Impact of perioperative characteristics on the recurrence risk and survival of patients with uterine leiomyosarcoma.

OBJECTIVES: To analyze the impact of perioperative characteristics on the risk of recurrence in patients with uterine leiomyosarcomas. METHODS: A sub-analysis of the SARComa of the UTerus (SARCUT) study, which is a multicentric cross-sectional pan-European study that included 390 patients diagnosed with leiomyosarcoma, between 2001 and 2007. Perioperative factors related to risk of recurrence and survival were analyzed. RESULTS: The 5-year and 10-year disease-free survivals (DFS) were 46% and 55%, respectively. Overall survival at 5 and 10 years was 34% and 47%, respectively. The most important factors related to global recurrence were the incomplete cytoreduction (hazard ratio [HR] 2.87; 95% confidence interval [CI] 1.91-4.31); performing bilateral adnexectomy (HR 2.71; 95% CI 1.23-5.93); tumor persistence after any treatment (HR 2.38; 95% CI 1.39-4.06); and adjuvant chemotherapy administration (HR 2.55; 95% CI 1.82-3.58) or adjuvant radiotherapy (HR 2.26; 95% CI 1.53-3.32). The major factors significantly associated with pelvic relapse were tumor persistence after any treatment (HR 3.63; 95% CI 1.83-7.20) and adjuvant radiotherapy (HR 2.74; 95% CI 1.44-5.20). Incomplete cytoreduction was the most important factor associated with distant relapse (HR 1.91; 95% CI 1.22-2.97). The most important factors related to overall survival were tumor persistence after any treatment (HR 4.59; 95% CI 2.51-8.40), incomplete cytoreduction (HR 3.68; 95% CI 2.44-5.56), tumor margin involvement (HR 2.41; 95% CI 1.64-3.55) and adjuvant chemotherapy (HR 1.91; 95% CI 1.31-2.78). CONCLUSIONS: Complete cytoreduction is the main prognosis factor impacting the DFS and overall survival of patients with uterine leiomyosarcoma. Adjuvant chemotherapy administration was associated with decreased rates of DFS and overall survival. The adjuvant radiotherapy was associated with a higher risk of global recurrence.

Mastectomía e injerto cutáneo autólogo por fascitis necrotizante torácica / Mastectomy and skin graft as treatment for thoracic necrotizing fasciitis

Se presenta el caso de una paciente fumadora con hipertensión arterial, diabetes mellitus tipo II en tratamiento con insulina, con control glucémico inadecuado, HS y dislipidemia que ingresó por infección en la mama y la pared torácica izquierda con progresión a fascitis necrotizante. Se intentó inicialmente una actitud quirúrgica conservadora, pero dado el mal control de sus enfermedades de base y la infección rápidamente progresiva, requirió desbridamiento más agresivo con mastectomía y exéresis de músculo afecto. Posteriormente, se realizó un injerto cutáneo mallado en la zona de mastectomía izquierda con zona donante de muslo izquierdo. A pesar de la gravedad del caso, con el tratamiento quirúrgico extenso, antibióticos de amplio espectro y curas diarias, la paciente superó el cuadro séptico y se limitó de ese modo la progresión de la infección. En controles posteriores, la paciente presentó buena evolución clínica. (AU)

Hidradenitis suppurativa is an inflammatory skin disease that affects the folliculopilosebaceous unit. Necrotizing fasciitis of the thoracic wall is a rare entity that affects subcutaneous tissue and deep fascia. It represents a diagnostic and therapeutic emergency requiring broad spectrum antibiotics and extense surgical debridement, with high mortality rates. Other reported cases do not describe fascitis as an infection complicating hidradenitis, as the case of our patient. We present a case of a patient with a history of hidradenitis suppurativa, smoking, hypertension, diabetes mellitus with poor glycemic control, and dyslipidemia, admitted to our hospital with left breast and thoracic wall infection, with progression to necrotizing fascitis. Initially a preservative surgery was attempted but given the patient's comorbidities and the rapidly progressive infection, a mastectomy was required. In second time surgery, an autologous skin graft was performed. Despite the severity of the case, the patient overcame the infection after extensive surgical debridement, broad spectrum antibiotics and daily cures. In follow-up controls the patient presented good clinical condition. (AU)

