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array:23 [ "pii" => "S0210573X24000522" "issn" => "0210573X" "doi" => "10.1016/j.gine.2024.100989" "estado" => "S300" "fechaPublicacion" => "2024-10-01" "aid" => "100989" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2024" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Clin Invest Ginecol Obstet. 2024;51:" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S0210573X24000352" "issn" => "0210573X" "doi" => "10.1016/j.gine.2024.100972" "estado" => "S300" "fechaPublicacion" => "2024-10-01" "aid" => "100972" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "rev" "cita" => "Clin Invest Ginecol Obstet. 2024;51:" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Revisión de conjunto</span>" "titulo" => "Preeclampsia como factor de riesgo de enfermedad cardiovascular en el futuro: etiopatogenia e implicación en la práctica clínica" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Preeclampsia as risk factor for future cardiovascular disease: Etiopathogenesis and implications for clinical practice" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3079 "Ancho" => 4110 "Tamanyo" => 526725 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Etiopatogenia de la preeclampsia. La placentación anómala es consecuencia de una alteración de la respuesta inmune, por aumento de Th1, de un fallo en la remodelación de las arterias espirales y por alteración en la vía del óxido nítrico. Todo ello, junto con otros factores como las infecciones, disbiosis, etc., favorece un aumento de la respuesta inflamatoria que promueve el daño endotelial y la disminución de la invasión trofoblástica, dando lugar a la hipertensión arterial y a la proteinuria típicas de la preeclampsia.</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">NO: óxido nítrico; PLGF: factor de crecimiento placentario; s-Flt-1: tirosina quinasa-1 soluble tipo fms; VEGF: factor de crecimiento endotelial vascular.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Moreno López" "autores" => array:1 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Moreno López" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210573X24000352?idApp=UINPBA00004N" "url" => "/0210573X/0000005100000004/v1_202410170447/S0210573X24000352/v1_202410170447/es/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0210573X24000479" "issn" => "0210573X" "doi" => "10.1016/j.gine.2024.100984" "estado" => "S300" "fechaPublicacion" => "2024-10-01" "aid" => "100984" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Clin Invest Ginecol Obstet. 2024;51:" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">CASO CLÍNICO</span>" "titulo" => "Descripción de un caso: síndrome de pseudo Meigs con leiomioma uterino" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Case report: Pseudo Meigs syndrome with uterine leiomyoma" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 706 "Ancho" => 875 "Tamanyo" => 49479 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Gran masa en el abdomen inferior, heterogénea, con áreas de degeneración quística, que parece depender del fundus uterino. Moderada cantidad de líquido libre en el abdomen.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Sánchez España, D.A. Sánchez Torres, F.J. Salazar Arquero" "autores" => array:3 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Sánchez España" ] 1 => array:2 [ "nombre" => "D.A." "apellidos" => "Sánchez Torres" ] 2 => array:2 [ "nombre" => "F.J." "apellidos" => "Salazar Arquero" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210573X24000479?idApp=UINPBA00004N" "url" => "/0210573X/0000005100000004/v1_202410170447/S0210573X24000479/v1_202410170447/es/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Synchronous presentation of endometrial adenocarcinoma and incidental paratubal borderline serous tumor: A rare case report" "tieneTextoCompleto" => true "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A.A. Khan, C. Ahluwalia, S. Ahuja" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A.A." "apellidos" => "Khan" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Ahluwalia" ] 2 => array:4 [ "nombre" => "S." "apellidos" => "Ahuja" "email" => array:1 [ 0 => "sanaahuja11@yahoo.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Presentación sincrónica de adenocarcinoma de endometrio y tumor seroso límite paratubario incidental: informe de un caso poco común" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1458 "Ancho" => 2340 "Tamanyo" => 1243680 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Microscopic and immunohistochemical findings of the endometrioid adenocarcinoma, uterus. (a, b) Hematoxylin and eosin-stained sections exhibited atypical glands involving the myometrium for more than 50%. The tumor cells were arranged in glands, sheets and occasionally in cribriform pattern. [×100, ×400]. (c, d) On immunohistochemistry, the cells were positive for vimentin (c) and ER (d). [×400].</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Paratubal cysts are common findings and almost always are benign findings in a hysterectomy or salpingectomy specimens. Small paratubal cysts tend to be missed on radiology and found incidentally while operating for any disease. These are also known as “hydatid cysts of Morgani” and are Mullerian in origin.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Due to Mullerian origin similar to surface ovarian tumors, various histologic subtypes of epithelium can arise namely, benign, borderline and malignant.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,3</span></a> However, borderline and malignant epithelial tumors are extremely rare and only four to five cases earlier being reported. Incidental finding of paratubal borderline serous tumors in a case of endometroid adenocarcinoma becomes an enigmatic entity and we haven’t found any reported case in the literature till date. Synchronous gynecologic malignancies account for only 1% of all female genital tract tumors and among the most common finding is serous ovarian neoplasm and endometroid adenocarcinomas comprising 50% of all.