RESUMO
BACKGROUND: Adequate management and treatment of ovarian carcinoma requires a complete surgical staging supported by frozen-section examination. To achieve this goal it is necessary a high level of accuracy. AIM: To evaluate the accuracy of frozen-sections in ovarian carcinoma considering the influence of tumor diameter and weight. PATIENTS AND METHODS: Retrospective study of frozen-sections performed in patients with ovarian tumors who underwent surgery. Frozen- and permanent-sections were divided into three categories (benign, borderline and malignant) and stratified by diameter (< 10 cm, 10 to 20 cm, > 20 cm) and weight (< 700 g, 700 a 1400 g, > 1400 g). The diagnostic correlation, sensitivity, specificity, predictive values and accuracy of each frozen-section diagnosis were determined. RESULTS: Eight hundred forty two ovarian tumors that underwent frozen-sections between January 1988 and October 1998 were studied. Final diagnosis was 86.7% benign, 2.7% low malignant potential (LMP) and 10.6% malignant. The diagnosis correlation between frozen- and permanent-sections was 98.2%. Misdiagnosis was in epithelial ovarian tumors, particularly in LMP tumors. Sensitivity, specificity, positive- and negative-predictive values and accuracy of the four hundred eighty nine epithelial tumor were 92.6%, 99.2%, 96.7%, 98.2% and 97.9%, respectively. Diagnostic correlation was higher in epithelial ovarian tumors with diameter < 10 cm (98.2% v/s 93.8%) and weight < 700 g (96.9% v/s 88.9%). CONCLUSIONS: Diagnostic correlation with permanent-section examination, sensitivity, specificity and predictive values of frozen-sections are high in ovarian tumors. Accurate diagnosis at frozen sections of epithelial ovarian tumors with diameter > 10 cm or weight > 700 g (particularly in LMP tumors) is difficult because of the extensive sampling required. Frozen-sections diagnoses are important to determine the type and extent of surgery performed at the initial operation.
Assuntos
Secções Congeladas , Neoplasias Epiteliais e Glandulares/patologia , Neoplasias Ovarianas/patologia , Biópsia/métodos , Intervalos de Confiança , Feminino , Humanos , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Fatores de TempoRESUMO
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.
Assuntos
Tumor Trofoblástico de Localização Placentária/patologia , Neoplasias Uterinas/patologia , Adulto , Feminino , Seguimentos , Humanos , GravidezAssuntos
Adenocarcinoma/cirurgia , Laparoscopia , Neoplasias Ovarianas/cirurgia , Idoso , Feminino , Humanos , ReoperaçãoRESUMO
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.
Assuntos
Eletrocirurgia , Displasia do Colo do Útero/cirurgia , Neoplasias do Colo do Útero/cirurgia , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Papillomaviridae , Infecções por Papillomavirus/patologia , Infecções por Papillomavirus/cirurgia , Infecções Tumorais por Vírus/patologia , Infecções Tumorais por Vírus/cirurgia , Neoplasias do Colo do Útero/patologia , Displasia do Colo do Útero/patologiaRESUMO
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.
Assuntos
Tumor de Krukenberg/secundário , Neoplasias Ovarianas/secundário , Neoplasias Gástricas/patologia , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Tumor de Krukenberg/patologia , Pessoa de Meia-Idade , Neoplasias Ovarianas/patologia , Estudos RetrospectivosRESUMO
Thirty one postmenopause patients were studied, twenty three had metrorrhagia. They were examined by transvaginal ultrasonography with the purpose of measuring the depth of the endometrium. Endometrium depth < or = 10 mm is associated with minimal risk of endometrial cancer. The relationship between the echographic measurements and endometrium cancer, reveals a sensitive of 75%; specificity of 89%; positive predictive value of 60% and negative of 94%.
Assuntos
Endométrio/diagnóstico por imagem , Metrorragia/diagnóstico por imagem , Pós-Menopausa , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Chile/epidemiologia , Neoplasias do Endométrio/diagnóstico por imagem , Neoplasias do Endométrio/epidemiologia , Endométrio/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , UltrassonografiaRESUMO
Two cases of epithelial ovarian tumors of borderline malignancy initially approached by laparoscopy are presented. The role of laparoscopy are presented. The role of laparoscopy in the management of ovarian tumors is discussed.
