ABSTRACT
Background: Ovarian carcinoma is a silent killer because it presents in advanced stage. In India, it ranks third after carcinoma cervix and breast. Incidence of ovarian cancer is 5.4-8.0 per 100,000 in India. Various versions of risk of malignancy index have been studied to show its validity in different settings. We have studied third version of risk of malignancy index in a resource poor setting in India.Methods: In this prospective observational study 74 perimenopausal and postmenopausal women with ovarian mass were recruited. Menopausal score (M), Ultrasonography score (U) and CA-125 are components of Risk of Malignancy Index 3. Patients underwent preoperative ultrasonography and CA-125 level was assessed. Scores of M 1-3, U 1-3 and absolute value of CA-125 was multiplied. This product was value of Risk of Malignancy Index 3. If it is less than 250 it suggests absence of malignancy and more than 250 strongly suggests malignancy. Results were confirmed by histopathology.Results: Fifty six percent women were cancer positive. Ovarian malignancy was more common in postmenopausal age group. Ultrasonography and CA-125 had high sensitivity of 90% but poor specificity. Risk of malignancy index 3 had a sensitivity, specificity, positive predictive value and negative predictive value of 90%, 91%, 78% and 96% respectively at a cut off value of 250.Conclusions: Risk of malignancy index was concluded to be a multimodal approach with better diagnostic scoring index in preoperative stage in women of ovarian masses. It is simple and easily applicable clinical tool in resource poor setting.
ABSTRACT
Primary ovarian pregnancy is a rare type of extra-uterine pregnancy, and occurs in 1:7000 to 1: 40,000 deliveries. This is a case that occurred in a 26 years old multiparous woman. She had presented with pain abdomen and bleeding per vaginum and was hemodynamically stable, negative pregnancy test, but vaginal examination showed painful cervical movements, slight bleeding through external os, uterus just bulky, tender mass felt in right adnexa. Ultrasonography revealed—Right tubo-ovarian mass with fluid in peritoneal cavity. Laparotomy showed Right Ovarian Pregnancy. Managed by Right Ovariectomy.
ABSTRACT
Gestational choriocarcinoma is a highly malignant tumor of trophoblastic cells with a propensity to metastasize to various sites including lungs, vagina, brain, liver, kidney, and gastrointestinal tract, in descending order of frequency. Usually it is treated by chemotherapy but rarely hysterectomy is indicated if bleeding is heavy, or if tumor is resistant to chemotherapy A 45-year-old woman presented to the hospital as an emergency with heavy bleeding per vagina since 4 days preceded by abdominal pain. H/O spontaneous abortion of 5months pregnancy 2 yrs back and was asymptomatic since 2years. Investigations showed severe anemia and high level of β-hCG. She underwent Total abdominal Hysterectomy for heavy bleeding and Histopathology revealed it to be a case of gestational choriocarcinoma. Chemotherapy was given pre and postoperatively and resulted in complete cure.
ABSTRACT
Objective: To find out whether Hysterosalpigography (HSG), can be used as initial method for assessing tubal factor of infertility, instead of more invasive method like diagnostic laparoscopy. Methods: Retrospective analysis of 75 cases, who had attended infertility Clinic at Medical College, Ujjain, and underwent HSG as initial test followed by Laparoscopy from November 2005 to December 2010. Results: Primary infertility was the major cause of tubal factor of infertility (75%) and majority of women were between 20-25 years (60%). In comparison to laparoscopy, HSG has 80.8% sensitivity & 100% specificity for determination of tubal patency. HSG also has a high sensitivity (100%) for determination of unilateral or bilateral blockage with specificity of 100% & 85.3% respectively. HSG can detect only endo-tubal and intrauterine pathology, whereas laparoscopy can detect pelvic pathology. Conclusion: HSG should be used as initial test to assess tubal patency whereas laparoscopy should be limited to selected cases.