bluuebunny/crossref_metadata_2025 huggingface dataset:
Sample survey of cancer awareness in health care workers
Authors: Shamsunder Saritha , Agarwal Kavita , Mishra Archana , Malik Sunita ,   Lalita
Published: February 2021

Objective: To see the awareness about cancer in women among ASHA workers.

Place of Study: Awareness Sessions at Safdarjung Hospital, New Delhi.

Background: ASHA workers are the first point of contact for women in the community & bridge the back between the hospital and women. They have been instrumental in the success of the family planning programme & polio eradication program in India.

Materials and Methods: A questionnaire about educational status, awareness about breast & cervical cancer statistics, methods of screening and diagnosis was distributed to Accredited Social Health Activists appointed by the government at two educational sessions organized at Safdarjung hospital.

Results: Of the 200 ASHA workers attending, 188 completed the questionnaire. Their educational status ranged from 7th standard to post-graduate, majority had studied up to 10th standard. Their sources of information were mostly television and mobile phones, 23% had knowledge about internet, 36% were using Whats app. Only 28% knew about the commonest cancer in Indian women. Regarding breast cancer, 63% were aware of self examination of breasts, 41% knew the frequency of self examination; awareness about symptoms of breast cancer was prevalent in 46%, 24% knew about risk factors of breast cancer. Regarding Cervical Cancer, 28% knew about risk factors, 22% knew about symptoms of cervical cancer; 19% knew about screening methods for cervical cancer, 9.5% knew the screening intervals.

Conclusion: Health education about cancer prevention should start at the primary school level. Special educational & motivational sessions for ASHA workers could help in cancer prevention programs.
Neo-adjuvant chemotherapy followed by surgery versus definitive chemo radiation as treatment for localized carcinoma cervix
Authors: Singh S. , Goel V. , Talwar V. , Raina S. , Mitra S. , Saxena U. , Shekhon R. , Rawal S.
Published: February 2021

Background: Cervical cancer is ranked as the most common cancer in Indian women, second most common cancer worldwide and the leading cause of death in the developing countries. In the developing countries majority of the patients are diagnosed at locally advanced stages. The standard treatment of locally advanced cervical cancer is concomitant chemoradiation (CTRT) using platinum based chemotherapy. However, some randomized studies have shown improved results for patients receiving neoadjuvant chemotherapy (NACT) followed by surgical resection in comparison to patient receiving radiation alone. The present study was designed to compare response to the treatment and survival of and NACT followed by radical surgery (RS) with CTRT in the patients of uterine cervix of a tertiary cancer care centre.

Patients and Methods: Retrospective study was performed in locally advanced/advance stage patients of cervix UTERI registered in the institute between years 2009 to 2013. Patients were included in the two groups, group A consists of 89 patients who have received NACT + RS and 67 patients in group B who have received CTRT. Clinical records were reviewed with particular reference to presenting complaint, clinical stage, response to the therapy, disease free survival and overall survival. Statistical analysis was done using SPSS version 22.

Results: In the neoadjuvant group (group A) (n=89) the median age of patients was 53 years (range 31-80 years), most of the patients (70%) were presented with complaint of postmenopausal bleeding. Of the total patients, 69 (77.5%) underwent to radical surgery and 5 (8.5%) received radiotherapy after NACT. From 69 patients, who had undergone to surgery, 54 (78.3%) had also received radiation. The overall response to induction chemotherapy was 84%. In the chemo radiation group (group B) (n=65) median age was 56 years (33-75 years). Vaginal bleeding (34%) followed by postmenopausal bleeding (32%) was major presenting complaint in this group. Overall response to the complete treatment was 91%. The median follow up time was 14.3 months in group A and 12.2 months in group B. The disease free survival for NACT group was 32 months (95% CI 26.8-36.5) whereas for CTRT group it was 28 months (95% CI 23.5-33) with 12 and 13 recurrences per group (p = .226). In NACT group overall survival was 46.2 months (95% CI 44-48.3) and for CTRT group it was 38.3 months (95%CI 36.6-40) with 3 and 2 deaths per group (p=.883).

Conclusion: Present study shows comparable results, with no difference in survival between both the groups. However, NACT + RS group had showed better disease free and overall survival than another group. Further studies should be performed with larger number of patients and longer duration of follow up.
Image guided interstitial brachytherapy for locally advanced disease after external beam radiotherapy in a case of carcinoma cervix – our institutional experience
Authors: Tandon S. , Mitra S. , Sharma M. K. , Saxena U. , Ahlawat P. , Kaur I. , Chowdhary A. , Surkar P.
Published: February 2021

Purpose/Objective: Cervical cancer is the third most common cancer in women worldwide. Definitive chemoradiation is the accepted standard of care for patients especially for locally advanced cervical cancers. Intracavitary brachytherapy (ICBT) is an important part of definitive radiotherapy shown to improve overall survival. Interstitial brachytherapy (ISBT) is generally reserved for patients either with extensive pelvic and/or vaginal residual disease after external beam radiotherapy (EBRT) or with anatomy not allowing ICBT with standard applicators in an attempt to improve local control. We have conducted an observational study for patients who underwent image guided HDR-ISBT at our institute.

Materials and Methods: Seven patients; diagnosed as a case of carcinoma cervix; were selected from the period of 2012 to 2015 who received EBRT by IMRT and for whom ICBT couldn’t be done for various reasons. These patients were then taken up for Martinez Universal Perineal Interstitial Template (MUPIT) image based ISBT. A descriptive analysis was done for doses received by HRCTV, bladder, rectum and sigmoid colon. At the end of treatment, early response at 3 months along with overall survival (OS) and disease free survival (DFS) was also calculated.

