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  • Morcelação uterina. Atualização e proposta de consentimento informado
    Publication . Nascimento, S; Reis, J
    Morcellation is a surgical technique, sometimes necessary to perform minimally invasive surgery, namely laparoscopic hysterectomy and myomectomy. As it is difficult to distinguish preoperatively a fibroid from a leyomiosarcoma, there are concerns that inadvert morcellation of a malignant tumor might occur, in which case the prognosis of the disease might be worsened. As new evidence arises regarding patient selection, preoperative care and preventive measures, it has become mandatory to inform and discuss the risks and benefits of the procedure with the patient, so that a true informed consent is achieved.
  • Interrupção voluntária da gravidez - correlação dos achados pré-natais e post-mortem
    Publication . Caeiro, F; Branco, R; Marques, M; Santos, I; Ferreira, AP; Fonseca, J; Santos, AP; Matos, F
    A interrupção voluntária da gravidez (IVG) é uma situação de elevada complexidade a vários níveis, implicando um diagnóstico pré-natal preciso e uma corroboração post-mortem do mesmo, com eventual acréscimo de informação que contribua para um adequado aconselhamento genético aos casais. Os autores pretenderam avaliar a qualidade de diagnóstico pré-natal efectuado no seu centro, estudando a população submetida a IVG, nomeadamente identificando as suas indicações/causas e avaliando os exames feto-patológicos para estabelecer uma concordância entre os achados pré-natal e post-mortem. Foram analisados retrospectivamente 84 casos, no período de Janeiro de 2012 a Junho de 2016. A idade média materna foi de 32 anos, sendo maior no grupo das IVG’s por cromossomopatias, com significado estatístico. A mediana da idade gestacional na IVG foi de 18 semanas, sendo que apenas 5% se realizaram após as 24 semanas. A distribuição das causas de IVG foi feita por 4 grupos: cromossomopatias 47,5%, malformações fetais 35,5%, outras causas fetais 12% e causas maternas 6%. Foi estabelecida uma concordância entre os achados pré-natais e os post-mortem no grupo das malformações fetais e outras causas fetais de 66%. Estes resultados estão de acordo com publicações nesta área, corroborando a importância da complementaridade dos achados ecográficos pré-natais com a avaliação minuciosa anatomo-patológica, nomeadamente nas situações de malformações fetais não associadas a cromossomopatia, de modo a obter diagnósticos mais precisos e melhor aconselhamento genético.
  • A disturbing vulvar mass – the tip of the iceberg
    Publication . Ambrósio, B; Ambrósio, P; Marques, C
    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.
  • Hysteroscopic tubal sterilization with Essure ® : a 7 year observational study
    Publication . Miranda, M; Bruno, D; Caeiro, F; Pedro, A; Pereira, JS
    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 idea method for women with high surgical risk and multiple co-morbidities
  • Cancro do ovário na adolescência – um caso clínico
    Publication . Miranda, M; Paixão, C; Pedro, A; Pereira, JS
    Small cell carcinoma of the ovary, hypercalcemic type is a rare and aggressive tumor affecting young women. The mechanism of development is unclear and there have been relatively few clinical studies reported in literature. The authors present a clinical case of a 15-year-old girl with a small cell carcinoma of the ovary
  • Pelvic inflammatory disease: an unexpected outcome
    Publication . Caeiro, AF; Ramilo, I; Veríssimo, C; Diniz-Costa, T; Pereira, JS
    Pelvic inflammatory disease is a polymicrobial infection of the upper genital tract, representing the most common complication of sexually transmitted diseases. Multiple agents are frequently involved, although some unusual agents have also been reported. The presentation is frequently sub-clinical, but may assume an acute form. We report a clinical case of a 39-year-old woman with recurrent pelvic inflammatory disease, resistant to systemic antibiotics, submitted to an exploratory surgery, with a histologic finding of tubal cysticercosis.
  • Anti-NMDA encephalitis and ovarian teratoma
    Publication . Dias, G; Mendinhos, G; Igreja, F; Pereira, JS
    Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis may be associated with ovarian teratoma and results in a characteristic syndrome that presents with psychiatric symptoms, rapid decline of the level of consciousness, central hypoventilation and seizures. Immunotherapy and resection of teratoma are effective therapies.
  • A case of follicular variant of papillary thyroid carcinoma in a mature cystic teratoma in a young woman
    Publication . Dias, G; Caeiro, F; Costa, T; Pedro, A; Pereira, JS
    Malignant transformation of a teratoma occurs in 1-2% of cases, with carcinoma of the thyroid being extremely rare. It is usually diagnosed in the postoperative histopathological exam. We describe a case of thyroid carcinoma in a mature cystic teratoma.
  • An 18-year-old woman with a 34-cm metaplastic breast carcinoma
    Publication . Gomes, A; Santos, V; Dias, G; Manso, RT; Gonçalves, L; Coiteiro, M; Gaspar, H; Nazaré, A
    Metaplastic breast carcinomas (MBCs) are rare malignancies usually with poor prognosis. We report a case of an 18-year-old African female patient who presented with a 34-cm tumor on the right breast. Biopsy showed an extensively necrotic MBC negative for estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 (triple negative). A modified right radical mastectomy was performed, followed by adjuvant chemotherapy. Histology confirmed a widely necrotic undifferentiated malignant tumor, with strong and diffuse expression of vimentin and B-cell lymphoma 2, focal high-molecular-weight keratins and focal CD34 expression; Ki67 was >90%. There was no skin, deep margin or lymph node involvement. Six months after surgery, the patient showed a 9 × 7 cm nodule adjacent to the suture and adherent to the anterior chest wall. The tumor was considered unresectable and the patient evolved with rapid systemic deterioration. The patient had a progression-free survival of 6 months and overall survival of 9 months.