Definir el valor de Ca 125 para predecir citorreducción óptima en pacientes con cáncer epitelial de ovario / Defining the Ca 125 value to predict optimal cytoreduction in patients with epithelial ovarian cancer

RESUMEN Definir el valor de Ca 125 para predecir citorreducción óptima en pacientes con cáncer epitelial de ovario. Estudio observacional, analítico y retrospectivo de 52 pacientes consecutivas intervenidas de cáncer de ovario epitelial en estadio clínico III y IV y que no recibieron quimioterapia preoperatoria, entre enero de 2014 y diciembre del 2018 en el Servicio de Ginecología del Hospital Carlos Alberto Seguín Escobedo, Arequipa, Perú. Se determinó sensibilidad, especificidad, valor predictivo positivo y negativo, y el área bajo la curva ROC del punto de corte de Ca 125 más adecuado para citorreducción óptima. Las pacientes tuvieron en promedio 58 años de edad, el subtipo histológico seroso fue el más frecuente con 73,1%, el estadio clínico IIIC correspondió a 65,4% de casos y se logró citorreducción óptima en 61,5% de las pacientes. La curva ROC alcanzó 78% con Ca 125 de 716,7 U/mL como el mejor punto de corte de predicción de citorreducción óptima, con sensibilidad de 75%, especificidad 75%, valor predictivo positivo 82,8% y valor predictivo negativo 65,2%. El marcador tumoral Ca 125 resultó útil en la predicción de citorreducción óptima en pacientes intervenidas de cáncer de ovario epitelial, siendo el mejor punto de corte 716,7 U/mL.

ABSTRACT To define the Ca 125 value to predict optimal cytoreduction in patients with epithelial ovarian cancer. Observational, analytical and retrospective study of 52 consecutive patients who had surgical intervention for clinical stage III and IV epithelial ovarian cancer and who did not receive preoperative chemotherapy. These patients were attended between January 2014 and December 2018 in the Gynecology Service of the Carlos Alberto Seguín Escobedo Hospital, Arequipa, Peru. Sensitivity, specificity, positive and negative predictive value, and the area under the ROC curve of the most appropriate Ca 125 cutoff point for optimal cytoreduction were determined. The patients were on average 58 years old, the serous histologic subtype was the most frequent with 73.1%; clinical stage IIIC corresponded to 65.4% of cases and optimal cytoreduction was achieved in 61.5% of patients. The ROC curve reached 78% with Ca 125 of 716.7 U/mL as the best cut-off point for predicting optimal cytoreduction, with sensitivity of 75%, specificity 75%, positive predictive value 82.8% and negative predictive value 65.2%. The tumor marker Ca 125 was useful in the prediction of optimal cytoreduction in patients who underwent surgery for epithelial ovarian cancer, with the best cut-off point being 716.7 U/mL.

[Proinflammatory cytokines in polycystic ovarian syndrome]. / Citocinas proinflamatorias en el síndrome de ovario poliquístico.

During folliculogenesis, different proinflammatory cytokines have a physiological role in the weakening of the follicle wall and an eventual rupture at ovulation. Chronic inflammation is closely related to endothelial dysfunction, cardiovascular disease, coronary artery disease, and polycystic ovary syndrome. Polycystic ovary syndrome is characterized by androgen excess and ovarian dysfunction. Emerging evidence suggests that the long-term metabolic effects and cardiovascular complications observed in this syndrome may be related to the presence of a mild chronic inflammatory state. It is unclear whether androgen excess promotes an inflammatory state or, conversely, whether inflammatory molecules stimulate androgen production. Early detection of risk factors will help in the prevention and control of cardiovascular diseases, since the metabolic alterations associated with this syndrome can predispose to worse cardiovascular health outcomes.

