Recurrencia del tumor ovárico de las células de la granulosa

We present the case of a 79-year-old woman who was misdiagnosed with an ovarian fibroma 5 years previously. The patient presented with pain in the right iliac fossa with leukocytosis and was diagnosed with diverticulitis. A mass was incidentally found in the anterior abdominal wall, which was later confirmed as metastasis from a granulosa cell tumor of the ovary.We provide a literature review, focussing on the clinical findings and treatment of this tumor. Few reports have been published of this uncommon entity, characterized by a long natural history and tendency to recur years after the initial diagnosis.     

Utilidad de la prueba de la fibronectina fetal y de la longitud del cérvix en la predicción del parto prematuro en gestantes sintomáticas

Objective

To evaluate the usefulness of fetal fibronectin and cervical length in predicting preterm birth in women with preterm uterine contractions.

Material and methods

A prospective study was conducted at the Virgen Macarena Hospital in Seville that included 153 pregnant women with suspected preterm labor and intact membranes. Cervical length was measured by transvaginal sonography and a rapid qualitative fibronectin test was performed in the emergency consultation. Women with a negative fibronectin test and cervical length ≥ 30 mm were not hospitalized or treated with tocolytics or corticosteroids.

Results

The mean gestational age at diagnosis was 223,02 ± 19,98 days, and 267,52 ± 14,15 days at delivery. Preterm birth < 37 weeks rate was 23% and 7,4% for deliveries < 35 weeks. There is an association between cervical length < 30 mm and birth < 37 weeks (OR, 3,68; 95% CI, 1,53-8,84), and with delivery in the following 14 days (OR, 3,35; 95% CI, 1,30-21,95). With the association of both tests we gain specificity in predicting preterm birth.

Conclusion

Cervical length is the test with higher specificity (E) and negative predictive value (VPN) for the prediction of preterm birth in women with symptomatic contractions.     

Tumor de células de la granulosa de patrón difuso sarcomatoide. Presentación de un caso

Granulosa-cell tumors are rare malignant neoplasms characterized by a long natural history and a tendency to recur years after the initial diagnosis.     

Carcinoma de células pequeñas neuroendocrino de cérvix uterino

We report a case of a neuroendocrine small-cell carcinoma of the cervix seen in our Gynaecology Department. This is a rare diagnosis and is of interest. Small-cell carcinoma of the cervix is a rare tumour with poor prognosis and high aggressiveness. Optimal treatment has not been established due to the rarity of the tumour.     

Es posible aplicar protocolos de cribado de cáncer de cérvix en la práctica diaria

Objective

To evaluate whether screening protocols for cervical cancer can be implemented without delaying the diagnosis of cancer and whether this practice is well accepted by patients.

Subjects and methods

In 2005, we developed a protocol for the early diagnosis of cervical cancer based on carrying out cervical smears every 3 years in women over the age of 30 with three previous normal smears. We studied 300 patients who had attended an appointment in 2006 and another 300 in 2008. We reviewed our records to determine whether we had performed a smear and, if one was indicated, whether we had recommended attendance at a follow-up visit 3 years later, and whether the women had returned earlier. Adherence to the protocol in cancers diagnosed from 2005 was also reviewed.

Results

The number of smears decreased by 32% in 2008 compared with 2004, the year prior to screening. In 2008, 21% of women were recommended to attend the next review 3 years later and 3% returned earlier. Of 17 cancers diagnosed since 2005, only one woman with adenocarcinoma had undergone screening.

Conclusions

The overuse of cytology/smears in daily clinical practice can be avoided.