Scielo RSS http://scielo.pt/rss.php?pid=1646-583020180001&lang=es vol. 12 num. 1 lang. es http://scielo.pt/img/en/fbpelogp.gif http://scielo.pt http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302018000100001&lng=es&nrm=iso&tlng=es http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302018000100002&lng=es&nrm=iso&tlng=es Overview and Aims: Cervical cancer is the fourth most frequent cancer in women worldwide, with 266.000 death cases in 2012. The epidermoid cancers are more prevalent, but the incidence of adenocarcinomas and its variants has increased over the past few decades, especially in young women. Problems impacting the diagnosis of cervical glandular lesions include reduced sensitivity of screening with cervical cytology, colposcopic inexperience and subtle colposcopic findings. This study aimed to evaluate in situ and invasive cervical adenocarcinoma cases with regards to relations between risk factors, prognostic factors and mortality. Study Design: Cross-sectional study. Methods: 28 women diagnosed with cervical adenocarcinoma, were revised. The diagnose was made at a tertiary center, from January 2009 to December 2015. Statistical analysis was performed by STATA 13.1 program. Results: Ten cervical adenocarcinoma in situ (AIS) and eighteen invasive adenocarcinoma (IA), were analyzed. It was identified statistical difference in the diagnostic age (AIS: median 39 years; IA: median 51 years), number of previous cervical cytologies (AIS: 80% performed screening vs IA: 50% no screening) and cytology findings (AIS: 63% Atypical glandular cells vs IA: 50% adenocarcinoma). There was no relation with obesity, hormonal contraception, smoking and number of sexual partners. It was identified statistical significance between prognosis and FIGO stage (55.6% Stage1). Five deaths were reported (IB1:1, IIA1: 2 e IVB:2) and also one successful pregnancy (IA1). Conclusion: In this study, it was not identified relation with risk factors and only FIGO stage statistically contributes to prognosis. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302018000100003&lng=es&nrm=iso&tlng=es Introduction: Hysteroscopic sterilization with the Essure® device is a method of contraception considered safe and effective already applied in more than 200,000 women. This study aims to evaluate the efficacy of this method of contraception and the adverse events associated with the placement of Essure®, including pain during the procedure and post­procedure complications. Material and methods: We performed a retrospective observational study with inclusion of all the women submitted to Essure® placement in a large urban hospital in Portugal, from January 2008 to December 2015 (7 years). The variables age, parity, duration and intercurrences of the procedure, follow-up exams and final outcome were evaluated. The statistical analysis was performed with STATA 12.1. Results: Of the 118 women only 100 finished the procedure with 16.9% reporting moderate or severe pain. Although less than 3 intrauterine rings were found in 8.5% of cases, the success rate was 92%. The complications described were tubal perforation (0.8%), pregnancy (1 case) and incorrect positioning of the implants (3%). Discussion/Conclusion: The success rate of the procedure was very close to that described in the literature with a low incidence of complications. That advantages make it an ideal method for women with high surgical risk and multiple comorbidities http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302018000100004&lng=es&nrm=iso&tlng=es Overview: Endometrial cancer is a common gynecological malignancy, diagnosed at stage I in 80% of cases. In the absence of contra-indication, staging is surgical. Pelvic lymphadenectomy is not recommended in low risk endometrial cancers. Magnetic resonance imaging (MRI) is useful to predict the depth of myometrial invasion in the preoperative assessment, but intra-operative pathological exam could also be used. Aim: To analyze the concordance between final histological exam and pre-operative MRI or intra-operative pathological exam. Study Design: Cross-Sectional Study Methods: It was performed a cross-sectional study of 145 women diagnosed with endometrial carcinoma, in a tertiary clinical center, from January 2010 to December 2015. It was analyzed 60 cases, the ones submitted to MRI and extemporaneous exam. Statistical analysis was performed by STATA 13.1. Results: Sixty cases of endometrial cancers have been rated using MRI and intraoperative