Fiebre de origen desconocido como presentación de carcinoma de cérvix / Fever of unknown origin as presentation of carcinoma of the cervix

El carcinoma de cérvix constituye una causa rara de fiebre de origen desconocido (FOD). Se presenta el caso de una paciente femenina de 42 años de edad con fiebre de 80 días de evolución. Había estado ingresada en dos hospitales sin que se llegase a diagnosticar su causa. Se le habían administrado múltiples regímenes antibióticos sin lograrse remisión de la hipertermia. Fue remitida al hospital Hermanos Ameijeiras para continuar estudios en el protocolo de atención a pacientes con ese tipo de afección. Tenía anemia ferropénica y refería hipermenorrea. Al examen físico se encontró engrosamiento del cuello uterino al tacto vaginal y se visualizó una tumoración del mismo al examen con espéculo. La biopsia mostró un carcinoma y recibió tratamiento con radioterapia y quimioterapia con lo cual desapareció la fiebre. Se concluye que esta neoplasia puede presentarse a forma de fiebre prolongada producida directamente por el tumor primario, por lo que debe mantenerse un índice de sospecha en pacientes con FOD. Resulta importante tener en cuenta la asociación de fiebre y sangramiento vaginal como posible forma de presentación. Puede constituir una pista diagnóstica relevante para no perder tiempo. Este caso resalta la importancia de realizar un examen físico completo y exhaustivo a todos los pacientes(AU)

Carcinoma of the cervix is a rare cause of fever of unknown origin. We present the case of a 42-year-old female patient with fever of 80 days of evolution. She had been admitted to two hospitals without a diagnosis of the cause. She had been administered multiple antibiotic regimens without achieving remission of hyperthermia. She was referred to the "Hermanos Ameijeirasˮ Hospital to continue studies under the protocol for the care of patients with this type of condition. She had iron deficiency anemia and reported hypermenorrhea. Physical examination showed thickening of the cervix on vaginal examination and a tumor was visualized on speculum examination. The biopsy showed a carcinoma and she was treated with radiotherapy and chemotherapy, with which the fever disappeared. It is concluded that this neoplasm can present as a prolonged fever directly produced by the primary tumor, so an index of suspicion should be maintained in patients with fever of unknown origin. It is important to take into account the association of fever and vaginal bleeding as a possible form of presentation. It may constitute a relevant diagnostic clue to avoid wasting time. This case highlights the importance of performing a complete and thorough physical examination in all patients(AU)

A Rare Case of Non-IUD-Related Chronic Endometritis caused by Actinomyces Bacteria in a Postmenopausal Woman: A Case Report.

Pelvic actinomycosis is a rare condition, usually associated with intrauterine device (IUD) use. Its clinical presentation may vary from being asymptomatic to the mimicking of pelvic malignancy; it has been described as one of the most misdiagnosed diseases. A 78-year-old woman without a history of IUD use, arrived at our clinic complaining of chronic and intermittent postmenopausal bleeding associated with lower pelvic pain. An endometrial curettage was performed, and endometritis (caused by Actinomyces) identified. Treatment with intravenous piperacillin and tazobactam for 7 days, followed by 6 weeks of oral ampicillin, daily, decreased the bleeding and the pain. Although rare, it is important to consider Actinomyces-related endometritis as a differential diagnosis in cases of elderly woman with postmenopausal bleeding and without a history of IUD use.

Importance of Doppler ultrasound in vaginal foreign body: case report and review of the literature.

The aim of this paper is to describe the distinctive ultrasound findings of a case of vaginal bleeding caused by the presence of a foreign body. We present the case of an infant who consulted for vaginal bleeding and foul-smelling discharge. The ultrasound revealed signs of vaginal distension due to heterogeneous-hematic contents and parietal thickening. At Doppler examination, a striking finding of increased vascularization limited to the upper two-thirds of the vaginal wall was found, which was initially interpreted as a sign of local inflammation suggesting the presence of an underlying foreign body. At direct vaginoscopic examination remains of toilet paper in the vaginal fundus were found. The presence of a foreign body in the vagina is an uncommon cause of discharge and vaginal bleeding in pediatrics, therefore, this etiology should be kept in mind when the adequate clinical context arises. Doppler ultrasound represents a first-line complementary method when this entity is suspected.

