Sistema Internacional Yokohama para el informe de la citología mamaria. Academia Internacional de Citología

Fine needle aspiration biopsy cytology is part of the diagnostic triad in the evaluation of breast pathology, along with clinical and mammography or ultrasound findings. The Yokohama international system of the International Agency for Cytology has been proposed to report fine needle puncture-aspiration biopsy breast cytology, through 5 diagnostic categories: Inadequate/insufficient, benign, atypical, suspicious for malignancy and malignant, including in each of these definitions, key cytological diagnostic criteria and suggestions for clinical management. The objective of this article was to know the guidelines of this new breast cytological classification system for its implementation in this region. Fine needle puncture-aspiration biopsy is a precise and effective method to diagnose different breast lesions, which requires an adequate cell sample and a precise cytomorphological interpretation. The application of standardized Yokohama system will allow to improve the evaluation, diagnosis and clinical management of the breast pathology. Keywords: Breast cytology. Fine-needle aspiration biopsy (FNAB). Reporting system Yokohama.

Efectos adversos perinatales asociados a adiposidad materna durante la gestación

Objective: To determine perinatal adverse effects associated with maternal adiposity during pregnancy between November 2017 and October 2018, in the Obstetrics and Gynecology Service at the University Hospital: Dr. Jesús María Casal Ramos, Acarigua – Araure, Edo. Portuguesa. Methods: Descriptive, retrospective cross-sectional with a sample consisting of 115 clinical records of overweight and obese pregnant women. Results: No early adolescent primigestas were found. Among the 67 overweight and type I obese patients, women aged 26-30 years (22/32.8 % and 10/34.5 %) predominated, followed by the 21-25 group (18/26.9 % and 8/27.6 %). Patients with type II and III obesity had a more homogeneous distribution. Weight gain during pregnancy was less than 10 kg in 85 patients (73.9 %). Full-term pregnancies predominated in all groups (91 %, 82.2 %, 80% and 88.9 %). Delivery was predominantly vaginal in overweight and obese patients type I (70.1% and 51.7%), cesarean section was more frequent in typi II and III obesity (60 % and 55.6 %). The most frequent maternal complications in overweight patients were: vaginal infections (25.4 %), urinary tract infections (14.9%) and anemia (14.9 %). Among obese women there was a higher frequency of hypertensive disorder of pregnancy (24.1 %, 50 % and 55.6 % in obesity I, II and III, respectively). Among the neonatal complications, low weight and prematurity predominated. Conclusions: Overweight and obesity are factors related to maternal and perinatal adverse effects. Key words: Adiposity, Perinatal effects, Overweight.

Coriocarcinoma gestacional primario de cuello uterino. Presentación de un caso

Choriocarcinoma represents a type of malignant tumor of gestational trophoblastic disease. It can develop after a molar pregnancy, miscarriage, normal or ectopic pregnancy. Generally its seat site is the uterine body; infrequent places such as the cervix have been described. We report the case of a 37-year-old patient is reported, VI gestations IV deliveries I cesarean section I molar pregnancy, with abnormal uterine bleeding, which is referred to the Hospital Oncology Service. On gynecological examination, an exophytic mass is observed in the cervix. A biopsy was taken that reported: Gestational choriocarcinoma and plasma levels of β-hCG were verified: 13805 IU / L. A total abdominal hysterectomy was performed with preservation of the ovaries. It was concluded as stage I of the International Federation of Gynecology and Obstetrics and 8, according to the score of the World Health Organization (ST I: 8), for which adjuvant was indicated. Currently no evidence of disease. Keywords: Choriocarcinoma, gestational trophoblastic disease, cervix.

