{"title":"Women empowerment and its impact on fertility","authors":"J. Puerta Suárez , S.M. Vélez Cuervo , W.D. Cardona Maya","doi":"10.1016/j.gine.2024.101017","DOIUrl":"10.1016/j.gine.2024.101017","url":null,"abstract":"","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"52 1","pages":"Article 101017"},"PeriodicalIF":0.1,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142746046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-27DOI: 10.1016/j.gine.2024.101016
P. Luque González , M. Pineda Mateo , J. Rodríguez Sánchez-Reyman
Assisted reproductive therapies have a limited success rate. New therapies are currently being investigated to increase their effectiveness, such as the use of platelet-rich plasma (PRP). This agent has demonstrated efficacy at the level of regenerative medicine and consists of the administration of blood plasma extracted from the patient herself with a high platelet count. Given the recent incorporation of this treatment in clinical research, the objective is to carry out a bibliographic review to elucidate the characteristics of its use, effects and benefits. The literature available in the main databases offers very optimistic results. It has been shown that PRP favors endometrial regeneration and folliculogenesis as well as restoration of the menstrual cycle, which may be useful in patients with thin endometrium refractory to classical treatments, chronic endometritis, repeated implantation failure, early ovarian failure or Asherman's syndrome. However, there are few studies and they have a small sample size, so it is necessary to continue and expand the research on PRP.
{"title":"Uso de plasma rico en plaquetas en el campo de la reproducción humana asistida","authors":"P. Luque González , M. Pineda Mateo , J. Rodríguez Sánchez-Reyman","doi":"10.1016/j.gine.2024.101016","DOIUrl":"10.1016/j.gine.2024.101016","url":null,"abstract":"<div><div>Assisted reproductive therapies have a limited success rate. New therapies are currently being investigated to increase their effectiveness, such as the use of platelet-rich plasma (PRP). This agent has demonstrated efficacy at the level of regenerative medicine and consists of the administration of blood plasma extracted from the patient herself with a high platelet count. Given the recent incorporation of this treatment in clinical research, the objective is to carry out a bibliographic review to elucidate the characteristics of its use, effects and benefits. The literature available in the main databases offers very optimistic results. It has been shown that PRP favors endometrial regeneration and folliculogenesis as well as restoration of the menstrual cycle, which may be useful in patients with thin endometrium refractory to classical treatments, chronic endometritis, repeated implantation failure, early ovarian failure or Asherman's syndrome. However, there are few studies and they have a small sample size, so it is necessary to continue and expand the research on PRP.</div></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"52 1","pages":"Article 101016"},"PeriodicalIF":0.1,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142722615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1016/j.gine.2024.101005
Y. Barral , M. Vidal , S. Peralta , L. Magnano
In recent decades, the use of fertility preservation techniques in women with oncologic pathology has increased, aiming to improve their future reproductive prognosis. This trend is attributed to the increasing incidence of neoplasms in women of reproductive age, improved survival rates, and the progressive delay of motherhood. The gonadotoxicity of chemotherapy is influenced by factors like the patient's age, baseline ovarian reserve, and the type and cumulative dose of chemotherapy. Therefore, it is crucial to provide appropriate reproductive counseling and refer patients to specialized fertility preservation programs, where comprehensive assessment of gonadotoxic risk and individual patient risk are performed. Oocyte cryopreservation is the main technique for fertility preservation, non-experimental since 2013. Controlled ovarian stimulation starts at any phase of the menstrual cycle (random start), avoiding the delay in starting chemotherapy. In addition, the treatment with letrozole is recommended to breast cancer patients performing ovarian stimulation to prevent excessive increases in serum estrogen levels. The ovarian cortex cryopreservation is still considered experimental in many countries. However, it is performed in some cases, for example, when chemotherapy cannot be delayed for 2 weeks or in prepubertal patients. At the present time, gonadotropin-releasing hormone (GnRH) treatment is not regarded as a fertility preservation technique. However, it can be employed in certain clinical contexts.
