The utility of ultrasound-guided tru-cut biopsy in the diagnosis of occult breast carcinoma presenting as ovarian malignancy with multiple metastases: A case of unknown primary

@#This paper documents the utility of ultrasound-guided tru-cut biopsy in the diagnosis and subsequent management of a case of occult breast carcinoma presenting with multiple distant metastases in the absence of a primary breast lesion. She was initially diagnosed as primary ovarian malignancy with metastatic disease and subsequently underwent transvaginal ultrasound-guided tru-cut biopsy of the right ovarian mass. Histologic and immunohistochemical studies were consistent with a metastatic adenocarcinoma of breast origin. The patient underwent chemotherapy for primary breast carcinoma and has responded well.

Cor pulmonale secondary to pulmonary tuberculosis in pregnancy: A report of two cases / Philippine Journal of Obstetrics and Gynecology

@#Cor pulmonale is defined as alteration in structure and function of the right ventricle of the heart caused by a primary disorder of the lungs. Presented are two cases of gravidocardiac patients from cor pulmonale secondary to multi-drug resistant tuberculosis. The first case is a case of a 37-year-old gravida 4 para 3 (3-0-0-3) and the second case is that of a 24-year-old pimigravid, both of which were on their third trimester with no known cardiac disease, both initially presenting with dyspnea and heart failure symptoms. The first patient was not in labor, managed conservatively and was discharged clinically improved; the latter was delivered abdominally who later succumbed to fatal arrhythmia. Presented are the strategies in management and challenges encountered in managing a pregnant cardiac patient from cor pulmonale, specifically from pulmonary tuberculosis.

The utility of ultrasound-guided tru-cut biopsy in the diagnosis of Occult Breast Carcinoma presenting as Ovarian Malignancy with Multiple Metastases: A case of unknown primary

@#This paper documents the utility of ultrasound-guided tru-cut biopsy in the diagnosis and subsequent management of a case of occult breast carcinoma presenting with multiple distant metastases in the absence of a primary breast lesion. She was initially diagnosed as primary ovarian malignancy with metastatic disease and subsequently underwent transvaginal ultrasound-guided tru-cut biopsy of the right ovarian mass. Histologic and immunohistochemical studies were consistent with a metastatic adenocarcinoma of breast origin. The patient underwent chemotherapy for primary breast carcinoma and has responded well.

Comparative study on the diagnostic accuracy of the different International Ovarian Tumor Analysis (IOTA) predictive model in discriminating between benign and malignant ovarian new growths: Logistic Regression 1 and 2 (LR1 and LR2) and assessment of the different Neoplasias of the Adnexa (ADNEX) model / Philippine Journal of Obstetrics and Gynecology

Objective@#To compare the diagnostic accuracy of the International Ovarian Tumor Analysis (IOTA)- Logistic Regression 1 and 2 (LR1 and LR2) and the Assessment of Different Neoplasias in the Adnexa (ADNEX) model in discriminating between benign and malignant ovarian new growths @*Methods@#The study was a prospective validation study. It included all patients admitted at the Gynecology ward of the Philippine General Hospital for elective surgery for ovarian new growths. Demographic information and clinical data were recorded for eligible patients. Two-dimensional ultrasonography with Doppler studies were performed. Ovarian new growths were classified based on IOTA LR1, LR2 and ADNEX model. Correlation of the ultrasound findings with the histopathology report and final staging based on Federation of Gynecology and Obstetrics (FIGO) classification was done. @*Results@#Sixty seven (67) patients were included in the final analysis. The mean age was 43 years old (range of 17-78). There were sixteen (16) nulligravid patients (22%). Eighteen (18) out of the 67 patients (27%) had malignant ovarian masses on histopathology. The IOTA LR1 had an area under the curve (AUC) of 0.96, sensitivity of 89% (95%CI, 74-100) and specificity of 92% (95%CI, 84-100). The IOTA LR2 had an AUC of 0.88, sensitivity of 61% (95%CI, 39-84) and specificity of 96% (95%CI, 90-100). The IOTA ADNEX had an AUC of 0.96, sensitivity of 89% (95%CI, 74-100) and specificity of 76% (95%CI, 63-88). Sensitivity and specificity of IOTA ADNEX for the diagnosis of specific malignant subtypes were as follows: Borderline, 80% and 76%, Stage I, 100% and 100, Stage II-IV, 86% and 100%. Accuracy values were not computed for the metastatic cancer since there was only one case seen. There was no significant difference in the accuracy values of IOTA ADNEX with or without CA 125. @*Conclusion@#In conclusion, IOTA LR1, LR 2 and ADNEX models were all useful tools in discriminating between benign and malignant ovarian masses. IOTA LR1 had the highest accuracy in differentiating between benign and malignant ovarian masses.

The role of sonography in the diagnosis of chronic puerperal uterine inversion: A case report / Philippine Journal of Obstetrics and Gynecology

Chronic puerperal uterine inversion is a rare and life-threatening obstetric emergency which requires emergent treatment. We present a case of a 27-year-old Gravida 2 Para 2 (2002) with chronic uterine inversion. A bleeding, 4 x 4 x 5 cm fleshy knob like mass protruding from the cervix, was seen during vaginal inspection. Two-dimensional transvaginal sonography and 3-dimensional imaging clinched the diagnosis of uterine inversion. The patient underwent Haultain's procedure and was discharged improved with resumption of normal menses. Postpartum transvaginal sonography revealed a normally positioned uterus.

Accuracy of two dimensional ultrasonography in detecting lymph node metastasis in cases of uterine and cervical malignancies seen in a tertiary hospital: A five year restropective study / Philippine Journal of Obstetrics and Gynecology

OBJECTIVE: This study aims to determine the accuracy of two dimensional ultrasound in detecting lymph node metastasis in uterine and cervical (stage IA2-IIA) malignancies.MATERIALS AND METHODS: This is a five-year retrospective, cross sectional study conducted for 6 months among uterine and cervical malignancy patients who underwent bilateral pelvic lymph node dissection and para-aortic lymph node sampling with ultrasound performed within two months prior to surgery in a tertiary hospital. Ultrasound findings were compared with histopathologic results as gold standard.RESULTS: The study included 319 patients, 267 uterine and 52 cervical malignancies. Uterine cancer (pelvic-7.1% and para-aortic-2.6%) and cervical cancer (pelvic-1.95%) nodal involvement showed majority having round shape. Mean pelvic nodal size was 1.75 x 0.93cm-uterine, 1.83 x 0.93cm-cervical and para-aortic 3.3x2.0cm-uterine. The study revealed accuracy, sensitivity, specificity, PPV and NPV of 91.5%, 29.4%, 96.4%, 25.0% and 96.0% respectively for pelvic node metastasis and 95.6%, 11.1%, 98.1%, 14.3% and 97.4% respectively for para-arotic involvement. Ultrasound accuracy in detecting pelvic node extension was 98.1%-cervical and 90.3%-uterine (sensitivity-50% vs 26.7%; specificity-100% vs 94.1%; PPV-100% vs 21.1% and NPV-100% vs 95.6%). Para-aortic nodal metastasis detection among cervical and uterine cancer patients showed the following: accuracy (98.1% vs 95.1%), specificity (100% vs 97.7%), and NPV (98.1% vs 97.3%).CONCLUSION: Two-dimensional ultrasound is reliable in ruling in the presence of pelvic and para-aortic lymph node metastasis among patients with uterine and cervical malignancies. However, its low sensitivity of detection makes it less dependable in ruling out nodal involvement. Larger size and round shape of lymph nodes represent nodal meatastasis.