Mioma nascens: reporte de caso / Myoma nascens: Clinical case

Resumen ANTECEDENTES: Los miomas uterinos son los tumores ginecológicos más frecuentes durante la edad reproductiva y extremadamente raros en la preadolescencia y adolescencia temprana; representan el 1% de todos los casos. Es aún más excepcional que estos casos se manifiesten como prolapso de un mioma (mioma nascens). CASO CLINICO: Paciente de 11 años, procedente de Tunja, Colombia, con talla de 143 cm, peso 31 kg, IMC 15.15 kg/m2 (riesgo de delgadez), sin antecedentes patológicos, farmacológicos o quirúrgicos; menarquia a los 11 años, sin inicio de la vida sexual activa. Fue llevada a consulta debido a un cuadro clínico de cinco horas de evolución, consistente en la aparición de una masa de aproximadamente 3 cm de diámetro, que protruía la vagina al momento de defecar, dolorosa a la palpación, con sangrado escaso y flujo vaginal. La sospecha inicial fue: posible pólipo cervical. CONCLUSIÓN: Los casos de mioma nascens son, en general, infrecuentes, más aún en la edad pediátrica. Hacen falta estudios que permitan establecer las características biológicas de este tipo de lesiones en niñas y adolescentes que den pie a indicar el tratamiento más adecuado. El quirúrgico parece ser la opción que ha recibido mayor apoyo en otros reportes de caso. El seguimiento es decisivo debido a que se desconoce el comportamiento de este tipo de lesiones en este grupo etario.

Abstract BACKGROUND: Uterine fibroids are the most frequent gynecologic tumors during reproductive age and extremely rare in preadolescence and early adolescence, representing only 1% of all cases. It is even more exceptional that these cases manifest as myoma prolapse (myoma nascens). CLINICAL CASE: 11-year-old female patient from Tunja, Colombia, height 143 cm, weight 31 kg, BMI 15.15 kg/m2 (risk of thinness by Colombian resolution), with no pathological, pharmacological or surgical history; menarche at 11 years old, without onset of sexual life. She was taken to consultation due to a clinical picture of five hours of evolution, consisting of a mass of approximately 3 cm in diameter, protruding the vagina at the time of defecation, painful on palpation, with scanty bleeding and vaginal discharge. The initial suspicion was possible cervical polyp. CONCLUSION: Cases of myoma nascens are, in general, infrequent, even more so in pediatric age. More studies are needed to establish the biological characteristics of this type of lesions in girls and adolescents to indicate the most appropriate treatment. Surgical treatment seems to be the option that has received the most support in other case reports. Follow-up is crucial because the behavior of this type of lesions in this age group is unknown.

Hipertecosis estromal ovárica: reporte de un caso / Ovaric stromal hypertecosis: a case report

Resumen ANTECEDENTES: La hipertecosis estromal ovárica es un tumor androgenizante del ovario, raro, que puede manifestarse como: hiperandrogenismo, carcinoma de endometrio, obesidad e hipertensión. En la bibliografía solo se encuentran algunos reportes de casos y pequeñas series de casos. CASO CLÍNICO: Paciente de 20 años, con sangrado vaginal continuo, hirsutismo, clitoromegalia, implantación androide del vello púbico y facial. En la ecografía del ovario derecho se advirtió una lesión sólida en su interior. Concentraciones elevadas de testosterona libre, testosterona e hidroxiprogesterona. Se sospechó un tumor androgenizante del ovario. Se practicó la salpingooforectomía derecha por vía laparoscópica. El reporte de patología fue: parénquima ovárico con extensos nidos de células estromales luteinizadas con hiperplasia estromal. Diagnóstico: hipertecosis estromal. CONCLUSIÓN: Ante la coexistencia de signos de virilización, alteración en la regularidad y frecuencia del ciclo menstrual, con altas concentraciones de andrógenos y una lesión tumoral ovárica en el estudio ecográfico debe sospecharse hipertecosis estromal ovárica. El tratamiento de elección es la resección quirúrgica del ovario afectado. Debido al bajo potencial de malignidad de estas lesiones puede considerarse el acceso laparoscópico.

