[Hormone therapy effect in postmenopausal women with history of endometrial cancer]

BACKGROUND

The increase of endometrial cancer survivors' incidence let the question if the management of postmenopausal hormone therapy will increase the risk of carcinogenesis.

OBJECTIVE

To determine the recurrence rate, in postmenopausal patients managed with hormonal therapy (HT) compared with patients without HT treated in El Instituto Nacional de Perinatologia Isidro Espinosa de los Reyes.

PATIENTS AND METHOD

Retrospective, analytical, historical cohort. We analyzed 29 patients who met the inclusion criteria from January 1, 2000 to December 31, 2008 RESULTS: The average age for diagnosis of endometrial cancer was 45 years. 100% of the patients had surgical treatment (82.8% routine endometrial open approach, laparoscopic 17.2%). The 93% of patients had criteria to begin HT, however, was administered alone to 37% due to medical criteria, 36% received tibolona, 64% received estrogen with an average administration time of 39 and 54 months for each one without affecting disease-free period. Patients who received hormonal therapy had no recurrence of disease-free period of 58 months. There was only one patient with recurrence for which no hormonal therapy was administered.

CONCLUSIONS

Patients who were under hormonal therapy did not modify the rate of endometrial cancer recurrence compared with those without HT. Although we cannot conclude irrefutably the safety of hormone therapy, based on biological knowledge and the results of this study, hormone therapy can be safely administered in stage I and II.

[Adnexal tumor and pregnancy: diagnosis and treatment]

BACKGROUND

The finding of adnexal masses during pregnancy is an exceptional event. Its reported incidence is less than 5% and most cases resolve spontaneously as the pregnancy progresses.

OBJECTIVE

Describe a case series of patients with adnexal mass and pregnancy.

MATERIAL AND METHODS

We retrospectively reviewed the medical records of patients who had diagnosis of pregnancy and adnexal over a period of five years.

RESULTS

The incidence was 0.22%. The mean age was 26 +/- 7.3 years, mean gestational age was 17 +/- 6.6 weeks. The diagnosis was established by ultrasound (USG) in 95% of cases, 48% had cystic characteristics, the mean diameter of the tumor was 99 +/- 42 mm. Cistectomy was performed during pregnancy or trans-cesarean section in 30% and 58% of patients respectably. The mean tumor size was 118 mm (range 2 a 40 mm), weight 1,370 g (range 10 a 5,800 g). The most frequent histological diagnosis were serous cyst (40%), mature teratoma (28%), mucinous (6%), malignancy (4%). There were not complications related to the surgical procedure.

CONCLUSIONS

The USG constitute a safe method for the diagnosis, but the image method with the highest positive predictive value is the MRI. Tumor markers (CA-125, AFP, GCH-B,DHL, ACE), are not useful during pregnancy. If the tumor doesn't achieve surgical criteria the recommended follow up is clinical observation and USG. If surgery is decided, it should be performed between 16 a 23 weeks of pregnancy, and it's recommended to send the tumor to histological diagnosis, in case of malignancy the surgery will continue according to the tumor stage. The time and delivery route will be decided by the obstetrician.