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> However, a synchronous malignancy involving endometrium and tumor arising in a paratubal cyst diagnosed post hysterectomy highlights the importance of careful examination of minute paratubal cysts while operating and grossing. It is often challenging to diagnose synchronous malignancies and it mandates a cautious approach while considering the number of lesions while handling the specimen, histological and immunohistochemical examinations. Here we present an enigmatic and rarest presentation in an adult female operated for endometroid adenocarcinoma and diagnosed with paratubal borderline serous tumor as in incidental finding.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Information of the patient</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 61-year-old female presented in gynecology outpatient department with complaints bleeding per vagina and lower abdominal pain for 2 months. She had menopause 11 years back. There was no relevant family or medical history.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Clinical findings</span><p id="par0015" class="elsevierStylePara elsevierViewall">On examination, the vitals are stable. During the bimanual examination, the uterus was palpated and found to be anteverted and normal in size, shape, and consistency. There were no palpable masses or tenderness appreciated upon gentle palpation.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Timeline</span><p id="par0020" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0025" class="elsevierStylePara elsevierViewall">Presentation with bleeding per vagina and lower abdominal pain.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0030" class="elsevierStylePara elsevierViewall">Elevated CEA and CA 19-9 levels.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0035" class="elsevierStylePara elsevierViewall">Ultrasonography showed thickened endometrium with moderate pyometra.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0040" class="elsevierStylePara elsevierViewall">Endometrial biopsy revealed endometrial intraepithelial neoplasia.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">•</span><p id="par0045" class="elsevierStylePara elsevierViewall">MRI showed an ill-defined lesion in the upper endometrium involving the myometrium.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">•</span><p id="par0050" class="elsevierStylePara elsevierViewall">Staging laparotomy performed.</p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Diagnostic evaluation</span><p id="par0055" class="elsevierStylePara elsevierViewall">An initial workup revealed a raised CEA and CA 19-9. Her ultrasonography of pelvis showed thickened endometrium with moderate pyometra. An endometrial biopsy was also performed which showed back-to-back arranged endometrial glands with minimal or absent stroma. The glands showed architectural and cytological atypia and occasional atypical mitosis at places, based on which a diagnosis of endometrial intraepithelial neoplasia was made on histopathology. An MRI was advised which revealed an ill-defined heterogenous signal intensity lesion in the upper endometrium along the right anterolateral wall showing diffusion restriction on DWI/ADC and involving the myometrium. However, there was no cervical or serosal or extrauterine extension seen. Both the ovaries appeared atrophic and no parametrial or adnexal mass was identified on imaging (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Therapeutic intervention</span><p id="par0060" class="elsevierStylePara elsevierViewall">Staging laparotomy was planned and bilateral salpingo-oophorectomy with hysterectomy and pelvic lymphadenectomy was done. The uterus on cut shows a friable growth in the fundus and body region measuring 2.6<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>1.8<span class="elsevierStyleHsp" style=""></span>cm and was grossly involving the myometrium for more than 50%. Bilateral ovaries appeared unremarkable on serial sectioning. However, a small paratubal cyst (1.2<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>0.5<span class="elsevierStyleHsp" style=""></span>cm) was identified on the left side from which thin serous fluid oozed out, but no solid or papillary excrescences were identified. The right right-sided fallopian tube was unremarkable (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Multiple sections examined from the growth showed atypical glands having nuclear atypia and many atypical mitoses in the endometrium and involving the myometrium for more than 50%. The tumor cells were arranged in glands, sheets and occasionally in cribriform pattern and were positive for estrogen receptor (ER), progesterone receptor (PR), vimentin and mutant p53 positivity (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Paratubal cyst showed many irregularly contoured papillae with fibrous, hyaline or myxoid cores. Pseudostratified, crowded lining with hobnailing and epithelial tufting was also identified. The cells were cuboidal to ciliated columnar and had a mild to moderate degree of pleomorphism, but no atypical mitosis was seen. Based on the above findings the left-sided ovary and fallopian tube were completely processed to rule out any possibility of serous ovarian neoplasm. However, no such lesion in any of the sections of the fallopian tube and ovary. On immunohistochemistry, these cells were positive for WT1, ER and PR and were negative for vimentin. Based on the above a diagnosis of endometroid adenocarcinoma FIGO grade II, stage IB with left-sided borderline serous paratubal cyst was made (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Monitoring and results</span><p id="par0065" class="elsevierStylePara elsevierViewall">The post-operative period was uneventful. The patient is currently under follow-up with no evidence of recurrence or metastasis.