Cáncer de cuello uterino. Incidencia registrada en el Hospital “Dr. Domingo Luciani” en el año 2020

Objective: To estimate the incidence of cervical cancer (CCU) in the year 2020 in the gynecology oncology consultation of the Obstetrics and Gynecology Service of the Hospital “Dr. Domingo Luciani”. Method: Retrospective, descriptive study, where the clinical histories of the patients diagnosed with cervical cancer who attended the first oncology gynecology consultation were reviewed, the period from January to December 2020. Results: Sixty patients met the inclusion criteria, the variables studied were age, histological type, stage at the time of diagnosis and indicated treatment;14.52% were diagnosed with cervical cancer; the mean age at the time of diagnosis was 43.15 years; the most common histological group was squamous, (96.67%). Regarding staging, 28 cases (46.67%) were diagnosed in stage IIIB, 14 cases (23.33%) in stage IIB, and only 6.66% were diagnosed in early stages. Treatment indicated radiotherapy and chemotherapy. Conclusion: We show in the present study that cervical cancer represents a significant percentage of gynecological consultations, that unfortunately the diagnosis is made in advanced stages, negatively affecting the prognosis of these patients and that the age at which it predominates is in full productive life of the women. affected women, constituting a real public health problem and chaos for families and society. Keywords: Cervical cancer, Incidence, Carcinoma, Adenocarcinoma, Stage

Cáncer de endometrio: influencia del tratamiento en la calidad de vida y función sexual

Objective: To determine the influence of the treatment received, in the quality of life and sexual function of women survivors of endometrial cancer during the period: January 2017 - August 2019. Methods: Prospective, observational, analytical, longitudinal research, in endometrial cancer survivors, to whom the SF-12 health questionnaire and the Female Sexual Function Index were applied, to determine the quality of life and sexual health respectively, before and after treatment. Results: Patients exposed to surgery alone who perceived deterioration in their physical health after treatment was 56.5 %, while in those exposed to surgery plus adjuvant treatment was 97.4 %, in those exposed to neoadjuvant treatment plus surgery was 100.0 % as in those exposed to external radiotherapy only. No patient treated with surgery or external radiotherapy alone perceived deterioration in their mental health after treatment, while the patients undergoing surgery plus adjuvant treatment the percentage was 33.33 % and in those exposed to neoadjuvant treatment plus surgery was 12.50 %. 40 women had sexual dysfunction after treatment, 65.5 % of women undergoing surgery alone, 93.3 % of those undergoing surgery plus adjuvant treatment and 100 % of those exposed to neoadjuvant treatment plus surgery. Conclusion: The prevalence of deterioration of physical health, mental health and sexual dysfunction in women exposed to combined treatments was higher than in those exposed to surgery alone. Key words: Endometrial Cancer, Quality of Life, Sexual Function, Physical Health, Mental Health.

Embarazo a término en útero bicorne con cuerno rudimentario no comunicante. Reporte de un caso

The bicorne uterus with a rudimentary non-communicating horn may be associated with gynecological and obstetric complications such as infertility, endometriosis, hematometra, urinary tract abnormalities, abortions, and preterm deliveries. Excision of the rudimentary horn should be done outside of pregnancy, with followup during pregnancy, looking for complications. We present the case of a 40-year-old patient, who presented abdominal pain and vaginal bleeding, with a full-term pregnancy in a rudimentary non-communicating horn of a bicorne uterus. Physical examination showed abdominal distention and loss of uterine contour and no fetal parts were palpated. The provisional diagnosis of rupture of the uterus was made. Emergency laparotomy revealed a dead and deformed fetus, 37 weeks old, in a bicorne uterus with a broken rudimentary non-communicating horn, along with an acretic placenta. Extraction of the gestational sac, fetus and placenta and subtotal hysterectomy with conservation of the left annex were performed. Keywords: Rudimentary horn not communicating, Bicornuate uterus, Term pregnancy

Púrpura trombocitopénica idiopática en el embarazo: a propósito de un caso

Idiopathic purple thrombocytopenia is a hemorrhagic pathology, characterized by a decrease in the platelet count during pregnancy, mediated by cells and anti-platelet antibodies, causing the premature destruction of platelets by the reticuloendothelial system, which during pregnancy could lead to a commitment to maternal fetal wellbeing in severe stages. This pathology occurs in 1 out of every 1,000 to 10,000 pregnancies, and corresponds to 3% of thrombocytopenic pregnancies. The goal of management is to maintain platelet counts within safe ranges, recommending starting harmacological management when a platelet count lower than 10,000 / uL is found at any time during pregnancy or 30,000 / uL in the second or third trimester. The case presented corresponds to a 40-yearold woman in the first trimester of pregnancy with a history of chronic idiopathic purple thrombocytopenic, with severe thrombocytopenia at the time of admission to the Hospital. Keywords: Idiopathic thrombocytopenic purpura. Pregnancy. Blood platlets.

