O câncer de ovário é a terceira causa de morte entre as neoplasias malignas em mulheres e o cistoadenocarcinoma mucinoso é uma neoplasia maligna originária do epitélio ovariano e que pode adquirir grandes dimensões. Alguns estudos sugerem um aumento do risco de neoplasia em pacientes com esclerose sistêmica (ES), mas a associação com neoplasia de ovário, principalmente do subtipo mucinoso, não é comum. Os autores descrevem um caso de cistoadenocarcinoma mucinoso de ovário em uma mulher branca de 52 anos com diagnóstico de ES difusa há seis anos, tratada previamente com D-penicilamina e ciclofosfamida, que procurou o serviço médico com queixa de dor e aumento do volume abdominal há três meses. Ao exame físico apresentava facies esclerodérmica, membros superiores com diminuição da elasticidade e enxerto bitibial em membros inferiores; no abdome havia a presença de uma massa endurecida estendendo-se da região suprapúbica até o epigástrio. Foi realizada laparotomia exploradora onde se encontrou uma massa cística no ovário direito, com peso de 3.300 gramas. Em seguida procedeu-se exérese do tumor com histerectomia total e ooforectomia bilateral. O exame histológico confirmou tratar-se de um cistoadenocarcinoma mucinoso sem invasão de cápsula.

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Introduction: Radiation therapy (RT) plays an important role in the management of patients with ductal carcinoma in situ (DCIS) of the breast, treated by breast-conserving surgery (BCS). RT significantly reduces the risk of local recurrences (LRs) in unselected patients. Efforts are being made, currently, to de-escalate the RT in this scenario with individualized decision-making. Several biomarkers were developed to predict the probability of LR and aid a tailored clinical decision. Objective: The aim of this study was to assess the potential of a modified MSKCC DCIS nomogram to forecast LR after BCS for DCIS patients and assist physicians to recommend RT. Methods: Women with DCIS undergoing BCS, with clear surgical margins and external RT, were enrolled in the study. The MSKCC DCIS Nomogram was modified with the omission of the RT parameter. Patients were considered at high risk for LR when the 10-year probability of LR was >10%. Receiver operating characteristic curves were drawn and the areas under the curves (AUCs) of 10-year follow-up evaluation were calculated. Results: In all, 110 women were studied. Eight patients had LR (7.3%), five being invasives (62.5%) and three in situ (37.5%). LRs occurred in 6.2% and 12.7% of patients who were classified as high risk by the original and by the modified nomogram, respectively. The AUCs were compared. The modified MSKCC DCIS nomogram is warranted for the 10-year risk LR prediction, and it may reinforce RT indication. Conclusion: The modified MSKCC DCIS nomogram may identify patients with DCIS treated by BCS with a high probability of LR and, therefore, may individualize RT recommendation.