Abstract BACKGROUND: Ovarian stromal hyperthecosis is a rare ovarian androgenizing tumor that can manifest as hyperandrogenism, endometrial carcinoma, obesity and hypertension. Only a few case reports and small case series are found in the literature. CLINICAL CASE: 20-year-old patient with continuous vaginal bleeding, hirsutism, clitoromegaly, and android implantation of pubic and facial hair. Ultrasonography of the right ovary showed a solid lesion inside the ovary. Elevated concentrations of free testosterone, testosterone and hydroxyprogesterone. An ovarian androgenizing tumor was suspected. A laparoscopic right salpingo-oophorectomy was performed. The pathology report was ovarian parenchyma with extensive nests of luteinized stromal cells with stromal hyperplasia. Diagnosis: stromal hyperthecosis. CONCLUSION: In the coexistence of signs of virilization, alteration in the regularity and frequency of the menstrual cycle, with high concentrations of androgens and an ovarian tumor lesion in the ultrasound study, ovarian stromal hyperthecosis should be suspected. The treatment of choice is surgical resection of the affected ovary. Due to the low malignant potential of these lesions, laparoscopic access can be considered.

Gestação heterotópica espontânea: relato de caso com diagnóstico e manejo oportunos / Spontaneous heterotopic pregnancy: a case report with appropriate diagnosis and management

Introdução: A gravidez heterotópica é um fenômeno obstétrico muito raro em concepções espontâneas no qual gestações tópica e ectópica coexistem. O diagnóstico é difícil, mas, se realizado precocemente, o prognóstico é favorável. Descrição do caso: Paciente do sexo feminino, de 35 anos de idade, admitida com quadro de dor abdominal e pequeno sangramento vaginal. Diagnosticada precocemente e tratada cirurgicamente por gravidez heterotópica naturalmente concebida. Como resultado, a gravidez tópica seguiu sem intercorrências. Conclusão: Esse caso enfatiza a necessidade de considerar esse diagnóstico diferencial e analisar clínica e ecograficamente as características globais da pelve, mesmo na ausência de fatores de risco em gestações tópicas.(AU)

Introduction: Heterotopic pregnancy (HP) is a rare obstetric phenomenon in spontaneous conceptions in which intrauterine and ectopic pregnancies coexist. The diagnosis is difficult, but, if performed early, the prognosis is favorable. Case description: A 35-year-old woman was admitted with abdominal pain and light vaginal bleeding. She was early diagnosed and surgically treated for a naturally conceived heterotopic pregnancy. As a result, the intrauterine pregnancy went on healthily. Conclusion: This case emphasizes the need to regard HP as a differential diagnosis and analyze the global pelvis characteristics both clinically and in ultrasound scans, even in the absence of risk factors when dealing with intrauterine pregnancies.(AU)

Preschool Girl With Vaginal Bleeding Due to Pinworm Endometritis.

Genital tract bleeding in prepubertal girls is a rare clinical condition, which can occur for multiple reasons. It frequently generates anxiety in the family and in health care professionals. A thorough anamnesis and careful genital inspection can give important diagnostic hints; however, there are cases in which the cause remains doubtful and a complete gynecological evaluation (including cultures and vaginoscopy) is necessary. Therefore, the attending physician should always consider less frequent diagnoses in order to perform the necessary studies in a sequential and rational manner. We present the case of a preschool girl with vaginal bleeding due to pinworm endometritis, which, to our knowledge, has never been reported before as a cause of genital bleeding in prepubertal girls.

Cáncer de vagina: reporte de un caso / Vaginal cancer: A case report

Vaginal cancer has a low incidence in the female population. We present the case of a 77-year-old woman who was admitted to the hospital due to postmenopausal vaginal bleeding and initial diagnosis of cancer of the uterine cervix. Vaginal biopsy was performed from an ulcerated exophytic 3 x 2 cm lesion in the superior third of the posterior vaginal wall. Pathology reported a poorly differentiated squamous cell carcinoma of the vagina. The surgical specimen showed an infiltrating, nonkeratinizing, moderately differentiated squamous cell carcinoma of the vagina. We present a case where similarity of symptomatology with cancer of the cervix may have led to a wrong diagnosis or management, due to the anatomical proximity of both tissues.

El cáncer de vagina tiene una baja incidencia en la población femenina. Una mujer de 77 años acudió al hospital con antecedentes de sangrado vaginal posmenopáusico y diagnóstico inicial de cáncer de cérvix. Se le realizó biopsia vaginal por lesión ulcerada exofítica de 3 x 2 cm en el tercio superior de la pared vaginal posterior, cuyo resultado patológico fue cáncer escamoso pobremente diferenciado de la vagina. La patología de la pieza operatoria mostró carcinoma de células escamosas, infiltrante, no queratinizante, medianamente diferenciado de vagina. Presentamos el caso, en el que pudo haber confusión en el diagnóstico y/o manejo por la similitud de la sintomatología con el cáncer de cuello uterino, debido a la localización anatómica y la proximidad de ambos tejidos.

