of a large abdominal mass. Abdominal ultrasound showed a mixed tumour, predominantly cystic, occupying the whole abdomen from the pelvis to the xyphoid process. Abdominal and pelvic computed tomography revealed a cystic mass that filled the abdomen. The preoperative diagnosis was ovarian mucinous cystadenoma/cystadenocarcinoma. Surgical treatment was indicated. The definitive diagnosis was leiomyoma with cystic degeneration. Leiomyomas are common tumours in women but if they have degenerative changes they may cause confusion in the initial diagnosis, as they can simulate a cystic adnexal mass (AU)

Dolor abdominal agudo como presentación de un linfoma ovárico / Acute abdominal pain as presentation of an ovarian lymphoma

Antecedentes: El linfoma no Hodgkin de ovario es una patología infrecuente, más aun el ovárico primario. Caso Clínico: Presentamos el caso de una paciente con antecedente de diverticulitis aguda y varios episodios posteriores de dolor abdominal agudo, fiebre y aumento de reactantes de fase aguda con pruebas de imagen no concluyentes. A pesar de la buena respuesta inicial al tratamiento antibiótico, durante uno de los episodios la paciente precisa intervención quirúrgica urgente. Durante la intervención se halla una enfermedad tumoral avanzada con diagnóstico histológico de linfoma difuso de células grandes B. Conclusión: En el diagnóstico diferencial ante una sintomatología similar a la de nuestra paciente, se debería tener presente la posibilidad de un linfoma ovárico, a pesar de su baja incidencia.

Background: Non-Hodgkin's lymphoma of the ovary is an infrequent pathology, even more primary one. Clinical case: We report a patient with a history of acute diverticulitis and several episodes of acute abdominal pain, fever and increased acute phase reactants with inconclusive imaging tests. Patient required urgent surgery during one episode despite a good initial response to antibiotic therapy. A locally advanced tumour disease was found in surgical intervention which was diagnosed as a diffuse large B-cell lymphoma. Conclusion: In the differential diagnosis in a manner similar to that of our patient symptoms, we should keep in mind the possibility of an ovarian lymphoma despite their low incidence.

[Spontaneous uterine venous rupture during pregnancy. Description of two cases and bibliographical review]. / Rotura espontánea de variz uterina durante la gestación. Descripción de dos casos y revisión bibliográfica.

Spontaneous uterine venous rupture is a very rare condition (1/10,000 pregnancies). The etiology is still unknown, and it is associated with an increased of venous pressure. The rupture especially occurs on third trimester. The most frequent site of the rupture is the broad ligament. Maternal mortality has decreased to 4% but the perinatal mortality rate is still as high as 31%. The presenting symptoms are commonly unspecific. Clinical presentations are usually hypovolemic shock signs with severe abdominal pain and reduction in hemoglobin levels. In view of these findings an exploratory laparotomy is usually necessary as well as the adequate blood and fluid replacement. Two cases of twin pregnancies on the third trimester with spontaneous uterine venous rupture are reported. Both cases have different evolution. In the first case the evolution was favorable. It wasn't necessary the vein suture because of the bleeding ended by compression. In the second case the diagnostic took place after the fetal death and it was required the vein suture. This rare condition has to be taken into account to de the differential diagnosis in a pregnant woman with severe abdominal pain.