Diferentes citocinas proinflamatorias producidas durante la foliculogénesis tienen un rol fisiológico en el debilitamiento de la pared del folículo y la eventual ruptura en la ovulación. La inflamación crónica está relacionada de forma muy cercana con disfunción endotelial, enfermedad cardiovascular, enfermedad arterial coronaria y con el síndrome de ovario poliquístico. El síndrome de ovario poliquístico se caracteriza por un exceso de andrógenos y disfunción ovárica. Evidencia emergente sugiere que los efectos metabólicos a largo plazo y las complicaciones cardiovasculares observadas en este síndrome pueden estar relacionadas con la presencia de un estado inflamatorio crónico leve. Es poco claro si el exceso de andrógenos promueve un estado inflamatorio o, contrariamente, si las moléculas inflamatorias estimulan la producción de andrógenos. La detección temprana de los factores de riesgo ayudará en la prevención y el control de las enfermedades cardiovasculares, dado que las alteraciones metabólicas asociadas con este síndrome pueden predisponer a peores resultados de salud cardiovascular.

Cistoadenoma volumoso associado a teratoma ovariano maduro, com evolução para pseudomixoma peritoneal: relato de caso / Giant cystadenoma associated with mature ovarian teratoma with progression to pseudomyxoma peritonei: a case report

Massas anexiais representam grande desafio diagnóstico, devido a seu caráter geralmente assintomático¹. Traz-se caso peculiar de paciente que evoluiu com sintomas exuberantes de rápida evolução, situação característica de cistoadenomas, tumores benignos de origem epitelial²,³. Realizada laparotomia, com achados macroscópicos que revelaram conteúdo mucinoso e presença de pelos e neovascularização em seu interior. O anatomopatológico confirmou o diagnóstico de cistoadenoma associado a teratoma ovariano, sendo assim considerado um tumor de colisão ovariana.

Adnexal masses represent a major diagnostic challenge due to its usually asymptomatic characteritcs¹. We present a peculiar case of a patient who evolved with exuberant symptoms of rapid evolution, characteristic of cystadenomas, benign tumors of epithelial origin²,³. Laparotomy was performed, with macroscopic findings that revealed mucinous content and the presence of hairs and neovascularization inside. Pathology confirmed the diagnosis of cystadenoma associated with ovarian teratoma, thus being considered an ovarian collision tumor.

Combination of GI-RADS and 3D-CEUS for differential diagnosis of ovarian masses

SUMMARY OBJECTIVE The purpose of this study is to evaluate the efficacy of the combination of gynecologic imaging reporting and data system (GI-RADS) ultrasonographic stratification and three-dimensional contrast-enhanced ultrasonography (3D-CEUS) in order to distinguish malignant from benign ovarian masses. METHODS In this study, 102 patients with ovarian masses were examined by both two-dimensional ultrasound(2D-US) and 3D-CEUS. Sonographic features of ovarian masses obtained from 3D-CEUS were analyzed and compared with 2D-US. All patients with ovarian masses were confirmed by operational pathology or long-term follow-up results. RESULTS (1)The Chi-square test and multiple Logistic regression analysis confirmed that there were only eight independent predictors of malignant masses, including thick septa (≥3mm), thick papillary projections(≥7mm), solid areas, presence of ascites, central vascularization, contrast enhancement, distribution of contrast agent, and vascular characteristics of the solid part and their odds ratios which were 5.52, 5.39, 4.94, 4.34, 5.92, 7.44, 6.09, and 7.67, respectively (P<0.05). (2)These eight signs were used to combine the GI-RADS with 3D-CEUS scoring system in which the corresponding value of the area under the curve (AUC) was 0.969, which was superior to using GI-RADS lonely (Z-value=1.64, P<0.025). Using 4 points as the cut-off, the scoring system showed the performance was clearly better than using GI-RADS alone (P<0.05). (3) The Kappa value was 0.872 for two different clinicians with equal experience. CONCLUSIONS The combination of GI-RADS and 3D-CEUS scoring system would be a more effective method to distinguish malignant from benign ovarian masses.

