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Relato de Caso
Intramammary lymph node sentinel metastasis without metastasis in axilla: axillary lymph node dissection or conservative surgery?
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(10):478-482
05-15-2012
Summary
Relato de CasoIntramammary lymph node sentinel metastasis without metastasis in axilla: axillary lymph node dissection or conservative surgery?
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(10):478-482
05-15-2012DOI 10.1590/S0100-72032012005000001
Views100The sentinel lymph node biopsy is a standard treatment for patients with breast cancer and clinically negative axilla lymph node. The presence of an extra-axillary and intra-axillary (IM) sentinel lymph node (SLN) occurs in up to 2.6% of cases. In the presence of a metastatic IM SLN, axillary positivity may occur in up to 81% of cases. Due to the limited number of cases reported, there is no standard treatment for the association of metastatic SLN IM and non-metastatic axillary SLN . We add here two cases to the literature, one of them with metastatic disease in the axilla. The use of a nomogram demonstrated that the risk of axillary metastasis was less than 10% and the addition of these cases to the literature showed that in this situation the rate of axillary metastasis is 6.25%. We discuss the pros and cons of further axillary dissection in this situation.
Key-words Breast neoplasmsCase reportsLymph nodes excisionLymphatic metastasisNomogramsSentinel lymph node biopsySee moreViews100
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Relato de CasoIntramammary lymph node sentinel metastasis without metastasis in axilla: axillary lymph node dissection or conservative surgery?
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(10):478-482
05-15-2012DOI 10.1590/S0100-72032012005000001
Views100The sentinel lymph node biopsy is a standard treatment for patients with breast cancer and clinically negative axilla lymph node. The presence of an extra-axillary and intra-axillary (IM) sentinel lymph node (SLN) occurs in up to 2.6% of cases. In the presence of a metastatic IM SLN, axillary positivity may occur in up to 81% of cases. Due to the limited number of cases reported, there is no standard treatment for the association of metastatic SLN IM and non-metastatic axillary SLN . We add here two cases to the literature, one of them with metastatic disease in the axilla. The use of a nomogram demonstrated that the risk of axillary metastasis was less than 10% and the addition of these cases to the literature showed that in this situation the rate of axillary metastasis is 6.25%. We discuss the pros and cons of further axillary dissection in this situation.
Key-words Breast neoplasmsCase reportsLymph nodes excisionLymphatic metastasisNomogramsSentinel lymph node biopsySee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Relato de Caso
Atipical form of Mayer-Rokitansky-Kuster-Hauser syndrome with renal malformation and skeletal abnormalities (MURCS association)
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(3):133-138
04-04-2012
Summary
Relato de CasoAtipical form of Mayer-Rokitansky-Kuster-Hauser syndrome with renal malformation and skeletal abnormalities (MURCS association)
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(3):133-138
04-04-2012DOI 10.1590/S0100-72032012000300008
Views74The atypical and more severe form of Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH) or MRKH type II is also known as MURCS association, an acronym meaning aplasia/hypoplasia of Müllerian ducts (MU), congenital renal dysplasia (R) and cervico-thoracic dysplasia (CS). It affects female patients with normal karyotype and ovarian function, evolving to primary amenorrhea. It has an incidence of 1:50,000, but it is underestimated due to late diagnosis and undefined etiology. We describe the cases of a child and an adolescent in order to predict the diagnosis even in childhood, before the onset of amenorrhea. Patients had in common renal malformation, agenesis or hypoplasia of Müllerian derivatives and vertebral anomalies, establishing the diagnosis of MURCS. The relevance of this paper is to show the importance of further investigation when some of pathologic signs are present, researching correlated abnormalities in order to establish an early diagnosis and consequently to provide guidance to the patients and their families about the best way to conduct the case, including genetic counseling.