{"title":"Bases fisiológicas, técnicas y principales indicaciones de preservación de la fertilidad en la paciente oncológica","authors":"Y. Barral , M. Vidal , S. Peralta , L. Magnano","doi":"10.1016/j.gine.2024.101005","DOIUrl":"10.1016/j.gine.2024.101005","url":null,"abstract":"<div><div>In recent decades, the use of fertility preservation techniques in women with oncologic pathology has increased, aiming to improve their future reproductive prognosis. This trend is attributed to the increasing incidence of neoplasms in women of reproductive age, improved survival rates, and the progressive delay of motherhood. The gonadotoxicity of chemotherapy is influenced by factors like the patient's age, baseline ovarian reserve, and the type and cumulative dose of chemotherapy. Therefore, it is crucial to provide appropriate reproductive counseling and refer patients to specialized fertility preservation programs, where comprehensive assessment of gonadotoxic risk and individual patient risk are performed. Oocyte cryopreservation is the main technique for fertility preservation, non-experimental since 2013. Controlled ovarian stimulation starts at any phase of the menstrual cycle (<em>random start</em>), avoiding the delay in starting chemotherapy. In addition, the treatment with letrozole is recommended to breast cancer patients performing ovarian stimulation to prevent excessive increases in serum estrogen levels. The ovarian cortex cryopreservation is still considered experimental in many countries. However, it is performed in some cases, for example, when chemotherapy cannot be delayed for 2 weeks or in prepubertal patients. At the present time, gonadotropin-releasing hormone (GnRH) treatment is not regarded as a fertility preservation technique. However, it can be employed in certain clinical contexts.</div></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"52 1","pages":"Article 101005"},"PeriodicalIF":0.1,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142528477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-19DOI: 10.1016/j.gine.2024.101000
A. Rodríguez Pérez , A. Caruso , M. Pantoja Garrido , I. Rodríguez Jiménez , A. Polo Velasco , J.J. Fernández Alba
Purpose
To evaluate the diagnostic accuracy of the International Ovarian Tumor Analysis (IOTA) Logistic Regression Model 1, 2 (LR1, LR2) ADNEX model and IOTA Simple Rules, in the pre-surgical evaluation of ovarian tumors classified as complex adnexal masses.
Methods
This is a cross-sectional observational study of diagnostic accuracy. We will select patients, who undergo surgical intervention due to adnexal mass with indeterminate, intermediate or high suspicion of malignancy (GI-RADS 4–5), as assessed by an expert ultrasound operator. We analyzed and compared the diagnostic performance and predictive capacity of the different models in the studied population, and also we analyzed each model by creating subgroups based on menopausal status.
Results
One hundred thirty five malignant masses (45%), one hundred forty benign (46.7%) and twenty five border line (8.3%) were included.
LR1 and LR2 models, and ADNEX were applicable to all lesions; however, in 72 lesions (24%), the simple rules were inconclusive.
We observed better performance for LR1 and simple rules, based on the following results: Sensitivity: LR1 91%. Specificity: simple rules 86%. PPV: simple rules 79%. NPV: LR1 88%.
Conclusions
Our study suggests that the subgroup of patients with complex adnexal masses, the IOTA risk stratification through LR1 shows higher sensitivity for risk stratification of malignancy, while simple rules has the highest specificity and diagnostic accuracy. However, it is inconclusive in one out of every four adnexal masses. Additionally, LR1–LR2 and ADNEX do not show significant differences in diagnostic accuracy.