RESUMO OBJETIVO O objetivo deste estudo é avaliar a eficácia da combinação da estratificação por ultrassonografia usando o Sistema de Relatórios e Dados de Imagem Ginecológica (GI-RADS) e ultrassonografia 3D com contraste (3D-CEUS) para diferenciar massas ovarianas benignas de malignas. METODOLOGIA Neste estudo, 102 pacientes com massas ovarianas foram examinadas usando ultrassonografia bidimensional (2D-US) e 3D-CEUS. As características ultrassonográficas das massas ovarianas obtidas com 3D-CEUS foram analisadas e comparadas com de 2D-US. Todos os pacientes com massas ovarianas tiveram o diagnóstico confirmado pelos resultados de patologia cirúrgica ou acompanhamento de longo prazo. RESULTADOS (1) O teste qui-quadrado e a regressão logística múltipla confirmaram a existência de apenas oito preditores independentes de massas malignas, incluindo septos espessos (≥3mm), projeções papilares espessas (≥7mm), áreas sólidas, presença de ascite, vascularização central, aumento de contraste, distribuição do agente de contraste e características vasculares da parte sólida e suas razões de possibilidades (OR), que foram 5,52, 5,39, 4,94, 4,34, 5,92, 7,44, 6,09 e 7.67, respectivamente (P< 0,05). (2) Esses oito preditores foram utilizados para combinar o GI-RADS com o sistema de escores da 3D-CEUS, para o qual o valor correspondente da área sob a curva (AUC) foi de 0,969, superior ao uso exclusivo do GI-RADS (valor de Z = 1,64, P < 0,025). Usando 4 pontos como corte, o sistema de escores mostrou que o desempenho foi muito melhor do que com o uso exclusivo do GI-RADS (P < 0,05). (3) O valor de Kappa foi 0,872, obtido por dois médicos diferentes com igual experiência. CONCLUSÃO A combinação do GI-RADS e do sistema de pontuação da 3D-CEUS é um método mais eficaz para distinguir massas ovarianas benignas de malignas.

Evaluación del efecto de la prasterona en el tratamiento del deseo sexual hipoactivo en mujeres posmenopáusicas / Evaluation of the effect of the Prasterone in the treatment of hypoactive sexual desire in postmenopausal women

Resumen OBJETIVO: Determinar los efectos de la dosis oral diaria de 50 mg de dehidroepiandrosterona en la función sexual de pacientes posmenopáusicas. MATERIALES Y MÉTODOS: Estudio experimental, clínico, prospectivo y longitudinal efectuado en pacientes posmenopáusicas atendidas en el Hospital Juárez de México entre los meses de abril a julio de 2017. La muestra se seleccionó de pacientes posmenopáusicas atendidas por primera vez que cumplieran los criterios de inclusión. Administración de 50 mg de prasterona (Biolaif™) por vía oral cada 24 horas durante 12 meses a las pacientes con protocolo de estudio completo; consulta de seguimiento cada 3 meses. Estadística descriptiva y análisis bidimensional de Friedman. Los estudios estadísticos se realizaron con el programa SPSS versión 22. RESULTADOS: En 29 pacientes se evaluó el índice de función sexual que se incrementó, posterior al tratamiento oral con 50 mg diarios de prasterona, de una media de 10.8 a 28.1, y a 12 meses en 18 pacientes de una media de 10.6 a 29.1. CONCLUSIONES: La disfunción sexual es un problema de salud infradiagnosticado en pacientes posmenopáusicas. La administración oral de prasterona (dehidroepiandrosterona) a dosis de 50 mg al día mejoró todos los dominios del índice de función sexual femenina de todas las pacientes estudiadas con resultados estadísticamente significativos, sin efectos secundarios de hiperandrogenismo.