Key-words AbnormalitiesAmenorrheaCase reportsChromosome aberrationsKidneyMullerian ductsmultipleUterusVaginaSee moreViews74This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Relato de CasoAtipical form of Mayer-Rokitansky-Kuster-Hauser syndrome with renal malformation and skeletal abnormalities (MURCS association)
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(3):133-138
04-04-2012DOI 10.1590/S0100-72032012000300008
Views74The atypical and more severe form of Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH) or MRKH type II is also known as MURCS association, an acronym meaning aplasia/hypoplasia of Müllerian ducts (MU), congenital renal dysplasia (R) and cervico-thoracic dysplasia (CS). It affects female patients with normal karyotype and ovarian function, evolving to primary amenorrhea. It has an incidence of 1:50,000, but it is underestimated due to late diagnosis and undefined etiology. We describe the cases of a child and an adolescent in order to predict the diagnosis even in childhood, before the onset of amenorrhea. Patients had in common renal malformation, agenesis or hypoplasia of Müllerian derivatives and vertebral anomalies, establishing the diagnosis of MURCS. The relevance of this paper is to show the importance of further investigation when some of pathologic signs are present, researching correlated abnormalities in order to establish an early diagnosis and consequently to provide guidance to the patients and their families about the best way to conduct the case, including genetic counseling.
Key-words AbnormalitiesAmenorrheaCase reportsChromosome aberrationsKidneyMullerian ductsmultipleUterusVaginaSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Relato de Caso
Placental vascular lesion as cause of IUGR and nonimmune fetal hydrops in twin pregnanc
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(12):421-425
01-23-2011
Summary
Relato de CasoPlacental vascular lesion as cause of IUGR and nonimmune fetal hydrops in twin pregnanc
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(12):421-425
01-23-2011DOI 10.1590/S0100-72032011001200008
Views132See morePlacenta vascular lesions are a group of distinct yet related entities that include chorangiomas and diffuse multifocal chorangiomatosis. Chorangioma is an expansive nodular lesion with an incidence of about 1%. Diffuse multifocal chorangiomatosis is rare (0.2%) and mostly seen in placentas before the 32nd gestational week. The authors present a case of a monochorionic/biamniotic twin pregnancy, in which, at the 26th gestational week, one fetus developed intrauterine growth restriction (IUGR), hydrops, and anemia associated with a tumor of the placenta with increased vascularization in the Doppler study. Pathological examination of the placenta diagnosed diffuse multifocal chorangiomatosis. This rare case report of diffuse multifocal chorangiomatosis with prenatal manifestations resembling those of a chorangioma proves that prenatal ultrasound detection of a placenta tumor, with increased vascularization at Doppler study, must raise other diagnostic possibilities beside chorangioma.
Views132This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Relato de CasoPlacental vascular lesion as cause of IUGR and nonimmune fetal hydrops in twin pregnanc
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(12):421-425
01-23-2011DOI 10.1590/S0100-72032011001200008
Views132See morePlacenta vascular lesions are a group of distinct yet related entities that include chorangiomas and diffuse multifocal chorangiomatosis. Chorangioma is an expansive nodular lesion with an incidence of about 1%. Diffuse multifocal chorangiomatosis is rare (0.2%) and mostly seen in placentas before the 32nd gestational week. The authors present a case of a monochorionic/biamniotic twin pregnancy, in which, at the 26th gestational week, one fetus developed intrauterine growth restriction (IUGR), hydrops, and anemia associated with a tumor of the placenta with increased vascularization in the Doppler study. Pathological examination of the placenta diagnosed diffuse multifocal chorangiomatosis. This rare case report of diffuse multifocal chorangiomatosis with prenatal manifestations resembling those of a chorangioma proves that prenatal ultrasound detection of a placenta tumor, with increased vascularization at Doppler study, must raise other diagnostic possibilities beside chorangioma.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Relato de Caso
Hyperandrogenic syndrome in a postmenopausal woman: a case report
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(8):214-220
12-08-2011
Summary
Relato de CasoHyperandrogenic syndrome in a postmenopausal woman: a case report
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(8):214-220
12-08-2011DOI 10.1590/S0100-72032011000800008
Views87ABSTRACT Hyperandrogenic syndromes include diseases that manifest through an increased biological activity of androgens and that can originate from neoplastic or functional diseases. Androgen-secreting ovarian tumors represent about 1% of ovarian neoplasias. Steroid cell tumors are among the more rare types which account for less than 0.1% of all ovarian tumors. They are usually benign, of small dimensions and unilateral. We report here a rare case of a unilateral steroid cell tumor. A 60-year-old woman was seen after four months of evolution of hirsutism, clitoris hypertrophy and elevation of serum estradiol levels. Her total testosterone and 17-OH-progesterone levels were also increased.
