Neekianund Khulpateea

Neuroendocrine tumour of the ovary

Non-small cell neuroendocrine carcinoma (NSCNEC) of the ovary is an aggressive and rare tumour, which is commonly associated with other surface epithelial and germ cell neoplasms (Veras et al. 2007...

Fistula between degenerated uterine leiomyoma and the bladder: case report

Most common reason for the vesicouterine fistula is a cesarean section; no cases were reported of degenerated uterine leiomyoma communicating with the urinary bladder. We report a case of fistulous communication between the degenerated leiomyoma and the bladder. The patients initial clinical presentation was consistent with recurrent UTI. She underwent multiple examinations including cystoscopy, cystouretrography, retrograde pyeolography, and MRI. The ultimate treatment was an exploratory laparotomy and en-block resection of the bladder wall, fistula tract, and degenerated leiomyoma. Fistula can develop between the bladder and degenerated leiomyoma and could be one of the reasons for the chronic pelvic pain and dysuria.

Adnexal masses: Relative accuracy of sonography and frozen section in predicting final pathology

In this retrospective study, we compared the accuracy of frozen section and sonographic diagnosis in predicting the final paraffin section diagnosis of ovarian lesions. We hoped thereby to determine if sonographic findings could obviate the need for frozen section in certain circumstances. The frozen section and sonographic diagnosis were compared with the final paraffin section diagnosis to determine whether the lesion was felt to be a benign or malignant tumour. Frozen section diagnosis agreed with final paraffin section diagnosis in 137 (77.4%) cases of primary malignant tumours, 201 (90.1%) cases of metastatic disease and 328 (82%) benign cases. Sonographic results matched final pathology of 133 cases of primary malignancy (75.1%) and 192 cases of metastatic disease (86.1%) and 304 benign cases (76%). Our study indicates that preoperative sonography is accurate enough in differentiating adnexal masses to make the routine use of frozen sections unnecessary.

Unusual presentation of genital tract tuberculosis.

A 27-year-old Mexican woman, gravida 2, para 0, abortus 1, presented to the emergency room with complaints of 2 weeks of vague abdominal pain and a history of menometrorrhagia for the prior 3 months. She also complained of malaise, dizziness and back pain. She denied any history of weight loss, chills, night sweats, wheezing, haemoptysis, or exposure to tuberculosis. She had no significant past medical or surgical history. She denied any family history of malignancy or tuberculosis. On admission, her vital signs were stable. Chest examination was unremarkable with normal breath and heart sounds. She had generalised mild abdominal tenderness. Her pelvic examination was unremarkable. No lymphadenopathy was noted. Laboratory values were significant for an elevated CA125 level of 451 units/ml. Human immunodeficiency virus (HIV) testing was negative. A transvaginal sonogram revealed a heterogeneous uterus measuring 8 cm and an endometrial thickness of 8.5 mm. Both ovaries appeared normal. Purified protein derivative (PPD) test was positive with 420 mm of indurations but the sputum collection was negative for acid fast bacilli. Her chest X-ray was within normal limits. Computed tomography (CT) scan revealed bilateral cystic ovarian structures with ascitic fluid. Diaphragmatic nodes were also noted. A 4 cm calcified granuloma of the right costophrenic angle was also noted. It also showed caecal wall thickening and associated inflammatory changes in the peritoneal fat. Fibrous strands were seen in the omentum and the mesentery, omental thickening was also seen. This has been referred to as omental and mesenteric straining/stranding. The woman was admitted with a provisional diagnosis of peritoneal carcinomatosis. However, an endometrial biopsy was performed that revealed granulomatous endometritis. Acid fast bacilli (AFB) staining revealed positive rods consistent with the diagnosis of mycobacterium, which was confirmed with further testing. Follow-up care was jointly managed by the pulmonary and gynaecology team. The patient received isoniazid, rifampin, pyrazinamide and pyridoxine. Follow-up examination after treatment revealed a non-tender abdomen and the patient reported having regular periods. A follow-up CT scan 4 months later revealed an otherwise unremarkable study.

Brain metastasis in two patients with stage IA papillary serous carcinoma of the uterus.

We report two cases of brain metastasis in patients initially diagnosed with extremely early stage UPSC after extensive staging surgery. They did not receive either adjuvant chemotherapy or adjuvant pelvic or vaginal cuff radiation. At the same time that these patients were diagnosed with systemic metastasis, they both had a local “drop” metastasis in the vulva or the vaginal cuff. After the initial response to palliative chemotherapy, they both developed brain metastasis. The pattern of recurrence with the lack of adjuvant treatment underscores the urgent need in further evaluation of the potential benefits of adjuvant treatment, including chemotherapy and possibly in combination with radiation in this highly aggressive disease.

Early Diagnosis of a Small Adenocarcinoma in a Rectovaginal Fistula Related to Crohn's Disease.

While adenocarcinomas have occasionally been reported in perianal fistulae, malignant changes occurring in rectovaginal fistulae are rare, with only a handful of reported cases. We report a 73-year-old woman with Crohns disease who was diagnosed at an early stage with adenocarcinoma in a rectovaginal fistula. This rare disease poses many diagnostic challenges.

Pain, An Atypical Presentation of Endometrial Cancer: Case Report and Literature Review

Endometrial cancer, the most common gynecologic malignancy in women in the United States typically presents with abnormal uterine bleeding. Given a case of endometrial cancer presenting as abdominal pain, we reviewed the different circumstances in which pain is the primary presenting symptom of endometrial cancer. Forty-one cases of endometrial carcinoma, were found. Patients presenting with bone pain were statistically significantly more likely to have a longer time to correct diagnosis (p<0.001), and to have metastatic disease than patients presenting with abdominal pain (p=0.001). Abdominal pain was more likely an initial presentation of endometrial cancer (p=0.003), to occur following any radiation treatment (p=0.001), and subsequent to irradiation for cervical cancer (p= 0.002), than was bone pain. Nevertheless, 21 of 32 cases (65.6%) of endometrial cancer presenting with pain for which stage is known, have advanced disease, confirming the widely held opinion that pain in endometrial cancer is indicative of advanced stage disease.