Renal angiomyolipoma is a benign tumor, composed of adipocytes, smooth muscle cells and blood vessels. The association with pregnancy is rare and related with an increased risk of complications, including rupture with massive retroperitoneal hemorrhage. The follow-up is controversial because of the lack of known cases, but the priorities are: timely diagnosis in urgent cases and a conservative treatment when possible. The mode of delivery is not consensual and should be individualized to each case. We report a case of a pregnant woman with 18 weeks of gestation admitted in the emergency room with an acute right low back pain with no other symptoms. The diagnosis of rupture of renal angiomyolipoma was established by ultrasound and, due to hemodinamically stability, conservative treatment with imaging and clinical monitoring was chosen. At 35 weeks of gestation, it was performed elective cesarean section without complications for both mother and fetus. ResumoO angiomiolipoma é um tumor benigno, constituído por adipócitos, células de músculo liso e vasos sanguíneos. Sua associação com a gravidez é rara e está relacionada com um aumento de complicações, nomeadamente rotura com hemorragia retroperitoneal maciça. O follow-up é controverso em razão do escasso número de casos descritos, no entanto as prioridades são: diagnóstico atempado nas situações urgentes e, sempre que possível, tratamento conservador. O tipo de parto não é consensual e deve ser individualizado caso a caso. Relatamos um caso de uma grávida com 18 semanas de gestação que recorreu ao serviço de urgência por lombalgia direita aguda, sem outros sintomas relevantes. Diagnosticou-se ecograficamente rotura de angiomiolipoma renal e, em decorrência da estabilidade hemodinâmica do quadro, procedeu-se ao tratamento conservador com monitorização imagiológica e clínica. Às 35 semanas de gestação, realizou-se uma cesariana eletiva que decorreu sem complicações maternas ou fetais.
Electronic poster abstractsMethods: A total of 87 patients were included in the study. Pattern recognition analysis and color Doppler blood flow location were used for establishing the initial diagnosis. Then the GI-RADS was used, with the following classifications: GI-RADS 1, definitively benign; GI-RADS 2, very probably benign; GI-RADS 3, probably benign; GI-RADS 4, probably malignant; and GI-RADS 5, very probably malignant. Patients with GI-RADS 1 and 2 tumors were treated expectantly and not included in the study. All GI-RADS 3, 4, and 5 tumors were removed surgically. Serum concentration of CA125 was measured for each patient before surgical operation. The definitive diagnosis of the adnexal pathology was confirmed by the pathological examination of the excised lesions. Results: The mean age of the patients was 44,5 years. Malignant disease was diagnosed in 17 cases (19,54%) and non-malignant disease was diagnosed in 70 cases (80,64%). The sensitivity GI-RADS and CA125 was 88,24% and 82,35% respectively. The specificity was 90% and 65,71% respectively. The positive predictive value was 68,18% and 36,84% respectively. The negative predictive value was 96,92% and 93,88% respectively. Conclusions: GI-RADS has higher sensitivity, specificity, positive and negative predictive values than CA125 in the preoperative assessment of adnexal tumors. P27.03Risk of malignancy index in pre-operative evaluation of borderline ovarian tumors Objectives: To assess the use of risk of malignancy index (RMI) in primary evaluation of patients diagnosed as having a borderline ovarian tumor (BOT). Methods: Retrospective study of RMI index of all patients histologically diagnosed as having a BOT in our hospital over a period of ten years. RMI was calculated using the product of the ultrasound score (U), the menopausal score (M), and the absolute value of serum CA-125 inserted in the following formula: RMI = U x M x serum CA-125. The ultrasound result (U) is scored 1 point for each of the following characteristics: multilocular cysts, solid areas, metastases, ascites and bilateral lesions. U = 0 (for an ultrasound score of 0), U = 1 (for an ultrasound score of 1), U = 3 (for an ultrasound score of 2-5). Postmenopausal status scored M = 3, while premenopausal condition scored M = 1. The absolute value of serum CA-125 was entered directly into the mentioned equation. A RMI cut-off level of 200 was accepted as positive for malignancy. Results: Twenty nine women were found to have BOT. Nineteen (65.5%) were premenopausal, and the majority of cases were unilateral (86.2%). In overall, the most frequent sonographic pattern associated to BOT was multilocular solid cyst (44.8%). Preoperative CA 125 levels were higher than 35 U/ml in 34.4% of BOT. When a cut-off value of 200 was used, RMI only detected 27.5% (8/29) of BOT (6/10; 60% of postmenopausal women and 10.5 % (2/19) of premenopausal ones). Conclusions: RMI is not a suitable tool for the detection of BOT.P27.04 A case of tubo-ovarian abscess in a pregnant woman Y. Kim, J. Kim, T. Song ...
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