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Objetivo. Determinar el valor de la clasificación Gynecologic Imaging Reporting and Data System (GI-RADS) para discriminar las masas anexiales malignas de las benignas. Material y métodos. Estudio observacional retrospectivo de 87 pacientes operadas en nuestro hospital con un total de 98 masas anexiales. Se clasificaron mediante el sistema GI-RADS y se compararon con la histología definitiva. Resultados. GI-RADS 3: 75 casos. En todos los casos GI-RADS 3, el diagnóstico definitivo fue de benignidad. GI-RADS 4: 11 casos. En el 27,27% de los casos el diagnóstico definitivo fue de malignidad (un carcinoma y 2 tumores borderline), y en el 72,72% de los casos, de benignidad. GI-RADS 5: 12 casos. En el 91,66% de los casos el diagnóstico histológico informó de malignidad (10 carcinomas y un tumor borderline). Discusión. Nuestros resultados refuerzan la fiabilidad de la clasificación para catalogar correctamente las tumoraciones malignas en los grupos GI-RADS 4 y 5 (AU)

Objective. To assess the clinical usefulness of the Gynecologic Imaging Reporting and Data System (GI-RADS) classification to distinguish between benign and malignant adnexal masses. Material and methods. A retrospective study was conducted in 98 adnexal masses in 87 patients who underwent surgery in our hospital. The masses were classified according to GI-RADS and the results were compared with their definitive histologic diagnosis. Results. Seventy-five masses were classified as GI-RADS 3. All GI-RADS 3 masses had a definitive histologic diagnosis of benignity. Eleven masses were GI-RADS 4, of which 27.27% had a definitive histologic diagnosis of malignancy (one carcinoma and 2 borderline tumors) and 72.72% were diagnosed as benign. Twelve masses were GI-RADS 5, of which 91.66% had a definitive histologic diagnosis of malignancy (10 carcinomas and one borderline tumor). Discussion. Our results support the reliability of the GI-RADS classification to correctly identify malignant tumors in GI-RADS 4 and 5 (AU)

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Objetivo. Evaluar el manejo de las torsiones anexiales en nuestro centro durante un periodo de 10 años. Pacientes y métodos. Estudiamos los casos de torsión anexial en pacientes en edad reproductiva manejados quirúrgicamente entre los años 1997 y 2007. Analizamos retrospectivamente los hallazgos clínicos, ecográficos, quirúrgicos e histológicos, así como el tratamiento realizado y el seguimiento de dichas pacientes. Resultados. Identificamos 25 casos de torsión anexial en 24 pacientes. El 92% tenía dolor abdominal, el 32% náuseas y/o vómitos, el 4% fiebre y el 54,2% leucocitosis. El hallazgo ecográfico más frecuente fue de tumoración compleja (52,2%). Sólo sospechamos torsión en la primera valoración en el 8% de los casos y antes de la cirugía en el 36%. El 72% de las torsiones involucraron al anejo derecho y el 52% a un anejo tumoral. La sospecha de necrosis se confirmó en el 66,6% y el diagnóstico histopatológico más frecuente fue el de teratoma (28,6%). Realizamos tratamiento conservador mediante destorsión y/o quistectomía en el 40% y en estas pacientes el control posterior fue normal. Conclusiones. El síntoma más frecuente cuando existe una torsión anexial es el dolor abdominal y la sospecha clínica en la primera valoración es poco frecuente, siendo habitual el diagnóstico durante la cirugía. Cuando se torsiona un anejo tumoral suele haber un teratoma y en muchas ocasiones realizamos tratamiento conservador con buena evolución (AU)

Objective. To evaluate the management of adnexal torsion in our center during a 10-year period. Patients and methods. We studied cases of adnexal torsion in patients of reproductive age treated surgically between 1997 and 2007. The clinical, ultrasonographic, surgical and histological findings, as well as the treatment and follow-up of these patients, were retrospectively analyzed. Results. We identified 25 cases of adnexal torsion in 24 patients. Abdominal pain was present in 92%, nausea and/or vomiting in 32%, fever in 4% and leucocytosis in 54.2%. The most frequent echographic findings were complex tumors (52.2%). Torsion was suspected in the first evaluation in only 8% of the cases and before surgery in 36%. Most (72%) of the torsions involved the right adnexa and 52% a tumoral adnexa. Suspicion of necrosis was confirmed in 66.6% and the most frequent histopathological diagnosis was teratoma (28.6%). Conservative treatment was performed through detorsion and/or cystectomy in 40% and in patients whose subsequent clinical course was normal. Conclusions. When an adnexal torsion is present, the most frequent symptom is abdominal pain. Clinical suspicion in the first evaluation is infrequent, and diagnosis is usually made during surgery. When a tumoral adnexa is torsioned, a teratoma is usually present. Conservative treatment is often performed with good results (AU)

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The occurrence of cylindromas, trichoepitheliomas, and spiradenomas completes the triad for Brooke-Spiegler syndrome (BSS). This combination represents a rare genetic syndrome with tumors expressing adnexal differentiation. Malignant transformation is rare but reported, and surgical excision is warranted to prevent turban tumor formation of the scalp. Genetic testing is encouraged, with mutations present on the cylindromatosis gene, CYLD, locus. The occurrence of pegged teeth in our patient was most interesting, as it has not been reported in the literature in patients with BSS.

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Nevus sebaceous is a congenital malformation of the skin within which a number of neoplasms showing adnexal differentiation may arise. Recently, deletions in the patched gene region were reported in nevus sebaceous and constitutive activation of the patched-hedgehog signaling pathway was implicated in the development of tumors arising within nevus sebaceous. To substantiate further a role of the patched-hedgehog signaling pathway in secondary tumors arising within nevus sebaceous, we examined 11 nevus sebaceous associated with secondary tumors for loss of heterozygosity of the patched gene region by microsatellite polymerase chain reaction and patched mRNA expression by in situ hybridization. Unexpectedly, however, none of the tumors (including eight trichoblastomas) and nevus sebaceous lesions showed loss of heterozygosity at any polymorphic loci close to the patched gene. Further more, none of the nevus sebaceous lesions and secondary tumors gave detectable signals for patched mRNA. In contrast, four of 11 sporadic basal cell carcinomas, that were examined for comparison, showed loss of heterozygosity at the patched gene locus (p <0.05), and moderate to strong signals for patched mRNA was observed in all seven basal cell carcinoma tumors examined (p <0.0001). Additional investigation by reverse transcription-polymerase chain reaction in four basal cell carcinomas and two nevus sebaceous tumors also showed the expression of Gli-1, another target gene in the patched-hedgehog signaling pathway, in all the basal cell carcinomas samples but not in any of the nevus sebaceous tumors examined. The findings in this study do not support the view that the deregulation of the patched-hedgehog signaling pathway is involved in the pathogenesis of nevus sebaceous and associated tumors, and show that, although morphologically similar, trichoblastomas and basal cell carcinomas have a different molecular pathogenesis.

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