Results: All the patients recruited were locally advanced with 3 patients in IIB, 1 patient in IIIA and 3 patients belonging to IIIB. The mean dose received by 95% high risk CTV (HRCTV) by IMRT was 49.75 Gy. Out of 7 patients, 3 were taken up for ISBT due to anatomical restriction whereas remaining 4 patients were included because of lack of dose coverage by ICBT. The mean doses received by 90% of HRCTV, 2 cc bladder, 2 cc rectum and 2 cc sigmoid colon were 20.58 Gy, 2.73 Gy, 3.19 Gy and 2.82 Gy respectively. The early response at 3 months was 57.14%. The DFS at one year and OS at 3 year were 53.6% and 53.3% respectively.

Conclusions: Our descriptive analysis of seven patients being treated by image based ISBT have revealed that locally advanced cervical cancer patients for whom ICBT is unsuitable can achieve equitable LRC and OS with a combination of EBRT by IMRT and image based HDR-ISBT.
Breaking the myth: All carcinoma cervix presenting as pyometra will have only palliative treatment
Authors: Aarthi C. , Kumar A. C. Senthil , Sasireka P.
Published: February 2021

Introduction: Carcinoma cervix is the second most common female carcinoma. Every year in India, 1,22,844 women are diagnosed with carcinoma cervix and of them 67,477 die. Carcinoma cervix rates among women in the age group between 30-64 has decreased by 1.8% per year on average but still date account for 16%. Of these, advanced carcinoma are about 80% and early are only 20%.

Case Series: We are reporting 5 consecutive early carcinoma cervix cases who presented with pyometra and got treated at our hospital from April 2015-September 2015. Cases of early carcinoma cervix presented with pyometra were treated by pyometra drainage, intravenous antibiotics and appropriate treatment in the form of surgery (4 cases underwent Wertheim’s hysterectomy and 1 case had radical chemo radiation as she opted for same in view of high cardiac risk for anaesthesia). All 5 of them are disease free at the end of treatment with follow up of minimum 4 months duration (range 4-10).

Conclusion: The idea is to emphasize that all carcinoma cervix with pyometra are not necessarily advanced and can still be given radical treatment like surgery or radiotherapy after pyometra drainage.
Comparative dosimetric study between point and volume based brachytherapy in definitive treatment of de novo carcinoma cervix
Authors: Hadi Rahat , Azam Mohammad , Gupta Pooja , Rath Satyajeet , Ali Mohammad , Prakash Chandra , Srivastava Anoop Kumar , Farzana S.
Published: February 2021

Introduction: Cervical cancer has a high incidence in developing countries including India. Brachytherapy (BT) is an important component in the curative management of carcinoma of the cervix, and significantly improves survival. In gynaecologic BT, correlation between the radiation dose and the normal tissue effects have been assessed using point doses. Since 1985, these points have been defined in the international commission of radiation units and measurements (ICRU-38) report. However GEC-ESTRO recommended volume based treatment planning in their respective series (I-IV). For cervical cancer BT, the correlation of ICRU point doses and volume based treatment planning is investigational till date. Analysis becomes feasible when cross sectional image-based treatment planning for BT using computerized tomography (CT) or magnetic resonance imaging (MRI) is utilised as per GEC-ESTRO recommendation.

Methods: It is a retrospective pilot study includes patients (pts.) of carcinoma cervix treated with high dose rate (HDR) BT 9 Gy in 2 fractions 1 week apart. All volume based dosimeteric parameters regarding high risk clinical target volume (HRCTV), intermediate risk clinical target volume (IRCTV) like D90, D100 and for organ at risk (OAR) D 0.1 cc, D 1.0 cc and D 2.0 cc were delineated and dose coverage was analysed in point dose based planning.

Results: We have analysed twenty pts. of squamous cell carcinoma (SCC) cervix. The median age was 52 yrs. (41-65 yrs), stage II B 10 pts. & III B 10 pts. The mean value of D90 & D100 in HRCTV during I and II session were 8.64, 6.75 and 5.76, 4.36 Gy respectively. Same values for IRCTV were 6.31, 4.91 and 3.68, 3.15 Gy respectively. Analysis of OARs demonstrated that mean dose received by 0.1, volume of bladder during I and II session received 10.68, 9.47, by 1 cc volume 8.39, 7.57 and by 2 cc volume 6.84, 6.21 Gy respectively. The mean dose received by 0.1 cc of rectum were 11.59, 10.12, by 1 cc volume 9.53, 8.19 and by 2 cc volume 7.76, 6.81 Gy respectively. In point based analysis mean dose delivered to bladder point during I and II session were 5.63, 6.02 and to rectum point were 5.98, 5.46 Gy respectively. Doses to 0.1 cc volume of bladder and rectum were higher in volume based BT as compared to point based BT in respective fractions.