Abstract OBJECTIVE: To determine the effects of the administration of 50 mg of DHEA orally daily on sexual function of menopausal patients. MATERIALS AND METHODS: We performed an experimental, clinical, prospective and longitudinal study in menopausal patients. We selected the sample from april to july 2017 with menopausal patients who attended for the first time at the clinic who met the inclusion criteria, having a final sample of 29 patients. Patients with a complete study protocol who met the entry criteria were administered 50 mg of prasterone (Biolaif™) orally daily for 12 months, with a follow-up consultation every 3 months. Descriptive statistics were used for the statistical analysis. Also, Friedman's two-dimensional analysis was used. All statistical studies were conducted in the SPSS program, v.22. RESULTS: Sexual Function Index evaluated with 29 patients at 6 months increased from an average of 10.8 to 28.1. At 12 months with 18 patients, after the treatment with 50 mg prasterone orally daily, it increased from an average of 10.6 to 29.1. CONCLUSIONS: Sexual dysfunction is an underdiagnosed health problem in patients over the postmenopausal stage. Administration of prasterone (DHEA) at a dose of 50 mg orally daily improved the domains of Female Sexual Function Index of all our patients with statistically significant results, without side effects of hyperandrogenism.

[Association of ovarian tumors with CA-125]. / Asociación de los tumores de ovario con el CA-125.

BACKGROUND: The tumor marker CA-125 is the most widely used serum marker for ovarian cancer screening. The aim of this paper was to establish the association between histopathologic result of ovarian tumors with serologic CA-125 and utility for the diagnosis of ovarian tumors at a Ginecoobstetric hospital. METHODS: An observational, retrospective, descriptive and longitudinal study, from September 1st 2010 to February 28 2013. All patients with histopathologic report ovarian tumor and CA-125 was selected to analyze the association of ovarian tumors with their histological type, biological behavior, range positivity of CA-125 and its relationship to the pre and postmenopausal state. RESULTS: Of 1213 patients, 334 were included. Utility of CA-125 in postmenopausal reported positive predictive value of 67.5%, with sensitivity (72%), specificity (82.6%) and negative predictive value (86.1%), both with p = 0.001, mainly in the epithelial origin. In premenopausal a low positive predictive value was reported. CONCLUSIONS: The CA-125 is useful for screening for ovarian cancer in postmenopausal women, mainly for epithelial origin.

Introducción: el marcador tumoral CA-125 es el marcador sérico más utilizado para el tamizaje del cáncer de ovario. El objetivo de este trabajo fue establecer la asociación entre el resultado histopatológico de los tumores de ovario con el serológico de CA-125 y la utilidad para el diagnóstico de tumores de ovario en nuestro hospital. Métodos: estudio observacional, retrospectivo, descriptivo y longitudinal. Comprendió el periodo del 1 de septiembre de 2010 al 28 de febrero de 2013. Se seleccionaron a todas las pacientes con reporte histopatológico de tumor de ovario y CA-125 para analizar la asociación de los tumores de ovario con su estirpe histológica, conducta biológica, rango de positividad del CA-125 y su relación con el estado pre y posmenopáusico. Resultados: de 1213 pacientes se incluyeron 334. La utilidad del CA-125 en las posmenopáusicas reportó valor predictivo positivo de 67.5%, con sensibilidad (72%), especificidad (82.6%) y valor predictivo negativo (86.1%), ambos con p = 0.001, principalmente en la estirpe epitelial. En las premenopáusicas se reportó un bajo valor predictivo positivo. Conclusiones: el CA-125 es útil para el tamizaje de cáncer de ovario en las mujeres posmenopáusicas, principalmente para la estirpe epitelial.

Minimally invasive approach of tubo-ovarian abscesses / Tratamento minimamente invasivo dos abcessos tubo-ováricos

PURPOSE: To evaluate the treatment outcome of tubo-ovarian abscesses managed by transvaginal ultrasound-guided aspiration. METHODS: Descriptive analysis of all patients with tubo-ovarian abscesses treated with a minimally invasive procedure, ultrasound-guided drainage, at the Department of Gynecology, Centro Hospitalar Vila Nova de Gaia/Espinho, during a period of 5 years (from June 2009 to June 2014). RESULTS: Twenty-six cases were included in the study. The mean age of the study group was 42.8 years. All patients were submitted to transvaginal ultrasound-guided aspiration and sclerosis with iodated solution, as well as received broad-spectrum intravenous antibiotics. The mean time from admission to drainage was 2.5 days. Cultures for aerobic and anaerobic pathogens were positive in 14 of the 26 cases. A complete response was noted in 23 of the 26 cases. No complications or morbidity were noted as a consequence of the drainage procedures. CONCLUSION: Minimally invasive treatment of tubo-ovarian abscesses by transvaginal ultrasound-guided drainage is an effective and safe approach. .