Relato de caso: melanoma primário de vagina / Case Report: Primary Vaginal Melanoma

Introdução: Melanoma maligno de vagina é um tumor raro e agressivo com incidência de 0,46 casos a cada milhão de mulheres por ano, descrito pela primeira vez por Poronas, em 1887. São relatados aproximadamente 500 casos mundialmente.É umavariante mucosa do melanoma, acometendo regiões não expostas à radiação ultravioleta. Representa menos de 3% dos tumores primários malignos da vagina, de prognóstico ruim e taxa sobrevida em 5 anos de 5-25%. O tratamento preconizado é controverso e assunto de discussões. Existem poucos dados na literatura, justificando o relato deste caso, que contribuirá para novos estudos a fim de definir um melhor tratamento. Objetivo: Relatar um caso de melanoma primário de vagina invasor. Relato de caso: Paciente do sexo feminino, 78 anos, relatava sangramento vaginal há 6 meses e secreção serosanguinolenta de odor fétido. Ao exame ginecológico, visualizou-se lesão vegetante em parede vaginal esquerda, com sangramento ativo, friável e odor fétido, ausência de lesões em colo uterino e útero de volume habitual. A biópsia evidenciou à imunohistoquímica neoplasia de células epitelioides com atipias proeminentes com pigmento melânico associado à extensão pagetoide para camadas superficiais do epitélio, mitoses atípicas e positividade forte e difusa para Melan A e proteína S100, favorecendo a hipótese de Melanoma invasor primário de vagina. A ressonância magnética da pelve evidenciou linfonodo inguinal heterogêneo à esquerda. Desfecho: Paciente submetida à colpectomia com excisão de lesão neoplásica em parede anterior da vagina e ressecção de lesões suspeitas em paredes laterais da vagina e parede lateral direita da vulva, sem intercorrências cirúrgicas. Conclusão: O caso relatado fomenta a discussão de doença rara e que mesmo quando o diagnóstico e o tratamento são instituídos, tem seu prognóstico ainda muito imprevisível, no que diz respeito à cura e melhoria da qualidade de vida.

Introduction: Malignant melanoma of the vagina is a rare tumor with 0.46 cases per one million women per year and first described by Poronas in 1887. There are 500 cases reported. It is a mucosal variant of melanoma wich affects regions not exposed to ultraviolet radiation. It represents less than 3% of vagina primary tumors, with a poor prognosis and five-year survival of 5-25%. The gold standard treatment is controversial and subject of discussions. There are few data in the literature, justifying the case report, which contribute to new studies. Objective: case report of primary invasive melanoma of the vagina. Case report: Female patient, 78 years old, reports vaginal bleeding for 6 months and serum blood secretion of foul-smelling. Gynecological examination revealed vegetation in the left vaginal wall, with active bleeding, friable and foul-smelling, no lesions in the cervix and uterus of normal volume. The biopsy followed by immunohistochemical test showed a neoplasia of epithelioid cells with prominent atypia with melanic pigment associated with pagetoid extension to superficial layers of the epithelium, atypical mitoses, and a strong and diffuse positivity for Melan A and protein S100, favoring the hypothesis of primary invasive melanoma of the vagina. The magnetic resonance imaging of the pelvis showed heterogeneous inguinal lymph node on the left. Results: Patient submitted to colpectomy with excision of anterior neoplastic lesion of the vagina and resection of suspicious lesions on side walls of the vagina and right lateral wall of the vulva, without surgical complications. Conclusion: The case reported encourages discussion of this pathology, and demonstrated that even if diagnosis and therapy are performed early, still has a very unpredictable prognosis, in terms of healing and improvement of the quality of life.