Key-words Case reportsClimactericGonodal steroid hormonesHirsutismHyperandrogenism/complicationsOvarian neoplasms/complicationsPostmenopauseVirilism/etiologySee moreViews87This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Relato de CasoHyperandrogenic syndrome in a postmenopausal woman: a case report
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(8):214-220
12-08-2011DOI 10.1590/S0100-72032011000800008
Views87ABSTRACT Hyperandrogenic syndromes include diseases that manifest through an increased biological activity of androgens and that can originate from neoplastic or functional diseases. Androgen-secreting ovarian tumors represent about 1% of ovarian neoplasias. Steroid cell tumors are among the more rare types which account for less than 0.1% of all ovarian tumors. They are usually benign, of small dimensions and unilateral. We report here a rare case of a unilateral steroid cell tumor. A 60-year-old woman was seen after four months of evolution of hirsutism, clitoris hypertrophy and elevation of serum estradiol levels. Her total testosterone and 17-OH-progesterone levels were also increased.
Key-words Case reportsClimactericGonodal steroid hormonesHirsutismHyperandrogenism/complicationsOvarian neoplasms/complicationsPostmenopauseVirilism/etiologySee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Relato de Caso
Inflammatory bowel disease – Crohn’s disease and pregnancy: case report
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(4):196-204
08-05-2011
Summary
Relato de CasoInflammatory bowel disease – Crohn’s disease and pregnancy: case report
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(4):196-204
08-05-2011DOI 10.1590/S0100-72032011000400008
Views102See moreThe Crohn's disease, a form of inflammatory bowel disease, is frequent in women of childbearing age. Its management requires greater attention during pregnancy. We report a case of refractory Crohn's disease in a pregnant patient that evolued to ileocolectomy at puerperium. The literature regarding pregnant patients with Crohn's disease was reviewed, including counseling of patients and investigation of active disease, and the existing data was summarized on the safety of medications used to treat Crohn's disease in pregnancy and breastfeeding.
Views102This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Relato de CasoInflammatory bowel disease – Crohn’s disease and pregnancy: case report
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(4):196-204
08-05-2011DOI 10.1590/S0100-72032011000400008
Views102See moreThe Crohn's disease, a form of inflammatory bowel disease, is frequent in women of childbearing age. Its management requires greater attention during pregnancy. We report a case of refractory Crohn's disease in a pregnant patient that evolued to ileocolectomy at puerperium. The literature regarding pregnant patients with Crohn's disease was reviewed, including counseling of patients and investigation of active disease, and the existing data was summarized on the safety of medications used to treat Crohn's disease in pregnancy and breastfeeding.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Relato de Caso
Dunnigan-type familial partial lipodystrophy: attention to precocious diagnosis
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(2):99-103
07-08-2011
Summary
Relato de CasoDunnigan-type familial partial lipodystrophy: attention to precocious diagnosis
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(2):99-103
07-08-2011DOI 10.1590/S0100-72032011000200008
Views93Dunnigan-type familial partial lipodystrophy (FPLD) is an autosomal dominant disease that results from heterozygous missense mutations in LMNA, the gene that encodes nuclear lamin A/C. FPLD is characterized by a progressive disappearance of subcutaneous adipose tissue in the limbs, gluteal region, abdomen and trunk, beginning at the time of or after puberty, and excessive amount of fat in the face, chin, labia majora, and intra-abdominal region, leading to a Cushingoid appearance and increased muscularity phenotype. Affected women are particularly predisposed to insulin resistance and its complications, including features of polycystic ovary syndrome. To emphasize the importance of an early FPLD diagnosis, which is necessary to prevent serious metabolic disturbances, we report a woman diagnosed at about 50 years of age. Increased muscularity and significant labia majora fat deposit made the diagnosis possible by gynecologists.