Conclusion: Both HRCTV and IRCTV had better dose coverage in 1st fraction as compared to 2nd fraction. Point doses to bladder and rectum is underestimated in point based (ICRU-38) BT. We need more number of pts in prospective randomized trial for more consistent result.
Primary clear cell adenocarcinoma of cervix in a young women: A rare entity
Authors: Jain Nidhi , Manchanda Rahul , Lekhi Anshika , Chithra Sravani , Kausar Hena
Published: February 2021

Cervical cancer is the most common gynaecological malignancy worldwide. The most common type of cervical carcinoma is squamous cell carcinoma followed by adenocarcinoma of cervix, which constitutes only 15% of cases. Adenocarcinoma of cervix can be categorized histologically into clear cell, mucinous, endometrioid, serous and mesonephric subtypes. Clear cell adenocarcinoma (CCA) most commonly occurs in the ovary, followed by endometrium, vagina, and cervix. Primary CCA of cervix is a rare neoplastic entity, which occurs in young women exposed to diethylstilbestrol (DES) in utero. It is extremely rare in women without in utero DES exposure and in such cases it concerns mostly postmenopausal women. Here, we present a case of 30 year old woman who presented with primary infertility. There was no history of in-utero exposure to diethyl stilbestrol. She was diagnosed a case of cervical fibroid on ultrasonography. Diagnostic hysteroscopy was done and she was found to have friable, vascular growth in endocervix, which was extending to uterine cavity. Biopsy was taken. On histopathology, moderately differentiated clear cell adenocarcinoma of cervix was reported. Through this case, authors would like to highlight the probability of rare occurrence and how to manage challenges posed by cervical cancer in young girl wishing to conceive, stressing on the role of hysteroscopy in diagnosis.
Carcinoma uterine cervix metastasis to the skin: A rare case report
Authors: Singh Gajender , Kataria Sant Parkash , Sen Rajeev
Published: February 2021

Introduction: Most common site of metastasis from carcinoma cervix is lung, liver, bone and brain. Cutaneous metastasis is rare occurrence in carcinoma cervix. Incidence reported ranges from 0.1 to 2%. Common morphological pattern of skin metastases are nodules, plaques and inflammatory telangiectatic lesions.

Materials and Methods: A 68 years old postmenopausal female diagnosed as squamous cell carcinoma of cervix stage III B. She was given chemotherapy and radiotherapy and on regular follow up without no evidence of disease locally. After two years she presented with a sub cutaneous nodule of approximately 5x4 cm size just below the left scapula of one month duration. There was no similar swelling in any other region. It was rapidly increased in size and painful. The FNAC of the nodule showed metastatic from squamous cell carcinoma. PET scan showed metastases in bilateral lung and pelvic lymph node with no evidence of local disease. Excision biopsy of the nodule confirmed the diagnosis.

Conclusion: Cutaneous metastases from carcinoma cervix are rare. Differential diagnoses include benign dermatitis, subcutaneous phycomycosis, and plaque like mycosis fungoides.
Early stage adenocarcinoma of cervix with ovarian micrometastasis
Authors: Satyaprakash Mathur Neha , Singh Pratibha , Vyas Suyasha
Published: February 2021

Introduction: Adenocarcinoma of cervix is a rare malignancy of cervix. It is an aggressive tumour with high incidence of metastasis. Ovarian metastasis in early stage adenocarcinoma is rare. Metastasis is usually seen when there is some other coexisting finding. In premenopausal patient and low risk category, ovarian metastasis is very rare.

Case Report: The present case is a 40 yrs old parous women, with complaints of discharge per vaginum. Her colposcopy showed an erosion on the lower lip. Radical hysterectomy with bilateral oophorectomy was planned. The histopathology was a well differentiated adenocarcinoma with surface ovarian metastasis on one side.

Discussion: Early stage adenocarcinoma of cervix can rarely present with ovarian metastasis. Thus radical surgery with oophorectomy is a an aggressive but practical approach in these patients.
Retrospective analysis of Ca cervix postoperative: An institutional study
Authors: Prakash Chandra
Published: February 2021

Introduction: Carcinoma of cervix is one of the leading causes of death worldwide and in developing countries like India. Cervical cancer is third most common cancer among women however there is a good chance of curability if diagnosed in early stage.

Materials and Methods: We had analysed 78 patient of carcinoma of cervix post op who were registered from 2012 to 2015 at Dr. Ram Manohar Lohia Institute of Medical Sciences.

Results: We analysed 78 patients between age of 32-70 years and median age is 50 year. Among all patients squamous cell carcinoma is most common (65 patient), adenocarcinoma were 12 and lieomyosarcoma was 1 patient. Among all patient 12 were of adenocarcinoma, 1 of lieomyosarcoma and 65 patient of squamous cell carcinoma. On examination 55 patients were NAD and 23 were residual. Among squamous cell carcinoma 35 were moderate differentiated, 18 were well differentiated and 12 were of poorly differentiated. On examination 55 patients were NAD rest were having disease. Gap between EBRT and SORBO ranging from 3 to 99 days and median is 27 days and median is 29 days. Treatment length varies from 4 cm to 8 cm and median is 6 cm. Ovoide size ranges from 2.5 cm to 3.5 cm and median is 2.5 cm. Dose per fraction ranges from 5 Gy to 9 Gy and median was 9 Gy. Median fraction of session were 2. Out of 78 patients 2 were developed metastasis and 6 having residual disease. 28 patients were NAD and rest were referral and send back to parent hospital.

Conclusion: Due to lack of resources and awareness of disease maximum number of patient presented with advanced stage. The recommended treatment time could not be achieved due to scarcity of cancer centres, treatment time is prolonged. We have not found any relation between treatment length and outcome. We are still investigating to conclude to found out relation among these variables.
A prospective study evaluating preoperative (clinical, imaging) and intraoperative predictors of suboptimal debulking in advanced epithelial ovarian cancer
Authors: Rajanbabu Anupama , Bagul Kiran ,   Venkatesan
Published: February 2021

Introduction: In advanced epithelial ovarian cancer, there is a survival benefit for patients who achieve optimalcytoreduction. Suboptimallycytoreduced patients are at risk of the increased morbidity of a surgery without associated survival benefit. Predicting which patients can undergo optimal cytoreduction represents a critical decision-making point. Present study analyses the predictors, pre operative (clinical and radiologic) and intraoperative of suboptimal debulking.

