Placental pathology and perinatal risk during the COVID-19 pandemic.

BACKGROUND: Respiratory and immune changes during pregnancy can lead to viral infections. In coronavirus disease 2019 (COVID-19), clinical characteristics and perinatal risks are difficult to assess and are relatively unknown. OBJECTIVE: To review placental pathology in asymptomatic women with COVID-19, and to evaluate effects on perinatal outcomes. MATERIAL AND METHOD: Retrospective, observational, cross-sectional study that included 29 pregnant women in 2020. The women underwent COVID-19 tests and were divided in two groups: 1) control, COVID-19-negative patients, and 2) asymptomatic COVID-19-positive patients; the placentas were studied at the pathology department, and clinical data were retrieved from the electronic medical record; in addition, a literature review was carried out. RESULTS: When the groups were compared, no differences were observed in general data and clinical characteristics. On the day of delivery, patients 2, 4, 5, 6, 8 and 9 of the COVID-19 group were between day 0 and 10.5 after having tested positive; only patients 1, 3 and 7 had overcome the infection. There was a decrease in weeks of gestation in the COVID-19 group (37.8 ± 1.8 vs. 39 ± 0.8; p ≤ 0.05). COVID-19-positive patients' placental histopathology showed a higher prevalence of thrombotic alterations in placental villi (55.5 vs. 0%). CONCLUSIONS: COVID-19 asymptomatic infection potentiates preexisting prothrombotic profile, thus increasing the risk of placental thrombosis and, potentially, of thrombosis in pregnant women.

ANTECEDENTES: Los cambios respiratorios e inmunitarios en el embarazo pueden conducir a infecciones virales. En la enfermedad por coronavirus 2019 (COVID-19) las características clínicas y riesgos perinatales son difíciles de evaluar y son relativamente desconocidos. OBJETIVO: Revisar patología placentaria en mujeres asintomáticas con COVID-19 y evaluar efectos en datos perinatales. MATERIAL Y MÉTODO: Estudio retrospectivo, observacional y transversal, incluye 29 mujeres embarazadas en 2020. Se realizaron prueba COVID-19 y dividieron en dos grupos: 1) control, pacientes COVID-19 negativas y 2) COVID-19 asintomáticas con COVID-19 positivo; las placentas se estudiaron en patología y los datos clínicos se tomaron del expediente electrónico; asimismo, se realizó revisión de literatura. RESULTADOS: Al comparar grupos no se observó diferencia en datos generales y características clínicas. El día del parto, las pacientes 2, 4, 5, 6, 8 y 9 del grupo COVID-19 se encontraban entre día 0 y 10.5 después de positividad; únicamente las pacientes 1, 3 y 7 habían superado la infección. Se presentó disminución de semanas de gestación en el grupo COVID-19 (37.8 ± 1.8 vs. 39 ± 0.8; p ≤ 0.05). La histopatología placentaria en COVID-19 mostró mayor prevalencia de alteraciones trombóticas en vellosidades placentarias (55.5 vs. 0%). CONCLUSIONES: La infección asintomática por COVID-19, potencializa perfil protrombótico preexistente, incrementando riesgo de trombosis placentaria y trombosis en mujeres embarazadas.

The International Society for the Study of Vulvovaginal Disease Surgical Oncological Procedure Definitions Committee "Surgical Terminology for Vulvar Cancer Treatment".

OBJECTIVES: The International Society for the Study of Vulvovaginal Disease (ISSVD) Surgical Oncological Procedure Definitions Committee propose a consistent terminology based on well-defined and reproducible anatomic landmarks that can be used by all who are involved in care of patients with vulvar conditions. MATERIALS AND METHODS: The fundamental principles behind the new terminology contained descriptions of the area extension and depth of the surgical procedure. RESULTS: Vulvar Surgical Topographic Anatomy LandmarksExtension. The internal border of the vulva is the hymenal ring. The genitocrural folds are the external lateral borders.The vertical line through the clitoris and the anus defines lateral portions of the vulva.The horizontal line from the upper border of the hymenal ring defines anterior and posterior portion of the vulva.Depth. The floor of the vulva is represented by the median perineal fascia or perineal membrane of the urogenital diaphragm.A. Vulvectomy1. Extension: partial/total vulvectomy. Removal of part/entire vulvar/perineal integument independent of the depth.2. Depth: superficial/deep. Removal of the most superficial layer/removal of the vulvar tissue to the superficial aponeurosis of the urogenital diaphragm and/or pubic periosteum.B. Inguinofemoral lymphadenectomy1. Superficial inguinofemoral lymphadenectomy. Removal of the nodes located beside the inguinal ligament and along the great saphenous vein.2. Deep femoral lymphadenectomy. Removal of the nodes below the cribriform lamina and medial to the femoral vein. CONCLUSIONS: This terminology helps avoid confusion and promote better understanding and exchange of experiences among gynecologic oncologists involved in vulvar carcinoma care.

Análogos de la hormona hipotalámica liberadora de gonadotropinas (GnRH) y cáncer mamario / Analogues of hypothalamic, gonadotropins releasing hormone (GnRH) and breast cancer

La hormonas esteroides, hormonas peptídicas, factores de crecimiento y otros factores tróficos, están involucrados en la regulación del crecimiento tumoral. La terapia hormonal del cáncer mamario consiste en una variedad de medidas médicas y quirúrgicas como la ooforectomía e hipofisectomía. El tratamiento de tumores hormonodependientes como el cáncer mamario, generalmente emplean antiestrógenos, pero con el advenimiento de análogos de la hormona liberadora de gonadotropinas (a-GnRH); estos neuropéptidos podrían jugar un importante papel en el tratamiento del cáncer mamario, por sus escasos efectos colaterales