Adenocarcinoma mucinoso bien diferenciado de tipo gástrico (adenoma maligno): un reto diagnóstico / Gastric-type mucinous well differentiated adenocarcinoma (adenoma malignum): a diagnostic challenge

Resumen ANTECEDENTES: El adenocarcinoma mucinoso bien diferenciado de tipo gástrico (adenoma maligno) es una variante histológica poco frecuente de adenocarcinoma mucinoso cervical. La hidrorrea, el sangrado vaginal persistente y las formaciones quísticas cervicales son manifestaciones sugerentes de la enfermedad. CASO CLÍNICO: Paciente de 52 años, que acudió a consulta por hidrorrea y sangrado genital persistente. Después de la exploración física se tomaron muestras de: exudado vaginal, citología cervical, biopsia endometrial e identificación de virus del papiloma humano. También se practicaron estudios de: colposcopia, legrado endocervical, ecografía transvaginal, histeroscopia y resonancia magnética. Se visualizaron múltiples quistes de Naboth, menores de 2 cm; líquido en la cavidad uterina y el canal endocervical, sin hallazgos patológicos adicionales. Por la persistencia de los síntomas se decidió efectuar la histerectomía total simple con doble anexectomía, por laparotomía. El reporte anatomopatológico fue: adenocarcinoma mucinoso bien diferenciado de tipo gástrico, estadio IB2 (FIGO). Se prescribieron: tratamiento coadyuvante, radioterapia externa y braquiterapia. Después de 12 esquemas de tratamiento no se identificaron signos de recidiva. CONCLUSIONES: Establecer el diagnóstico anatomopatológico preoperatorio es decisivo para disminuir la morbilidad y mortalidad por adenocarcinoma mucinoso. Es importante establecer el diagnóstico diferencial exhaustivo con lesiones benignas cervicales.

Abstract BACKGROUND: Gastric-type mucinous well differentiated adenocarcinoma (adenoma malignum) is an infrequent cervical mucinous adenocarcinoma. It must be suspected if persistent hydrorrhea or vaginal bleeding are present, as well as multiple cervical cysts. CLINICAL CASE: A case of a 52-year-old woman with persistent hydrorrhea and vaginal bleeding. The study was completed with vaginal culture, cervical cytology and HPV (Human Papiloma Virus), colposcopy, endocervical curettage, transvaginal ultrasound, endometrial biopsy, hysteroscopy and magnetic resonance imaging. Multiple Nabothian cysts <2 cm and fluid in the uterine cavity and the endocervical canal were observed, with no other pathological findings. Due to the symptom persistence and severity, surgical treatment was decided, revealing the diagnosis of gastric-type mucinous well differentiated adenocarcinoma, stage IB2 (FIGO). Adjuvant treatment consisted in external radiotherapy and brachytherapy. After one year of follow-up, the patient did not show any sign of relapse. CONCLUSIONS: Reaching a pathological diagnosis prior to surgery has a crucial importance to decrease morbi-mortality. A thorough differential diagnosis including benign cervical lesions is essential.

Genitorragia en una paciente prepuberal: reporte de un caso y su diagnóstico diferencial / Vaginal bleeding in the prepubescent child: clinical case and differential diagnosis

la genitorragia en pacientes prepuberales es siempre anormal, por lo que requiere estudio. Objetivo: presentar el caso clínico de una paciente prepuberal con genitorragia y revisar en la literatura los diagnósticos diferenciales. Caso clínico: paciente de 10 años con historia de 3 meses de genitorragia sin otros síntomas. Al examen físico mamas Tanner I, vello púbico Tanner II. Genitales externos sin lesiones, himen anular, rojo y delgado. Se descartó pubertad precoz. Se insertó una tórula húmeda en la vagina que dio salida a un trozo de papel higiénico y vello púbico. Después del procedimiento no ha presentado nuevos episodios de sangrado. Conclusión: la genitorragia es un signo alarmante, pero la mayoría de las veces las causas son benignas. En este caso la causa del sangrado fue un cuerpo extraño. Se recomienda derivar a ginecólogo infanto juvenil para evaluación exhaustiva...

Vaginal bleeding in prepubescent girls is always abnormal and needs evaluation. Objective: to present a clinical case and discuss differential diagnosis. Case report: A 10 years old girl with 3 months of vaginal bleeding and no other symptoms. Her breast exam is Tanner stage 1. Her pubic hair is Tanner stage 2, external genitalia were normal; her hymen was red, thin and annular. Precocious puberty was ruled out. By inserting a small sterile catheter into the vagina a piece of pubic hair and toilet paper were easily removed, after that all symptoms resolved. Conclusion: Vaginal bleeding in prepubertal children is an alarming symptom. Our patient vaginal bleeding was due to a vaginal foreign body one of the most common causes. It is recommended that all patients must be referred to a pediatric gynecologist in order to be exhaustively evaluated...