Methods: This was a prospective observational study conducted at Amrita Institute of Medical Sciences from March 2013 to May 2015. All the patients with clinically (physical examination, laboratory and imaging results) diagnosed Stage IIIc epithelial ovarian, fallopian tube, or primary peritoneal carcinoma (PPC) who were planed for primary debulking surgery were included. The demographic data and details of tumor markers, radiological investigations including CT scan, intra operative findings and histopathologic details were collected. Statistical analysis was done using SPSS v20.0.

Results: 36 patients fit the inclusion criteria. Gross ascites wasthe clinical parameter found to be associated with suboptimal debulking. CT scan had low sensitivity (35-53%) in diagnosing small bowel mesenteric and porta hepatis disease and high sensitivity in diagnosing diffuse peritoneal thickening, omental disease, diaphragmatic and nodal disease. On univariate analysis diffuse peritoneal thickening and small bowel serosa and mesenteric disease were significantly consistent with sub optimal debulking.

Conclusion: Finding out disease at the sites which are associated with suboptimal debulking (diffuse peritoneal thickening, smallbowel mesenteric and serosal disease) pre operatively or at the beginning of surgery can predict optimal debulking and can help avoid un necessary surgery.
Modified posterior pelvic exenteration and rectosigmoid anastomosis for advance epithelial ovarian cancer: A safe cytoreductive procedure
Authors: Bora Rashmi Rekha
Published: February 2021

Introduction: Surgery plays an important role in the management of advanced stage ovarian cancer and is complex involving surgical procedures including peritonectomy, splenectomy, diaphragmatic stripping, retroperitoneal lymph node dissection and bowel resection including resection of recto-sigmoid.

Objective: To assess the safety and efficacy of the patients undergoing modified posterior pelvic exenteration and rectosigmoid anastomosis achieving in optimal cytoreduction.

Methods: Between June 2011 and June 2014 a total of 100 patients underwent surgical cytoreduction for advanced epithelial ovarian cancer of which 20 patients had undergone modified posterior pelvic exenteration with rectosigmoid anastomosis. The present study includes a retrospective analysis of these 20 patients. Rectosigmoid anastomosis was done using circular stapler in these patients. All patients had a PS score of 1 or 2.

Results: The median age of patients was 50 years. The optimal status of no macroscopic residual disease was achieved in all patients. Modified posterior pelvic exenteration with rectosigmoid anastomosis was carried out to achieve optimal status of surgical cytoreduction in 20 patients out of which fifteen patients had primary surgical cytoreduction, three patients had interval surgical cytoreduction surgery after receiving three cycles of neoadjuvant chemotherapy with paclitaxel & carboplatin while two patients had this procedure as a part of secondary surgical cytoreduction. The most common histology was papillary serous carcinoma. Average blood loss was 500 ml. Mean operative time was 6 hours. There were no intra operative complications. Bowel movements returned to normal in 3 to 5 days. The median length of hospital stay was 7 days. The median time to start postoperative chemotherapy was 32 days. There was no major morbidity and mortality.

Conclusion: Modified posterior pelvic exenteration with rectosigmoid anastomosis should be performed when indicated as a part of cytoreduction. In our experience this is a safe and effective procedure to achieve optimal status in advanced ovarian cancer.
Evaluation of ovarian reserve in women undergoing ovarian cystectomy by laparoscopy and laparotomy
Authors: Chahal Amandeep , Dahiya Pushpa
Published: February 2021

Ovarian cysts are one of the commonest problems encountered in the gynecological field. Majority of these cysts are functional i.e., disappear spontaneously, while few need cystectomy. Ovarian cystectomy is done by laparotomy and laparoscopic technique. The method to achieve haemostasis in the ovarian bed after cyst removal varies with the type of technique. Electrocoagulation is used to achieve haemostasis in laparoscopic cystectomy while the bleeding vessels are sutured for haemostasis in cystectomy by laparotomy. Both the modalities of management varies in terms of compromise of ovarian reserve. The study was carried out to evaluate the surgical impact of benign ovarian masses on ovarian reserve as measured by serum levels of antimullerian harmone. In this prospective study on 30 women of reproductive age group with benign ovarian masses, 15 women were enrolled for laparoscopic ovarian cystectomy and another 15 women were enrolled for cystectomy by laparotomy and ovarian reserve was measured by levels of serum AMH preoperatively, postoperative one week and postoperative 3 months using standard ELISA assay kit. The preoperative, postoperative one week and postoperative 3 months levels of mean AMH were 4.74 ± 1.86 ng/ml, 2.92 ± 1.45 ng/ml and 2.64 ± 0.96 ng/ml respectively, in women undergoing laparoscopic cystectomy and 3.98 ± 1.35 ng/ml, 2.48 ± 0.64 ng/ml and 2.11 ± 0.63 ng/ml respectively in women undergoing ovarian cystectomy by laparotomy. So there was decline of mean AMH levels in postoperative one week and postoperative 3 months samples in both of the groups of enrolled women. However, this decline varied with the type of cyst removed and is insignificantly greater in laparoscopy group, wherein electrocoagulation may cause extensive and sustained damage to ovarian tissue.
Multiple recurrence of granulosa cell tumor of the ovary: A case report and literature review
Authors: Chandra Varkha , Jain Sandhya , Goel Neerja , Gupta Bindia , Rajaram Shalini
Published: February 2021

Introduction: Granulosa cell tumors comprise approximately 5% of all ovarian malignancy and account for 70% of malignant sex cord stromal tumors. Granulosa cell tumors have been diagnosed from infancy, the peak incidence being perimenopausal age. The potential of malignancy of these tumors is low, recurrences are often late and found in 10-33% of cases.

