Priyankur Roy

Primary Granulocytic Sarcoma of Ovary

Granulocytic sarcomas (GS) is a rare extramedullary tumor composed of myeloid progenitor cells. Bones, lymph nodes, and skin are the favored sites of involvement. The orbit, sacrum, para-nasal sinuses, spine, and sternum are frequent sites and multiple other sites of involvement have been reported [1]. Primary involvement of the ovary is exceedingly rare leading to underdiagnosis of GS [2] and hence our interest to report this rare event.

Ovarian hyperstimulation syndrome and pulmonary edema – a rare complication

Background: Ovarian Hyperstimulation Syndrome (OHSS) is a life-threatening complication of controlled ovarian stimulation almost exclusively associated with gonadotropins but occasionally with clomiphene citrate. Prevention of this syndrome lies in the recognition of risk factors and individualizing the treatment regimens. Causes of respiratory distress in patients with OHSS are pleural effusion, pulmonary embolism, and acute respiratory distress syndrome (ARDS). Pulmonary edema is rare but a grave complication of OHSS. Case report: We report, a case of severe OHSS with tense ascites and anasarca after controlled ovarian hyperstimulation (COH) for IVF. She was managed conservatively followed by paracentesis after which she developed pulmonary edema during the course of the treatment. Conclusion: OHSS is an iatrogenic complication which can be prevented by individualizing stimulation protocols and should be managed urgently with a multidisciplinary approach.

Transcervical resection of endometrium: A novel mode of management of patients with abnormal uterine bleeding with chronic kidney disease and renal transplant recipients

Objective: Abnormal uterine bleeding (AUB), especially in cases with chronic kidney diseases (CKDs) have a significant impact on physical, social, economic, and material quality of life of women. The objective of this study was to evaluate the efficacy, change in menstrual pattern, and patient satisfaction after transcervical resection of endometrium (TCRE) in women with AUB and CKD who underwent or were awaiting renal transplant and nonrespondents to medical management. Materials and Methodology: Eleven women with CKD (either underwent renal transplant or on dialysis) and AUB who did not respond to medical management underwent TCRE. The study period was 5 years. The main outcome measures were change in menstrual status, level of satisfaction with the procedure, and the need for repeat TCRE or hysterectomy. Results: The average age of the patients was 44.9 years. Out of the 22 women enrolled, 11 responded to medical management and only the remaining 11 women required TCRE. All 11 women underwent hysteroscopic-guided biopsy, and their histopathological reports revealed nonmalignant status. The average operating time for TCRE was 21.5 ± 8.02 min. Postoperatively 9 (81.81%) women had achieved amenorrhea while 2 (18.18%) developed oligomenorrhea. The duration from TCRE to amenorrhea ranges between 7 and 60 days with an average of 31.54 days. None of the women required hysterectomy. Conclusion: TCRE is clinically and cost effective alternative to medical management or hysterectomy in women with AUB and CKD. The cost-effectiveness, work performance, rapid convalescence, and improved the quality of life provide TCRE a “distinct edge” over the definitive management – hysterectomy.

Case series of paediatric adnexal torsion: rare yet urgent entity

Ovarian torsion is a true emergency which warrants early diagnosis and timely surgical management to avoid the catastrophic consequences of further adnexal injury. In paediatric population, this is especially dangerous as the condition can go undiagnosed because of its rarity and nonspecific presentation of disease. This leads to delay in surgical exploration and loss of ovarian function. We encountered 6 cases of ovarian torsion in paediatric age group during a period of 2 years, at a tertiary care hospital in Ahmedabad. After enquiry of the symptoms and a series of investigations, a provisional diagnosis of torsion ovary was made and they were taken up for surgery. Intra-operatively all the patients were found to have non-salvageable ovary and fallopian tube on the affected side, and subsequently they underwent salpingo-oophorectomy. Diagnosis of ovarian torsion requires clinician awareness and a high degree of suspicion. Conservative surgery, in the form of ovarian detorsion can be tried in cases of ischemia but if ovarian necrosis has occurred, then salpingo-oophorectomy is performed as the last resort.

Unicornuate uterus and pregnancy outcome: a case report -

Mullerian duct anomalies (MDAs) are congenital defects of the female genital tract that arise from abnormal embryological development of the Mullerian ducts. Unicornuate uterus with or without rudimentary horn is developmental anomaly which occurs due to abnormal or failed development of one of the paired mullerian duct or fusion of the ducts. Women with unicornuate uterus have increased incidence of obstetric complications like spontaneous abortions, preterm delivery and intrauterine foetal demise and gynaecological complications like infertility, endometriosis and dysmenorrhoea. A 25 years old, primigravida was admitted at 38 weeks 3 days gestational age with complaints of leaking per vaginum. She was induced with PGE2 gel under antibiotic coverage to prevent chorioamnionitis. She underwent emergency caesarean section for failure to progress and intra-operatively she was incidentally found to have unicornuate uterus with contralateral fallopian tube directly getting attached to the ovary. The baby cried immediately after birth, though it was growth retarded (IUGR). If pregnancy with unicornuate uterus is managed well, it can result in favourable obstetric outcome.

A novel treatment option in management of tubal ectopic pregnancy after in vitro fertilization with embryo transfer by trans-vaginal aspiration of gestational sac: a case report -

Majority of the reports suggest that the frequency of ectopic pregnancies have grown in the last 30 years, especially in patients conceived through artificial reproductive techniques (ART). Ectopic pregnancy occurs mostly in the fallopian tubes (90%), and the most common region is the ampula. Its prompt diagnosis and appropriate management is important in preventing severe morbidity and mortality. In a select patient population, most of the unruptured, live ectopic pregnancies can be successfully managed without surgical intervention using trans-vaginal ultrasound guided aspiration and instillation of local injection KCl or administration of systemic injection Methotrexate. We report a case of tubal ectopic pregnancy in a patient who underwent IVF-ET and was successfully treated conservatively by ectopic aspiration and instillation of injection KCl locally in the ectopic site.