Virilizing Brenner tumor of the ovary: case report.

A case of ovarian Brenner tumor displaying androgenic activity and clinical masculinization is reported in a 65-year-old woman. Plasma androstenedione, dehydroepiandrosterone sulfate (DHEAS), testosterone, dihydrotestosterone, cortisol, estradiol, FSH, LH, and prolactin were measured before and after suppression with dexamethasone and stimulation with hCG, and again after removal of the tumor. The plasma androgenic compounds were measured in both ovarian and peripheral veins. Basal levels of androstenedione and of total testosterone were significantly elevated, decreasing to normal ranges after operation and remaining after 3 months. There was a sharp increase of total testosterone, DHEAS, and dihydrotestosterone levels after administration of hCG. The levels of androstenedione, DHEAS, testosterone, and dihydrotestosterone were higher in the ovarian vein than in the peripheral vein. These findings indicate that the tumor was the main source of these androgenic hormones.

[Congenital adrenal hyperplasia and pregnancy]. / Hiperplasia adrenal congênita e gravidez.

About 90% of CAH cases are due to 21-hydroxylase (21-OH) deficiency. There are decreased cortisol and increased ACTH secretions; and elevated cortisol precursors and androgens. CAH is an important factor of menstrual disorders and infertility. Pregnancy is very much uncommon in the classic form, and 90% of reported cases belong to the postnatal form. The authors present two patients with classic form of CAH (21-OH deficiency) who became pregnant. They had been treated in early childhood (2-4 years old) with glucocorticoids and had surgical correction of the ambiguous external genitalia. During pregnancy, daily prednisone dose was raised to 5 mg twice, serum levels of 17-hydroxyprogesterone (17-OHP) and androgens were monthly measured. The 17-OHP levels remained high (about 1.6 ng/dl), and androgens (testosterone, androstenedione, SDHEA) levels remained normal. Cesarean section was performed in both cases; newborns were normal and 17-OHP was within normal limits. Adequate early replacement therapy has improved fertility and pregnancy.

[Intrauterine adhesion: analysis of 28 cases]. / Sinequia intra-uterina: analise de 28 casos.

PIP: Intrauterine adhesions are frequent in women with puerperal or post-abortion curettages. In rare cases there are adhesions due to inflammatory processes, particularly due to endometrial tuberculosis. The adhesions occur in patients in the menacme, without any endocrinological complaints. The disease affects women of different ethnic backgrounds; however this study is comprised of white females. A histopathological exam of the endometrial material revealed different histological varieties of the uterine wall including fibrous leukocytic exudate. In 89 cases studied, an increase was noted in the vascularity of fragments of the miometrium and fibrosis as well as changes of the miometrium in accordance with the cycle. These findings indicate that there are no endocrinological changes in women with intrauterine adhesions. Regarding treatment carried out by means of curettages, IUD insertion and estrogen treatment, good results were obtained in the normalization of the menstrual cycle in more than 60.8% cases. However, only 3 women were able to get pregnant, 2 had spontaneous abortions, and only 1 achieved a full term gestation.^ieng

Tumor do seio endodermico do ovario. / Endodermal sinus tumor of the ovary

Os autores estudam um caso de tumor no seio endodermico; neoplasia rara, de linhagem germinativa em paciente de 14 anos de idade, com queixa clinica de crescimento progressivo de abdome. Os exames clinico e ginecologico revelaram abdome abaulado, tenso, com sinais de ascite e presenca de um tumor palpavel no hipogastrico. O achado operatorio mostrou o ovario esquerdo transformado em tumor de aproximadamente 12 cm de diametro, sem sinais de propagacao (estadio lai). O exame histopatologico revelou tumor do seio endodermico. A vista da idade da paciente e do estadiamento do tumor, optou-se, apesar de sua indubitavel malignidade, pela cirurgia conservadoura: anexectomia unilateral com biopsia do ovario contralateral e do omento, complementado pela poliquimioterapia.A citologia do liquido peritoneal e a biopsia do ovario oposto e do omento foram negativas. Decorridos quase tres anos da cirurgia, a paciente acha-se viva, aparentemente sem sinais clinicos de recidiva nem de metastases

Tumor mesodermico misto, heterologo do corpo do utero. / Mixed mesodermic heterologous tumor of the uterine corpus

Os autores analisam um exemplo de tumor mesodermico misto, heterologo do corpo do utero, em paciente de 69 anos de idade. Apresentava, entre as manifestacoes clinicas, hemorragia genital com duracao de um ano e crescimento do abdome ha dois meses. Os exames clinico e ginecologico revelaram abdome abaulado, tenso com sinais de ascite e presenca de uma volumosa massa tumoral, ocupando todo abdome. A citologia oncotica cervico-vaginal e endometrial eram positivas e compativeis com neoplasia do corpo do utero. Foi submetida, inicialmente, a curetagem uterina fracionada, que revelou tratar-se de tumor mesedermico misto, heterologo, maligno, do corpo do utero A ulterior laparotomia mostrou carcinomatose difusa, generalizada, sendo realizada apenas biopsia das massas tumorais. Por esse fato, constituiu a terapeutica na quimioterapia intraperitoneal e sistemica e na hormonioterapia (progestogenioterapia). A evolucao foi insatisfatoria, tendo o obito ocorrido cinco meses apos a cirurgia

Lesoes precursoras do cancer do colo uterino. / Precancerous lesions of the uterine cervix

Os autores descrevem o aspecto histologico do colo do utero e enfatizam a importancia da juncao escamocolunar (JEC) na genese da terceira mucosa ou zona de transformacao tipica.Definem a zona de transformacao atipica, sede inicial das lesoes precursoras; salientam a sua progressao ao cancer invasor, embora, as vezes, sejam passiveis de regressao sem tratamento. Sobrelevam no diagnostico o emprego da colposcopia, da citologia oncotica e da biopsia dirigida. Por fim, analisam a conduta terapeutica seguida no Posto de Prevencao do Cancer Ginecologico da Escola Paulista de Medicina