Key-words Case reportsFenotypeHeterozygoteInsulin resistanceLaminsLipodystrophy, familial partialMutation, missenseSee moreViews93This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Relato de CasoDunnigan-type familial partial lipodystrophy: attention to precocious diagnosis
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(2):99-103
07-08-2011DOI 10.1590/S0100-72032011000200008
Views93Dunnigan-type familial partial lipodystrophy (FPLD) is an autosomal dominant disease that results from heterozygous missense mutations in LMNA, the gene that encodes nuclear lamin A/C. FPLD is characterized by a progressive disappearance of subcutaneous adipose tissue in the limbs, gluteal region, abdomen and trunk, beginning at the time of or after puberty, and excessive amount of fat in the face, chin, labia majora, and intra-abdominal region, leading to a Cushingoid appearance and increased muscularity phenotype. Affected women are particularly predisposed to insulin resistance and its complications, including features of polycystic ovary syndrome. To emphasize the importance of an early FPLD diagnosis, which is necessary to prevent serious metabolic disturbances, we report a woman diagnosed at about 50 years of age. Increased muscularity and significant labia majora fat deposit made the diagnosis possible by gynecologists.
Key-words Case reportsFenotypeHeterozygoteInsulin resistanceLaminsLipodystrophy, familial partialMutation, missenseSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Relato de Caso
Neoadjuvant chemotherapy followed by radical surgery in pregnant patient with invasive cervical cancer: case report and literature review
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(1):43-48
05-17-2011
Summary
Relato de CasoNeoadjuvant chemotherapy followed by radical surgery in pregnant patient with invasive cervical cancer: case report and literature review
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(1):43-48
05-17-2011DOI 10.1590/S0100-72032011000100007
Views84The treatment options for pregnant patients with invasive cervical cancer (ICC) depend on gestational age, clinical stage and the patient's wishes. Some authors have reported cases of neoadjuvant chemotherapy followed by radical surgery in these patients. The aim of this paper was to revisit this subject and to add a new case and review the literature. We report the case of a 30 year-old woman in the 24th week of gestation. She was diagnosed with ICC (squamous cell carcinoma grade 2), stage IIB (International Federation of Gynecology and Obstetrics - FIGO). Nulliparous, the patient refused to interrupt the pregnancy. After meticulous counseling, the patient accepted treatment with neoadjuvant chemotherapy (cisplatin 75 mg/m² and vincristine 1 mg/m²) and subsequent evaluation of radical surgery concomitant to a cesarean section. Four complete cycles of chemotherapy were administered without delays or significant adverse effects. A few days before the date scheduled for surgery, the patient was admitted in advanced labor (37th week of gestation). Due to tumor clinical response, the obstetric team decided to monitor the labor, and the patient gave birth to a male newborn (2,450 g) uneventfully. Radical surgery was performed three days after birth, and histopathology analysis revealed carcinoma confined to the cervix without lymphatic involvement. Mother and son are in good general condition 12 months after delivery. Cisplatin-based chemotherapy during the second or third trimester of pregnancy appears to be a safe option for patients who do not wish to interrupt a pregnancy while awaiting fetal maturity. However, additional studies are needed to confirm the prognosis and assure the safety of newborns and patients.
