Tumores infrecuentes en pediatría: tumor de ovario: caso clínico / Infrequent tumors in pediatrics: ovarian tumor presentation of a case and bibliographic review

Introducción: Los tumores malignos de ovario son raros en la edad pediátrica, con una incidencia de 1-2 por cada 1 000 000 habitantes, caracterizados por dolor abdominal y efecto de masa, cuya edad de diagnóstica varia teniendo dos picos de incidencia entre 8 a 9 años de vida y entre los 13 a 17 años. Objetivo: Identificar los puntos critico que influyeron en el diagnóstico y tratamiento de niña con tumor de ovario. Descripción del caso: Referimos el caso de una adolescente de 14 años que ingresa al servicio de pediatría, por presentar dolor abdominal, distención abdominal y vómito. Al ser evaluada se encuentra una gran distención abdominal con una masa dura que abarca especialmente hemi-abdomen derecho. La TAC y ECO revelan masa quística dependiente de ovario derecho que desplaza asas intestinales, además la presencia de derrame pleural bilateral que lleva al diagnóstico de metástasis pulmonar. No se realiza examen histopatológico debido a que la paciente acude a recibir atención médica especializada en estadios avanzados de la enfermedad al proceder de área rural. Conclusiones: Se describe un caso de niña a la que se le realiza diagnóstico de tumor de ovario avanzado y metástasis pulmonar, que no se realiza examen histopatológico por provenir de área rural, recibir tratamientos naturales por periodo prolongado lo que impidieron realizar diagnóstico y tratamiento oportuno

Introduction: Malignant ovarian tumors are rare in the pediatric age, with an incidence of 1-2 per 1 000 000 persons. Introduction: Malignant ovarian tumors are rare in the pediatric age, with an incidence of 1-2 per 1 000 000 inhabitants, characterized by abdominal pain and mass effect, whose diagnostic age varies with two peaks of incidence between 8 to 9 years of life and between 13 to 17 years. Objetive: To identify the critical points that influenced the diagnosis and treatment of a girl with an ovarian tumor. Case description: We report the case of a 14-year-old girl who enters the pediatric service, due to abdominal pain, abdominal distention and vomiting. When evaluated, a large abdominal distension is found with a hard mass that especially includes the right hemi-abdomen. CT and ECO reveal cystic mass dependent on the right ovary that displaces intestinal loops, in addition to the presence of bilateral pleural effusion that leads to the diagnosis of pulmonary metastasis. Histopathological examination is not performed because the patient goes to receive specialized medical attention in advanced stages of the disease when coming from rural area. Conclusions: We describe a case of a girl who is diagnosed with advanced ovarian tumor and pulmonary metastasis, who did not undergo histopathological examination due to being from rural areas, receiving natural treatments for a prolonged period, which prevented diagnosis and timely treatment

[Neddle-guided biopsy in the diagnosis of non-palpable breast cancer]. / Biopsia guiada con arpón en el diagnóstico de cáncer de mama no palpable.

OBJECTIVE: To estimate the diagnostic accuracy of the spearfishing or neddle-guided biopsy to breast cancer and no palpable mammography and ultrasound findings suspicious for malignancy. MATERIAL AND METHODS: Observational, transversal, prolective, and descriptive study was made. A histopathological diagnosis were conducted from August 2004 to December 2011 in the Radiology and Image Departmen of Centro Médico La Raza to patients sent by the service of Surgical Oncology-with non-palpable breast findings identified by mammography and/or ultrasound with any suspicion of malignancy. Radiographic and ultrasonographic images of the specimen were obtained after the surgical procedure. RESULTS: Harpoon 532 placements with histopathological report. Malignancies were 4.0% of the biopsies were performed in negative mammograms (ACR BI-RADS® 3) and 34.3% (p ≤ 0.05) of which were performed in positive mammography: 19.5% of mammograms ACR BI-4 and RADS® 89.7% (p < 0.0001) of mammograms ACR BI-RADS® 5. The negative mammography (ACR BI-RADS® 3) which resulted in cancer occurred in a patient with a personal history of breast cancer who had a solid nodule in one breast. In the evaluation of mammography studies and placing seven harpoons participated certified radiologists and additional qualification in breast imaging, and five radiology technicians trained in mammography. CONCLUSIONS: The positive cases in the evaluation of mammography studies and placing seven harpoons participated certified radiologists and additional qualification in breast imaging, and five radiology technicians trained in mammography. (sum of the ACR BI-RADS® cases 4 and ACR BI-RADS® 5) and individual cases ACR BI-RADS® 4 had a PPV within recommended ranges ACR BI-RADS®; PPV ACR BI-RADS® may was lower than recommended by the literature, although most recommended by other series, which forces us to emphasize adherence to the semiotics suggested by ACR BI-RADS® and avoid unnecessary surgery. Patients with a personal history of breast cancer and finding a new ACR BI-RADS® 3 should have an individual assessment and consider biopsy before the short-term monitoring.