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BACKGROUND: Cervical varices complicating pregnancy are rare but can cause significant maternal and perinatal morbidity. There is limited evidence regarding the optimal management of bleeding caused by cervical varices during pregnancy. CASE: A 38-year-old woman was admitted to the hospital at 16 weeks of gestation due to vaginal hemorrhage in the setting of cervical varices accompanied by placenta previa. A cervical pessary was placed at 21 weeks of gestation without further bleeding. Magnetic resonance imaging demonstrated variceal reduction after pessary placement, and a cesarean delivery was performed at 36 weeks of gestation without complications. CONCLUSION: Cervical pessary should be considered as conservative option to control the bleeding associated with cervical varices during pregnancy.

INTRODUCTION AND OBJECTIVES: The COVID-19 pandemic is causing great social and health impact. We need to involve patients in identifying their new needs in this situation. The aim of this study was to assess the perception of organisations associated with the Spanish Patients' Forum regarding the pandemic. MATERIAL AND METHODS: A descriptive cross-sectional study using an online survey. Organisations associated with the FEP participated over the second half of May 2020. The questionnaire was pre-assessed by professionals and patients. The subject areas were overall effect of the pandemic, impact, the role of patient associations, limitations, and challenges. A descriptive analysis of the quantitative variables and a content analysis of the qualitative information were performed. RESULTS: The participation rate was 88.7%. The respondents highlighted the impact of the pandemic on the quality of life and well-being of patients and their families. They also reported the effect of the baseline disease and delay in treatment and testing. The pandemic has also affected patient associations. CONCLUSIONS: The pandemic has had an impact at the level of healthcare and other spheres of society. Patients' health, quality of life and use of health services have been affected. The need is highlighted to involve patients, their families, and legal representatives in the search for solutions adapted to the current needs of these groups.

We present the case of a 39 year-old woman with a possible malignant ovarian tumor suspected in imaging tests. After the laparoscopic surgery removal of the ovary, the definitive histological diagnosis is struma ovarii, a rare benign ovarian tumor. We take the case to discuss different aspects of the diagnosis of this rare tumor and how it can be easily confused with an ovarian cancer.

Purpose ofinvestigation: To analyze which are the risk factors in developing multicentric lesions of lower genital tract.A prospective study of 1,011 patients was conducted at the low genital tract pathology clinic of Sant Joan de Deu Hospital between 2003-2011. A complete assessment of cervix, vagina, and vulva was carried out including HPV-DNA testing, cytology study, colposcopy, and biopsy in case of atypical findings. The statistical analysis was done with SPSS v.19 software. Differences between groups were considered statistically significant atp0.05.Twenty-two patients presented multicentric lesions (2.2%). The average age was 43 years. Most of the lesions were bicentric affecting cervix and vagina and cervix and vulva. Only in two cases (9%) there were three sites of genital neoplasia. The authors found four cervical cancer, 17 high grade, and one low grade lesions of the cervix. Eighteen vaginal intraepithelial neoplasia (VAIN), six high grade, 14 low grade, and four vulvar intraepithelial neoplasia (VIN) were found. HPV infection, age35 years, multiparity, contraceptive method, immunodeficiency, and level of studies were significantly correlated with multicentric lesions. High percentage of affected margins were found. VIN cases were treated with surgical excision and in two cases microinvasion was found. VAIN III cases were treated with surgical excision or with laser and one case progressed to vaginal cancer. Recurrence after treatment was 27%.Age, multiparity, contraceptive method, immunodeficiency, and level of studies were significantly correlated with multicentric lesion. Multicentric lesions had an increased risk of recurrence and progression to cancer.

Neuroendocrine neoplasm occurs predominantly in the lungs, but can be occasionally found in the gastrointestinal and genitourinary tracts [1]. When this neoplasia affects the genital tract, usually involve the uterine cervix and the ovary [2]. Neuroendocrine tumors are classified as poorly-differentiated and well differentiated, and further categorized into small and large cell neuroendocrine carcinomas. Approximately only 90 cases of small cell neuroendocrine carcinoma of the endometrium have been reported [3,4]. Studies of large cell endometrial neuroendocrine carcinoma (LCNEC) are even less common, with only 16 cases documented [1,5,6]. Our case concerns a 58-year-old woman with a metastatic LCNEC arising from the endometrium. We, correspondingly, also reviewed the literature and emphasize the most important diagnostic and therapeutic aspects of this rare clinical entity.