histological exam. The observed concordance (MRI versus final invasion) was 81%, with kappa index of 0.54 (moderate concordance). MRI has demonstrated diagnostic sensitivity of 86%, specificity of 80% (AUC:0.84). Adjusting for prevalence, MRI negative predictive value (NPV) was 95% and positive predictive value (PPV) was 55%. When compared to MRI, the extemporaneous exam demonstrates higher sensitivity and specificity (Sensitivity:91%; specificity:93%, AUC:0.92; PPV: 77%, NPV: 98%). The Kappa index was 0.79 (substantial concordance). Comparing the two diagnostic tools, the extemporaneous exam was superior (p= 0.04). Conclusion: Extemporaneous exam has demonstrated diagnostic superiority http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302018000100005&lng=es&nrm=iso&tlng=es Overview: Although low sensitivity of cervical cytology, this screening test was responsible by 70 to 80% reduction of incidence and mortality of cervical cancer worldwide. Inflammation is a common finding, that could be meaningless, could occlude premalignant lesions or could represent an oncological risk. Aims: To analyze cases of persistent inflammatory pap smears and their association with intraepithelial high grade lesions or carcinoma. Study Design: Cross-sectional study. Methods: Two hundred sixty cases of women with persistent inflammatory smears, opportunistically admitted to a tertiary unit, from January 2013 to December 2015, were revised. Statistical analysis was performed by STATA 13.1 program. Results: Two hundred sixty cases were analyzed, 13% in 2013 (91/692), 12% in 2014 (76/624) and 14% in 2015 (93/649). The mean age was 41 years, 60% were under hormonal contraception and 15% were postmenopausal. It was performed 106 human papillomavirus (HPV) typifications, 95 were negative, one positive to HPV-18 and 10 positive to others high-risk HPV. Considering patients follow-up, 15.4% (n=40) colposcopic abnormal findings were identified, 67.5% grade 1 and 32.5% grade 2. Thirty nine colposcopy guided biopsies were carried out. Histologically, 15 cases of cervicitis were identified, 12 of squamous metaplasia, 11 of low grade squamous intraepithelial lesion (LSIL) and one of high grade (HSIL). Ten women were submitted to treatment, four to excision of transformation zone (histology: three LSIL and one HSIL) and six to cryotherapy. 74%(n=192) had medical discharge after eighteen months, 13%(n=35) missed next appointments, 10% (n=25) maintain follow-up and 3% (n=8) were readmitted (3 LSIL, 1 atypical squamous cells of undetermined significance and 1 that cannot exclude HSIL, 2 persistent inflammation and 1 vulvar condilomatosis). Conclusion: In conclusion, the persistence of pap smears partially obscured by inflammation should persist to be targeted, until prospective and randomized trials are not performed. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302018000100006&lng=es&nrm=iso&tlng=es Non-invasive prenatal testing (NIPT) is a recent approach to prenatal aneuploidy screening. NIPT has an excellent test performance but it is not a diagnostic test, as there are known limitations associated with false positive and false negative results. When compared to standard screening, pre-test counselling is complicated by concepts such as the possibility of incidental findings. It is important for all the health professionals involved in this field to be familiarised with the state-of-the art knowledge in NIPT. The aim of this article is to review the evidence on the clinical use of NIPT for aneuploidy screening. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302018000100007&lng=es&nrm=iso&tlng=es The prevalence of uterine leiomyomatosis (UL) in pregnancy is 3.2-10.7% with a complication rate of 10-40%. Due to the heterogeneity of its behavior in pregnancy, it is impossible to predict its course. The most frequent clinical complaint is pain (89%), metrorrhagia (41%) and cystic degeneration (6%). UL increases the risk of: miscarriage (2x), preterm labor (3.9%, less than 34 weeks) and premature rupture of membranes (10.4%). Dynamic dystocia and fetal malpresentation (5.3%) are the main causes of the high cesarean rate (33%). UL is associated with placenta previa (1.4-3.5%), placental abruption (0-7.5%), retained placenta (1.25-2.4%) and postpartum haemorrhage http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302018000100008&lng=es&nrm=iso&tlng=es Studies about the effect of mode of delivery in postpartum sexual function have shown inconsistent results, perpetuating the