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Acta Obstet Ginecol Port 2008;suppl 1
“See and treat” rates were 60.7% for moderate
dysplasia, and 56.4 % for severe dysplasia. Most patients
with Moderate and severe dysplasia on Cervical smear
showed CIN2 and CIN3 respectively on histological
analysis. Only 18.2% of patients with moderate dysplasia
and 8.9% of patients with Severe dysplasia justifed “first
biopsy” management. There appeared to be a higher
tendency for “first biopsy” in younger patients.
Only 6 out of 64 patients with “incomplete excision” on
LLETZ had positive cervical smears on subsequent 12
month follow up. These included 3 with borderline, 1 with
moderate and 2 with severe dyskaryosis on follow up
smears.
Conclusions: There is a need for an increase in “See
and treat” patients. Conservative “biopsy first” is not
justified unless the clinical picture and findings at
Colposcopy indicate otherwise. Cytology correlates well
with Histology except in Borderline and to an extent
mild dysplasia on Cervical Smears. Patients with
incomplete excision do well; however caution is needed
as high grade lesions can be detected at a later stage.
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Endometrial stromal tumours - the
experience of the Division of Gynecology
of Hospital S. Marcos (Portugal) from
1991-2007
Diogo Cunha 1 , Cátia Abreu 1 , Teresa Ramos 1 , Paula
Serrano 1 , Pedro Cabrita 1
1 Hospital S.Marcos, Portugal
Introduction: Endometrial stromal tumours (EST) are
rare tumours that occur primarily in perimenopausal
women.
Material and methods: Retrospective study of 8 cases
of EST occurred between Jan 1991 – Sep 2007 in the
Division of Gynecology of Hospital S. Marcos. Statistical
analysis involved SPSS® 15.0 version.
Results: The 8 cases of EST correspond to 4,1% of all
primary uterine corpus malignancies (n=193) occurred in
that time-span in our institution. The 3 types of EST
observed were low-grade endometrial stromal sarcoma
(50%), undifferentiated endometrial sarcoma (37,5%) and
stromal nodule (12,5%). Mean-age of presentation was
52,2 ± 10.8 years and these neoplasms were usually
diagnosed (87,5%) in stage I disease of FIGO classification.
Management of EST was always surgical, complemented
with adjuvant therapies in 50% (n=4) of cases, being
radiation therapy alone in one half of these (n=2) and
radiation therapy + chemotherapy in the other half. One
patient’s contact was lost during follow-up, nevertheless
global mean time of follow-up was 7,0 ± 5,2 years.
Recurrence of the malignancy was detected in 14,3% (n=1)
of the cases. The global 5-year survival rate was 53%.
114
Conclusion: Although being a small series, this study
reproduces the knowledge about endometrial stromal
tumours that’s available in literature. The majority of EST
presented initially as stage I disease but the 5-year
survival was only 53% reflecting the aggressive nature
of these neoplasms. We observed a lesser rate of
recurrence of tumours than in the literature (14,3% vs
50%) perhaps due to the short period of follow-up that
some patients still have.
334
Germ cell ovarian tumors with malignant
potential casuistic of the Division of
Gynecology, S. Marcos Hospital
Portugal (1990-2006)
Cátia Abreu 1 , Diogo Cunha 1 , Teresa Ramos 1 ,
Pedro Cabrita 1 , Paula Serrano 1
1 Hospital S. Marcos, Portugal
Introduction: Germ cell tumors represent 20 to 25% of
all ovarian neoplasms, but only 3% are malignant. These
tumors occur mainly in young women, which involves
decisions concerning specially childbearing. Advances
in chemotherapy have modified the prognosis of different
types of germ cell tumors.
Material and methods: Retrospective study of
seventeen cases of germ cell ovarian tumors with malignant
potential occurred between January 1990 and December
2006, with particular attention to clinical profile, staging,
treatment options and follow-up. The statistical analysis
was performed using SPSS for Windows, version 15.0.
Results: Seventeen cases (9,9%) of germ cell tumors
with malignant potential were reviewed, representing 2,7%
of all gynecologic tumors diagnosed in S. Marcos Hospital
– Braga, in a 16-year period. The average age of incidence
was 37,9 (14-83) years, with the most affected group
ranging from 10 to 30 years (41,2%). The histological
types verified were immature teratomas (47,1%), struma
ovarii (17,6%) dysgerminomas (11,8%), and also 11,8%
of mature cystic teratoma with malignant transformation
(both with development of squamous cell carcinoma).
Most teratomas were diagnosed grade II tumors, although
reported one case of grade III with gliomatosis peritonei.
All struma carcinoids were stage Ia at diagnosis;
dysgerminomas were stage Ic, one of them occurring in
a pregnant patient at the first trimester. The initial approach
to most of these germ cell malignancies had been
unilateral oophorectomy and proper surgical staging.
Chemotherapy with BEP regimens was used for treatment
of grade II and III immature teratomas, and a second-look
laparotomy was performed in a patient with grade II tumor.
One dysgerminoma was treated with chemotherapy; the
other one with radiation therapy, which led to fertility
problems. The 5-year and 10-year survival rates were