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">Paratubal serous borderline tumors are extremely rare with only a handful of cases available in the literature and that too associated with endometrial adenocarcinoma as a synchronous malignancy is a presentation hardly being reported. The differentiation between ovarian and paratubal cysts is quite challenging in imaging especially when they are smaller in size as was in this case. The size of these cysts ranges from 1<span class="elsevierStyleHsp" style=""></span>cm to as large as 16<span class="elsevierStyleHsp" style=""></span>cm as described in the literature. Microscopic examination of all the paratubal cysts is extremely important to rule out malignancy, although the majority of them are benign. Every time a borderline or malignant paratubal is discovered it is recommended to completely process the ovaries and fallopian tubes of that side to confirm the further extensions of the lesion. This case was unique as the patient was known case of endometrial carcinoma and the borderline tumor in the paratubal cyst was diagnosed incidentally which was later confirmed also by complete exhaustion of the tube and ovary of that side. From the management point of view also no further surgery was required as the patient underwent staging laparotomy for endometrial carcinoma.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Borderline tumors also known as tumors with low malignant potential are characterized by cellular proliferation, epithelial tufting, stratification of epithelial lining of the papilla, and mild nuclear atypia but without any foci of stromal invasion.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The endometroid subtype is the most common one among the endometrial carcinomas and the development of a surface epithelium of the ovary or a paratubal or para-ovarian cysts from the embryological Mullerian duct and sharing of estrogen receptors in predisposed tissues are the likely cause of synchronous malignancy. Surprisingly, the prognosis of these synchronous tumors is better than the patients with single-organ cancer.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes all the previously reported cases of paratubal borderline tumors.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">The present case of synchronous malignancy with an incidental paratubal serous borderline tumor highlights a rare presentation and also provides insights into the malignancy arising in paratubal cysts. These paratubal cysts whether small or large must be examined carefully to rule out any possibility of malignancy.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Ethical disclosures</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Protection of human and animal subjects</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association (Declaration of Helsinki).</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Confidentiality of data</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Right to privacy and informed consent</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Ethics approval and consent to participate</span><p id="par0105" class="elsevierStylePara elsevierViewall">Informed patient consent was taken. The study was done in accordance with the Declaration of Helsinki of 1975.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Funding</span><p id="par0110" class="elsevierStylePara elsevierViewall">None.</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Authors’ contributions</span><p id="par0115" class="elsevierStylePara elsevierViewall">AAZ, SA, CA were responsible for the reporting and diagnosis of the case. AAZ and SA were major contributors to the writing of the manuscript while CA were responsible for the article review and editing. All authors read and approved the final manuscript.</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Consent for publication</span><p id="par0120" class="elsevierStylePara elsevierViewall">Informed written patient consent was taken before publication of the article.</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Informed patient consent</span><p id="par0125" class="elsevierStylePara elsevierViewall">Informed patient consent was taken. The study was done in accordance with the Declaration of Helsinki.</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conflicts of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Availability of data and material</span><p id="par0135" class="elsevierStylePara elsevierViewall">That data is available from the corresponding author on request.</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Declaration of generative AI in scientific writing</span><p id="par0140" class="elsevierStylePara elsevierViewall">Not applicable.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:22 [ 0 => array:3 [ "identificador" => "xres2272718" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Main symptoms and/or clinical findings" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Main diagnoses, therapeutic interventions, and outcomes" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1894160" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2272719" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Principales síntomas y/o hallazgos clínicos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Principales diagnósticos, intervenciones terapéuticas y resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1894159" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Information of the patient" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Clinical findings" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Timeline" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Diagnostic evaluation" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Therapeutic intervention" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Monitoring and results" ] 11 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 12 => array:3 [ "identificador" => "sec0045" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0060" "titulo" => "Right