Key-words Case reportsNeoadjuvant therapyPregnancy complications, neoplasticUterine cervical neoplasmsSee moreViews84This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Relato de CasoNeoadjuvant chemotherapy followed by radical surgery in pregnant patient with invasive cervical cancer: case report and literature review
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(1):43-48
05-17-2011DOI 10.1590/S0100-72032011000100007
Views84The treatment options for pregnant patients with invasive cervical cancer (ICC) depend on gestational age, clinical stage and the patient's wishes. Some authors have reported cases of neoadjuvant chemotherapy followed by radical surgery in these patients. The aim of this paper was to revisit this subject and to add a new case and review the literature. We report the case of a 30 year-old woman in the 24th week of gestation. She was diagnosed with ICC (squamous cell carcinoma grade 2), stage IIB (International Federation of Gynecology and Obstetrics - FIGO). Nulliparous, the patient refused to interrupt the pregnancy. After meticulous counseling, the patient accepted treatment with neoadjuvant chemotherapy (cisplatin 75 mg/m² and vincristine 1 mg/m²) and subsequent evaluation of radical surgery concomitant to a cesarean section. Four complete cycles of chemotherapy were administered without delays or significant adverse effects. A few days before the date scheduled for surgery, the patient was admitted in advanced labor (37th week of gestation). Due to tumor clinical response, the obstetric team decided to monitor the labor, and the patient gave birth to a male newborn (2,450 g) uneventfully. Radical surgery was performed three days after birth, and histopathology analysis revealed carcinoma confined to the cervix without lymphatic involvement. Mother and son are in good general condition 12 months after delivery. Cisplatin-based chemotherapy during the second or third trimester of pregnancy appears to be a safe option for patients who do not wish to interrupt a pregnancy while awaiting fetal maturity. However, additional studies are needed to confirm the prognosis and assure the safety of newborns and patients.
Key-words Case reportsNeoadjuvant therapyPregnancy complications, neoplasticUterine cervical neoplasmsSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Relato de Caso
Acute abdomen in pregnant woman treated for bariatric surgery for obesity: case report
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(10):516-519
02-01-2010
Summary
Relato de CasoAcute abdomen in pregnant woman treated for bariatric surgery for obesity: case report
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(10):516-519
02-01-2010DOI 10.1590/S0100-72032010001000008
Views57Bariatric surgery is currently considered as an alternative for the treatment of morbid obesity refractory to conventional clinical treatments. The surgeries more frequently used, which are radical and invasive, yield better and faster results, but are subject to clinical and surgical complications such as intestinal obstructions and subocclusions. Pregnancies in women submitted to this type of surgery are increasingly frequent, and the related complications have been increasingly reported. We present the case of a pregnant woman previously submitted to bariatric surgery who developed subocclusion with intestinal intussusception. This extremely serious complication requires attention for its diagnosis, i.e. , imaging and laboratory exams that are not usually employed during pregnancy. Gestation confuses and impairs their interpretation. In addition to the fact that the only treatment that reaches a good result is invasive, exploratory laparotomy is undesirable during this period. Maternal, fetal and perinatal mortality is usually high. In the present case, delivery occurred spontaneously during the first hours of hospitalization before the surgical procedure. Evolution was good and both mother and newborn, although premature, had good course and were discharged in good conditions.
Key-words Acute abdomenBariatric surgeryIntestinal obstructionObesity, morbidPregnancy complicationsSee moreViews57This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Relato de CasoAcute abdomen in pregnant woman treated for bariatric surgery for obesity: case report
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(10):516-519
02-01-2010DOI 10.1590/S0100-72032010001000008
Views57Bariatric surgery is currently considered as an alternative for the treatment of morbid obesity refractory to conventional clinical treatments. The surgeries more frequently used, which are radical and invasive, yield better and faster results, but are subject to clinical and surgical complications such as intestinal obstructions and subocclusions. Pregnancies in women submitted to this type of surgery are increasingly frequent, and the related complications have been increasingly reported. We present the case of a pregnant woman previously submitted to bariatric surgery who developed subocclusion with intestinal intussusception. This extremely serious complication requires attention for its diagnosis, i.e. , imaging and laboratory exams that are not usually employed during pregnancy. Gestation confuses and impairs their interpretation. In addition to the fact that the only treatment that reaches a good result is invasive, exploratory laparotomy is undesirable during this period. Maternal, fetal and perinatal mortality is usually high. In the present case, delivery occurred spontaneously during the first hours of hospitalization before the surgical procedure. Evolution was good and both mother and newborn, although premature, had good course and were discharged in good conditions.
Key-words Acute abdomenBariatric surgeryIntestinal obstructionObesity, morbidPregnancy complicationsSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Relato de Caso Archives - Revista Brasileira de Ginecologia e Obstetrícia