Case Report: A 32-year-old P1L1 presented with large abdominal mass for which she underwent staging laparotomy with debulking surgery. She was a known case of granulosa cell tumor in the past and had undergone three laparotomies, along with chemotherapy. At the age of 13 years, she was diagnosed with a stage IA granulosa cell tumor (GCT) of the ovary first time. She underwent surgical staging and removal of left sided adnexal mass, after which she was asymptomatic for 7 years. In 2003 she again presented with lump abdomen for which she underwent resection of adnexal mass, histopathology was consistent with recurrent GCT. After second surgery she also received two cycles of chemotherapy. Despite adjuvant chemotherapy, patient presented again after three years in 2006 with adnexal mass and was found to have a third recurrence. At that time, she received 6 cycles of chemotherapy and the mass regressed. Meanwhile she got married and had one child. After four year in 2010 she again presented with lump abdomen and she underwent surgical staging, total abdominal hysterectomy with right salphingo ophorectomy along with removal of mass. After five year in 2015 she again presented with lump abdomen; there was a large pelvic mass which was removed and patient referred for chemotherapy.

Discussion: GCTS which a rare malignant tumors of ovary tend to be associated with late recurrences. Although most recurrences occurs within 10 years after initial diagnosis, there are occasional reports of recurrences after10 years. We experienced the rare case of a patient who relapsed multiple times over 20 years, despite surgical and targeted treatment. In conclusion the long history of granulosa cell tumor highlights the importance of extended follow up of the patient.
Role of IL-6 and VEGF in epithelial ovarian cancer
Authors: Dalal Venus
Published: February 2021

Introduction: Over the last two decades there is a trend toward increasing incidence of ovarian cancer cases. CA-125 and some other tumor markers are known to have prognostic importance. Some cytokines have also been studied for their role in prognosis; IL-6 and VEGF are among them. It is hypothesized that these cytokines might affect the clinical progression of patients with ovarian cancer.

Aim and Objectives: To measure and correlate the effect of levels of IL-6 and VEGF in ascitic fluid on presentation, treatment response and outcome in patients with epithelial carcinoma ovary and to determine whether levels of IL-6 significantly correlate with progression-free survival.

Materials and Methods: Thirty patients with epithelial ovarian carcinoma and 15 patients who were undergoing hysterectomy for benign condition were recruited. Once patients found fit for study, they were taken up for primary debulking surgery. Ascitic fluid was collected and sent for measuring IL 6 and VEGF levels. Peritoneal washings taken from patients posted for total abdominal hysterectomy for benign pathology was used as control to achieve the values of IL-6 and VEGF in the study population. Patients were followed up for 1 year after surgery with ultrasound abdomen and pelvis and serum CA 125 levels.

Results: Median value of IL-6 in ascetic fluid was 8563.18 pg/ml in EOC cases and 17 pg/ml in benign pathology group and of VEGF was 6090.35 pg/ml and 34.01 pg/ml, which were found to be significantly higher in cases compared to control group (p = 0.0001). Levels of VEGF was significantly higher in patients with positive ascitic fluid cytology (p = 0.009) and ascitic fluid volume >1L (p = 0.021). Correlation of VEGF and IL6 levels with other prognostic was not statistically significant. Levels of IL-6 and VEGF in ascitic fluid did not correlate statistically with survival time or with recurrence (p = 0.651).

Conclusion: Levels of VEGF in ascitic fluid were found to correlate with ascitic fluid cytology and volume but not with FIGO stage, histological grade, histological type, tumor size, residual tumor, CA 125 levels, chemotherapy response, presentation and with overall outcome and survival time. None of the above mentioned prognostic factors were found to correlate with levels of IL-6 in ascitic fluid.
Clinicopathological review of epithelial ovarian tumors in young females and reproductive and survival outcome: Ten years expierence from a tertiary center
Authors: Lata Kusum , Agarwal Nutan , Bhatla Neerja , Kriplani Alka
Published: February 2021

Objective: To find out the prevalence of epithelial ovarian tumors in young females and correlation with reproductive and survival outcome.

Design: Retrospective study.

Setting: Tertiary referral hospital.

Methods: A retrospective analysis of females from 9-35 year of age group treated for ovarian tumors between January 2003 to July 2013 was performed. Variables studied included age, presenting symptoms, imaging, tumor markers, surgical findings, type of surgery, histopathology reports and follow-up.

Main Outcome Measures: Histopathological variant, FIGO stage, reproductive and survival outcome.

Results: A total of 155 patients were found to have ovarian tumors. Mean age at time of diagnosis was 24.9 ± 1.8 years (range 9-35). Clinical presentation in majority of the cases was abdominal pain in 68 (43.8%), ascites in 13 (8.3%) mass in abdomen in 25 (16%), followed by irregular menstrual cycles in 15 (9.6%), infertility in 18 (11.6%) 12 (7.7%) were found to be incidental on ultrasound examination while 4 women were found to have virilising symptoms. There were 76 (49.1%) cases of epithelial ovarian tumors, 6 (0.03%) of borderline tumors and 30 (19.3%) were of malignant ovarian tumors while 40 (25.8%) were benign. Stage IA (N = 80), Stage I 8 (n = 2), Stage III (N = 6) and Stage IV (N = 12). Females were further subdivided into three age groups 9-15 years, 15-25 years and 25 to 35 years for determining outcome of epitheliail tumors. Reproductive and survival outcome were studied in each stage.

