RESUMEN
INTRODUCTION: Gestational trophoblastic neoplasia (GTN) is a rare tumor that arises from trophoblastic tissues with high remission rates after chemotherapy treatment. GTN can develop from any gestational events, such as miscarriage, ectopic pregnancy, and preterm/term pregnancy, but is more frequent after hydatidiform mole. The sensitivity of this tumor to chemotherapy and the presence of an exceptional tumor marker allow high remission rates, especially when patients are treated in referral centers. AREAS COVERED: Observational, retrospective, prospective, systematic reviews, and meta-analysis studies focusing on GTN treatment. We searched PubMed, Medline, and the Library of Congress from January 1965 to May 2022. EXPERT OPINION: Early GTN diagnosis allows low-toxic and highly effective treatment. Even multimetastatic disease has high rates of remission with multiagent regimen chemotherapy. Surgery is reserved for uterine disease in patients who have completed childbearing, in cases of chemoresistance to multiagent regimens or in the rare cases of placental site trophoblastic tumor or epithelioid trophoblastic tumor. While resistance is managed by salvage chemotherapy, cases with limited clinical response to sequential regimens have been successfully treated with immunotherapy.
Asunto(s)
Enfermedad Trofoblástica Gestacional , Neoplasias Uterinas , Recién Nacido , Embarazo , Humanos , Femenino , Estudios Retrospectivos , Estudios Prospectivos , Placenta/patología , Enfermedad Trofoblástica Gestacional/tratamiento farmacológico , Enfermedad Trofoblástica Gestacional/diagnóstico , Enfermedad Trofoblástica Gestacional/patología , Neoplasias Uterinas/tratamiento farmacológicoRESUMEN
Introducción: Los leiomiomas uterinos son los tumores pélvicos benignos más comunes entre las mujeres. Se estima que 60% de las mujeres llegan a tener miomatosis a lo largo de la vida (1). La necesidad de tratamiento médico y/o quirúrgico es muy importante de evaluar, ya que los fibromas son una fuente importante de morbilidad ginecológica. Objetivos: Describir el caso de un gran mioma uterino con manejo prequirúrgico de análogos de GnRH, analizando los hallazgos obtenidos en el caso según la evidencia actual. Discusión: Se reporta el caso de una mujer de 29 años sin antecedentes mórbidos conocidos, con presencia de una gran masa abdominal, motivo por el cual se realizó una ecotomografía abdominal que evidenció una masa sugerente de un gran mioma uterino subseroso. Se realizó miomectomía vía laparotomía previo tratamiento médico con análogos de GnRH. Actualmente la frecuencia de miomas de gran tamaño es poco frecuente, por lo que se busca discutir el impacto del tratamiento médico previo a la cirugía en mujeres jóvenes. Conclusiones: La experiencia con el uso prequirúrgico de agonistas de GnRH indica una ventaja en el trabajo bien definida y su uso como tratamiento coadyuvante a la cirugía está bien establecido. Sin embargo, se debe tener en cuenta la posibilidad de recurrencia de los miomas
Introduction: Uterine leiomyomas are the most common benign pelvic tumors in women. It is estimated that 60% of women develop myomatosis throughout life (1). The need for medical and / or surgical treatment is very important to assess, since fibroids are an important source of gynecological morbidity. Objectives: To describe the case of a large uterine myoma with presurgical management of GnRH analogues and to summarize updated evidence on their use. Discussion: The case of a 29-year-old woman with no known morbid history is reported, with the presence of a large abdominal mass, which is why an abdominal ultrasound scan was performed, which revealed a mass suggestive of a large subserous uterine myoma. Myomectomy was performed via laparotomy after medical treatment with GnRH analogues. Currently, the frequency of large fibroids is rare, so we seek to discuss the impact of medical treatment prior to surgery in young women. Conclusions: Experience with the presurgical use of GnRH agonists indicates a well-defined treatment advantage and its use as adjunctive treatment to surgery is well established. However, the possibility of recurrence of fibroids should be taken into account
Asunto(s)
Humanos , Femenino , Adulto , Neoplasias Uterinas/tratamiento farmacológico , Hormona Liberadora de Gonadotropina/uso terapéutico , Leiomioma/cirugía , Leiomioma/tratamiento farmacológico , Procedimientos Quirúrgicos Ginecológicos , Neoplasias Uterinas/diagnóstico por imagen , Leiomioma/diagnóstico por imagenRESUMEN
Reproductive cancers in both genders represent serious health problems, whose incidence has significantly risen over the past decades. Although considerable differences among reproductive cancers exist, we aimed to identify similar signaling pathways and key molecular oncomarkers shared among six human reproductive cancers that can advance the current knowledge of cancer biology to propose new strategies for more effective therapies. Using a computational analysis approach, here we uncover aberrant miRNAs-mRNAs networks shared in six reproductive tumor types, and identify common molecular mechanisms strictly associated with cancer promotion and aggressiveness. Based on the fact that estrogenic and androgenic signaling pathways were most active in prostate and breast cancers, we further demonstrated that both androgen and estrogen deprivation therapy are capable of regulating the expression of the same key molecular sensors associated with endoplasmic reticulum dysfunction and cell cycle in these cancers. Overall, our data reveal a potential mechanistic framework of cellular processes that are shared among reproductive cancers, and particularly, highlight the importance of hormonal deprivation in breast and prostate cancers and potentially new biomarkers of response to these therapeutic approaches.
