Vulval carcinoma at the site of recent Bartholin gland excision: a rare case report

Around 2-7% of all vulvar cancers are represented by primary carcinomas of Bartholin gland. Here we are presenting such a rare case of carcinoma of Bartholin gland. 45/F P2L2 presented in our OPD with non-healing lesion in vulva for 2 months. She had history of Bartholin’s cyst excision (elsewhere), 2 months back (the exact time since when she is having the non-healing lesion in vulva). Diagnostic biopsy revealed it to be vulval squamous cell carcinoma. She was given two cycles of Neo adjuvant chemotherapy (Inj. Paclitaxel and Carboplatin). In view of better response to the treatment patient was planned for surgery. Patient underwent wide local excision with bilateral inguinofemoral lymphadenectomy. Although the majority of vulvar lesions are benign, especially in women younger than 50 years of age, any solid mass should be carefully evaluated for malignancy. Preferably biopsy of Bartholin gland should be considered if the patient is more than 40 years of age and should be mandatory in a menopausal woman.

Surgical management of a case of recurrent carcinoma cervix: a case report

Worldwide cervical cancer is the fourth most common cancers among females. Pelvic recurrence, distant metastases, or a combination of both can occur in patients of carcinoma cervix. A 42-year-old P2L2 with a history of carcinoma cervix stage 3-b came to our OPD for routine follow up. Two year back she was managed with chemoradiation for her primary carcinoma which had parametrium extension. There was a 1 × 1 cm lesion on the anterior vaginal wall which was diagnosed to be cervical recurrence. Patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy with pelvic lymphadenectomy. Patient is disease free till now. Treatment decisions should be individualised based on the performance status of the patient, the site of recurrence and/or metastases, the extent of metastatic disease, and prior treatment.

Modified ovarian response prediction index: a novel index for ovarian response prediction in GnRH agonist cycles

Background: Evaluation of the ovarian reserve is necessary to achieve an appropriate controlled ovarian stimulation (COS). This can be done by correctly predicting the ovarian response. The objective of this study was to derive a simple index by combining the above parameters which will be helpful determining ovarian response.Methods: This retrospective analysis was performed at Guru hospital, Madurai, involving 162 patients between July 2016 and July 2018. Inclusion criteria was all patients attending for their first ICSI (intracytoplasmic sperm injection) cycle between the above period, GnRH agonist protocol as the method of ovarian stimulation, no history of any previous ovarian surgery, presence of both ovaries and no evidence of any obvious endocrine disorders. We calculated MORPI values by multiplying the AMH (ng/ml) level by the number of antral follicles (2-9 mm), and the result was divided by the age (years) of the patient and the day- 3 serum FSH level.Results: At a cut-off value of 35 (AUC-0.952) for collection of ≥ 4 oocytes and 140 (AUC-0.952) for collection of ≥ 15 oocytes, MORPI was found to have optimum sensitivity and specificity under ROC curve analysis.Conclusions: MORPI is a simple, precise and cost effective index to predict a low ovarian response, the collection of >4 MII oocytes and an excessive ovarian response in infertile women. This index also has a good ability to predict the clinical pregnancy rate. This might be used to improve the cost-benefit ratio of ovarian stimulation regimens.

Coexistence of both Brenner tumor and cystadenofibroma of ovary in a postmenopausal woman: a rare case

Brenner tumor, and cystadeno fibroma of ovary are rare varieties of ovarian tumor, characterized by presence of solid components. There are very rare instances where both Brenner tumor and cystadenofibroma coexist in a single patient. A 48-year P1L1, postmenopusal woman presented at Guru hospital, Madurai, with chief complaints of on and off postmenopausal bleeding for 6 months. On ultrasonography there were two simple cysts of ovary measuring 6x 6 cm on left side and 4x4 cm on right side. She was managed with total laparoscopic hysterectomy and bilateral salpingoophorectomy.  Intraoperatively there was a right ovarian mass of 6x6 cm size and a left ovarian mass of 4x4 cm size. Left ovarian mass reported as benign cystadenofibroma while the right ovarian mass was reported to be brenners tumor on histopathology. As the preoperative imaging are not completely relied for diagnosing these tumors, awareness of the surgeons of these entities is particularly important. The prognosis of both of these tumors is excellent with suitable treatment. They have a very low recurrence risk on compete removal through surgery.