OBJETIVO: Avaliar os resultados da aspiração transvaginal ecoguiada no tratamento dos abcessos tubo-ováricos. MÉTODOS: Análise descritiva de todas as pacientes com diagnóstico de abcesso tubo-ovárico tratadas com um procedimento minimamente invasivo, drenagem ecoguiada, no Serviço de Ginecologia do Centro Hospitalar Vila Nova de Gaia/Espinho, durante um período de 5 anos (junho de 2009 a junho de 2014). RESULTADOS: Vinte e seis casos foram incluídos neste estudo, com média de idade de 42,8 anos. Todas as pacientes foram submetidas a punção aspirativa transvaginal ecoguiada e esclerose com solução iodada, associada a antibioterapia endovenosa de largo espectro de ação. O tempo médio desde a admissão até o procedimento de drenagem foi de 2,5 dias. Os exames culturais para micro-organismos aeróbicos e anaeróbicos foram positivos em 14/26 casos. Resposta completa com o tratamento instituído ocorreu em 23 dos 26 casos. Não houve registro de complicações ou morbilidade com os procedimentos de drenagem realizados. CONCLUSÃO: O tratamento minimamente invasivo dos abcessos tubo-ováricos, com drenagem transvaginal ecoguiada, constitui uma abordagem terapêutica eficaz e segura. .

Características clínicas y metabólicas de síndrome de ovario poliquístico en la ciudad de Temuco / Clinical and metabolic characteristics of polycystic ovary syndrome in the city of Temuco

Polycystic Ovarian Syndrome (PCOS) is the most common endocrine disorder, its etiologyis multifactorial. It is associated with multiple metabolic abnormalities. Objective: To evaluate statistical association between the clinical characteristics of patients diagnosed with PCOS. Patients and Methods: Descriptive study, 121 patients between 13 and 44 years with PCOS were included, and their clinical characteristics, blood glucose, insulin, lipid profile and calculated HOMA were evaluated. Data was analyzed with Chi2, considering p < 0.05 as statistically significant. Results: Mean age 25,5 years, 12,5 years menarche. 22 percent with a history of abortion. Mean BMI 31,4. Acanthosis nigricans was presented in 58,6 percent. Average Glucose 96,5 mg/dl. Insulin resistance (IR) was found in 79.3 percent. Average HOMA 4,5. 64 percent of patients with IR presented Acanthosis nigricans (p = 0.002).It showed direct relationship between BMI and RI (p 0.000). 38,8 percent had dysglycemia. RI was found in 78,7 percent of patients with dysglycemia (p 0.8). Lipid profile was measured in 78 patients, of whom 40 percent had total cholesterol above 200 mg/dl, 49 percent hypertriglyceridemia and high LDL in 13 percent of cases. Conclusions: The data reported are similar to those reported in the international literature. Ourpopulation has obesity and dyslipidemia figures higher than those reported in national studies. The menarche occurs at a younger age while the prevalence of dyslipidemia and RI is greater than the general population, forming a higher risk group...

Síndrome de teratoma creciente: presentación de un caso / Growing Teratoma Syndrome: A Case Report

El síndrome de teratoma creciente (STC) es una entidad histopatológica rara y está definida por la aparición de un teratoma maduro durante o después de la quimioterapia de un tumor maligno de células germinales no seminomatoso. Hasta la fecha han sido pocos los casos presentados en la literatura mundial. Por la baja incidencia de esta patología, presentamos el caso de una paciente joven con un teratoma inmaduro de ovario tratada con cirugía y quimioterapia, quien desarrolló posteriormente una masa pélvica con resultado histológico de teratoma maduro. El reconocimiento de esta patología es importante para evitar confusiones con el desarrollo de tumores malignos.