Asunto(s)
Neoplasias de la Mama/genética , Biología Computacional/métodos , Neoplasias Endometriales/genética , Redes Reguladoras de Genes , MicroARNs/genética , Neoplasias de Células Germinales y Embrionarias/genética , Neoplasias Ováricas/genética , Neoplasias de la Próstata/genética , Neoplasias Testiculares/genética , Neoplasias Uterinas/genética , Antagonistas de Andrógenos/farmacología , Antagonistas de Andrógenos/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Bases de Datos Genéticas , Neoplasias Endometriales/tratamiento farmacológico , Antagonistas de Estrógenos/farmacología , Antagonistas de Estrógenos/uso terapéutico , Femenino , Perfilación de la Expresión Génica , Regulación Neoplásica de la Expresión Génica/efectos de los fármacos , Redes Reguladoras de Genes/efectos de los fármacos , Humanos , Masculino , Neoplasias de Células Germinales y Embrionarias/tratamiento farmacológico , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias de la Próstata/tratamiento farmacológico , Análisis de Supervivencia , Neoplasias Testiculares/tratamiento farmacológico , Neoplasias Uterinas/tratamiento farmacológicoRESUMEN
OBJECTIVE: The growth of uterine leiomyomas is regulated by progesterone, although the underlying molecular mechanisms are not fully understood. METHODS: Primary leiomyoma cells were isolated by standard method from 16 samples of uterine leiomyoma tissue. Uterine leiomyoma explants and primary leiomyoma cell cultures were exposed to progesterone in concentrations of 0.01 µg/ml, 0.1 µg/ml and 1 µg/ml for 24 h. Cell apoptosis was assessed with Annexin V assays performed in cell cultures by flow cytometry. The expression of PR-A, PR-B, Ki67, Akt, ERK, PTEN and PPARγ mRNAs was estimated in cultured leiomyoma cells and tissue explants by real time RT-PCR. RESULTS: Treatment with progesterone promoted viability and proliferation of cultured leiomyoma cells in a dose-dependent manner. Low and high doses of progesterone decreased early apoptosis of leiomyoma cells. High concentrations of progesterone increased the number of living cells in Annexin V assays. High doses of progesterone increased the expression of Ki67 mRNA, while low doses increased the expression of PR-A mRNA in cultured leiomyoma cells and tissue explants. In cell cultures, low doses of progesterone increased the expression of PR-B mRNA and the expression of PTEN and PPARγ mRNAs in a dose-dependent manner. Exposure of leiomyoma tissue explants to progesterone led to increased expression of PR-B and ERK mRNAs in a dose-dependent manner. CONCLUSIONS: The effects of progesterone on the apoptosis and proliferation of leiomyoma cells was dose-dependent and different in cell cultures and leiomyoma explants, possibly as a result of impacts derived from the tumor microenvironment.
Asunto(s)
Leiomioma , Neoplasias Uterinas , Apoptosis , Técnicas de Cultivo de Célula , Proliferación Celular , Femenino , Humanos , Progesterona , Receptores de Progesterona , Microambiente Tumoral , Neoplasias Uterinas/tratamiento farmacológicoRESUMEN
INTRODUCTION: Uterine fibroids are frequently encountered in gynecology and are a therapeutic challenge. New therapies, such as ulipristal acetate, could help with symptomatic relief, improve quality of life, and decrease uterine fibroid size. Notwithstanding, there is controversy about adverse effects, especially for hepatotoxicity. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis, and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified nine systematic reviews and included ten studies overall, of which five were randomized trials. We conclude that ulipristal increases the likelihood of amenorrhea, improves the quality of life, and decreases menstrual bleeding. However, there is also a likely increase in the risk of adverse effects. Furthermore, ulipristal could decrease the size of fibroids.
INTRODUCCIÓN: Los miomas uterinos son una patología frecuente en ginecología, que tiene como desafío el enfrentamiento terapéutico. Existen nuevas terapias como el uso de acetato de ulipristal que podrían ayudar con el alivio sintomático y mejoría de la calidad de vida, además de la disminución del tamaño de los miomas uterinos. No obstante, existe controversia respecto a los efectos adversos, especialmente frente a la hepatotoxicidad. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el tamizaje de múltiples fuentes de información, incluyendo MEDLINE/PubMed, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos nueve revisiones sistemáticas que incluyeron diez estudios primarios, de los cuales cinco son ensayos aleatorizados. Concluimos que el uso de ulipristal aumenta la probabilidad de amenorrea, mejora la calidad de vida y disminuye el sangrado menstrual. Además, el uso de ulipristal podría disminuir el tamaño de los miomas. Sin embargo, podría aumentar el riesgo de efectos adversos.
