Indu Chawla

Uterine primitive neuroectodermal tumor with adenosarcoma: a case report

IntroductionPrimitive neuroectodermal tumor of the uterus is extremely rare. They occur as either pure primitive neuroectodermal tumors or admixed with neoplasms of mullerian origin.Case presentationA case of uterine primitive neuroectodermal tumor with adenosarcoma in a 50-year-old Asian Indian woman is presented. Histologically, the neoplasm displayed perivascular pseudorosettes and occasional Homer-Wright rosettes. A strong positivity for neuronspecific enolase and synaptophysin was noted, while chromogranin and CD99 were negative. Merging imperceptibly with the neuroectodermal components were the areas of adenosarcoma.ConclusionTo the best of our knowledge, this report represents the second case of a uterine primitive neuroectodermal tumor with an admixed adenosarcoma.

Epithelioid cotyledonoid leiomyoma of uterus

A 42-year-old para 2 women underwent laparotomy with a preoperative diagnosis of leiomyoma uterus and ovarian endometrioma. At laparotomy, uterus was 12-week size and bilateral tubes and ovaries were normal. There was a large friable reddish-brown mass dissecting the leaves of broad ligament with extension into pelvic cavity and retroperitoneal spaces. Total abdominal hysterectomy with bilateral salpingo-oophorectomy with resection of tumour was performed as there was concern about the possibility of malignancy. Histopathological examination revealed a cotyledonoid leiomyoma epithelioid variant. These tumours, though benign, raise the possibility of malignancy at the time of surgery due to their bizarre and sarcoma-like appearance. It is important for the pathologist and gynaecologist to be aware of this rare variant of leiomyoma to avoid an overtreatment

Saline infusion sonography in evaluation of uterine cavity abnormalities in infertility: a comparative study

Background: Infertility is defined as one year of unprotected intercourse without pregnancy. Female factor is responsible for 40-50% of cases of infertility. Uterine pathologies are the cause of infertility in as many as 15% of couples seeking treatment. The objective of this study was to evaluate the accuracy of trans-vaginal sonography (TVS) and saline infusion sonography (SIS) for detection of uterine cavity abnormalities in patients of infertility taking hysteroscopy as gold standard. Methods: A prospective comparative study was done in 60 patients of infertility. Patients were selected from gynaecology OPD of a tertiary care hospital. Patient selected underwent TVS and SIS followed by hysteroscopy for presence of uterine cavity abnormalities. The presence of uterine cavity abnormality and its type (endometrial polyp, submucous myoma, intrauterine synechiae or any other) was noted. The results of TVS and SIS were compared with hysteroscopy. Results: In 60 infertile patients, hysteroscopy revealed intrauterine pathology in 22 patients (36.7%). Among them eight had endometrial polyp and another eight patients had intrauterine synechiae. Submucous myoma was detected in five patients and one patient had thin endometrium. SIS detected eight out of 22 uterine cavity abnormalities indicating sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 36.4%, 100%, 100% and 73.1% respectively. In comparison TVS showed abnormalities in six patients only and thus had sensitivity, specificity, PPV and NPV of 27.35%, 100%, 100% and 70.4 % respectively. Sensitivity of SIS for specific lesion was least for intrauterine synechiae (12.5%) and maximum for submucous myoma (60%). Conclusions: The sensitivity of both TVS and SIS for detection of uterine cavity abnormalities in patients of infertility was low in the present study and they cannot be recommended as replacement for hysteroscopy.