Abstract Breast tubular adenomas are rare epithelial proliferative tumors. They are diagnosed mainly in young premenopausal women. We describe a case of tubular breast adenoma in a 15-year-old girl. Clinical examination revealed a breast lump with benign clinical characteristics. Imaging studies showed a complex mass with solid and cystic elements. In the absence of typical characteristics of a benign mass, a lumpectomy was performed. Histological findings were suggestive of a tubular breast adenoma. Preoperative diagnosis of breast benign mass is difficult and even the histopathology of a biopsy can be misleading. Surgical excision is necessary to establish a definitive diagnosis.

Resumo Os adenomas tubulares da mama são tumores epiteliais raros. São mais frequentes em mulheres na pré-menopausa. Neste artigo, descrevemos o caso clínico de um adenoma tubular da mama numa jovem de 15 anos. À palpação, o nódulo mamário apresentava características sugestivas de benignidade, mas ecograficamente observou-se uma imagem nodular mista, com um componente sólido e quístico (BIRADS 4a). Uma vez que os achados imagiológicos não eram exclusivamente sugestivos de benignidade, foi realizada uma tumorectomia. O diagnóstico histológico da peça excisada foi compatível com adenoma tubular da mama. O diagnóstico pré-operatório de massas benignas da mama pode ser difícil e por vezes não é possível ter uma confirmação da benignidade da massa através do resultado histológico da biópsia. Assim, a confirmação do diagnóstico definitivo é obtida apenas por excisão da massa.

Abstract The identification of anti NMDA-Receptor encephalitis made it possible to recognise that some patients with rapidly progressive psychiatric symptoms, cognitive impairment, seizures, movement disorders, or coma of unknown cause, had an autoimmune disease.There are a female predominance, affecting young adults. with diverse clinical presentation and frequent association with tumours (ovarian teratoma).In the acute stage of the disease, many patients need to be hospitalised for at least 3-4 months, including admission to an Intensive Care Unit, followed by several months of physical and behavioural rehabilitation The first management should focus on immunotherapy and the detection and subsequent removal of tumour.

Abstract Overview and Aims: In vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) show discouraging results in poor ovarian responders. We aim to characterize low prognosis women, stratifying them according to POSEIDON criteria -based on ovarian reserve markers and response in previous cycles. Study Design: data base retrospective study Population: women undertaking an IVF/ICSI cycle between May/2012 and December/2017 in our public centre. Methods: all women undertaking IVF/ICSI cycles with registered antimullerian hormone levels and antral follicule count (the ovarian reserve markers considered in POSEIDON criteria) were divided in 4 groups -women with normal ovarian reserve markers but low response in previous cycle (<35 years-G1; ≥35 years-G2) and women with at least one low ovarian reserve marker (<35 years-G3; ≥35years-G4). Ovarian reserve markers, previous ovarian response, socio-demographic features, type/etiology of infertility, number of oocytes collected, clinical pregnancy and delivery rates per cycle/ovarian puncture(OP)/transfer were determined. Ovarian response (categorized into optimal/non-optimal based on the number of oocytes collected), clinical pregnancy and delivery rates of the 4 groups were compared to population non-POSEIDON(PNP). X 2 test was used. Significance was set at p-value<0.05. Results: 1789 cycles were analysed; 49.6%(887/1789) of them met POSEIDON criteria - n=86(G1), n=129(G2); n=180(G3); n=492(G4). 85.7% of those reaching OP had a non-optimal response. G4 showed the worse pregnancy and delivery rates, significantly lower than PNP. The highest rates of pregnancy and delivery were verified in a subgroup of G2, except for delivery/cycle; no difference was observed between G1/G2 and PNP. Most women were Portuguese, Caucasian, normal weighted, non-smokers and presented primary infertility. Male factor was the most frequently identified cause. Conclusion: POSEIDON criteria showed high positive predictive value of having a non-optimal response. Results may help managing expectations of women undergoing IVF/ICSI with similar characteristics. Exclusion from POSEIDON group should not be considered reassuring due to low negative predictive value.

Abstract Introduction Malignant mesonephric tumors are uncommon in the female genital tract, and they are usually located where embryonic remnants of Wolffian ducts are detected, such as the uterine cervix. The information about these tumors, their treatment protocol, and prognosis are scarce. Case report A 60-year-old woman with postmenopausal vaginal bleeding was initially diagnosed with endometrial carcinoma. After suspicion co-testing, the patient underwent a loop electrosurgical excision of the cervix and was eventually diagnosed with mesonephric adenocarcinoma. She was subjected to a radical hysterectomy, which revealed International Federation of Gynecology and Obstetrics (FIGO) IB1 stage, and adjuvant radiotherapy. The follow-up showed no evidence of recurrence after 60 months. Conclusion We present the case of a woman with cervical mesonephric adenocarcinoma. When compared with the literature, this case had the longest clinical follow-up without evidence of recurrence, which reinforces the concept that these tumors are associated with a favorable prognosis if managed according to the guidelines defined for the treatment of patients with cervical adenocarcinomas. Though a rare entity, it should be kept in mind as a differential diagnosis for other cervical cancers.