Asunto(s)
Leiomioma , Norpregnadienos , Neoplasias Uterinas , Femenino , Humanos , Leiomioma/tratamiento farmacológico , Norpregnadienos/uso terapéutico , Calidad de Vida , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento , Neoplasias Uterinas/tratamiento farmacológicoRESUMEN
A endometriose torácica é uma forma de endometriose extrapélvica encontrada em tecidos pulmonares ou na pleura. Caracteriza- se clinicamente pela presença de pneumotórax catamenial, hemotórax catamenial, hemoptise e nódulos pulmonares. O pneumotórax catamenial é a manifestação mais frequente, sendo caracterizado pelo acúmulo recorrente de ar na cavidade torácica durante o período menstrual. Ocorre, geralmente, no hemitórax direito e possui maior incidência na faixa etária dos 30 aos 40 anos de idade. Nosso objetivo é descrever um caso de derrame pleural hemorrágico recorrente e pneumotórax espontâneo correlacionados ao período menstrual em paciente de 34 anos. (AU)
Thoracic endometriosis is a form of extrapelvic endometriosis found in pulmonary tissue or the pleura. Clinically, it is characterized by the presence of catamenial pneumothorax, catamenial hemothorax, hemoptysis, and pulmonary nodules. The most frequent clinical presentation is catamenial pneumothorax, which is typified by a recurrent collection of air in the thoracic cavity occurring in conjunction with menstrual periods. It occurs more commonly on the right side and its highest incidence is between 30 and 40 years of age. Our objective is to describe a case of recurrent hemorrhagic pleural effusion and spontaneous pneumothorax correlated to the menstrual period in a 34-year-old patient. (AU)
Asunto(s)
Humanos , Femenino , Adulto , Endometriosis/diagnóstico , Hemoneumotórax/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico por imagen , Derrame Pleural/diagnóstico por imagen , Progestinas/uso terapéutico , Toracoscopía , Neoplasias Uterinas/tratamiento farmacológico , Neoplasias Uterinas/diagnóstico por imagen , Radiografía , Tomografía Computarizada por Rayos X , Dolor de Espalda , Leiomiomatosis/tratamiento farmacológico , Leiomiomatosis/diagnóstico por imagen , Pleurodesia , Anticonceptivos Hormonales Orales/uso terapéutico , Tos , Diabetes Mellitus , Disnea , Endometriosis/tratamiento farmacológico , Fiebre , Toracocentesis , Hemoneumotórax/tratamiento farmacológico , Neoplasias Pulmonares/tratamiento farmacológicoRESUMEN
The aim of this study was to elucidate the concise effects of a traditional herb pair, Curcumae rhizoma-Sparganii rhizoma (CRSR), on uterine leiomyoma (UL) by analyzing transcriptional profiling. The UL rat model was made by intramuscular injection of progesterone and gavage administration of diethylstilbestrol. From 11 weeks of the establishment of the model, rats of the UL+CRSR group were gavaged daily with CRSR (6.67 g/kg). The serum concentrations of progesterone (P) and estradiol (E2) were determined by radioimmunoassay, the uterine index was measured by caliper measurement, and the pathological status was observed by hematoxylin and eosin stain. Gene expression profiling was checked by NimbleGen Rat Gene Expression Microarrays. The results indicated that the uterine mass of UL+CRSR rats was significantly shrunk and serum P and E2 levels significantly reduced compared to UL animals and nearly to the level of normal rats. Results of microarrays displayed the extensive inhibition of CRSR upon the expression of proliferation and deposition of extracellular matrix (ECM)-related genes, and significantly regulated a wide range of metabolism disorders. Furthermore, CRSR extensively regulated key pathways of the UL process, such as MAPK, PPAR, Notch, and TGF-ß/Smad. Regulation of the crucial pathways for the UL process and ECM metabolism may be the underlying mechanisms of CRSR treatment. Further studies will provide clear clues for effectively treating UL with CRSR.
Asunto(s)
Curcuma/química , Regulación Neoplásica de la Expresión Génica/efectos de los fármacos , Leiomioma/tratamiento farmacológico , Extractos Vegetales/farmacología , Rizoma/química , Neoplasias Uterinas/tratamiento farmacológico , Animales , Modelos Animales de Enfermedad , Femenino , Leiomioma/genética , Leiomioma/metabolismo , Análisis de Secuencia por Matrices de Oligonucleótidos , Radioinmunoensayo , Ratas , Ratas Sprague-Dawley , Factores de Transcripción , Neoplasias Uterinas/genética , Neoplasias Uterinas/metabolismoRESUMEN
The aim of this study was to elucidate the concise effects of a traditional herb pair, Curcumae rhizoma-Sparganii rhizoma (CRSR), on uterine leiomyoma (UL) by analyzing transcriptional profiling. The UL rat model was made by intramuscular injection of progesterone and gavage administration of diethylstilbestrol. From 11 weeks of the establishment of the model, rats of the UL+CRSR group were gavaged daily with CRSR (6.67 g/kg). The serum concentrations of progesterone (P) and estradiol (E2) were determined by radioimmunoassay, the uterine index was measured by caliper measurement, and the pathological status was observed by hematoxylin and eosin stain. Gene expression profiling was checked by NimbleGen Rat Gene Expression Microarrays. The results indicated that the uterine mass of UL+CRSR rats was significantly shrunk and serum P and E2 levels significantly reduced compared to UL animals and nearly to the level of normal rats. Results of microarrays displayed the extensive inhibition of CRSR upon the expression of proliferation and deposition of extracellular matrix (ECM)-related genes, and significantly regulated a wide range of metabolism disorders. Furthermore, CRSR extensively regulated key pathways of the UL process, such as MAPK, PPAR, Notch, and TGF-β/Smad. Regulation of the crucial pathways for the UL process and ECM metabolism may be the underlying mechanisms of CRSR treatment. Further studies will provide clear clues for effectively treating UL with CRSR.