Growing teratoma syndrome is a rare histopathologic entity, defined by an enlarged mass of mature teratoma which appears during or after chemotherapy of a malignant nonseminomatous germ cell tumor. Few reported cases in world literature have been reported until today, due to the low incidence of this pathology. We report one patient in our hospital with immature teratoma. This patient was treated with surgical resection and chemotherapy. She had a pelvic mass and histology revealed a mature teratoma. It is important to recognize this pathology in order to avoid confusion with a developing malignancy.

Cistoadenoma seroso gigante de ovario: reporte de un caso / Giant ovarian serous cystadenoma: a case report

El cistoadenoma seroso de ovario es un tipo de tumor derivado del epitelio superficial (celómico), formado por áreas quísticas. La razón del predominio de estos tumores en el ovario es un misterio. Se presenta el caso de una paciente con cistoadenoma seroso de ovario; que fue referida al Servicio de Cirugía del Hospital Provincial Docente Dr Antonio Luaces Iraola por presentar un gran aumento del volumen abdominal, de 12 meses de evolución, cuyo diagnóstico fue sospechado por hallazgo de ultrasonografía pélvica; se encontró en la sala de operaciones una tumoración gigante de 10 kg de peso que fue confirmado por anatomopatología como un cistoadenoma seroso de ovario.

Giant ovarian serous cystadenoma is a type of tumor derived from the surface epithelium (celomic), formed by cystic areas. The reason for the prevalence of these ovarian tumors is a mystery. It is reported the case of a patient with ovary serous cystadenoma that was referred to the Surgery Service of the Teaching Provincial Hospital Dr Antonio Luaces Iraola for presenting a large increase volume in abdominal, 12 months evolution, whose diagnosis was suspected by pelvic ultrasonography; a giant of 10 kg was found during surgery and diagnosis was confirmed by histopathology as an ovarian serous cystadenoma.

Edema maciço de ovário / Massive ovarian edema

O edema maciço de ovário é uma condição benigna rara caracterizada pelo aumento tumoral símile do ovário comprometido. As doenças ovarianas de importância cirúrgica da infância não são frequentes e podem ser divididas em lesões neoplásicas, em cistos não neoplásicos e em alterações inflamatórias. Os autores descrevem um caso de edema maciço de ovário em uma paciente de treze anos que referia dor abdominal associada a uma lesão sólido-cística do ovário direito, avaliada como neoplasia pela ultrassonografia. Ao exame macroscópico, o ovário era bocelado e estava aumentado de volume, medindo 9,5×6,0×5,0 cm e apresentando uma lesão sólida com áreas císticas à superfície de corte. O aspecto microscópico fundamental desse processo era a presença de edema acentuado e difuso do estroma, envolvendo folículos, e associado a uma camada cortical com espessamento fibroso superficial. O conhecimento dessa entidade é fundamental para auxiliar no diagnóstico durante a avaliação ultrassonográfica de tumores ovarianos e prevenir tratamentos incorretos.

Massive ovarian edema is a rare benign condition characterized by similar tumor growth of the affected ovary. The ovarian disorders of surgical importance of childhood are not frequent and can be divided into neoplastic lesions, non-neoplastic cysts, and inflammatory alterations. Here the authors describe the case of a massive ovarian edema in a 13-year-old female patient who reported abdominal pain associated with a solid-cystic lesion of the right ovary evaluated as a neoplasm by ultrasonography. The macroscopic examination showed ovary with increased volume, measuring 9.5×6.0×5.0 cm, and presenting a solid lesion with cystic areas at the cutting surface. The key microscopic feature of this process was the presence of pronounced diffuse edema of the stroma, involving follicles and associated with a cortical layer with superficial fibrous thickening. Knowledge of this entity is key in aiding the diagnosis during the ultrasonographic evaluation of ovarian tumors and preventing improper treatments.