Malignant Transformation in Mature Cystic Dermoid: A Case Series of 8 Cases

Introduction: One of the most common types of ovarian germ neoplasm is Mature cystic teratoma(MCT) which accounts for almost 20% of all ovarian neoplasm. Objective: Analyze patients with Malignant Transformation (Mt) arising from Mature Cystic Teratoma of the ovary to evaluate Clinico-pathological features and treatment modalities. Methods: This is an observational study of 8 patients of Mt in MCT, who had taken complete treatment at GCRI between the period from September 2016 to September 2021. During this observation period, a total of two thousand one hundred and seventy seven ovarian tumors were diagnosed. Out of these patients, 9.32% (203) were MCTs. Of the consecutive cases of 203 ovarian MCTs diagnosed, 3.9% (8) had Mt of MCT, which was our study group. Results: The mean age of patients with Mt in MCT was 47.1 years (27- 65 yrs), while mean age of the patients with MCT was 42 years (35-55 years). Among the 21 postmenopausal, MCT's 28.5% (6) cases developed Mt and only 1% i.e., two cases from premenopausal showed Mt. Abdominal pain as main symptom was seen in 87.5% (7/8) patients. The duration of symptoms ranged from 3 to 6 months. CA125 was elevated in 75% patients. Germ cell markers including beta HCG, AFP, LDH were found to be normal. Conclusion: Diagnosis of malignant transformation of MCT is very difficult. There should be high index of suspicion of malignant transformation if the MCT has been present for a long time; the patient is postmenopausal, age>45 yrs; the tumor diameter is greater than 9.5 cm; or there is thickening of the cyst wall or papillary growth occurs, increased tumor markers

Primary retroperitoneal mucinous cystadenocarcinoma: a rare surgico-pathological entity

Ovarian cancer (OC) is the seventh most common cancer for females in the world. Epithelial OC is the most predominant pathologic subtype (85%-90%), with five major histotypes- serous, mucinous, endometrioid, brenner and clear cell tumour. Each have three pathological subtypes ie benign, borderline and malignant. Mucinous cystadenomas and carcinomas of the ovary are well-established and common tumors. Primary retroperitoneal mucinous cystadenomas and carcinomas are being very rare and histopathogenesis of which is still uncertain. Most pathologists suggest their origin through mucinous metaplasia in a pre-existing mesothelium-lined cyst. An accurate preoperative diagnosis of these tumors is challenging due to lack of established effective diagnostic measures. Hereby presenting a 50-year-old woman, who visited to the hospital with abdominal distension and discomfort since two months. Sonography and computed tomography scans were performed and showed large predominantly cystic lesion arising from right adnexa. Patient underwent exploratory laparotomy for removal of the tumor. Histology and immunohistochemistry revealed primary retroperitoneal mucinous cystadenocarcinoma.

Maternal and neonatal outcomes in vacuum assisted births in the government tertiary care hospital in Mandya: a retrospective record-based study

Background: Vacuum extraction and forceps are the two options when an instrument is needed to facilitate a vaginal birth. Vacuum extraction has recently gained popularity because of new designs of vacuum cups with reduced risk of injury to the neonate. Vacuum extraction is one of the evidence-based interventions that can prevent complications by shortening the second stage of labour. The present study has been carried out to evaluate the maternal and neonatal morbidity, mortality and failure associated with vacuum assisted vaginal deliveries, at a Government tertiary care hospital in Mandya, Karnataka, India.Methods: The study was a record-based study including a total of 207 women who underwent vaginal assisted delivery in the form of vacuum assisted deliveries in a period of 6 months from January 2019 to June 2019 at the Government tertiary care hospital in Mandya, Karnataka, India. Records of women who had vacuum assisted deliveries and records of their newborn children were accessed.Results: In our study 41.5% of the subjects were in the age group of 21-25 years. Nearly 3/4th (74.4%) of the subjects were primigravida. More than half (54.1%) of the study subjects had to be put under vacuum assisted techniques for delivery because of the prolonged second stage of labour, failure rate was 0.4%. Out of 207 vacuum assisted deliveries maternal complication rate was 8.21%, 17.3% neonates had NICU admission and 14.97% had perinatal complications.Conclusions: Vacuum assisted vaginal delivery is comparatively a better choice in preventing the complications caused due to prolonged second stage of labour thus reducing the cesareans rate. It is a safe alternative to cesareans delivery in rightly chosen case. Vacuum assisted delivery by a skilled person and a proper technique is associated with lesser maternal and neonatal morbidity.