Conclusions: Limited data exists about the histological type distribution, surgical treatment and overall survival of epithelial ovarian tumors in women aged below 35 years. Young patients have higher overall progression-free survival and a better clinical outcome than older patients. Any women presenting with pain and nonspecific symptoms should be investigated and evaluated properly.
Study of efficacy and safety of adjuvant intraperitoneal chemotherapy in carcinoma ovary
Authors: Goel Varun , Singh Sajjan , Talwar Vineet , Goyal Pankaj , Upadhyay Amitabh ,   Prashant
Published: February 2021

Background: The benefit of administering chemotherapy directly into the peritoneal cavity is supported by preclinical, clinical and pharmacokinetic data. In view of paucity of data from the Indian subcontinent, we decided to study the response and tolerability of intraperitoneal (I/P) chemotherapy in carcinoma ovary in Indian population.

Methods: In this observational study, from March 2013 to June 2015, the efficacy and tolerability of adjuvant I/P chemotherapy in optimally cytoreduced stage III epithelial ovarian cancer patients were assessed. Treatment consisted of 135 mg/m2 of i.v. paclitaxel over a 3-hours period on day 1 followed by AUC 5 carboplatin i.v. on day 2 and 60 mg/m2 of i.p. paclitaxel on day 8 every 3 weekly for six cycles.

Results: Total 50 patients were enrolled. The median age of patients was 53 yrs (32 yrs – 67 yrs). Out of a total of 240 I/P cycles, 225 cycles (93%) were completed. 30 patients (75%) received all the 6 cycles by IP route, 6 patients completed 5, 3 patients completed 4 cycles and 1 completed 3 I/P cycles. 4 Out of 30 patients who completed all 6 cycles of I/P chemotherapy, had one or more adjustment including delay while in 3 patients (7.5%) dose had to be reduced. after median follow up of 14 months, 8 patients (12.5%) had local or systemic recurrence, 2 patients (5%) had progression during treatment and died due to disease. median progression free survival not reached yet. One patients had vaginal leak. Catheter block was seen in five cases. Two cases had needle displacement and extravasations of drug around the port chamber. 6 patients had severe abdominal pain and cramp (grade 3) after infusion of saline. Hematologic toxicity was evaluated in all patients and in all cycles. Grade 3 or 4 Leucopenia was experienced by 25 patients (50%) but Febrile Neutropenia occurred in only 5 (10%) patients. Grade 3 or 4 anemia occurred in 17 (42.5%) and grade 3 or 4 thrombocytopenia was experienced by 6 patients (15%). Renal complication present in 3 patients (7.5%) and transient transfusion reaction developed in 5 patients. mucositis present in 21 patients.

Conclusions: Adjuvant I/P chemotherapy in optimally cytoreduced epithelial ovarian cancer is active and well tolerated in Indian patients.
To assess the role of addition of bevacizumab therapy to carboplatin and paclitaxel as frontline treatment of epithelial ovarian cancer
Authors: Vatsa Richa , Kumar Sunesh , Kumar Lalit
Published: February 2021

Introduction: Efforts are going on for development of new drugs for epithelial ovarian cancer (EOC). We assessed safety profile of bevacizumab, a VEGF receptor blocking antibody in treatment of EOC.

Methods: We assigned women with EOC to carboplatin (area under curve, 5 or 6) and paclitaxel (175 mg/square meter of body-surface area), given every 3 weeks for 6 cycles, or to this regimen plus bevacizumab (15 mg/kilogram body weight), given concurrently every 3 weeks for 5 or 6 cycles and continued for 30 additional cycles. Primary outcome measures was safety profile of bevacizumab and secondary outcome was to see progression free survival (PFS).

Results: Out of 30 patients, 10 were in Bevacizuma arm (Arm A) and 20 in conventional chemotherapy arm (Arm B). Haematological toxicity, GI perforation and proteinuria was similar in both. Other toxicities e.g. bleeding complication (p = 0.002) and hypertension (p = 0.04) was more in Arm A. PFS was similar in both arms; 24 months in Arm A and 22 months in Arm B (p = 0.565). 4 (40%) patients in arm A discontinued treatment, two (20%) because of disease progression after PFS of 9 and 6 months, two because of development of toxicity considered to be due to bevacizumab; of which one developed jejenal perforation and disease progression after PFS of 6 months and 1 because of development of persistent proteinuria of grade 3 after 18 months.

Conclusion: Bevacizumab therapy does not improve PFS in EOC but increases toxicity spectrum of chemotherapy.
Two interesting cases of granulosa cell tumor: A case report
Authors: Savita Pannu , Harsha Khullar
Published: February 2021

Introduction: Granulosa cell tumor (GCT) is an ovarian malignancy that arise from granulosa cells of the ovary. This tumour is a type of the sex cord-gonadal stromal tumour. GCT have good prognosis in comparison with other epithelial tumors.

Methodology: Two cases of granulosa cell tumors were diagnosed in sir Ganga ram hospital, Rajender Nagar, New Delhi in December 2015 and January 2016. The patient’s age, clinical manifestations, radiological and histopathological findings were evaluated. One was in perimenopausal age group and other case was in postmenopausal age group. The clinical manifestations were menorrhagia and abdominal pain. Ultrasonographically, in one case focal hypoechoic zone showing peripheral hypervascularity with possibility of old hemorrhage follicular cyst was seen and in other case of granulosa cell tumors was both solid and cystic areas were seen. Histologically, variety of patterns like diffuse, trabecular, nodular, sheets, nests and fascicular patterns with nuclear grooving in ovarian tissue. In addition endometrial findings were suggestive of simple hyperplasia without atypia. Treatment modalility used was surgery i.e. Total hysterectomy and bilateral salpingo-oophorectomy in both cases.