to privacy and informed consent" ] ] ] 13 => array:2 [ "identificador" => "sec0065" "titulo" => "Ethics approval and consent to participate" ] 14 => array:2 [ "identificador" => "sec0070" "titulo" => "Funding" ] 15 => array:2 [ "identificador" => "sec0075" "titulo" => "Authors’ contributions" ] 16 => array:2 [ "identificador" => "sec0080" "titulo" => "Consent for publication" ] 17 => array:2 [ "identificador" => "sec0085" "titulo" => "Informed patient consent" ] 18 => array:2 [ "identificador" => "sec0090" "titulo" => "Conflicts of interest" ] 19 => array:2 [ "identificador" => "sec0095" "titulo" => "Availability of data and material" ] 20 => array:2 [ "identificador" => "sec0100" "titulo" => "Declaration of generative AI in scientific writing" ] 21 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2024-06-10" "fechaAceptado" => "2024-07-18" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1894160" "palabras" => array:5 [ 0 => "Paratubal" 1 => "Borderline" 2 => "Serous tumor" 3 => "Synchronous" 4 => "Case report" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1894159" "palabras" => array:5 [ 0 => "Paratubálico" 1 => "Límite" 2 => "Tumor seroso" 3 => "Sincrónico" 4 => "Informe de caso" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Paratubal cysts, commonly benign and incidentally found during hysterectomy or salpingectomy, are often termed “hydatid cysts of Morgagni.” While most are benign, borderline and malignant subtypes are rare. This report presents an unusual case of synchronous malignancies involving an endometrioid adenocarcinoma and a paratubal borderline serous tumor, emphasizing the need for careful examination of paratubal cysts.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Main symptoms and/or clinical findings</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A 61-year-old postmenopausal woman presented with two months of vaginal bleeding and lower abdominal pain. Elevated CEA and CA 19-9 levels were noted. Ultrasonography showed thickened endometrium and moderate pyometra, and MRI revealed a lesion in the upper endometrium involving the myometrium without extrauterine extension. An endometrial biopsy indicated endometrial intraepithelial neoplasia.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Main diagnoses, therapeutic interventions, and outcomes</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The patient underwent a staging laparotomy, bilateral salpingo-oophorectomy, hysterectomy, and pelvic lymphadenectomy. Histopathology confirmed endometrioid adenocarcinoma (FIGO grade II, stage IB) and identified a left paratubal cyst with borderline serous tumor features. Immunohistochemical analysis supported these findings. The post-operative period was uneventful, and the patient remains under follow-up with no signs of recurrence or metastasis.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">This case underscores the importance of thorough examination of paratubal cysts. The rare coexistence of endometrioid adenocarcinoma with a borderline serous paratubal tumor highlights the necessity for detailed histopathological and immunohistochemical evaluation in synchronous malignancies. Such meticulous examination ensures accurate diagnosis and appropriate management, potentially enhancing patient outcomes.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Main symptoms and/or clinical findings" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Main diagnoses, therapeutic interventions, and outcomes" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Los quistes paratubarios, comúnmente benignos y que se encuentran incidentalmente durante una histerectomía o salpingectomía, a menudo se denominan “quistes hidatídicos de Morgagni”. Si bien la mayoría son benignos, los subtipos limítrofes y malignos son raros. Este informe presenta un caso inusual de neoplasias malignas sincrónicas que involucran un adenocarcinoma endometrioide y un tumor seroso límite paratubal, enfatizando la necesidad de un examen cuidadoso de los quistes paratubales.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Principales síntomas y/o hallazgos clínicos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Una mujer posmenopáusica de 61 años presentó dos meses de sangrado vaginal y dolor abdominal bajo. Se observaron niveles elevados de CEA y CA 19-9. La ecografía mostró endometrio engrosado y piómetra moderada, y la resonancia magnética reveló una lesión en el endometrio superior que afectaba al miometrio sin extensión extrauterina. Una biopsia de endometrio indicó neoplasia intraepitelial endometrial.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Principales diagnósticos, intervenciones terapéuticas y resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La paciente fue sometida a una laparotomía de estadificación, salpingooforectomía bilateral, histerectomía y linfadenectomía pélvica. La histopatología confirmó el adenocarcinoma endometrioide (FIGO grado II, estadio IB) e identificó un quiste paratubárico izquierdo con características de tumor seroso limítrofe. El análisis inmunohistoquímico apoyó estos hallazgos. El postoperatorio transcurrió sin complicaciones y el paciente permanece en seguimiento sin signos de recidiva ni metástasis.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Este caso subraya la importancia de un examen exhaustivo de los quistes paratubarios. La rara coexistencia de adenocarcinoma endometrioide con un tumor paratubárico seroso límite resalta la necesidad de una evaluación histopatológica e inmunohistoquímica detallada en neoplasias malignas sincrónicas. Este examen meticuloso garantiza un diagnóstico preciso y un tratamiento adecuado, lo que potencialmente mejora los resultados de los pacientes.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Principales síntomas y/o hallazgos clínicos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Principales diagnósticos, intervenciones terapéuticas y resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">This paper has been prepared by the abovementioned authors and reviewed and agreed upon for submission. The requirements for authorship as stated above in this document have been met, and that each author believes that the manuscript represents honest work.