Profile and compliance of recipients of injection depot medroxy progesterone acetate as a contraceptive method in the government tertiary care hospital in Mandya, South Karnataka, India

Background: The advanced contraceptive devices available nowadays have minimal side effects and utmost efficacy. The use of safe and effective contraception is the need of the hour in India. Inj. Depot medroxy progesterone (DMPA) has been found to provide effective, long acting and reversible contraception in lactating mother and post-abortal patients. Objective of this study was to describe the profile of women utilizing inj. DMPA as a contraceptive, to determine its compliance and to assess the factors affecting discontinuation of inj. DMPA (Anthara) at the government tertiary care institute in Mandya.Methods: The present study was a record-based study of 18 months (January 2018 to June 2019). The records of 266 women who utilized inj. DMPA as contraception in our institution was analysed.Results: It was observed that out of 266 women 48.5% were from age group of 21-25 years and 64.3% were primipara. Most of the women who initiated inj. DMPA (Anthara) were in the lactational period (56.0%). Most common side effect was irregular bleeding (54.8%). Discontinuation rate was 55.6% after first injection and 16.9% after second injection and gradually reduced with subsequent injections. The most common reason for discontinuation was irregular spotting per vagina (53.9%).Conclusions: Inj. DMPA is a safe, effective, long acting contraceptive taken once in three months. Many women in early reproductive age and lactational period are using inj. DMPA (Anthara) for contraception because of its convenience of dosing and is easily made available at government health care centres free of cost and has no effect on lactation. Discontinuation rate can be reduced by proper counselling.

Chemo-resistant gestational trophoblastic neoplasia: a review of cases at a tertiary cancer centre

Background: Gestational trophoblastic neoplasia (GTN) was earlier a dreaded malignancy with high mortality rates. GTN is now considered to be one of the most curable solid tumours in women with cure rates greater than 90% even in the presence of metastases. Despite the high chemo sensitivity, treatment failure or drug resistance has been described in both groups.Methods: In this study, available records of GTN cases over 6 years were reviewed with emphasis on those who were resistant to the first line of chemotherapy. Of these, 37(34.58%) were resistant to the first line of chemotherapy. These cases were studied with respect to age, parity, antecedent pregnancy, interval from antecedent pregnancy, pretreatment β hCG, risk score and presence of metastases. The data was analyzed in order to find any risk factors associated with chemo-resistance.Results: Total number of cases of GTN was 107. Out of these 107 cases, 63 (58.88%) were low risk and 44 (41.12%) were high risk according to FIGO scoring system. Complete response was achieved with first line chemotherapy in 70 (65.42%) patients. The remaining 37 (34.57%) were resistant to first line chemotherapy. In the low risk group, 30 (47.62%) cases, and in the high-risk group, 7(15.91%) were resistant to first line of chemotherapy.Conclusions: Despite the high chemo sensitivity of GTN, resistance to first line chemotherapy may be encountered in up to 40% of cases.  It is important to identify the patients who are at risk to develop resistance, early identification of resistance and change of chemotherapy so as to minimize the exposure of these patients to ineffective chemotherapy.

Early stage cervical cancer with negative pelvic lymph nodes: morbidity and survival patterns following radical hysterectomy and postoperative adjuvant radiotherapy

Background: The objective of the present study was to optimize the role of adjuvant radiotherapy in lymph node negative cervical cancer treated with radical hysterectomy and pelvic lymph node dissection, and to analyse patterns of failure and complication following surgery and radiotherapy in same patients.Methods: This is retrospective analysis of 98 patients of cancer cervix FIGO Stage IB; IIA treated with radical hysterectomy with bilateral lymphadenectomy and adjuvant radiotherapy between the years 2000 and 2007at our hospital. Among all node negative patients who were operated during this period 97 patients were high risk. [High risk-Two or more of following risk factors: primary tumor size >4 cm, cervical stromal invasion ≥1/2, lymph-vascular space invasion, Unfavorable histology,>].Results: Median follow up: 79 months [6 months to 109 months], Recurrence rate: 13.26% [2 Pelvic and 11 distant recurrence] Pelvic control rate: 98 %Radiotherapy Complications: 4 % [Grade 3-4].Conclusions: Adjuvant radiotherapy following radical hysterectomy in high risk node negative early cervical cancer is effective treatment. It reduces pelvic recurrence with acceptable morbidity.