{"title":"Diagnostic rentability of IOTA models for differentiating between benign and malignant complex adnexal masses","authors":"A. Rodríguez Pérez , A. Caruso , M. Pantoja Garrido , I. Rodríguez Jiménez , A. Polo Velasco , J.J. Fernández Alba","doi":"10.1016/j.gine.2024.101000","DOIUrl":"10.1016/j.gine.2024.101000","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the diagnostic accuracy of the <em>International Ovarian Tumor Analysis (IOTA)</em> Logistic Regression Model 1, 2 (LR1, LR2) ADNEX model and IOTA Simple Rules, in the pre-surgical evaluation of ovarian tumors classified as complex adnexal masses.</div></div><div><h3>Methods</h3><div>This is a cross-sectional observational study of diagnostic accuracy. We will select patients, who undergo surgical intervention due to adnexal mass with indeterminate, intermediate or high suspicion of malignancy (GI-RADS 4–5), as assessed by an expert ultrasound operator. We analyzed and compared the diagnostic performance and predictive capacity of the different models in the studied population, and also we analyzed each model by creating subgroups based on menopausal status.</div></div><div><h3>Results</h3><div>One hundred thirty five malignant masses (45%), one hundred forty benign (46.7%) and twenty five border line (8.3%) were included.</div><div>LR1 and LR2 models, and ADNEX were applicable to all lesions; however, in 72 lesions (24%), the simple rules were inconclusive.</div><div>We observed better performance for LR1 and simple rules, based on the following results: Sensitivity: LR1 91%. Specificity: simple rules 86%. PPV: simple rules 79%. NPV: LR1 88%.</div></div><div><h3>Conclusions</h3><div>Our study suggests that the subgroup of patients with complex adnexal masses, the IOTA risk stratification through LR1 shows higher sensitivity for risk stratification of malignancy, while simple rules has the highest specificity and diagnostic accuracy. However, it is inconclusive in one out of every four adnexal masses. Additionally, LR1–LR2 and ADNEX do not show significant differences in diagnostic accuracy.</div></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"52 1","pages":"Article 101000"},"PeriodicalIF":0.1,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142528478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1016/j.gine.2024.101002
L. Monroy Martínez , I. Da Cuña Carrera , A. Alonso Calvete , L. Núñez Remiseiro , M. Fernández Paz
Cesarean section is one of the most commonly performed surgeries in obstetrics and involves the removal of a neonate through an abdominal and uterine incision. This intervention can cause different consequences, such as pain, which can be treated using physiotherapy techniques. The objective of this work is to analyze the existing literature to know what the effects of physiotherapy are on pain after cesarean section. A bibliographic search was carried out in the databases PudMed, Cinahl, Medline, PEDro, Scopus, Web of Science and ENFISPO. The search terms «Pain», «Cesarean Section», «Physiotherapy», «Physical Therapy» and «Physical Therapy Modalities» were used. Studies were limited to randomized clinical trials published in English or Spanish. Of the 220 initial results, 12 articles were chosen for analysis. The therapies carried out were varied, including electrotherapy, massage therapy and cryotherapy to analyze different variables. Physiotherapy is beneficial in controlling pain in patients after a cesarean section through techniques such as TENS. Other therapies such as massage therapy and cryotherapy seem to obtain some improvements, but it cannot be concluded that they have significant benefits.
{"title":"Fisioterapia en el dolor tras cesárea","authors":"L. Monroy Martínez , I. Da Cuña Carrera , A. Alonso Calvete , L. Núñez Remiseiro , M. Fernández Paz","doi":"10.1016/j.gine.2024.101002","DOIUrl":"10.1016/j.gine.2024.101002","url":null,"abstract":"<div><div>Cesarean section is one of the most commonly performed surgeries in obstetrics and involves the removal of a neonate through an abdominal and uterine incision. This intervention can cause different consequences, such as pain, which can be treated using physiotherapy techniques. The objective of this work is to analyze the existing literature to know what the effects of physiotherapy are on pain after cesarean section. A bibliographic search was carried out in the databases PudMed, Cinahl, Medline, PEDro, Scopus, Web of Science and ENFISPO. The search terms «Pain», «Cesarean Section», «Physiotherapy», «Physical Therapy» and «Physical Therapy Modalities» were used. Studies were limited to randomized clinical trials published in English or Spanish. Of the 220 initial results, 12 articles were chosen for analysis. The therapies carried out were varied, including electrotherapy, massage therapy and cryotherapy to analyze different variables. Physiotherapy is beneficial in controlling pain in patients after a cesarean section through techniques such as TENS. Other therapies such as massage therapy and cryotherapy seem to obtain some improvements, but it cannot be concluded that they have significant benefits.</div></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"52 1","pages":"Article 101002"},"PeriodicalIF":0.1,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-14DOI: 10.1016/j.gine.2024.101003
A. Martínez-Varea
In recent years, there has been an increase in the age at which women conceive and have children, especially in developed countries.