Utilidad del recuento de plaquetas en el diagnóstico del cáncer de ovario

Objective: To evaluate the usefulness of the platelet count and CA-125 in the discrimination between malignant and bening ovarian tumors at the Hospital Universitario de Los Andes, in a period of 5 years. Methods: Retrospective observational research. 419 patient medical stories coded as ovarian tumors were reviewed. The definitive pathology report was used as the gold standard test. Multiple statistical parameters of diagnostic performance were calculated from 2x2 tables and receiver operating characteristic (ROC) curves were plotted. Results: The mean platelet count: with invasive malignant ovarian tumors was 386/nl (CI 95 % 362-409), in benign tumors it 243/nl (CI 95 % 235-251) and in borderline tumors 237/nl (CI 95 % 198-276). Although the area under the curve receiver operating characteristic was higher for platelet count compared to CA125 levels (0.880 vs 0.790) this difference was not statistically significant. Among the mucinous tumors, the malignant ones did not present an elevated CA-125, but an elevated platelet count. Highest PPV of the platelet count was 95.6 % for > 350 / nl in postmenopausal women and 100 % for > 400/nl (p <0.001). Conclusion: The platelet count seems to have a similar utility to CA-125 to discriminate malignant from benign tumors and could improve diagnostic performance when both preoperative values are combined. Keywords: Platelets, Thrombocytosis, Ovary, Tumor, Cancer, CA-125, Diagnostic accuracy, Menopause.

Técnicas quirúrgicas en cesárea segmentaria. Revisión de evidencias

Aim: To know which have been the variations of the Pfannenstiel-Kerr technique and how they have influenced maternal morbidity and mortality. Methods: An electronic search was carried out in PubMed, Medline and Cochrane, of works in English and Spanish languages, regardless of the country of origin, preferably randomized and controlled between 2010 and 2020, on variations in the original surgical technique, with emphasis on the differences between the PfannenstielKerr and Miglav-Ladash techniques. Results: The more importants variations regarding morbidity and mortality were: 1. Preferring the transverse skin incision, especially the Joel Cohen type; 2. Lateral blunt dissection of the subcutaneous and cranio-caudal aponeurosis, after its incision; 3. Digital and lateral separation of the rectus abdominis muscles; 4. Digitally and laterally prolong the hysterotomy; 5. Uterine incision closure, without externalizing the uterus, in one or two suture planes, indifferently; 6. Do not suture the visceral and parietal peritoneum or approach the rectus abdominis; 7. Closure of the subcutaneous to separate points, if the thickness is greater than 2 cm. Conclusions: Modifications to the original technique achieved a statistically significant decrease in operative time, the number of sutures, the requirement for analgesics, blood loss, febrile morbidity, as well as operative wound infection and hospital stay. Keywords: Cesarean section, Surgical technique, Pfannenstiel-Kerr, Misgav-Ladach.

Suplementación de vitamina D en embarazadas y en mujeres con patologías ginecológicas

Apart from the well-known effects of vitamin D in maintaining calcium homeostasis and promoting bone mineralization, there is evidence to suggest that it modulates reproductive processes. About 70% adults have vitamin D deficiencies and there is a gap between recommended dietary intakes and deficient supply in general population. Observational studies show that vitamin D deficiency is a risk marker for reducing fertility and resulting adverse pregnancy. Evidence suggests that it could have beneficial effects on metabolic, hormonal and cellular parameters of polycystic ovarian syndrome, uterine myomatosis and endometriosis, while it seems to be associated with improvements in outcome of in vitro fertilization. The objective of this review was to evaluate the data of current literature on the role of vitamin D supplementation in pregnant women and in women with gynecological pathologies. Keywords: Vitamin D, Supplementation, Pregnancy, Endometriosis, Uterine myomatosis, Infertility.