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1382 "Ancho" => 2340 "Tamanyo" => 568780 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Radiological findings of the case. (a, b) Ultrasonography of the pelvis showed thickened endometrium with moderate pyometra. (c, d) Magnetic resonance imaging exhibited an ill-defined heterogenous signal intensity lesion in the upper endometrium along the right anterolateral wall showing diffusion restriction on DWI/ADC and involving the myometrium.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 686 "Ancho" => 1874 "Tamanyo" => 196810 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Gross images of the case. (a, b) The uterus on cut shows a friable growth in the fundus and body region grossly involving >50% of the myometrium. A small paratubal cyst was identified on the left side but no solid or papillary excrescences were identified.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1458 "Ancho" => 2340 "Tamanyo" => 1243680 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Microscopic and immunohistochemical findings of the endometrioid adenocarcinoma, uterus. (a, b) Hematoxylin and eosin-stained sections exhibited atypical glands involving the myometrium for more than 50%. The tumor cells were arranged in glands, sheets and occasionally in cribriform pattern. [×100, ×400]. (c, d) On immunohistochemistry, the cells were positive for vimentin (c) and ER (d). [×400].</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1513 "Ancho" => 2674 "Tamanyo" => 1199040 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Microscopic and immunohistochemical findings of the paratubal borderline serous tumor. (a–c) Hematoxylin and eosin-stained sections exhibited a paratubal cyst with many irregularly contoured papillae. The papillae were lined by cuboidal to ciliated columnar cells with mild to moderate degree of pleomorphism. [×40, ×100, ×400]. (d–f) On immunohistochemistry, these cells were positive for WT1 (d), ER (e) and PR (f). [×400].</p>" ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Author \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tumor type \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Presentation \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Size \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Surgery \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Follow-up \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Seamon et al.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Borderline serous \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pelvic pain, pelvic mass and torsion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.5<span class="elsevierStyleHsp" style=""></span>cm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right salpingo-oophorectomy and staging laparotomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 months disease free \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Shin et al.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Borderline serous \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Left flank pain and pelvic mass \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16<span class="elsevierStyleHsp" style=""></span>cm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right paratubal cystectomy, washing and peritoneal biopsy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 months disease free \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Limaiem et al.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Borderline serous \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pelvic pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8<span class="elsevierStyleHsp" style=""></span>cm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Paratubal cystectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 months disease free \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mehawej et al.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Borderline serous \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Postmenopausal bleeding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1<span class="elsevierStyleHsp" style=""></span>cm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total abdominal hysterectomy with bilateral salpingo-oophorectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 months disease free \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Baek et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Borderline serous \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pelvic pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6<span class="elsevierStyleHsp" style=""></span>cm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hysterectomy and bilateral salpingo-oophorectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 months disease free \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Present case \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Borderline serous \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Postmenopausal bleeding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1<span class="elsevierStyleHsp" style=""></span>cm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bilateral salpingo-oophorectomy with hysterectomy with staging laparotomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 months disease free \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3690617.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Clinicopathological findings of previously reported cases of paratubal borderline tumors.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tumors of the ovary, maldeveloped gonads, fallopian tube and broad ligament" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S.L. 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