Asunto(s)
Animales , Femenino , Ratas , Neoplasias Uterinas/tratamiento farmacológico , Extractos Vegetales/farmacología , Regulación Neoplásica de la Expresión Génica/efectos de los fármacos , Curcuma/química , Rizoma/química , Leiomioma/tratamiento farmacológico , Factores de Transcripción , Neoplasias Uterinas/genética , Neoplasias Uterinas/metabolismo , Radioinmunoensayo , Ratas Sprague-Dawley , Análisis de Secuencia por Matrices de Oligonucleótidos , Modelos Animales de Enfermedad , Leiomioma/genética , Leiomioma/metabolismoRESUMEN
CONTEXTO CLÍNICO: Los miomas uterinos son los tumores benignos más comunes del tracto reproductivo femenino. Se los conoce también como fibroleiomiomatosis, leiomiomatosis, fibromiomatosis o fibromas uterinos. Se producen por una mutación de los miocitos uterinos ante la estimulación de los receptores de estrógenos que producen factores de crecimiento y de los receptores de progesterona que inducen mitosis e inhiben la apoptosis en miocitos de miomas. Se clasifican en miomas intramurales, submucosos, subserosos y cervicales. TECNOLOGÍA: El acetato de ulipristal es un modulador selectivo de los receptores de progesterona de las células del mioma, inhibiendo la proliferación celular y de la matriz extracelular a través de la inducción de apoptosis. También reduce la expresión de citoquinas proinflamatorias. Produce cambios celulares del endometrio miomatoso sin afectar el resto del endometrio ni los vasos sanguíneos. OBJETIVO: El objetivo del presente informe es evaluar la evidencia disponible acerca de la eficacia, seguridad y aspectos relacionados a las políticas de cobertura del uso de ulipristal en miomatosis uterina. MÉTODOS: Se realizó una búsqueda en las principales bases de datos bibliográficas, en buscadores genéricos de internet, y financiadores de salud. Se priorizó la inclusión de revisiones sistemáticas (RS), ensayos clínicos controlados aleatorizados (ECAs), evaluaciones de tecnologías sanitarias (ETS), evaluaciones económicas, guías de práctica clínica (GPC) y políticas de cobertura de diferentes sistemas de salud. RESULTADOS: Se incluyeron dos revisiones narrativas, cuatro GPC, cuatro evaluaciones económicas, y seis informes de políticas de cobertura para el acetato de ulipristal en miomatosis uterina. No se encontraron estudios que comparen el uso de acetato de ulipristal versus miomectomía o histerectomía. CONCLUSIONES: Evidencia de alta calidad sugiere que el uso de acetato de ulipristal en mujeres de edad fértil con miomatosis uterina sintomática, sería más efectivo y más seguro que los análogos de hormona liberadora de gonadotrofina controlando las metrorragias moderadas y severas, y reduciendo el tamaño tumoral a corto plazo. No se encontraron estudios que evalúen la reducción de tasas de miomectomía o histerectomía. Las guías de práctica clínica de Latinoamérica, Europa y Canadá consideran al ulipristal como uma alternativa válida a los análogos de hormona liberadora de gonadotrofina en mujeres en edad fértil con metrorragias severas, anemia sintomática, miomas mayores a 3 cm y necesidad de preservar el útero. La mayoría de los financiadores de salud europeos dan cobertura a este tratamiento. No es cubierta por financiadores estadounidenses por no tener aprobación por la agencia regulatória estadounidense para esta indicación. No se encontraron políticas de salud en Latinoamérica.
Asunto(s)
Humanos , Femenino , Neoplasias Uterinas/tratamiento farmacológico , Receptores de Progesterona/uso terapéutico , Leiomioma/tratamiento farmacológico , Evaluación de la Tecnología Biomédica , Análisis Costo-EficienciaRESUMEN
OBJECTIVE: To compare the outcomes of Brazilian patients with molar pregnancy who continue human chorionic gonadotropin (hCG) surveillance with those treated with chemotherapy when hCG was still positive, but falling at 6months after uterine evacuation. METHODS: Retrospective chart review of 12,526 patients with hydatidiform mole treated at one of nine Brazilian reference centers from January 1990 to May 2016. RESULTS: At 6months from uterine evacuation, 96 (0.8%) patients had hCG levels raised but falling. In 15/96 (15.6%) patients, chemotherapy was initiated immediately per FIGO 2000 criteria, while 81/96 (84.4%) patients were managed expectantly. Among the latter, 65/81 (80.2%) achieved spontaneous remission and 16 (19.8%) developed postmolar gestational trophoblastic neoplasia (GTN). Patients who received chemotherapy following expectant management required more time for remission (11 versus 8months; p=0.001), had a greater interval between uterine evacuation and initiating chemotherapy (8 versus 6months; p<0.001), and presented with a median WHO/FIGO risk score higher than women treated according to FIGO 2000 criteria (4 versus 2, p=0.04), but there were no significant differences in the need for multiagent treatment regimens (1/15 versus 3/16 patients, p=0.60). None of the women relapsed, and no deaths occurred in either group. CONCLUSION: In order to avoid unnecessary exposure of women to chemotherapy, we no longer follow the FIGO 2000 recommendation to treat all patients with molar pregnancy and hCG raised but falling at 6months after evacuation. Instead, we pursue close hormonal and radiological surveillance as the best strategy for these patients.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Gonadotropina Coriónica/sangre , Mola Hidatiforme/tratamiento farmacológico , Neoplasias Uterinas/tratamiento farmacológico , Legrado por Aspiración , Espera Vigilante , Adolescente , Adulto , Brasil , Estudios de Casos y Controles , Quimioterapia Adyuvante , Estudios de Cohortes , Ciclofosfamida/administración & dosificación , Dactinomicina/administración & dosificación , Etopósido/administración & dosificación , Femenino , Enfermedad Trofoblástica Gestacional , Humanos , Mola Hidatiforme/sangre , Mola Hidatiforme/patología , Leucovorina/administración & dosificación , Metotrexato/administración & dosificación , Persona de Mediana Edad , Estadificación de Neoplasias , Embarazo , Estudios Retrospectivos , Resultado del Tratamiento , Neoplasias Uterinas/sangre , Neoplasias Uterinas/patología , Vincristina/administración & dosificación , Adulto JovenRESUMEN
Los miomas uterinos son las tumoraciones genitales más frecuentes cuyo tratamiento más habitual es el quirúrgico. Actualmente existe un tratamiento médico eficaz para reducir su volumen y la clínica asociada que es el acetato de ulipristal (AU), que es un modulador selectivo de los receptores de la progesterona. A nivel endometrial puede ocasionar cambios histológicos que cuando son muy marcados plantean dudas diagnósticas. Se presenta el caso de una paciente con útero miomatoso sintomático bajo tratamiento con AU, la histología en las muestras de biopsia planteó el diagnóstico diferencial con adenocarcinoma de endometrio.