This study aims to elucidate whether pregnancy at a very advanced maternal age is ethically acceptable or if it is better to promote pregnancy at a younger age. The specific objectives include evaluating the medical risks associated with pregnancy at a very advanced maternal age and analyzing the ethical and social implications of pregnancies at advanced maternal ages.
A systematic review was conducted using PubMed and Web of Science with the keywords pregnancy outcome, 45 years, 50 years, very advanced maternal age, menopause, ethics, bioethics. Studies published in the last 10 years in Spanish or English were included. Reviews, meta-analyses, clinical cases, letters to the editor, comments, and opinion articles were excluded.
The systematic review revealed that pregnancy at age 45 or older is associated with more adverse maternal-fetal outcomes compared to younger ages. Thus, patients of very advanced maternal age should receive appropriate prenatal counseling and close prenatal monitoring. Women of very advanced age wishing to conceive with their own oocytes should be informed about the low probabilities of success and high risk of embryonic aneuploidies. Preimplantation genetic diagnosis is recommended for women over 43 years with good ovarian reserve, and in vitro fertilization cycles should be limited to three for patients aged 44-45 years. Patients aged 45-46 years should be informed about the minimal probability of success with autologous oocytes.
As a conclusion, pregnancy at a very advanced maternal age is increasingly common and is considered ethically acceptable by both patients and specialists in reproductive medicine and obstetrics and gynecology.
本研究旨在阐明高龄产妇怀孕在伦理上是否可以接受，还是提倡在更年轻的年龄怀孕更好。具体目标包括评估与高龄产妇怀孕相关的医疗风险，并分析高龄产妇怀孕的伦理和社会影响。我们使用 PubMed 和 Web of Science 进行了系统性综述，关键词为妊娠结果、45 岁、50 岁、高龄产妇、绝经、伦理、生物伦理学。纳入了过去 10 年中以西班牙语或英语发表的研究。系统综述显示，45 岁或以上妊娠与年轻妊娠相比，会导致更多不良的母胎结局。因此，高龄产妇应接受适当的产前咨询和密切的产前监护。希望用自己的卵细胞受孕的高龄产妇应了解胚胎非整倍体的低成功率和高风险。建议对 43 岁以上、卵巢储备良好的女性进行胚胎植入前遗传学诊断，44-45 岁的患者体外受精周期应限制在三个以内。总之，高龄产妇怀孕越来越常见，而且患者和生殖医学及妇产科专家都认为这在伦理上是可以接受的。
{"title":"¿Es la gestación a edad materna muy avanzada éticamente aceptable?","authors":"A. Martínez-Varea","doi":"10.1016/j.gine.2024.101003","DOIUrl":"10.1016/j.gine.2024.101003","url":null,"abstract":"<div><div>In recent years, there has been an increase in the age at which women conceive and have children, especially in developed countries.</div><div>This study aims to elucidate whether pregnancy at a very advanced maternal age is ethically acceptable or if it is better to promote pregnancy at a younger age. The specific objectives include evaluating the medical risks associated with pregnancy at a very advanced maternal age and analyzing the ethical and social implications of pregnancies at advanced maternal ages.</div><div>A systematic review was conducted using PubMed and Web of Science with the keywords pregnancy outcome, 45 years, 50 years, very advanced maternal age, menopause, ethics, bioethics. Studies published in the last 10 years in Spanish or English were included. Reviews, meta-analyses, clinical cases, letters to the editor, comments, and opinion articles were excluded.</div><div>The systematic review revealed that pregnancy at age 45 or older is associated with more adverse maternal-fetal outcomes compared to younger ages. Thus, patients of very advanced maternal age should receive appropriate prenatal counseling and close prenatal monitoring. Women of very advanced age wishing to conceive with their own oocytes should be informed about the low probabilities of success and high risk of embryonic aneuploidies. Preimplantation genetic diagnosis is recommended for women over 43 years with good ovarian reserve, and in vitro fertilization cycles should be limited to three for patients aged 44-45 years. Patients aged 45-46 years should be informed about the minimal probability of success with autologous oocytes.</div><div>As a conclusion, pregnancy at a very advanced maternal age is increasingly common and is considered ethically acceptable by both patients and specialists in reproductive medicine and obstetrics and gynecology.</div></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"52 1","pages":"Article 101003"},"PeriodicalIF":0.1,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142433429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-11DOI: 10.1016/j.gine.2024.101004
L. Arce Gálvez , R.E. Valencia Gómez , A. Ceballos Vejarano , J. Daes Mora , D.A. Méndez Vega
Introduction
The erector spinae plane block is a useful intervention in the management of somatic and visceral nociceptive pain at different spinal levels. Studies of its use during pregnancy are still limited, however, it has shown interesting results in the management of non-obstetric pain during pregnancy.
