Primary Peritoneal Carcinoma with long term survival: A case report / Philippine Journal of Obstetrics and Gynecology

@#Primary peritoneal carcinoma is rare, presents with non-specific abdominal symptoms, is usually diagnosed late and is associated with a poor prognosis. A 51-year-old female with Primary Peritoneal Carcinoma Stage III-C, was initially treated with cytoreductive surgery and intravenous paclitaxel and carboplatin. After 28 months in remission, she developed tumor recurrence. She underwent tumor excision followed by combined intravenous paclitaxel and intraperitoneal carboplatin. The patient is alive and disease-free 5 years after the initial operation. This case was reported to inform our clinicians that the peritoneum can be the primary site of a rare malignancy. Prognosis may be poor but long-term survival can be achieved in younger patients with good performance status. Having a tumor that is sensitive to platinum-based chemotherapy can contribute to a longer survival even if the tumor was sub-optimally reduced.

A dilemma in the management of fetal pleural effusion: A case report of two cases / Philippine Journal of Obstetrics and Gynecology

@#Fetal Pleural Effusion is a rare case whose management is still a matter of debate. Its course may spontaneously resolve or lead to pulmonary hypoplasia and result in death in utero or poor neonatal outcome. This paper is a report of 2 cases and their course, from prenatal diagnosis of Pleural Effusion to delivery. This report includes sonographic scans, description of the laboratory work – up and other imaging tests that were done. The 1st case report was successfully managed with Thoraco-amniotic shunting, while the 2nd case was seen late and had an adverse neonatal outcome. This case report was done to increase awareness among obstetricians and sonologists in offering counsel to patients and their families, especially in our low resource set-up, where in in utero interventions are not available.

Creation of a scoring system to determine endometrial cancer risk using the International Endometrial Tumor Analysis (IETA) features / Philippine Journal of Obstetrics and Gynecology

GENERAL OBJECTIVE: To determine endometrial cancer risk among patients with abnormal uterine bleeding based on the International Endometrial Tumor Analysis (IETA) features.SPECIFIC OBJECTIVES: 1. To described the profile of patients with AUB suspected of having endometrial pathology; 2. To describe sonologic features of patients with AUB suspected of endometrial cancer using IETA features; and 3. To determine the association of a scoring system and endometrial cancer risk.METHODS: We prospectively studied 542 participants who came in the CWCU of CSMC with a diagnosis of AUB from July 1, 2016 to December 31, 2016. We excluded patients with endometrial thickness of less than 4 mm on gray-scale sonography, those with technical difficulties in assessing the endometrium such as in cases of very large myomas, absence of histopathological diagnosis, and those whose sampling was done as an office procedure. A total of 98 participants were included, 89 (90.8%) had benign pathologies and 9 (9.2%) were malignant. Patient characteristics including, age, gravidity, BMI, medical history, and endometrial assessment using IETA were tabulated with each characteristic given a score of 0-3 depending on the degree of risk factor. Percentages, Pearson Chi-square Test with corresponding P-value and ROC curve analysis were performed.RESULTS: The best predictors for endometrial cancer were age more than 50 years, nulligravid, BMI of more than 25, and presence of hypertension and diabetes mellitus. Sonographic features based on IETA showed an endometrial thickness of more than 20mm, irregular endometrial-myometrial junction, heterogenous endometrium, presence of multiple and large vessels on doppler analysis, contributed to endometrial cancer risk. These variables were used to create a scoring system with an area under the curve of 0.974 giving the best cut-off value of more than or equal to 9, with 100% sensitivity and 89% specificity.CONCLUSION: Among patients with abnormal uterine bleeding and endometrial thickness of more than 4mm, we can predict the risk for endometrial cancer and aid the clinician in decision making on who may be managed conservatively or aggressively based on the value obtained from the scoring system. The study, however, needs to be validated prior to use in clinical practice.