Uterine fibroids are the most common genital tumors and the most common treatment is surgery. Actually there is an effective medical treatment to reduce its volume and the symptoms. It is ulipristal acetate (UA), a selective progesterone receptor modulator. In the endometrium it can cause some peculiar histological changes. We present a patient with symptomatic uterine fibroid with UA, and it was difficult to make differential diagnosis with endometrial cancer.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Neoplasias Uterinas/tratamiento farmacológico , Neoplasias Uterinas/diagnóstico por imagen , Carcinoma Endometrioide/diagnóstico , Leiomioma/tratamiento farmacológico , Leiomioma/diagnóstico por imagen , Norpregnadienos/uso terapéutico , Adenocarcinoma , Receptores de Progesterona , Diagnóstico DiferencialRESUMEN
BACKGROUND: Uterine carcinosarcoma is well known for its aggressive behavior. There is little evidence regarding the gold standard combination chemotherapy in metastatic or locally advanced carcinosarcoma, due to poor survival outcomes obtained with conventional scheduled chemotherapy. This case report represents the first-ever reported objective response to a metronomic chemotherapy regimen and adds to the current literature. CASE PRESENTATION: We describe a case of a Caucasian woman diagnosed with metastatic carcinosarcoma that had already been treated with multiple lines of conventional chemotherapy, with progressive disease. This patient had a surprising clinical and imaging response when treated with oral metronomic cyclophosphamide. CONCLUSIONS: We reviewed the mechanism of action implicated in metronomic chemotherapy, and correlated it with the biology of disease in carcinosarcoma. This information may add to the current literature, providing important insights to future clinical trials in this patient population.
Asunto(s)
Antineoplásicos Alquilantes/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica , Carcinosarcoma/tratamiento farmacológico , Ciclofosfamida/administración & dosificación , Recurrencia Local de Neoplasia/tratamiento farmacológico , Neoplasias Peritoneales/tratamiento farmacológico , Sarcoma Estromático Endometrial/tratamiento farmacológico , Neoplasias Uterinas/tratamiento farmacológico , Administración Metronómica , Antineoplásicos Alquilantes/toxicidad , Carcinosarcoma/patología , Ciclofosfamida/toxicidad , Esquema de Medicación , Femenino , Humanos , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Neoplasias Peritoneales/secundario , Sarcoma Estromático Endometrial/patología , Resultado del Tratamiento , Neoplasias Uterinas/psicologíaRESUMEN
BACKGROUND: Synchronous multiple primary malignancies in the female genital tract are infrequent. From 50 to 70% of them corresponds to synchronous cancers of the endometrium and ovary. To our knowledge, this is only the third case report in the international literature of three concurrent gynaecological cancers of epithelial origin. A case is presented, as well as a literature review due to the infrequency of its diagnosis and the lack of information on the subject. CLINICAL CASE: A 49-year-old woman, with previous gynaecological history of ovarian endometriosis. She underwent a hysterectomy and bilateral oophorectomy, as she had been diagnosed with endometrial hyperplasia with atypia. The final histopathology reported synchronous ovarian, Fallopian tube, and endometrial cancer. An extension study and complete surgical staging was performed, both being negative. She received adjuvant treatment of chemotherapy and radiotherapy. She is currently free of disease. CONCLUSIONS: The aetiology is uncertain. There is controversy relating to increased susceptibility of synchronous neoplasms to pelvic endometriosis and inherited genetic syndromes. Its diagnosis needs to differentiate them from metastatic disease. Additionally, they are problematical from a clinical, diagnostic, therapeutic, and prognostic point of view. The presentation of more cases of triple synchronous cancers is necessary for a complete adjuvant and surgical treatment.