Metástasis cutáneas como primer signo clínico de adenocarcinoma de ovario / Cutaneous metastasis as the first clinical sign of ovarian adenocarcinoma

Introducción. Las metástasis cutáneas de origen ovárico son raras y representan un signo de mal pronóstico. Pueden adoptar diferentes formas clínicas de presentación que obligan al diagnóstico diferencial con gran variedad de dermatosis. Caso clínico. Se presenta el caso de una paciente de 86 años que consulta por aparición de lesiones cutáneas nodulares en el abdomen inferior y la parte proximal de ambas piernas como signo inicial de una neoplasia no conocida previamente. El estudio histológico revela metástasis de adenocarcinoma de ovario. Conclusiones. Las metástasis cutáneas de origen ovárico como tumor primario constituyen una afección infrecuente y con mal pronóstico. Normalmente, aparecen a lo largo de la enfermedad, pero pueden ser el primer signo clínico de una neoplasia silente. Su manejo sigue siendo un reto clínico; por lo que son necesarios más estudios que evalúen el papel de terapias específicas para estandarizar el tratamiento (AU)

Introduction. Cutaneous metastases are rare and represent a poor prognostic sign. Clinical forms of presentation differ, requiring differential diagnosis with a variety of dermatoses. Case report. We report the case of an 86-year-old woman who presented with nodular skin lesions on the lower abdomen and proximal part of both legs as the initial sign of a previously unknown neoplasia. Histological examination revealed metastatic ovarian adenocarcinoma. Conclusions. Cutaneous metastases from a primary ovarian tumor are rare and have a poor prognosis. They typically develop during the disease, but can be the first clinical sign of a silent neoplasia. Their management remains a clinical challenge; consequently, more studies evaluating the role of specific therapies are needed to standardize treatment (AU)

Opciones terapéuticas en el embarazo intersticial / Therapeutic options in interstitial pregnancy

El embarazo cornual es un hecho muy poco frecuente, con una incidencia entre un 2-4% de las gestaciones ectópicas. Al igual que el embarazo tubárico, las opciones terapéuticas incluyen la cirugía, la terapia médica o la combinación de ambas. Actualmente, existen otras opciones terapéuticas también eficaces. Presentamos un caso de gestación cornual tratado a través de resección histeroscópica con posterior revisión laparoscópica como opción terapéutica eficaz (AU)

Cornual pregnancy is very rare, with an incidence of 2-4% of ectopic pregnancies. As with tubal pregnancy, treatment options include surgery, medical therapy or a combination of both. Currently, there are also other treatment options that are effective. We report a case of cornual pregnancy treated with hysteroscopic resection followed by laparoscopic review, which can be an effective treatment option (AU)

Fibroma ovárico torsionado / Torsion of ovarian fibroma

Se presenta un caso de una paciente de 80 años con una tumoración abdominal orientada erróneamente como neoplasia de ovario. La paciente acudió a nuestro servicio médico por presentar dolor en la fosa ilíaca derecha y pérdida de 5 kg de peso en 1 mes. En las exploraciones efectuadas se detectó una tumoración de 17 x 10 cm de diámetro y una pequeña cantidad de ascitis. Se intentó realizar una paracentesis sin obtener resultados positivos. Analíticamente, destacamos Ca125: 484 U/ml. Se decide realizar un intervención quirúrgica, tras la cual se detectó un fibroma de ovario torsionado, sin criterios de malignidad e implantes de fibrina en Douglas

We present the case of an 80-year-old patient with a large abdominal tumor erroneously interpreted as ovarian cancer. The patient presented with pain in the right iliac fossa and weight loss of 5 kg in the previous month. Investigations revealed a 17 x 10 cm tumor and a small quantity of ascites. An attempt at paracentesis was unsuccessful. A notable laboratory finding was Ca125: 484 U/ml. Surgical intervention was performed, revealing a twisted ovarian fibroma, without criteria for malignancy, and fibrin implants in Douglas's pouch