Leiomiosarcoma uterino en una anciana / Cervical Leiomiosarcoma in an aged woman

Se describe el caso clínico de una paciente senil, asistida en el Hospital Oncológico "Conrado Benítez" de Santiago de Cuba, por presentar sangrado vaginal desde hacía un mes. Al examen físico ginecológico se observó un tumor que se desplazaba a través del cuello uterino, el cual fue diagnosticado como un leiomiosarcoma uterino. Se realizaron los exámenes correspondientes, incluida la biopsia, cuyos resultados confirmaron dicho diagnóstico.

The case report of a senile patient, attended in "Conrado Benítez" Oncological Hospital from Santiago de Cuba is described, for presenting vaginal bleeding for a month. During the physical and gynecological examination a tumor was observed extending through the cervix, which was diagnosed as an uterine leiomiosarcoma. The corresponding exams were carried out, including biopsy which results confirmed the diagnosis.

Qualitative cross-cultural exploration of vaginal bleeding/spotting symptoms and impacts associated with hormone therapy in post-menopausal women to inform the development of new patient-reported measurement tools.

OBJECTIVES: To understand the vaginal bleeding/spotting experiences of postmenopausal (PM) women taking estrogen plus progestin therapies (EPT) and develop measures to assess these symptoms and their impact on women's daily lives in four countries. DESIGN: (1) Concept elicitation interviews were conducted with PM women in the US (n=14), Italy (n=15), Mexico (n=15) and China (n=15) to explore vaginal bleeding/spotting symptoms associated with EPT. The Post-Menopausal Bleeding Questionnaire (PMBQ) was also debriefed to evaluate understanding and comprehensiveness. (2) Based on concept elicitation, a single item electronic daily diary was developed and the PMBQ modified to form a 12-item impact measure. (3) The measures were pilot-tested and then cognitively debriefed with US women receiving EPT. All qualitative data was subject to thematic analysis. MAIN OUTCOME MEASURES: The Vaginal Bleeding/Spotting Daily Diary, (VBS-DD) and Post-Menopausal Bleeding Impact Questionnaire (PMBIQ) were developed in this study. RESULTS: Concept elicitation identified vaginal bleeding and spotting as important symptoms for women taking EPT, impacting their emotional wellbeing, social life, ability to move freely, clothing and sexual activity. Based on pilot testing and cognitive debriefing, women demonstrated good understanding of the VBS-DD and the PMBQ was reduced to 10 items due to conceptual redundancy. CONCLUSIONS: Women taking EPT in the US, China, Mexico and Italy reported vaginal bleeding/spotting symptoms that have a detrimental impact on their quality of life. Two new measures were developed to assess the severity and impact of vaginal bleeding/spotting specific to EPT. This work highlights the need for EPT-related symptoms to be a part of treatment decision-making.

Carcinoma epidermoide no queratinizante de células grandes y pequeñas en vagina / Large and small cells non-keratinizing epidermoid vaginal carcinoma

Se presentan 5 casos clínicos de pacientes atendidas en la consulta de patología de cuello del Hospital Provincial Ginecoobstétrico "Mariana Grajales Coello" de Santiago de Cuba por presentar sangrado vaginal, dolor en bajo vientre, leucorrea y lesiones vaginales. El estudio anatomopatológico confirmó el diagnóstico de carcinoma de células escamosas o epidermoide.

Five case reports of patients who were assisted at the cervix Pathology Department from "Mariana Grajales Coello" Provincial Gynecological Obstetrical Hospital in Santiago de Cuba due to vaginal bleeding, low abdominal pain, leukorrhea and vaginal injuries are presented. The pathological study confirmed the diagnosis of squamous or epidermoid cells carcinoma.