Asunto(s)
Adenocarcinoma , Neoplasias de las Trompas Uterinas , Neoplasias Primarias Múltiples , Neoplasias Ováricas , Neoplasias Uterinas , Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/radioterapia , Adenocarcinoma/cirugía , Carcinoma Endometrioide/tratamiento farmacológico , Carcinoma Endometrioide/radioterapia , Carcinoma Endometrioide/cirugía , Quimioterapia Adyuvante , Cisplatino/administración & dosificación , Terapia Combinada , Endometriosis/complicaciones , Endometriosis/tratamiento farmacológico , Endometriosis/radioterapia , Endometriosis/cirugía , Neoplasias de las Trompas Uterinas/tratamiento farmacológico , Neoplasias de las Trompas Uterinas/radioterapia , Neoplasias de las Trompas Uterinas/cirugía , Femenino , Humanos , Histerectomía , Persona de Mediana Edad , Neoplasias Primarias Múltiples/tratamiento farmacológico , Neoplasias Primarias Múltiples/radioterapia , Neoplasias Primarias Múltiples/cirugía , Enfermedades del Ovario/complicaciones , Enfermedades del Ovario/tratamiento farmacológico , Enfermedades del Ovario/radioterapia , Enfermedades del Ovario/cirugía , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/radioterapia , Neoplasias Ováricas/cirugía , Ovariectomía , Paclitaxel/administración & dosificación , Radioterapia Adyuvante , Salpingectomía , Neoplasias Uterinas/tratamiento farmacológico , Neoplasias Uterinas/radioterapia , Neoplasias Uterinas/cirugíaRESUMEN
BACKGROUND: Leiomyomas are the most common benign tumors of the uterus, frequently associated with abnormal uterine bleeding. Medroxyprogesterone (MP) acetate it is a therapeutic alternative. OBJECTIVE: To determine the efficacy of the medroxyprogesterone for abnormal uterine bleeding associated with leiomyomatosis in perimenopause women. METHODS: An observational, prospective, longitudinal study. We selected 31 patients with uterine myomas and abnormal uterine bleeding. Two years monthly doses of 150 mg of MP were given. If the bleeding did not stop at six months of treatment or increased a hysterectomy was performed. RESULTS: Two (6.4%) patients abandoned the treatment after a first doses; 21 (67.7%) completed the treatment without uterine bleeding (efficacy observed of 72.4%; CI 95% 54.4 to 90.4%, intention to treat efficacy 67.7%, CI 95% 49.6 to 86.8%). Eight (25.8%) patients persisted with uterine bleeding before 6 months of treatment and a hysterectomy was performed. There was no severity secondary effect informed. CONCLUSIONS: Management with medroxyprogesterone may be an effective treatment to control the uterine bleeding associated with myomatosis. Their use could reduce the necessity of some hysterectomies.
Asunto(s)
Leiomioma/tratamiento farmacológico , Acetato de Medroxiprogesterona/uso terapéutico , Perimenopausia , Neoplasias Uterinas/tratamiento farmacológico , Antineoplásicos Hormonales/uso terapéutico , Femenino , Humanos , Histerectomía/métodos , Leiomioma/patología , Estudios Longitudinales , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento , Neoplasias Uterinas/patologíaRESUMEN
Background: Although exercise training is known to promote post-exercise hypotension, there is currently no consistent argument about the effects of manipulating its various components (intensity, duration, rest periods, types of exercise, training methods) on the magnitude and duration of hypotensive response. Objective: To compare the effect of continuous and interval exercises on hypotensive response magnitude and duration in hypertensive patients by using ambulatory blood pressure monitoring (ABPM). Methods: The sample consisted of 20 elderly hypertensives. Each participant underwent three ABPM sessions: one control ABPM, without exercise; one ABPM after continuous exercise; and one ABPM after interval exercise. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR) and double product (DP) were monitored to check post-exercise hypotension and for comparison between each ABPM. Results: ABPM after continuous exercise and after interval exercise showed post-exercise hypotension and a significant reduction (p < 0.05) in SBP, DBP, MAP and DP for 20 hours as compared with control ABPM. Comparing ABPM after continuous and ABPM after interval exercise, a significant reduction (p < 0.05) in SBP, DBP, MAP and DP was observed in the latter. Conclusion: Continuous and interval exercise trainings promote post-exercise hypotension with reduction in SBP, DBP, MAP and DP in the 20 hours following exercise. Interval exercise training causes greater post-exercise hypotension and lower cardiovascular overload as compared with continuous exercise. .
Fundamento: Embora se saiba que o exercício promova hipotensão pós-exercício, até o momento não há argumentações consistentes sobre os efeitos da manipulação de seus diversos componentes (intensidade, duração, intervalos de descanso, tipos de exercício, métodos de treinamento) na magnitude e duração da resposta hipotensora. Objetivo: Comparar os efeitos dos exercícios dinâmicos, contínuo e intervalado, sobre a magnitude e duração da resposta hipotensora em hipertensos por meio da monitorização ambulatorial da pressão arterial (MAPA). Métodos: A amostra foi composta por 20 idosos hipertensos. Cada participante realizou três sessões de MAPA, sendo uma controle (sem exercício), uma após exercício contínuo e uma após exercício intervalado. O monitoramento de pressão arterial sistólica (PAS), pressão arterial diastólica (PAD), pressão arterial média (PAM), frequência cardíaca (FC) e duplo produto (DP) foi realizado para verificação da hipotensão pós-exercício e comparação entre cada MAPA. Resultados: As MAPAs após exercício contínuo e intervalado demonstraram hipotensão pós-exercício e redução significativa (p < 0,05) de PAS, PAD, PAM e DP por 20 horas, na comparação com a MAPA controle. Na comparação entre as MAPAs após exercício contínuo e intervalado, verificou-se redução significativa (p < 0,05) de PAS, PAD, PAM e DP após exercício intervalado. Conclusão: Os exercícios contínuo e intervalado promovem hipotensão pós-exercício, com redução significativa de PAS, PAD, PAM e DP ao longo das 20 horas subsequentes à atividade. O exercício intervalado gera maior magnitude de hipotensão pós-exercício e menor sobrecarga cardiovascular, medida por menor DP. .