Clinical case
We present the case of a 27.5-week pregnant woman with a history of pancreatitis and a thoracotomy with neuropathic pain at intercostal level and repeated emetic symptoms who was taken to an ESP at T6 level with a sudden improvement of her symptomatology, without side effects or maternal–fetal damage.
Conclusion
This is the first description of the use of ESP blockade in intercostal pain during gestation, where we highlight its clinical efficacy and maternal–fetal safety profile.
{"title":"Management of thoracic neuropathic pain with an ESP block in a pregnant patient","authors":"L. Arce Gálvez , R.E. Valencia Gómez , A. Ceballos Vejarano , J. Daes Mora , D.A. Méndez Vega","doi":"10.1016/j.gine.2024.101004","DOIUrl":"10.1016/j.gine.2024.101004","url":null,"abstract":"<div><h3>Introduction</h3><div>The erector spinae plane block is a useful intervention in the management of somatic and visceral nociceptive pain at different spinal levels. Studies of its use during pregnancy are still limited, however, it has shown interesting results in the management of non-obstetric pain during pregnancy.</div></div><div><h3>Clinical case</h3><div>We present the case of a 27.5-week pregnant woman with a history of pancreatitis and a thoracotomy with neuropathic pain at intercostal level and repeated emetic symptoms who was taken to an ESP at T6 level with a sudden improvement of her symptomatology, without side effects or maternal–fetal damage.</div></div><div><h3>Conclusion</h3><div>This is the first description of the use of ESP blockade in intercostal pain during gestation, where we highlight its clinical efficacy and maternal–fetal safety profile.</div></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"52 1","pages":"Article 101004"},"PeriodicalIF":0.1,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gestational cancer affects approximately 1 in 1,000 pregnant women, with renal cell carcinoma (RCC) being the most common in the urinary tract. RCC dissemination can include cutaneous metastases in 2.8-6.8% of cases. A multidisciplinary approach to RCC during pregnancy is crucial due to diagnostic and therapeutic challenges that can impact maternal and neonatal outcomes.
Symptoms and Clinical Findings
A 15-week pregnant woman presents with asymptomatic cutaneous lesions for 4 months. Physical examination reveals two erythematous-violaceous nodules in the right hypochondrium and two in the right thigh, all adherent to deep planes and without palpable lymphadenopathy.
Diagnosis, Therapeutic Intervention, and Results
Excisional skin biopsy with immunohistochemical and molecular studies suggests cutaneous metastasis of papillary-pattern renal carcinoma. Nuclear magnetic resonance reveals multiple metastatic implants and lymphadenopathies. Despite recommendations to terminate pregnancy for targeted therapy, the patient chooses to continue. At week 31, a cesarean section is performed due to maternal clinical deterioration from disease progression. Oncologic treatment with Cabozantinib begins postpartum. Six months later, the patient remains stable with significant lesion improvement.
Conclusion
Diagnosing cancer during pregnancy presents a complex challenge, balancing maternal prognosis with fetal health is critical. Emphasizing a multidisciplinary approach and early consultation optimizes both clinical and emotional management.
