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A clinical case of placental site trophoblastic tumor, is presented in a patient of 27 years old. Diagnosis, clinical behavior and treatment are emphasized in this very infrequent pathology.

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Three extracorporal uterine endometrial stromal-like sarcomas are reported. One of them was a bilateral ovarian sarcoma, with extensive infiltration and vascular compromise of paratubarian tissues, parametrium, omentum, and periureteral tissue. Endometriotic foci were also found in the ovaries and periureteral tissue. The other two cases corresponded to localized polypoid lesions of the endocervical and vaginal mucosa, respectively. None of these cases was associated with endometriosis. Histologically, the tumors were made up of rounded cells, with scant cytoplasm, numerous small vessels and low mitotic index. The findings correspond to those of low grade endometrial stromal sarcomas. The present cases emphasize the multipotentiality of müllerian organs. Not only different types of paramesonephric epithelial tumors can develop from these organs, but also different müllerian sarcomas.

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A uterine smooth muscle tumor belonging to the category of unknown malignant potential in a 20-year-old woman is reported. The major axis of the tumor was 5 cm, and the tumor was soft and homogeneous. Histologically, it was composed of cellular groups, arranged in an epithelioid pattern, with hyaline bands dissecting the groups, moderate nuclear hyperchromasia and pleomorphism, and mitotic index of 2 per 10 high power fields; the tumor had infiltrating margins and tumoral vascular invasions were found. Immunohistochemically, the tumor was positive for vimentin, and negative for keratins, desmin, actin, and S 100 protein. Epithelioid smooth muscle tumors of the uterus should be classified as tumors of unknown malignant potential under the following conditions: if they are larger than 5 cm, if they show at least moderate cellular pleomorphism, if their mitotic index is at least 1 per 10 high power fields, or if they show cellular necrosis. The present immunohistochemical findings suggest more a fibroblastic than a smooth muscle cell origin of this neoplasm.

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Between 1987 to 1992, nine patients with metastatic ovarian tumors of extragenital origin were analyzed. Seven corresponded to Krükenberg tumors, according to the traditional description of carcinoma with signet-ring cells and stroma with sarcomatoid reaction. The primary neoplasia was detected in 8 patients (89%) and corresponded to: gastric cancer (n = 4), colon cancer (n = 2), gallbladder cancer (n = 1) and breast cancer (n = 1). Mean survival in these patients was 11 months (range 4 to 20 months). Irrespective of their histology and origin, all the lesions were found to share similar macroscopic characteristics: bilateral enlarged ovaries, solid and embossed appearance.

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Three hundred and five patients undergoing exploratory laparotomy by adnexial tumors in our institution from January 1987 to October 1992 were studied. The results of the frozen sections vs permanent sections were compared. The diagnosis was concordant in 98.7% of the cases. Sensitivity was 96.9% and specificity was 99.6%. These results consagrate frozen sections as an accuracy and efficient intraoperative diagnostic form in the ovary tumoral pathology.

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One observed case of verrucous carcinoma involving the uterine cervix is presented. Both clinical and pathologic aspects, and pertinent literature are discussed.

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"Second look" laparotomy in ovarian cancer demonstrated negative result in 49%, microscopic positive result in 17%, and macroscopic positive result in 34%. The prediction factors were related with, clinical stage, degree of differentiation and the postsurgical residual tumors after the first operation.

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Twenty patients bearing lesions caused by human papillomavirus and intraepithelial neoplasia of the lower genital tract and treated with electrosurgical excision of the lesions are presented. The technique used, the benefits of the histopathologic assessment of the specimen, and the changes that this procedure produces in the specimen tissue are analyzed. In general terms, the pre and postoperative diagnosis were concordant and the early and late morbidity was found to be not significative. The efficacy of this therapy in the long term remains to be evaluated.

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Dermatomyositis (DM) is associated to malignant neoplasia in up to one third of the cases. Not considering breast neoplasia, ovarian cancer is the malignancy most frequently associated with DM in women. This study shows the evolution and outcome of a case of this association managed in our unit. The principal features of similar cases reported in the literature are summarized.

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The accuracy of frozen section biopsy was evaluated determining the deep of myometrial invasion in 30 samples of hysterectomies performed because of endometrial cancer. Results were compared with the definitive biopsy. Two sections were performed guided by the site of largest lesion seen when the uterus was sectioned in a frontal plane. The diagnosis of myometrial invasion was well determined in 29 cases with a 96.6% of accuracy. We conclude that frozen section is an exact and low cost method to determine intraoperatively, deep of myometrial invasion. This method helps the surgeon to decide the extent of surgery, specially if lymphadenectomy is necessary, during staging laparotomy.