Asunto(s)
Adulto , Femenino , Humanos , Embarazo , Endosonografía , Mola Hidatiforme Invasiva , Neoplasias Uterinas , Aborto Espontáneo/cirugía , Quimioterapia Adyuvante , Gonadotropina Coriónica Humana de Subunidad beta/sangre , Dilatación y Legrado Uterino , Mola Hidatiforme Invasiva/irrigación sanguínea , Mola Hidatiforme Invasiva/tratamiento farmacológico , Mola Hidatiforme Invasiva/cirugía , Metotrexato/uso terapéutico , Neovascularización Patológica , Reoperación , Biomarcadores de Tumor/sangre , Ultrasonografía Doppler en Color , Neoplasias Uterinas/irrigación sanguínea , Neoplasias Uterinas/tratamiento farmacológico , Neoplasias Uterinas/cirugíaRESUMEN
BACKGROUND/AIMS: We aimed at assessing the efficacy of combined oral contraceptives (COC) in treating women with uterine leiomyomata and heavy menstrual bleeding (HMB), as well as their effect over quality of life (QoL), tumor size, and hemoglobin concentration. METHODS: We searched various electronic databases and reference lists from all included studies. Randomized and nonrandomized controlled clinical trials were selected, and two trials were considered eligible - one randomized and one 'pseudo'-randomized. RESULTS: COCs performed less well than levonorgestrel-releasing intrauterine systems (LNG-IUSs) in controlling HMB, improving QoL, and improving the hemoglobin concentration, whereas the estimate was not sufficiently precise to define whether COCs were better than, equal to, or worse than LNG-IUSs in reducing tumor size. It must be stressed that these results are based on low-quality evidence, stemming from a single trial. Additionally, COCs were more effective than placebo in tumor size reduction, another conclusion based on another single study, considered as being at a high risk of bias and judged as very low-quality evidence. CONCLUSION: Evidence regarding the use of COCs as treatment for women with symptomatic fibroids is very scarce and of low quality, and we are very uncertain about the real efficacy of such treatment.
Asunto(s)
Anticonceptivos Orales Combinados/uso terapéutico , Leiomioma/tratamiento farmacológico , Menorragia/tratamiento farmacológico , Neoplasias Uterinas/tratamiento farmacológico , Femenino , Hemoglobinas , Humanos , Leiomioma/complicaciones , Menorragia/complicaciones , Calidad de Vida , Resultado del Tratamiento , Neoplasias Uterinas/complicacionesRESUMEN
The focus of this article is choriocarcinoma (CC), a rare and aggressive obstetric/gynecologic cancer that occurs once in every 20,000 to 40,000 pregnancies. CC is a form of gestational trophoblastic disease, which is the result of abnormal trophoblastic activity encompassing a spectrum of nonmalignant and malignant disease. Forms of gestational trophoblastic disease include complete or partial mole, invasive mole, CC, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. Typically asymptomatic, the first symptom of CC in 80% of cases is shortness of breath, indicative of metastasis to the lungs. CC affects women of all ages and can occur during pregnancy, after birth, or even years remote from the antecedent pregnancy. It is highly responsive to chemotherapy, with an overall remission rate greater than 90%. This case study presents the story of a pregnant adolescent thought to have an uneventful pregnancy until metastatic CC at term was diagnosed. Available treatments, outcomes and surveillance for the disease, psychosocial aspects, and implications for nursing care are discussed.
Asunto(s)
Coriocarcinoma/secundario , Complicaciones Neoplásicas del Embarazo/patología , Neoplasias Uterinas/patología , Adolescente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Estudios de Casos y Controles , Coriocarcinoma/diagnóstico , Coriocarcinoma/tratamiento farmacológico , Coriocarcinoma/patología , Femenino , Humanos , Persona de Mediana Edad , Embarazo , Complicaciones Neoplásicas del Embarazo/tratamiento farmacológico , Tercer Trimestre del Embarazo , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/tratamiento farmacológico , Adulto JovenRESUMEN
UNLABELLED: Uterine sarcomas are a group of uncommon tumors that account for approximately 1% of malignant neoplasms of the female genital tract and between 3 and 8.4% of malignant uterine neoplasms. OBJECTIVE: To evaluate the factors associated with the clinical behavior of uterine sarcomas. MATERIALS AND METHODS: In the period from October 1983 to December 2009, clinical files of patients with a confirmed diagnosis of uterine sarcoma at the National Institute of Cancerology of Mexico (INCan) were reviewed and evaluated. RESULTS: We identified 77 cases with complete information; average age at presentation was 51.6 years (range, 14-78 years); most frequent histology was leiomyosarcoma (LMS) in 53/77 (68.8%) cases; most frequent symptom reported at the time of diagnosis was abnormal vaginal bleeding in 36/77 (46.7%) cases, and the most frequent clinical stage was clinical stage (CS) I in 31/77 (40.2%) cases. Initial treatment was total abdominal hysterectomy (TAH) and bilateral salpingo-oophrectomy (BSO) in 53/77 (68.9%) cases. Disease-free period was 27.8 months (range, 0-184 months), with disease recurrence in 33/77 (42.85%) cases, most frequent site as lung in 13/33 (39.39%) cases. Management of recurrences was surgery and chemotherapy (CT) in 5/33 (15.15%) and CT in 10/33 (30.30%) of cases. At present, 40.3% of the patients (31/77) are found to be Disease-free. CONCLUSION: Notwithstanding that uterine sarcomas are aggressive neoplasms, most accepted management to date is TAH + BSO, observing that the fact that this procedure is not performed by oncologists does not affect the DFP nor OS, contrary to what occurs in other gynecological neoplasms.