Conclusion: Granulosa cell tumor of the ovary is a rare ovarian malignancy. Endometrial pathology to rule out endometrial carcinoma specially when postmenopausal bleeding is concomitant finding is advised. Radical surgery is usually not required.
Neoadjuvant chemotherapy in epithelial ovarian cancer: Largest single institute experience
Authors: Kumar Siva
Published: February 2021

Purpose: Neoadjuvant chemotherapy followed by interval debulking surgery (IDS) is an alternative treatment option, compared to the current standard of care primary debulking surgery for treating advanced epithelial ovarian cancer (EOC). We present our institute experience of neoadjuvant chemotherapy strategy in the management of EOC which is one of the largest single institute experience.

Methods: This is a retrospective analysis of patients with epithelial ovarian cancer who were treated in our institute between 2000 and 2006. Patient with advanced disease by clinical and imaging were treated with 3 cycles of neoadjuvant chemotherapy and then taken up for interval debulking surgery (IDS) who had static or partial or complete response to chemotherapy. The remaining chemotherapy is delivered after the surgery. Patient who had limited disease had primary debulking surgery and then adjuvant chemotherapy according to institute protocol. Outcomes in terms of disease free and overall survival were analysed.

Results: This retrospective analysis included 59 patients with limited disease who had primary debulking surgery and 283 patients with advanced disease who received neoadjuvant chemotherapy. The median age was 50 years and majority are in the 50-59 years age group. Age more than 60 years represent 14.5%. Postmenopausal women were55.3 % and premenopausal women were 44.7 %. Multiparity is higher 70.2% than the uniparity 16.4% ornulliparity 11.7%. Abdomen distension 42% and pain 25 % are the most common symptoms. Advanced stage was the most common presentation 71% with stage III-56.1% and stage IV-14.9%. Among the neoadjuvant chemotherapy group 126/283(44.5%) had optimal cytoreduction, 44/283 (15.5%) had suboptimal cytoreduction and 113/283 (40%) not suitable for IDS. The 5 year disease free and overall survival was 30.8% and 41.5% in the NACT group with advanced disease and 58.5% and 75.8% in the primary cytoreduction group who had limited diseaserespectively. The 5 years overall survival among the IDS group with optimal cytoreduction was 57.1% and 11.7% for the suboptimal cytoreduction group. The 5 years survival was not affected by the number of neoadjuvant chemotherapy cycles delivered before surgery in the IDS group. Patient who received paclitaxol + carboplatin as first line chemotherapy had better survival than carboplatin alone or cyclophosphamide + cisplatin.

Conclusion: NACT as an alternative option to primary debulking surgery in operable EOC is still debatable. But for patient with high disease burden where optimal cytoreduction is not possible NACT strategy is a valid option. Recent randomised controlled trials from Europe had shown the noninferiority of neoadjuvant chemotherapy followed by IDS when compared to the primary debulking surgery in operable advanced EOC.
Malignant ovarian germ cell tumors in children: A single centre experience
Authors: Soni Priyanka , Mishra Shalini , Jain Sandeep , Kapoor Gauri
Published: February 2021

Background: Germ-cell tumors (GCT) are the commonest ovarian neoplasm in the first two decades of life.

Aim: To study the profile of ovarian GCT in children and their outcome.

Methods: Retrospective study of all cases of malignant ovarian GCT in the pediatric age (up to 18 years) was done from January 2002 to December 2015. The medical records of all admitted cases during this period were reviewed and the data was analysed with respect to age at diagnosis, clinical presentation, tumor markers, surgical stage, tumor histology, therapy, clinical course, and outcome.

Results: Girls with malignant ovarian GCT were seen at our institute during the study period. Out of these 25 underwent treatment. Mean age at presentation was 11.7 years (range: 3-18 years). Abdominal pain was the commonest presentation. Twelve (47.3%) had right sided disease, 11 (42%) had left sided disease and 2 had bilateral disease. Twelve cases (57.8%) were diagnosed as stage I disease, 5 (10.5%) as stage II, 7 (26.3%) as stage III and 1 (5.2%) as stage IV. Elevated AFP >1000 was found in 9 (47.3%), elevated B-HCG (>50) in 7 (42%) and elevated LDH (>1000) in 7 (36.8%) patients at presentation. Twenty (73.6%) patients underwent surgery prior to chemotherapy out of which 4 (21%) patients presented after undergoing surgery at other centre. Fourteen (57.8%) patients received 4 cycles of BEP based chemotherapy, 6 (21%) received 3 cycles, 2 (10.5%) received 2 cycles and 1 patient did not receive any chemotherapy as it was mature teratoma. The most common histology was dysgerminoma in 8 (42%) patients followed by mixed germ cell tumor in 4 (21%), teratoma in 3 (15.7%), embryonal carcinoma in 2 (10.5%) and yolk sac tumor and mature teratoma in 1 patient each. Four (21%) patients had relapse on contralateral side which was salvaged. 1 patient presented with relapse who underwent only surgery outside, 1 patient had ovarian torsion. Median follow up is 27months. The event free survival rate was 78.9%.