Urgencias en obstetricia / Emergencies in obstetrics

Tradicionalmente, el embarazo es considerado un evento fisiológico. Sin embargo, cerca de un 20 por ciento de las embarazadas desarrolla patologías obstétricas que se asocian a mortalidad materna y perinatal. A nivel mundial, cada año medio millón de mujeres fallece durante el embarazo y parto debido a estas complicaciones. Desafortunadamente, un número significativo de las urgencias obstétricas ocurre en pacientes sin factores de riesgo, por lo que la prevención, identificación precoz e intervención a tiempo de estos eventos juegan un rol fundamental para contrarrestar un resultado perinatal adverso. En el presente capítulo hemos seleccionado las emergencias que concentran la mayor morbimortalidad de nuestra especialidad. Si bien algunas han quedado fuera, creemos que los temas aquí presentados representan las urgencias obstétricas más importantes que enfrentamos a diario, para las cuales debemos estar preparados con el fin de realizar un manejo óptimo del embarazo y parto para la obtención de un resultado perinatal favorable.

Traditionally, pregnancy is considered a physiologic condition. However, close to 20 percent of pregnant women develop obstetrical diseases that are associated to maternal and perinatal mortality. World wide, every year half a million of women die during pregnancy, labor and delivery due to these complications. Unfortunately, a significant number of obstetrical emergencies occur among patients without risk factors, so that prevention, early identification and timely intervention play a key role to overcome an adverse pregnancy outcome. In the present chapter, we have selected the emergencies that concentrate most of the morbidity and mortality of our field. Although some have not been included, we believe that the obstetrical emergencies presented here in represent the most important ones that we face daily, and for which we should be prepared in order to execute the best possible obstetrical care either during pregnancy or at the time of delivery to obtain a favourable perinatal outcome.

Tumores müllerianos mixtos malignos uterinos / Uterine malignant mixed mullerian tumors

Los tumores müllerianos mixtos malignos o carcinosarcomas son neoplasias poco frecuentes y altamente agresivas que suelen presentarse en pacientes mayores de 60 años, generalmente en forma de metrorragia posmenopáusica y/o presencia de masas uterinas. Entre los factores de riesgo reconocidos está descrita la historia de irradiación previa del área pélvica. Presentamos 3 casos clínicos de pacientes diagnosticadas y tratadas de tumores müllerianos mixtos uterinos malignos, existiendo en todos ellos el antecedente de neoplasias que habían precisado radioterapia pélvica como parte de su tratamiento.

The malignant Mullerian mixed tumors are rare and highly aggressive, these tumors usually occur in women over 60 years and the most common clinical appearance is that of postmenopausal vaginal bleeding or the presence of uterine mass. As a risk factor is described the history of prior irradiation of the pelvic area. We reported the case of three patients with mullerian mixed tumors, in all these cases the patients have a history of cancer who required pelvic radiation as part of their treatment.

Terapia hormonal na menopausa: quando não usar: [revisão] / Hormone therapy in menopause: when not to use: [review]

A menopausa corresponde à cessação permanente da menstruação, conseqüente à perda da função folicular ovariana ou à remoção cirúrgica dos ovários. A idade média para ocorrência da menopausa natural gira em torno de 50 anos. A deficiência estrogênica decorrente da menopausa está associada com sintomas vasomotores, atrofia urogenital, declínio cognitivo, assim como a um aumento no risco de doenças crônico-degenerativas, aterosclerose e doença cardiovascular, osteoporose e doença de Alzheimer. A estrogenioterapia permanece sendo o tratamento mais efetivo para o manejo dos sintomas vasomotores e atrofia urogenital. Em mulheres com útero presente, a progesterona natural ou os progestogênios devem ser associados ao tratamento com estradiol para antagonizar os efeitos proliferativos deste hormônio sobre o endométrio e anular o risco de hiperplasia/carcinoma endometrial. Por outro lado, em determinadas condições clínicas, a terapia hormonal não é recomendada ou é mesmo contra-indicada. Neste artigo, focalizamos criticamente essas situações clínicas em que não se deve indicar a terapia hormonal na menopausa.

Menopause is defined as the permanent cessation of menses, as a result of the loss of ovarian follicular function or of surgical removal of ovaries. The mean age for occurrence of natural menopause is around 50 years. Estrogen deficiency has been associated with vasomotor symptoms, urogenital atrophy, and cognitive impairment, as well as increased risk of chronic degenerative diseases such as osteoporosis and Alzheimer’s disease. Estrogen therapy remains the most effective treatment for the management of vasomotor symptoms and urogenital atrophy. Progesterone or progestins should be added to estrogen treatment in women with uterus, in order to antagonize the estrogen-induced endometrial proliferation. In turn, in specific clinical conditions hormone therapy is not recommended. In the present article, the authors critically focus these clinical conditions in which hormone therapy should not be used.