Asunto(s)
Sarcoma/diagnóstico , Neoplasias Uterinas/diagnóstico , Adolescente , Adulto , Anciano , Supervivencia sin Enfermedad , Femenino , Humanos , Estimación de Kaplan-Meier , México , Persona de Mediana Edad , Estudios Retrospectivos , Sarcoma/tratamiento farmacológico , Sarcoma/patología , Neoplasias Uterinas/tratamiento farmacológico , Neoplasias Uterinas/patologíaRESUMEN
BACKGROUND: Uterine fibroids are the most common benign uterine tumours present in women of reproductive age. Mifepristone (RU-486) competitively binds and inhibits progesterone receptors. Studies have suggested that fibroid growth depends on the sexual steroids. Mifepristone has been shown to decrease fibroid size. This review summarises the effects of mifepristone treatment on fibroids and the associated adverse effects as described in randomised controlled trials. OBJECTIVES: To determine the efficacy and safety of mifepristone for the management of uterine fibroids in pre-menopausal women. SEARCH METHODS: We searched the specialised register of the Cochrane Menstrual Disorders and Subfertility (Cochrane Menstrual Disorders and subfertility Review Group), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 4), MEDLINE, EMBASE, PsycINFO, and CINAHL (to November 2011). We handsearched a number of journals, and searched reference lists, databases of ongoing trials and the Internet. There were no language restrictions. SELECTION CRITERIA: Only truly randomised controlled trials of mifepristone versus other forms of medical therapy or placebo in pre-menopausal women with confirmed uterine fibroids were included. DATA COLLECTION AND ANALYSIS: Four authors independently extracted data and assessed trial quality. Data were analysed using the Peto odds ratios (OR) for dichotomous data and the weighted mean differences for continuous data, with 95% confidence intervals (CI). Meta-analyses were performed using the fixed-effect model. MAIN RESULTS: Three studies involving 112 participants were included. Comparison interventions included different dosages of mifepristone, placebo and vitamin B tablets. There is evidence that treatment with mifepristone relieves heavy menstrual bleeding compared with placebo (Peto OR 17.84; 95% CI 6.72 to 47.38; 2 RCTs, 77 women, I(2) = 0%). Three studies (Bagaria 2009; Engman 2009; Fiscella 2006) were included in the meta-analysis of this comparison. There was no evidence of an effect of mifepristone on the fibroid volume (standardised mean difference (SMD) -0.02; 95% CI -0.38 to 0.41; 99 women). Two studies (Bagaria 2009; Fiscella 2006) were included in the meta-analysis of this comparison. There was no evidence of an effect of mifepristone on uterine volume (mean difference (MD) -77.24; 95% CI -240.62 to 86.14; 72 women). The pooled data suggest an increased adverse event (abnormal endometrial histology) in the mifepristone group compared to placebo (OR 31.65; 95% CI 4.83 to 207.35; 2 RCTs; 54 women; I(2) = 0%). Only one study (Bagaria 2009) reported endometrial hyperplasia at the end of the therapy (12/19 women in the mifepristone group versus 0/16 in the placebo group; OR 55.0; 95% CI 2.86 to 105.67). Engman 2009 found a significantly higher rate of cystic glandular dilatation in women in the mifepristone group (5/8 women biopsied) compared with the placebo group (1/11 women biopsied) (OR 16.67; 95% CI 1.36 to 204.03). One study (Fiscella 2006) suggested significant improvements (P < 0.001) for specific quality of life outcomes. AUTHORS' CONCLUSIONS: Mifepristone reduced heavy menstrual bleeding and improved fibroid-specific quality of life. However, it was not found to reduce fibroid volume. Further well-designed, adequately powered RCTs are needed before a recommendation can be made on the use of mifepristone for the treatment of uterine fibroids.
Asunto(s)
Leiomioma/tratamiento farmacológico , Mifepristona/uso terapéutico , Receptores de Progesterona/antagonistas & inhibidores , Femenino , Humanos , Leiomioma/patología , Menorragia/tratamiento farmacológico , Mifepristona/efectos adversos , Premenopausia , Ensayos Clínicos Controlados Aleatorios como Asunto , Carga Tumoral/efectos de los fármacos , Neoplasias Uterinas/tratamiento farmacológico , Neoplasias Uterinas/patologíaRESUMEN
OBJECTIVE: To evaluate hysterectomy prevalence, indications and impact on clinical outcomes in a reference center in southern Brazil. STUDY DESIGN: Institutional Ethical Committee approval was granted for this study. In a cohort study spanning 21 years, all patients who underwent hysterectomy for gestational trophoblastic neoplasia (GTN) were included, and technical differences between hysterectomy performed in the reference center and those performed elsewhere were evaluated as well. RESULTS: Of 1,023 patients with gestational trophoblastic disease, 57 (5.6%) underwent hysterectomy (95% CI, 4.3-7.1). Hysterectomy incidence in 230 GTN patients was 17.7% (95%CI, 15.1-23.3). Indications for 41 hysterectomies in the reference center were as follows: primary treatment in 14 (34.1%) cases and secondary treatment in 27 (65.9%); of these, the main indications were GTN recurrence (7 [25.9%] cases), hemorrhage (6 [22.2%]), resistance to single-agent chemotherapy in patients who refused more aggressive treatment (6 [22.2%]), and tumor mass reduction (5 [18.5%]). Twelve (92.3%) of the 13 hysterectomies with bilateral oophorectomy were performed elsewhere (p < 0.001). Thirty-five (85.4%) patients had no complications, and median hospitalization time was short (3 +/- 4 days). None of the 4 deaths were associated with hysterectomy. In the reference center, when associated with hysterectomy, GTN cure rates reached 93% after 63 +/- 87 months of follow-up. CONCLUSION: When treatment is in a reference center, hysterectomy frequency and morbidity may be low, and indications due to hemorrhage are significantly lower. Furthermore, at a reference center there is significantly greater ovarian preservation at the time of hysterectomy, and significantly more patients who undergo hysterectomy have low-risk GTN.