INTRODUCTION: The aim of this study was to compare oncological outcomes and morbidity in patients with early-stage vulvar cancer with negative sentinel lymph node (SLN) biopsy vs negative inguinofemoral lymphadenectomy (IFL). MATERIAL AND METHODS: Study with retrospectively collected data in patients with squamous cell vulvar carcinomas = 4 cm without suspected inguinofemoral lymph node metastases. Only patients with negative nodes after histopathology procedure were followed. Patients who underwent only SLN were compared with patients who underwent IFL ± SLN to compare recurrences, survival rates and morbidity. RESULTS: Ninety-three patients were eligible for follow up: 42 with negative SLN and 51 with negative IFL ± SLN. The median follow-up period was 60.4 months (range 6.7-160.7). The rate of isolated first groin recurrence was 4.8% in patients with negative SLN and 2.0% in patients with negative IFL ± SLN (P = 0.587) and the rates of first isolated local recurrence were 28.6% and 31.4%, respectively (P = 0.823). Only 1 patient (2.4%) in the group of negative SLN had distant recurrence. The disease-specific survival rate at 5 years was 83.3% in the negative SLN group and 92.2% in the negative IFL ± SLN group (P = 0.214). We observed a higher rate of wound breakdown and infection after IFL than SLN biopsy (17.6% vs 10.6%; P = 0.020) and lymphedema (33.3% vs 0%; P

OBJECTIVE: To determine the proportion of patients diagnosed with cervical cancer or cervical intraepithelial neoplasia grade 2 or 3 (CIN 2/3) despite testing negative for HPV. METHODS: A prospective study was conducted at a university hospital in Barcelona, Spain, between March 2003 and January 2015 among women with abnormal cytology results according to the Bethesda classification system. All participants underwent HPV testing, cytology, and colposcopy. RESULTS: Among 1376 participants, 609 (44.3%) were diagnosed with CIN 2/3. Of these women, 74 (12.2%) tested negative for HPV. Among 479 women with colposcopy-guided biopsy sampling showing CIN 2/3, cone biopsy results that were negative for CIN 2/3 were more frequent among patients with negative HPV testing (13/61 [21.3%]) than among those with positive HPV tests (58/418 [13.9%]; P=0.03). Additionally, among 59 patients diagnosed with cervical cancer, 9 (15.3%) tested negative for HPV. CONCLUSION: The HPV test was negative for 12% and 15% of patients diagnosed with biopsy-proven CIN 2/3 and cervical cancer, respectively.

To document the prevalence of infection by multiple genotypes of the human papilloma virus (HPV) in patients with cervical pathology in a study population, and to determine the relationship between multiple genotype infection, age of the patient, and the type of cervical pathology.Prospective, cross-sectional descriptive study. A total of 1,007 patients were recruited among women seen at the cervical pathology clinic of Sant Joan de Déu University Hospital in Barcelona (Spain) between January 2003 and March 2011. Statistical analyses were done with SPSS v.19 software. Differences between groups were considered statistically significant atp0.05.There was 28.3% of the women (286 cases) that were infected by multiple HPV genotypes. The mean number of genotypes identified was 2.52 (range 2 to 8). Mean age of the patients with multiple genotype infection was 32.31 years, and mean age of the patients with single genotype infection was 37.27 years (p0.001). The prevalence of infection by multiple HPV genotypes was 28% in patients with cervical intraepithelial neoplasia grade 1 (CIN 1) and 33% in patients with grade CIN 2-3 lesions, and both prevalence rates were significantly higher than in patients with carcinoma (20%) (p = 0.03).In the present study population the authors found no evidence of higher prevalence of multiple HPV genotype infection in women with carcinoma. Age of women with multiple infection was lower than those with single infection.