idea that a cesarean delivery has fewer consequences for women's sexuality. This systematic review aims to examine the role of mode of delivery in sexual health after childbirth. The published studies are scarce and quite heterogeneous. Any study has found a solid association between the mode of delivery and specific effects in long-term postpartum sexuality. In light of this review, cesarean delivery does not seem to be associated with a protective effect in female postpartum sexuality http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302018000100009&lng=es&nrm=iso&tlng=es Mammary-like neoplasms have been described through the mammary-line, axilla, vulva and prostate, and are rare lesions of un uncertain histological origin. Phyllodes tumor occuring in the vulva is rare with only a few cases reported. We describe a case of a 41-year-old woman with a vulvar swelling that revealed to be a phyllodes tumor after complete excision. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302018000100010&lng=es&nrm=iso&tlng=es Parasitic myomas are a rare form of uterine leiomyomas. Distinction from other abdominal masses may be difficult, due to parasitic leiomyomas' variable anatomic locations and clinical manifestations. We describe the case of a 45 years-old woman, presenting with abdominal pain and a large pelvic mass that turned out to be a parasitic myoma at surgical assessment. Histological analysis confirmed the intraoperative suspicion. We intend to bring awareness to the inclusion of this condition in the differential diagnosis of pelvic masses, especially in women with risk factors for parasitic myomas, such as previous surgery for uterine fibromyomatosis or concomitant uterine myomas. http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302018000100011&lng=es&nrm=iso&tlng=es There is currently few data regarding radiation tolerance of a transplanted kidney. We report on a patient with renal transplant, submitted to surgery for endometrial cancer, followed by chemotherapy and radiotherapy. She was treated with Intensity-Modulated Radiation Therapy(IMRT) to a dose of 45Gy to the target volume and a mean dose of 6,4Gy to the graft. After one year of follow-up, she remains free of disease and has normal renal function. Pelvic radiotherapy in the setting of a transplanted kidney is feasible with IMRT. A mean dose of 6,4Gy to the graft seems to be safe to preserve renal function http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302018000100012&lng=es&nrm=iso&tlng=es Although the incidence of preinvasive vulvar lesions seems to be rising in the younger population, invasive squamous cell carcinoma remains exceedingly rare. As a result, diagnostic biopsy is often delayed and ablative therapy is frequently instituted without an adequate histologic diagnosis. We present an invasive squamous carcinoma of the vulva in a 28-year-old nulliparous woman who presented with a painless vulvar ulcer for the past 6 months. Biopsy revealed an invasive squamous cell carcinoma of the vulva. Conservative surgery (tumorectomy with safety margins and sentinel lymph node biopsy) was performed with good patient recovery and return to normal working life before 30 days http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302018000100013&lng=es&nrm=iso&tlng=es Squamous cell carcinoma (SCC) is the most frequent histological type of cervical cancer. It generally invades directly into the uterine wall but, in rare cases, spreads superficially to the inner surface of the uterus, replacing the endometrium, known as superficial spreading SCC. The authors present a rare case of a postmenopausal woman with carcinoma in situ of the cervix with superficial extension through the totality of the uterine cavity, including fundus. SCC is a rare entity which staging, prognosis and management guidelines have not been described http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302018000100014&lng=es&nrm=iso&tlng=es Uterine fibroids are benign monoclonal tumors that originates from the smooth muscle cells of the myometrium and are the most common solid pelvic tumors in women. In the differential diagnosis of vulvar masses we should considered Bartholin's cysts or abscesses, Bartholin's tumors, fibroids (usually fibroids of the round ligament), subcutaneous lipomas, inguinal hernia or adenomegaly. With this images we present a case of a vulvar mass caused by a fibroid, probably from the round ligament, which was a tip of the iceberg of an extensive pelvic leiomyomatosis