Assuntos
Cistadenocarcinoma Papilar/patologia , Laparoscopia , Neoplasias Ovarianas/patologia , Adulto , Biópsia , Cistadenocarcinoma Papilar/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/cirurgiaRESUMO
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.
Assuntos
Secções Congeladas , Neoplasias Epiteliais e Glandulares/patologia , Neoplasias Ovarianas/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Criança , Feminino , Humanos , Pessoa de Meia-Idade , Sensibilidade e EspecificidadeRESUMO
"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.
Assuntos
Laparotomia , Neoplasias Ovarianas/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Ovarianas/mortalidade , Neoplasias Ovarianas/patologia , Valor Preditivo dos Testes , Prognóstico , Reoperação , Taxa de SobrevidaRESUMO
The possible relationship between the intrauterine accumulation of fluid during the peri and post-menopause period and genital cancer are studied by ultrasonography. In our experience 22% of the patients had endometrial cancer.
Assuntos
Endométrio/diagnóstico por imagem , Exsudatos e Transudatos/diagnóstico por imagem , Pós-Menopausa , Adenocarcinoma/patologia , Adenocarcinoma de Células Claras/patologia , Idoso , Atrofia/diagnóstico por imagem , Neoplasias do Endométrio/patologia , Endométrio/patologia , Feminino , Humanos , Metrorragia/diagnóstico por imagem , Pessoa de Meia-Idade , Estudos Prospectivos , UltrassonografiaRESUMO
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.
Assuntos
Cistadenocarcinoma Papilar/complicações , Dermatomiosite/etiologia , Neoplasias Ovarianas/complicações , Cistadenocarcinoma Papilar/terapia , Dermatomiosite/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/terapiaRESUMO
The microbiology of twenty-nine asymptomatic infertile women was evaluated prospectively. Samples were taken from the cervix and the endosalpinx during laparoscopy. Cultures for aerobes, anaerobes, Neisseria gonorrhoeae, Mycoplasma, Ureaplasma urealyticum and Chlamydia trachomatis were performed. No association was found between the presence of germs in the abdomen or cervix and tubal abnormalities. History of previous IUD use was associated with tubal disease.
Assuntos
Abdome/microbiologia , Colo do Útero/microbiologia , Infertilidade Feminina/microbiologia , Adulto , Bactérias Aeróbias/isolamento & purificação , Bactérias Anaeróbias/isolamento & purificação , Chile/epidemiologia , Feminino , Humanos , Infertilidade Feminina/epidemiologia , Dispositivos Intrauterinos , Laparoscopia , Paridade , Estudos ProspectivosRESUMO
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.
Assuntos
Neoplasias do Endométrio/patologia , Cuidados Intraoperatórios , Miométrio/patologia , Biópsia , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Histerectomia , Laparotomia , Excisão de Linfonodo , Invasividade NeoplásicaRESUMO
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.
Assuntos
Carcinoma in Situ/patologia , Neoplasias dos Genitais Femininos/patologia , Hospedeiro Imunocomprometido , Transplante de Rim , Papillomaviridae , Infecções por Papillomavirus/patologia , Infecções Tumorais por Vírus/patologia , Adolescente , Adulto , Carcinoma in Situ/epidemiologia , Chile/epidemiologia , Feminino , Neoplasias dos Genitais Femininos/epidemiologia , Humanos , Pessoa de Meia-Idade , Infecções por Papillomavirus/epidemiologia , Infecções Tumorais por Vírus/epidemiologiaRESUMO
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.
Assuntos
Neoplasias Epiteliais e Glandulares/terapia , Neoplasias Ovarianas/terapia , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Chile/epidemiologia , Protocolos Clínicos , Terapia Combinada , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Epiteliais e Glandulares/epidemiologia , Neoplasias Epiteliais e Glandulares/mortalidade , Neoplasias Epiteliais e Glandulares/patologia , Neoplasias Ovarianas/epidemiologia , Neoplasias Ovarianas/mortalidade , Neoplasias Ovarianas/patologia , Estudos ProspectivosRESUMO
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.
Assuntos
Carcinoma/complicações , Histerectomia/efeitos adversos , Complicações Intraoperatórias/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Neoplasias do Colo do Útero/complicações , Adulto , Idoso , Carcinoma/epidemiologia , Carcinoma/patologia , Carcinoma/cirurgia , Distribuição de Qui-Quadrado , Chile/epidemiologia , Terapia Combinada , Feminino , Humanos , Histerectomia/estatística & dados numéricos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgiaRESUMO
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.