Clinica e Investigacion en Ginecologia y Obstetricia最新文献

Introduction

Primary involvement of the female genital tract by non-Hodgkin lymphoma is very rare, so there is no consensus on treatment, and for this reason we present this clinical case and the treatment performed, as well as the prognosis of our patient.

Clinical findings

The patient presented is a 72-year-old woman who consulted for vaginal bleeding.

Diagnosis

Primary extranodal non-Hodgkin lymphoma of the cervix with immunophenotype B of high cytological grade and high proliferative index was diagnosed.

Therapeutic interventions and results

The treatment of choice was chemotherapy only. This patient has presented a disease-free survival of 5 years. It is currently being monitored by carrying out annual analytical controls.

Conclusion

The symptoms of this type of tumor are highly non-specific, as well as cytology is frequently negative, which is why it is necessary to resort to biopsy. Immunohistochemistry is essential for both diagnosis and prognosis. There are multiple imaging techniques used for both extension study and follow-up, highlighting the role of FDG-PET.

It currently seems that the most recommendable treatment is the R-CHOP chemotherapy regimen followed by radiotherapy.

The prognosis is generally good, with up to 80% survival at 5 years.

The definitive diagnosis of ovarian cancer requires histological confirmation. In certain situations, to avoid the morbidity of surgical resection, it is possible to perform an ultrasound-guided biopsy to obtain the pathological diagnosis. The aim of this systematic review was to assess the adequacy, reliability, accuracy, and safety profile of ultrasound-guided biopsy of ovarian masses. Following the PRISMA 2020 model, a bibliographic search was carried out in PubMed, Embase and Scopus, collecting a total of 10,245 articles, of which 24 were finally included. The studies mainly included patients with advanced inoperable tumors, poor performance status and other poor prognostic factors, with masses of solid content and irregular margins, generally accessible through the transvaginal route. In most of the articles, the patients had a previous history of malignancy or had inoperable tumors in advanced stages. Biopsiable ovarian masses were defined ultrasonographically as malignant or potentially malignant, mainly highlighting the presence of a solid or mixed component and irregular or heterogeneous margins. The most widely used technique in the included studies was core needle or tru-cut biopsy, presenting high values of adequacy, reliability, precision and performance, as well as a good safety profile with low complication rates. In conclusion, ultrasound-guided core needle biopsy of adnexal masses in patients eligible for neoadjuvant treatment is a technique with high adequacy, reliability, and precision rates, as well as a good safety profile.

Introduction

Ovarian fibrosarcoma is an extremely rare malignant ovarian stromal tumor, with few cases reported in the literature.

Main symptoms and/or clinical findings

A 56-year-old posmenopausal woman with scant vaginal bleeding of several days’ duration and pain in the right iliac fossa without fever or digestive symptoms. The gynecological examination was normal.

Main diagnoses, therapeutic interventions and results

Transvaginal ultrasound showed a homogeneous endometrium, a 2.4 × 1 cm myoma, and a heterogeneous solid-cystic lesion with thick septa measuring 6.4 × 6.8 cm in the left ovary. An intraoperative histological study was performed, which was reported as: solid neoplasm suspicious of malignancy. Hysterectomy plus double adnexectomy, omentectomy, and lymphadenectomy were performed. Histologically, the neoplasm was made up of spindle cells arranged in sheets and intertwined fascicles with a diffuse spike-like appearance, with moderate nuclear atypia, areas of necrosis and hemorrhage foci; 12 mitoses were identified for every 10 high-power fields. Immunohistochemically the cells were positive for inhibin, actin 1A4, vimentin, calretinin, CD56 and CD99. The proliferative rate with Ki-67 was 25%. The definitive diagnosis was: primary ovarian fibrosarcoma. One year later, the patient is free of the disease without any adjuvant treatment and continues to be followed up.

Conclusion

Ovarian fibrosarcoma is an exceptional malignancy with a poor prognosis. Currently, the treatments and prognostic factors for ovarian fibrosarcoma are still the subject of debate. This case highlights the important role of the intraoperative study and immunohistochemistry for its correct diagnosis.

Remnant ovarian syndrome is the persistence of ovarian cortex after a deficient resection, mainly after oophorectomy. It is a misdiagnosed condition that significantly affects patients. It is typical from endometriosis, pelvic inflammatory disease or previous multiple surgeries. Our objectives are to review the current evidence to determine clinic features, differential diagnosis, treatment and preventive strategies. For this, we have carried out a bibliographic literature search through the PubMed, Medline, Embase, BioMed Central and SciELO databases.We conclude that this pathology should be included in the differential diagnosis in patients with chronic pelvic pain who have undergone oophorectomy. Its treatment is surgical, being the laparoscopic approach the gold standard. It allows a better anatomic exposure, with lower blood loss, complication rate and hospital stay. Isolating the infundibulopelvic ligament in the retroperitoneal space during the oophorectomy is the main strategy to prevent this complication.

Introduction

Herlyn–Werner–Wünderlich syndrome is a uterine malformation characterized by uterus didelphys, obstructed hemivagina and ipsilateral renal agenesis.

Clinical findings

The manifestation of the disease is widely diverse; it is usually diagnosed after menarche, with dysmenorrhea and abnormal uterine bleeding; it is also associated with infertility.

Main diagnosis

Four clinical cases, their diagnosis are reported here.

Therapeutic interventions and results

The treatment and results of these four patients are described here.

Conclusion

When studying uterine malformation it is important to consider this rare disease to avoid possible complications and giving the patient a correct diagnose and treatment. The hysteroscopy resection of the longitudinal vaginal septum in those symptomatic patients with hematocolpos should be considered as a good option for treatment.