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Twenty seven female patients immunosuppressed after renal transplantation were studied. Cytological, colposcopic and histologic studies of biopsies were used to determine the incidence of neoplastic intraepithelial lesions and those due to infection by human papilloma virus. Intraepithelial neoplasia was found in 7.4% and papilloma virus infection in 60%. Cervix cytology was insensitive (33%) for diagnosis of intraepithelial lesions. Therefore, cytology and colposcopy are recommended for routine follow up of immunosuppressed women.

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We present the results on the treatment of 43 patients with epithelial ovarian cancer excluding borderline tumours. Nine cases were FIGO Stage I, 4 FIGO Stage II, 24 FIGO Stage III and 6 FIGO Stage IV. The protocol consists in cytoreductive surgery followed by chemotherapy for Stages I, III, and IV, mainly using cisplatin + cyclophosphamide (PC) or cisplatin + adriamycin + cyclophosphamide (PAC). We used pelvis and whole abdomen radiotherapy for patients on Stage II. The follow up was between 26 and 76 months. The undifferentiated tumours had bad prognosis in Stage I, instead of receiving chemotherapy. Radiotherapy for patients on Stage II reached satisfactory local regional disease control but with late recurrences. On Stage III, size of residual tumour less than 2 cm on primary surgery was of good prognosis (60% 44 months survival). The addition of adriamycin to PC seems to be of no benefit in long term results. The five year actuarial survival was 44% for FIGO Stage I, 75% for FIGO Stage II, 16% for FIGO Stage III and 0% for FIGO Stage IV. These results don't differ significantly from similar protocols.

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Complications of radical surgery in 60 cases of cervicouterine cancer are presented with the purpose of evaluating the morbi-mortality associated with this treatment. Radical hysterectomy with pelvic lymphadenectomy was the most frequent surgery. Intraoperative complications reached to 13.3%; the most frequent was the vascular venous lesion. Minor postoperative complications reached to 15% and majors to 6.7%. There was no mortality associated with the treatment. Five year survival for this series was 91% for FIGO Stage IB and 86% for FIGO Stage IIA.

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Higher folate needs are present during pregnancy, which may lead to tissular deficiency in the mother and to depleted newborn folate reserves. The aim of this work was to assess the prevalence of folate deficiency and to establish the rates of serum and red cell folate in two groups of mothers and newborn infants, one receiving only iron and the other iron and folate during pregnancy. The rates of serum and red cell folate found at the end of pregnancy were significantly higher in the group which received folate; however, the percentage of cases with tissular folate deficiency was low in both groups, with no significant difference (3.8% and 1.3%, respectively). These findings, along with the lack of effect of supplemental folate on erythropoiesis, pose some questions on the usefulness of supplemental folate during pregnancy in our country.

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Between July 1978 and November 1985, 73 abdominal operations were performed for the surgical correction of genuine stress incontinence using the Marshall-Marchetti-Krantz technique. Non-absorbable suture materials were used in the vesicourethropexy in 30 case (41%) and absorbable suture materials in 43 cases (59%). A relapse was not observed after two years of follow-up in the group of patients operated on with nonabsorbable suture materials while a relapse of 5% after one month, 14% after six months, 22% after one year and 44% after two years was observed in the group of patients operated on with absorbable suture materials. A statistically significant difference was found between both groups after one year (p = 0.031) and after two years (p = 0.012) of follow up. The postoperative complications were similar in both groups, urinary infection being the most frequent one. We conclude that nonabsorbable suture materials offer definitive advantages with respect to absorbable suture materials in the abdominal surgical correction of genuine stress incontinence.

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CA-125 levels were measured in 27 normal women, 11 with benign gynecologic pathology and 13 with ovarian cancer in different stages of evolution. The analysis of data was made retrospectively. Considering a level of 65 U/ml as normal, no false positives were found. Patients with benign gynecologic pathology behave as the normal ones with no significative differences in their levels. Levels higher that 65 U/ml were always found in women with ovarian cancer. There were 4 patients with negative levels and clinically or surgically verified disease. Positive levels correlated with histologic type and with surgical staging. In patients with serial levels, decrease in tumoral volume was correlated with decrease in levels. These data suggest that the behaviour of CA-125 in our local population is the same as reported in the literature. It is useful, when is positive, in follow-up, management and prognosis of patients with ovarian cancer. Its negativity is not guarantee of cure and positive levels make evident the presence of the disease. It is a poor diagnostic method because of its low sensitivity.

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