Study of epidemiology, clinicopathological correlation, prognostic factors and management in squamous cell carcinoma of vulva

Background: Carcinoma of the vulva is rare cancer, pruritus is the most common and long-lasting reported symptom. It is found to be associated with HPV and HIV infection. Currently, a more individualized and less radical treatment is suggested. In this study we evaluated epidemiology, clinicopathological prognostic factors, HPV distribution and risk factors for metastases to lymph nodes. We also reviewed multidisciplinary clinical management carried out at our institute.Methods: It is a prospective study of 25 biopsy proven cases of Squamous Cell Carcinoma of Vulva, treated at our center from September 2014 to September 2016. We collected the data regarding the clinical presentation, histological details, treatment given, survival and complications. HPV 16 and 18 testing were done using PCR method. Median follow up of the patients are for 24 months.Results: The mean age of patients was 54.6 years. Commonest presentation was perineal itching (36%). HPV 16/18 were positive in 25% of the patients. Radical vulvectomy with bilateral groin dissection was done in 14/25 (56%) patients. Among these 14 patients, 35.7 % (5/14) has lymph node metastases, disease free survival was 63.6% and overall survival was 81.1% for median follow up of 24 months. About one third of the patient presented with locally advanced disease.  Six (24%) patients received only chemo radiation as a treatment.Conclusions: HPV and HIV infection increase the risk of vulvar cancer. Individualization of treatment is necessary. The use of preoperative chemoradiation in locally advanced disease might have promising results in future.

Association between Socio-Demographic Factors and the Type of Tobacco Consumption among Subjects Attending a Rural Hospital, South India.

Aim: To assess the association between socio-demographic factors and type of tobacco consumption among subjects attending a rural hospital in south India. Methods: A pre-tested questionnaire was designed for recording the relevant data pertaining to selected socio-demographic variables and the details of tobacco consumption. Patients as well as persons accompanying them formed the study sample and they were chosen by systematic random sampling method. Chi-square test was used to assess the association between the variables. Results: A total of 350 subjects were included in the study. There was statistically significant association between age groups, gender, education, occupation, economic status and the type of tobacco consumption. Conclusion: The present study revealed a significant association between selected sociodemographic factors and the type of tobacco consumption.

LMA C Trach aided endotracheal intubation in simulated cases of cervical spine injury: a series of 30 cases

Laryngeal mask airway [LMA] C Trach is a novel device designed to intubate trachea without conventional laryngoscopy. The aim of the study was to evaluate the clinical efficacy of C Trach in the simulated scenario of cervical spine injury where conventional laryngoscopy is not desirable. This prospective pilot study was carried out in 30 consenting adults of either gender, ASAPS I or II, scheduled for surgery requiring endotracheal intubation. An appropriate sized rigid cervical collar was positioned around the patient's neck to restrict the neck movements and simulate the scenario of cervical spine injury. After induction of anesthesia, various technical aspects of C Trach facilitated endotracheal intubation, changes in hemodynamic variables, and complications were recorded. Mask ventilation was easy in all the patients. Successful insertion of C Trach was achieved in 27 patients at first attempt, while 3 patients required second attempt. Majority of patients required one of the adjusting maneuvers to obtain acceptable view of glottis [POGO score >50%]. Intubation success rate was 100% with 26 patients intubated at first attempt and the rest required second attempt. Mean intubation time was 69.8 +/- 27.40 sec. With experience, significant decrease in mean intubation time was observed in last 10 patients as compared to first 10 [46 +/- 15.77 sec vs. 101.3 +/- 22.91 sec]. Minor mucosal injury was noted in four patients. LMA C Trach facilitates endotracheal intubation under direct vision and can be a useful technique in patients with cervical spine injury with cervical collar in situ