Conclusion: This study confirms an excellent outcome for girls with ovarian germ cell tumor. Patients with advanced surgical stage relapsed frequently. The mainstay of treatment is fertility preserving surgery and cisplatin-based chemotherapy.
Single centre experience of ovarian germ cell tumours over 8 years
Authors: Veena P.
Published: February 2021

Introduction: Germ cell tumours comprise approximately 15-20% of all ovarian tumours. Two third of ovarian tumours in first two decades of life are germ cell tumours. Majority of ovarian germ cell tumours are benign teratomas. The malignant germ cell tumours are usually solid and arise from totipotent germ cells. Over the past 3 decades the clinical outcome of women with ovarian germ cell tumours (OGCT) have significantly improved mainly due to development of more effective chemotherapy regimens.

Objective: To study the clinic pathological features, treatment and survival of women with ovarian germ cell tumours.

Methods: This is a retrospective descriptive study taken from the case files of patients with histo-pathologically proven ovarian germ cell tumours who were treated in JIPMER over 8 years from 2007 to 2014.

Results: There were totally 63 patients with ovarian germ cell tumours over 8 years who were treated in JIPMER. The age at presentation varies from 12 years to 65 years with a median age of 26.5 years. Three were pre pubertal and 1 was post-menopausal. Twenty two women (34%) were unmarried and 5 were pregnant at the time of presentation. Forty eight (76%) of them did not have any menstrual abnormalities. Pain abdomen (55%) was the most common presentation. Ten of them presented with acute abdomen of which 8 were torsion, 1 was ruptured dermoid and 1 was infected dermoid. Another 6 patients had torsion which was diagnosed only during surgery. Majority (68%) were benign tumours (dermoid) and among malignant tumours, there were 6 dysgerminomas, 5 immature teratomas, 5 mixed germ cell tumours and 4 yolk sac tumours. Almost half (22 out of 43) of women with benign tumours were <25 years whereas 3/4th (14 out of 20) of women with malignant germ cell tumours were <25 years. The most common tumour marker which was elevated was alpha feto protein (8) followed by LDH (5). Fertility sparing surgery (salpingo-ovariotomy) was commonly performed which was 95% (41/43) in benign tumours and 60% (8/20) in malignant tumours. Contra lateral ovary was biopsied in only 5 patients with suspected involvement (negative on final HPR). Out of 20 women with malignant ovarian tumours 7 were in advanced stage (Stage III). Majority of them recovered well from surgery, only 12% had post-operative febrile morbidity and one patient had subclavian vein thrombosis on post op D9 which required anticoagulants. 7 of 20 women received chemotherapy (BEP) for 4 cycles. No serious side effects of chemotherapy were noted in these women. 3 out of 20 women with malignant germ cell tumour were lost to follow up. No recurrences have been found in rest of the women and there are no deaths till last follow up.

Conclusion: Advances in the field of medicine like effective chemotherapy regimens, improved imaging, precise surgical staging and fertility sparing surgical procedures enable women not only to preserve the reproductive function but also to improve their quality of life.
Cystic adnexal lesion on USG – causing a diagnostic dilemma in oncology institute
Authors: Aggarwal Abhinav
Published: February 2021

Adnexal lesions are one of the most common cause of gynecological complains, including possibility of ectopic pregnancy in reproductive age group. Ultrasound is the first imaging modality used for evaluation of adnexal lesions. On ultrasound large non-adnexal lesions can be confused as adnexal lesions causing a diagnostic dilemma, rendering use of cross-sectional imaging mandatory. We present a case of middle-aged female who was diagnosed with a right adnexal lesion (possibly malignant) on ultrasound, but on further evaluation was found to be suffering from a benign non-adenexal etiology.
Multiple recurrence of granulosa cell tumor of the ovary: A case report and literature review
Authors: Chandra Varkha , Jain Sandhya , Goel Neerja , Gupta Bindia , Rajaram Shalini
Published: February 2021

Introduction: Granulosa cell tumors comprise approximately 5% of all ovarian malignancy and account for 70% of malignant sex cord stromal tumors. Granulosa cell tumors have been diagnosed from infancy, the peak incidence being perimenopausal age. The potential of malignancy of these tumors is low, recurrences are often late and found in 10-33% of cases.

Case Report: A 32-year-old P1L1 presented with large abdominal mass for which she underwent staging laparotomy with debulking surgery. She was a known case of granulosa cell tumor in the past and had undergone three laparotomies, along with chemotherapy. At the age of 13 yrs, she was diagnosed with a stage IA granulosa cell tumor (GCT) of the ovary first time. She underwent surgical staging and removal of left sided adnexal mass, after which she was asymptomatic for 7 years. In 2003 she again presented with lump abdomen for which she underwent resection of adnexal mass, histopathology was consistent with recurrent GCT. After second surgery she also received two cycles of chemotherapy. Despite adjuvant chemotherapy, patient presented again after three years in 2006 with adnexal mass and was found to have a third recurrence. At that time, she received 6 cycles of chemotherapy and the mass regressed. Meanwhile she got married and had one child. After four year in 2010 she again presented with lump abdomen and she underwent surgical staging, total abdominal hysterectomy with right salphingo ophorectomy along with removal of mass. After five year in 2015 she again presented with lump abdomen; there was a large pelvic mass which was removed and patient referred for chemotherapy.

Discussion: GCTS which a rare malignant tumors of ovary tend to be associated with late recurrences. Although most recurrences occurs within 10 years after initial diagnosis, there are occasional reports of recurrences after10 years. We experienced the rare case of a patient who relapsed multiple times over 20 years, despite surgical and targeted treatment.

Conclusion: The long history of granulosa cell tumor highlights the importance of extended follow up of the patient.