Primary ovarian leiomyosarcoma in a postmenopausal woman diagnosed using immunohistochemistry / Philippine Journal of Obstetrics and Gynecology

@#Primary ovarian leiomyosarcoma is a very rare tumor which is most commonly seen in postmenopausal women. Primary ovarian leiomyosarcoma has a very poor prognosis, with less than 20% of patients being alive at 5 years. The case is a 51‑year‑old female who presented with a lower abdominal mass secondary to an ovarian new growth. An exploratory laparotomy, peritoneal fluid cytology, unilateral salpingo‑oophorectomy with malignant frozen section of affected ovary, which revealed malignant tumor, proceeded with surgical staging total abdominal hysterectomy contralateral salpingo‑oophorectomy, then proceeded to complete surgical staging with infracolic omentectomy, Jackson‑Pratt drain insertion was performed. Microscopic and immunohistochemical findings established the diagnosis of primary ovarian leiomyosarcoma. Surgery is the cornerstone of treatment, while the role of chemotherapy and radiotherapy is still not clear because substantial data are lacking. The prognosis of primary pure ovarian leiomyosarcomas is extremely poor and there is no established treatment modality for this rare type of tumor.

Peripheral precocious puberty with ovarian new growth: A case report

@#Precocious puberty is defined as appearance of secondary sexual characteristics that begins earlier than usual, and may be central or peripheral in origin. It is the physician’s duty to undertake a detailed investigation of the cause of the condition so as not to overlook a potentially correctable pathologic lesion, and prevent long-term somatic and psychosocial consequences in the child. This paper presents a case of 10 year old female with clinical signs and symptoms and laboratory results that point to a possible peripheral type of precocious puberty , and with a huge ovarian mass, which intraoperatively yielded inconclusive histopathologic findings due to massive necrosis. This paper aimed to discuss the possible etiologies for the development of precocious puberty in the index case, and the treatment options for both precocious puberty and ovarian new growth.

Leiomyoma of the bladder presenting with an ovarian new growth: A case report and review of literature

@#Benign mesenchymal tumors of the urinary bladder are extremely rare. This is a case of a 56- year old female presenting with an enlarging abdomen initially managed as a case of an ovarian new growth. Aside from the ruptured ovarian mass, a urinary bladder mass was also noted intraoperatively and a surgical dilemma was resolved by imaging review. The patient underwent exploratory laparotomy, enterolysis, total hysterectomy, bilateral salpingooophorectomy, and partial cystectomy. Final histopathology identified the bladder tumor to be a leiomyoma. The patient had an uneventful postoperative course. Awareness of this clinical entity and presentation will aid in diagnosis and management.

Comparative study on the diagnostic accuracy of the different International Ovarian Tumor Analysis (IOTA) predictive model in discriminating between benign and malignant ovarian new growths: Logistic Regression 1 and 2 (LR1 and LR2) and assessment of the different Neoplasias of the Adnexa (ADNEX) model / Philippine Journal of Obstetrics and Gynecology

Objective@#To compare the diagnostic accuracy of the International Ovarian Tumor Analysis (IOTA)- Logistic Regression 1 and 2 (LR1 and LR2) and the Assessment of Different Neoplasias in the Adnexa (ADNEX) model in discriminating between benign and malignant ovarian new growths @*Methods@#The study was a prospective validation study. It included all patients admitted at the Gynecology ward of the Philippine General Hospital for elective surgery for ovarian new growths. Demographic information and clinical data were recorded for eligible patients. Two-dimensional ultrasonography with Doppler studies were performed. Ovarian new growths were classified based on IOTA LR1, LR2 and ADNEX model. Correlation of the ultrasound findings with the histopathology report and final staging based on Federation of Gynecology and Obstetrics (FIGO) classification was done. @*Results@#Sixty seven (67) patients were included in the final analysis. The mean age was 43 years old (range of 17-78). There were sixteen (16) nulligravid patients (22%). Eighteen (18) out of the 67 patients (27%) had malignant ovarian masses on histopathology. The IOTA LR1 had an area under the curve (AUC) of 0.96, sensitivity of 89% (95%CI, 74-100) and specificity of 92% (95%CI, 84-100). The IOTA LR2 had an AUC of 0.88, sensitivity of 61% (95%CI, 39-84) and specificity of 96% (95%CI, 90-100). The IOTA ADNEX had an AUC of 0.96, sensitivity of 89% (95%CI, 74-100) and specificity of 76% (95%CI, 63-88). Sensitivity and specificity of IOTA ADNEX for the diagnosis of specific malignant subtypes were as follows: Borderline, 80% and 76%, Stage I, 100% and 100, Stage II-IV, 86% and 100%. Accuracy values were not computed for the metastatic cancer since there was only one case seen. There was no significant difference in the accuracy values of IOTA ADNEX with or without CA 125. @*Conclusion@#In conclusion, IOTA LR1, LR 2 and ADNEX models were all useful tools in discriminating between benign and malignant ovarian masses. IOTA LR1 had the highest accuracy in differentiating between benign and malignant ovarian masses.