Electronic poster abstracts follow-up. Patient was discharged stable. Ultrasound performed six months later noted a left ovarian cyst with low-level echoes. On follow-up, she was noted to have recovered completely and a scan performed a year later did not demonstrate any abnormalities in the pelvis. Conclusion: Patient was virgo intacta. Transrectal scan was attempted but unsuccessful. Transabdominal ultrasound was restricted by body habitus, hence resulting in suboptimum demonstration of the dermoid. EP26: DIAGNOSING A CAUSE FOR PELVIC PAIN AND CLASSIFYING ENDOMETRIOSIS EP26.01Value of ''elasto strain ratio'' ultrasound elastography in the diagnosis of adenomyosis: preliminary study Objectives: Elastography is an ultrasound-based imaging technique visualising the stiffness of the examined region. This technique enables to match the elasticity of organs with a range of colours and depicts the strain ratios on a colour map. Adenomyosis is one of the most extensive pathologies of the uterus wall, secondary to leiomyomas. The characteristic adenomyosis changes in the issue ultrastructure may modify the stiffness of the myometrium, which can be detected by ultrasound elastography. The aim of the study was to assess the accuracy of ultrasound elastography in the diagnosis of adenomyosis. Methods: We performed transvaginal ultrasound examinations in fifty two women aged 26 -45 years. 23 women who presented without any uterine pathology in ultrasonography were included in a control group and 29 women suspected of having adenomyosis were included in study group. Diagnosis of adenomyosis was set in presence of globular uterine configuration, myometrial anterior-posterior asymmetry, heterogeneous myometrial echotexture, subendometrial cysts and poor definition of the endometrial-myometrial interface and presence of dysmenorrhea, and/or menorrhagia. Finally the elastography option was activated. Elastographic evaluation of the myometrium was performed using Alpinion E-CUBE 15 EX equipped with ''Elasto Strain Ratio'' software. The stiffness of adenomyosis changes was compared to the stiffness of normal myometrium and ''Elasto Strain Ratio'' was calculated. Results: ''Elasto Strain Ratio'' of myometrium in group of healthy women was calculated as 0.96 (range 0.81 -0.99). In group of women suffering from adenomyosis ''Elasto Strain Ratio'' was 0.69 (range 0.51 -0.88). Conclusions:The results of the study indicate a decrease of the myometrial stiffness estimated in patients with adenomyosis. This study showed that, the use of elastography in addition to conventional ultrasound could help to diagnose uterine adenomyosis. Objectives: The diagnosis accuracy of deep infiltrating endometriosis (DIE) for magnetic resonance (MRI) and transvaginal scan (TVS) is not well stabilised and varies widely. The aim of this study was to assess the accuracy of TVS and MRI by comparing with surgical findings in our centre. Methods: Prospective observational study carried out between years 2009 and 2014, during which time 393 consecutive patients...
Background: the association between ovarian endometriosis (OE) and endometriosis-associated ovarian cancer (EAOC) is extensively documented, and misfunction of the immune system might be involved. The primary objective of this study was to identify and compare the spatial distribution of tumour-infiltrating lymphocytes (TILs) and tumour-associated macrophages (TAMs) in OE and EAOC. Secondary objectives included the analysis of the relationship between immunosuppressive populations and T-cell exhaustion markers in both groups. Methods: TILs (CD3, CD4, and CD8) and macrophages (CD163) were assessed by immunochemistry. Exhaustion markers (PD-1, TIM3, CD39, and FOXP3) and their relationship with tumour-associated macrophages (CD163) were assessed by immunofluorescence on paraffin-embedded samples from n = 43 OE and n = 54 EAOC patients. Results: we observed a predominantly intraepithelial CD3+ distribution in OE but both an intraepithelial and stromal pattern in EAOC (p < 0.001). TILs were more abundant in OE (p < 0.001), but higher TILs significantly correlated with a longer overall survival and disease-free survival in EAOC (p < 0.05). CD39 and FOXP3 significantly correlated with each other and CD163 (p < 0.05) at the epithelial level in moderate/intense CD4 EAOC, whereas in moderate/intense CD8+, PD-1+ and TIM3+ significantly correlated (p = 0.009). Finally, T-cell exhaustion markers FOXP3-CD39 were decreased and PD-1-TIM3 were significantly increased in EAOC (p < 0.05). Conclusions: the dysregulation of TILs, TAMs, and T-cell exhaustion might play a role in the malignization of OE to EAOC.
Introducción: La endometriosis es una patología benigna, dependiente de estrógenos, en la que el tejido que normalmente crece dentro del útero aparece fuera de este. Su localización habitual es en la pelvis, pero en ocasiones puede aparecer en otras áreas, como es el caso de la endometriosis umbilical. Objetivo: Familiarizar al ginecólogo con esta patología y entregar una serie de herramientas para diagnosticar, tratar y seguir a las pacientes que la presentan. Casos clínicos: Se presentan dos casos clínicos de endometriosis umbilical primaria diagnosticados en el Hospital La Paz, en Madrid (España), entre los años 2018 y 2019. Las pacientes, de 30 y 34 años, consultaron por dolor o sangrado umbilical durante la menstruación. Ninguna tenía antecedentes de patología ginecológica ni cirugía abdominal previa. Tras una exhaustiva exploración física y una ecografía de alta resolución, se decidió extirpar la lesión con la colaboración del servicio de cirugía plástica. En ambos casos, el estudio anatomopatológico confirmó que se trataba de tejido endometriósico. Las dos pacientes presentaron una buena evolución posquirúrgica, sin recidivas hasta la fecha. Conclusiones: La endometriosis umbilical primaria es una patología infrecuente, pero es necesario incluirla en el diagnóstico diferencial de una mujer con un nódulo umbilical. Siempre deben realizarse una exploración física exhaustiva y una ecografía ginecológica, para descartar posibles patologías concomitantes. El tratamiento de elección es la extirpación quirúrgica de la lesión y el diagnóstico final se establece con el estudio anatomopatológico.
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