Overview and Aims: Menopause hormone therapy (MHT) has been associated with mammographic changes and increased risk of breast cancer. The aim of this study was to evaluate the frequency of mammographic changes and breast cancer in women undergoing MHT. Population and Methods: Retrospective study with a series of women undergoing MHT between January 2009 and December 2013 divided in three groups: unopposed estrogen (E, n = 28), combined estrogen plus progestin (E+P, n = 118) or tibolone (n = 98). Primary outcome was the frequency of breast cancer. Secondary outcomes included: frequency of mammographic changes, need of mammary biopsy and the association of those outcomes with first-degree family history of breast cancer. Results: Among the 244 women included, the mammographic reports of 12% (30/244) revealed BIRADS ≥3, and in 7 of these cases a breast biopsy was performed. There were two cases of breast cancer in patients undergoing E+P and tibolone, respectively. Mammographic breast density was increased in 19% of women (46/244), with no statistically significant difference among the three groups. There was a statistically significant higher frequency of increased density on mammographies of women with first-degree family history of breast cancer compared to those without family history (8/20 vs. 38/224; p = 0,03). Conclusions: In our sample the increased density after MHT was more significant for women with family history of breast cancer.

Overview and aims: This article summarises the Portuguese endometriosis consensus elaborated in order to adapt to our population the consensus documents published in the literature. Endorsed by the Portuguese Society of Gynaecology, we established recommendations that provide guidance to our medical society to better decision making concerning the assistance of patients with endometriosis, to improve diagnosis and to optimize management. We expose here a short version of the first section of the guidelines, addressing the clinical and diagnosis management of this disease. Study design and Methods: The European Society of Human Reproduction and Embryology (ESHRE) guideline for the diagnosis and treatment of endometriosis (2014) was the reference paper for these clinical recommendations in endometriosis. A group of experts in the field performed a thorough systematic search of the publications between January 2012 up to December 2014 and a quality assessment of the included papers. A consensus meeting with all members of the guidelines developing group reached the final version of the recommendations. Conclusions: The present clinical practice guidelines on endometriosis may improve the accurate clinical and imaging diagnosis of pelvic and extra pelvic endometriosis and enhance endometriosis risk assessment and care.

Overview and aims: Hysterectomy is one of the most common gynecological surgical procedures and several studies have demonstrated the multiple advantages of laparoscopic approach in general. Obesity was initially considered to be a contraindication for laparoscopy. However, this historical perspective has been disputed. The aim of this study was to assess the effect of the body mass index (BMI) on intra-operative parameters and intra and post-operative complication rates of total laparoscopic hysterectomy (TLH). Study design: A retrospective, observational, descriptive and analytic study. Population : All TLH performed in our department, by the same surgical team, between April 2009 and March 2014, were evaluated. Methods : Medical records were reviewed for patient characteristics (BMI, age, medical and surgical history), surgical characteristics (surgical indication and concomitant procedure, uterine weight, operating time, post-operative hemoglobin variation, length of hospital stay), and intra and post-operative complications. The data were analyzed according to patients' BMI. Results: The study population was divided in normal BMI (n=145), overweight (n=119) and obese (n=54). Obese patients were older, more frequently postmenopausal and with more medical pathology than normal BMI patients. More than 50% of the patients had history of at least one previous abdominopelvic surgery with no differences among the groups. No significant differences were found in terms of uterine weight (217.7 ± 154.8 vs. 257.5 ± 176.1 vs. 225.4 ± 151.0 g; p> 0.05), post-operative hospital stay (1.6 ± 0.9 vs. 1.5 ± 1.0 vs. 1.5 ± 0.9 days; p> 0.05), operating time (72.2 ± 25.3 vs.77.5 ± 25.8 vs. 83.6 ± 35.3 minutes; p> 0.05) or complication rates (12.4% vs. 14.3% vs. 13.0%). Conclusions: This study demonstrates that, in qualified hands, obesity did not increase the operating time and the intra or post-operative complication rates associated with TLH. Thus, high BMI should not be considered a contraindication for this procedure.