Polycystic ovary syndrome (PCOS) is a female endocrinopathy recognized as a heterogeneous disorder characterized by hyperandrogenism and ovulatory dysfunction that leads to fertility problems. In addition, patients usually present with associated symptoms such as insulin resistance, glucose intolerance, central obesity and/or metabolic syndrome that can induce an increased risk of cardiovascular disease. Since one of the main goals of PCOS is to reduce the metabolic consequences related to obesity, insulin resistance, and the metabolic syndrome, targeted dietary interventions may be effective in treating PCOS.

A bibliographic search has been carried out in different databases such as Web of Science, Pubmed and Google Scholar, establishing previously defined search criteria. Eleven have been chosen for full review and critical analysis. Among the different interventions that have been used, dietary strategies have been followed such as the dietary approaches to stop hypertension (DASH), modifications in carbohydrates, the inclusion of a certain food in the usual dietary pattern and/or lifestyle modifications. Of the results obtained, we highlight the improvements in body markers with a DASH diet, the benefits promoted by diets with modifications in carbohydrates, in insulin resistance and hormonal markers and favorable effects on clinical manifestations related to hyperandrogenism, fostered by soy consumption and lifestyle modifications.

Objective

The objectives were to estimate the performance of the IOTA-ADNEX model test after its incorporation into the ultrasound tests of our third-grade hospital gynecology service, as well as to assess whether its capacity of accuracy is modified when taking into account the patient's menopausal status.

Methods

A cross-sectional study was conducted to clinically evaluate the diagnostic performance of the IOTA-ADNEX model test, which was performed between January 2016 and December 2021. The study included 573 women with an adnexal injury who underwent surgical excision within 180 days after ultrasound diagnosis and histological confirmation (gold standard). After the ultrasound exam, the injuries were classified using the ADNEX model. The study estimated the area under the receiver-operating-characteristics curve (AUC) of the ADNEX model for classifying between benign and malignant adnexal masses and compared the performance by menopausal state. Sensitivity and specificity were determined for different cut-off points.

Results

Out of the 573 women, 183 (31.9%) had a malignant tumor. The AUC of the ADNEX model for differentiating between benign and malignant adnexal masses at the time of ultrasound examination was 0.92 and the best malignancy threshold, detected by Youden index, was 22.5%. At this cut-off, the sensitivity of the ADNEX model was 91.8% and the specificity was 76.4%. However, it varies according to menopausal status: in the group of pre-menopausal patient, sensitivity was 86.1% (95% CI, 85.4%–86.8%) and specificity was 81.3% (95% CI, 85.4%–86.8%). In the postmenopausal group, sensitivity was 96.1% (95% CI, 95.6%–96.7%) and specificity was 68.5% (95% CI, 68.1%–68.8%).

Conclusions

The IOTA-ADNEX model is a reliable diagnostic tool to discard ovarian cancer. However, the accuracy of the test, at the same cut-off point, varies according to the menopausal state of the patient so it may be important to take it into account when taking decisions in clinical practice.

Introduction

Pregnancy represents a procoagulant state that increases women's risk of thrombotic phenomena. As in the non-pregnant population, we must diagnose and treat these events as early as possible to avoid the migration of the thrombus to other locations. Anticoagulation is the first-line therapeutic measure. However, certain situations of increased bleeding such as labor may be a contraindication to initiate such anticoagulation. The following article develops a clinical case in which the deep vein thrombosis diagnosis occurred at the onset of labor.

Main symptoms and/or clinical findings

Increase in diameter of the left lower limb, with redness of the same and increase in local temperature. The patient described pain at the level of this limb for 15 days. He had no dyspnea and oxygen saturation was 100%.

Main diagnoses

Deep vein thrombosis, labor.

Therapeutic interventions

The contraindication of anticoagulation and the need for immediate treatment raised the inferior vena cava filter as the most reasonable option.

Results

After the placement of the filter, the delivery proceeded without incident. The plunger did not migrate and the filter was removed 29 days after delivery without complications.

Conclusion

Despite our limited clinical experience in the management of these cases, we can affirm that the inferior vena cava filter represents a reasonable and safe option in cases of thrombosis of the lower limbs in women in labor.

Objective

The aim of this study is to determine the financial burden of preeclampsia (PE) from a single institution's perspective and then determine the cost of the illness from the reimbursement institution perspective and finally draw a regression model that predicts the annual cost of a patient.

Materials and methods

The research is a descriptive and cross-sectional type of research and a retrospective cost analysis. Patients diagnosed with PE in 2021 were included in the study. For the regression analysis of the study, a dataset with 29 parameters belonging to 65 patients was created. Regression models were built on top of it.

Results

In our study, per-patient expenses of PE patients from the perspective of the reimbursement institution were calculated and presented as average costs; severe PE patient with cesarean section 7598.5 Ł ($769.8), severe PE patient with normal vaginal delivery 8487.48 Ł (1050.43 $), mild PE patient with cesarean section 5331.67 Ł ($659.86) and mild PE patient with normal vaginal delivery was calculated as 6220.65 Ł (769.88 $). In the study, different regression formulas were created for the two groups of PE. The created regression model had an R² score of 91.85%.

Conclusion

The actors involved in the management of the disease should determine the cost-effectiveness of the disease by using the financial data of the patients and choose the right approach. Health costs in Turkey differ from the parameters in the European Union economy. Therefore, there are lower health costs. The financial findings of the disease are a guide for health policy makers, health managers and researchers.