{"title":"Diagnóstico de cáncer renal metastásico en gestante a través de lesiones cutáneas: descripción de un caso clínico","authors":"A. Ramírez Castán , M.J. Cuerva González , J.L. Bartha Rasero","doi":"10.1016/j.gine.2024.100999","DOIUrl":"10.1016/j.gine.2024.100999","url":null,"abstract":"<div><h3>Introduction</h3><div>Gestational cancer affects approximately 1 in 1,000 pregnant women, with renal cell carcinoma (RCC) being the most common in the urinary tract. RCC dissemination can include cutaneous metastases in 2.8-6.8% of cases. A multidisciplinary approach to RCC during pregnancy is crucial due to diagnostic and therapeutic challenges that can impact maternal and neonatal outcomes.</div></div><div><h3>Symptoms and Clinical Findings</h3><div>A 15-week pregnant woman presents with asymptomatic cutaneous lesions for 4 months. Physical examination reveals two erythematous-violaceous nodules in the right hypochondrium and two in the right thigh, all adherent to deep planes and without palpable lymphadenopathy.</div></div><div><h3>Diagnosis, Therapeutic Intervention, and Results</h3><div>Excisional skin biopsy with immunohistochemical and molecular studies suggests cutaneous metastasis of papillary-pattern renal carcinoma. Nuclear magnetic resonance reveals multiple metastatic implants and lymphadenopathies. Despite recommendations to terminate pregnancy for targeted therapy, the patient chooses to continue. At week 31, a cesarean section is performed due to maternal clinical deterioration from disease progression. Oncologic treatment with Cabozantinib begins postpartum. Six months later, the patient remains stable with significant lesion improvement.</div></div><div><h3>Conclusion</h3><div>Diagnosing cancer during pregnancy presents a complex challenge, balancing maternal prognosis with fetal health is critical. Emphasizing a multidisciplinary approach and early consultation optimizes both clinical and emotional management.</div></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"52 1","pages":"Article 100999"},"PeriodicalIF":0.1,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-30DOI: 10.1016/j.gine.2024.100998
M.I. Limia Pérez , J.A. Moreno Domingo , L. Juez González , M.J. Fernández Mellado , S. Ajuriagogeaskoa , L. Muñoz Arberas , A. Urones Goikoetxea
Main symptoms and/or clinical findings
Breast sarcoma is a very rare entity that constitutes only 1% of all primary malignant breast tumors. It has a very poor prognosis with a high risk of recurrence. In this article, we present the case of a patient diagnosed with breast liposarcoma after having received radiotherapy for a previous breast carcinoma.
Main diagnoses
Due to the rarity of breast liposarcoma, it is important to make an adequate differential diagnosis. In our case, the study of overexpression of the MDM2 and/or CDK4 proteins allowed us to establish the definitive diagnosis.
Therapeutic interventions and results
The patient in our case underwent surgery, obtaining tumor-free margins with a favorable subsequent evolution. She currently has 18 months of disease-free survival.
Conclusion
The treatment of breast liposarcoma is mainly surgical since this sarcoma has a poor response to both chemotherapy and radiotherapy. The correct tumor resection is the most important prognostic factor for local control of the disease and long-term survival.
{"title":"Descripción de un caso: liposarcoma de mama radioinducido","authors":"M.I. Limia Pérez , J.A. Moreno Domingo , L. Juez González , M.J. Fernández Mellado , S. Ajuriagogeaskoa , L. Muñoz Arberas , A. Urones Goikoetxea","doi":"10.1016/j.gine.2024.100998","DOIUrl":"10.1016/j.gine.2024.100998","url":null,"abstract":"<div><h3>Main symptoms and/or clinical findings</h3><div>Breast sarcoma is a very rare entity that constitutes only 1% of all primary malignant breast tumors. It has a very poor prognosis with a high risk of recurrence. In this article, we present the case of a patient diagnosed with breast liposarcoma after having received radiotherapy for a previous breast carcinoma.</div></div><div><h3>Main diagnoses</h3><div>Due to the rarity of breast liposarcoma, it is important to make an adequate differential diagnosis. In our case, the study of overexpression of the MDM2 and/or CDK4 proteins allowed us to establish the definitive diagnosis.</div></div><div><h3>Therapeutic interventions and results</h3><div>The patient in our case underwent surgery, obtaining tumor-free margins with a favorable subsequent evolution. She currently has 18<!--> <!-->months of disease-free survival.</div></div><div><h3>Conclusion</h3><div>The treatment of breast liposarcoma is mainly surgical since this sarcoma has a poor response to both chemotherapy and radiotherapy. The correct tumor resection is the most important prognostic factor for local control of the disease and long-term survival.</div></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"52 1","pages":"Article 100998"},"PeriodicalIF":0.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142358184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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