Primary debulking surgery versus neo-adjuvant chemotherapy in stage III/IV ovarian cancer: Comparison of perioperative morbidity and survival data in Pakistani women

To compare the peri-operative morbidity and survival rates between ovarian cancer patients treated with two different approaches. The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised data related to patients with advanced stage ovarian carcinoma treated between 1999 and 2008. Medical records were reviewed and relevant demographic, clinical, surgical, pathologic and follow-up information was acquired. Progression-free survival and overall survival rates were compared between patients who underwent primary debulking surgery and those who had received neo-adjuvant chemotherapy before surgery. SPSS 19 was used for statistical analysis. Of the total 118 patients, 78[66%] had undergone primary debulking surgery and 40[34%] had received neo-adjuvant chemotherapy. The mean age and pre-operative carcinoma antigen-125 level were similar. The debulking group had 74[94.8%] patients with stage 3, and 4[5.1%] patients with stage 4 disease, while the other group had 32[80%] and 8[20%] with stage 3and 4 respectively. The frequency of optimal debulking was 42[56.8%] in the former group against 27[79.4%] in the latter [p=0.01]. Duration of surgery, estimated blood loss >1500ml and stay at the intensive care unit were not statistically different [p>0.05]. Rate of Urinary tract, bowel injury and bowel resections were also similar. There was no difference in the progression-free survival in both groups [p>0.05]. Neo-adjuvant chemotherapy followed by interval debulking produced comparable survival rates and peri-operative complications

Uterine perivascular epithelioid cell tumour presenting as a cervical mass

Perivascular Epithelioid Cell Tumour [PEComa] also known as myelomelanocytic tumours are uncommon, recently described mesenchymal tumours that include angiomyolipoma, clear cell "sugar" tumour of the lung, lymphangioleiomyoma and tumours composed predominantly of epithelioid cell morphology. A predilection for uterus has been described. However up till now only 14 cases of uterine PEComas have been described. All of these were seen in adult females in the peri and post menopausal age group [from 40-75years], and almost all were located in the region of body of uterus. A single case in the upper cervical region has been reported with uterine PEComatoses. We report an unusual presentation of this rare tumour presenting as a polypoidal cervical mass in a young female. Occurrence of this tumor in a young female as seen in our case warrants inclusion of PEComa in the diferential diagnosis of all epithelioid and clear cell neoplasms of uterus irrespective of age