Reason for improper simple hysterectomy in invasive cervical cancer in Northeast India.

Objective: The objective of the study was to determine the reasons for improper simple hysterectomy in the presence of invasive cervical cancer in Northeast India. Materials and Methods: The medical records of 52 patients who had undergone improper simple hysterectomy in the presence of invasive cervical cancer and were referred to a tertiary regional cancer Institute at Guwahati, Assam, between January 2015 and December 2019 were reviewed. Results: Most of the patients presented with abnormal vaginal bleeding (40.4%). The failure to perform cervical cytology before the operation was quite high at 48.1% (25 patients). Interestingly, normal cytologic smear could still be found in 15.4% (8 patients) despite the presence of invasive cervical cancer. Failure to perform preoperative Papanicolaou smear, incomplete evaluation of cervical intraepithelial neoplasia (CIN) on cervical biopsy, and negative Papanicolaou smear accounted for 75% of the patients undergoing inappropriate simple hysterectomy. The most common indications for inappropriate operation were abnormal vaginal bleeding (40.4%) and CIN (19.2%). The reasons for inappropriate simple hysterectomy included lack of preoperative cervical cytology (48.1%), false-negative cervical cytology (15.4%), incomplete evaluation of cervical dysplasia or microinvasion on biopsy (11.5%). failure to perform indicated conization( 5.8%), emergency hysterectomy (3.8%), errors in colposcopic examination (3.8%), incomplete evaluation of an abnormal cervical cytology (3.8%), failure to review slide (3.8%) and failure to biopsy a gross cervica lesion (3.8%). Conclusion: Most improper simple hysterectomy resulted from deviation from guideline for cervical cancer detection protocols. Improper simple hysterectomy in the presence of invasive cervical cancer can be avoided if one sticks to the diagnostic guideline for patients with an abnormal cervical cytology.

Choriocarcinoma in Post-Menopausal Women- 3 Case Reports with Review of Literature.

Gestational trophoblastic neoplasia is of uncommon occurrence in postmenopausal women, unlike in the reproductive age group. The diagnosis is based on levels of beta-human chorionic gonadotropin (hCG) in serum. The management is similar to that in premenopausal women. First case, fifty-two-year-old, P8 L4A3 postmenopausal female, presented with postmenopausal bleeding. Diagnosis of choriocarcinoma was made in view of raised serum betah-CG levels with uterine lesion with lung metastasis. The patient started on Multi-agent chemotherapy. The patient succumbed to death due to Grade III hematological toxicity while on the first cycle of the EMA/CO regimen. Second case, forty-two-year-old, P2 L2, postmenopausal, with a history of Choriocarcinoma 20 years, back presented with postmenopausal bleeding. After metastatic workup, the patient started on EMACO regimen. She is asymptomatic and on regular follow-up after 8 cycles of chemotherapy. Third case, forty-seven-year-old, P4 L4, postmenopausal, presented with histopathology report suggestive of choriocarcinoma after hysterectomy. After evaluation, lung metastasis was detected. The patient responded to eight cycles to Multi-agent chemotherapy and is on regular follow-up. Choriocarcinoma is a rare gynecological malignancy in postmenopausal women. High index of suspicion is required for its diagnosis. The prognosis of the disease is not encouraging as compared to the premenopausal woman.

An Overview of Vulvar Cancer: A Single-Center Study from Northeast India.

STUDY: Carcinoma vulva is a rare cancer of the female genital tract. It mostly presents in postmenopausal women. The treatment of vulvar cancer is surgery, chemoradiation, radiotherapy or a combination of all modalities. Here, we present a study of 33 cases of carcinoma vulva over a period of 2 years at a Northeast India regional cancer institute describing its demographic features and treatment outcomes. METHODOLOGY: A retrospective cohort study of vulvar cancer diagnosed at Northeast India regional cancer institute from January 2017 to December 2018. RESULTS: A total of 33 cases of biopsy proven carcinoma (Ca) vulva were studied. Maximum number of cases belonged to the age group: 60-69 years (39.4%). 66.67% cases had palpable inguinal lymph nodes at presentation, and 100% had squamous cell carcinoma on histopathology. Maximum number of cases belonged to stage III (44.8%), and least number of cases belonged to stage IV (10.3%) of FIGO 2009 staging of Ca vulva. 87.9% cases underwent treatment, and 12.1% were lost to follow-up. Out of the cases who underwent treatment, 55.2% cases were taken up for primary surgery and 44.8% cases for primary radiotherapy. 75% cases who underwent surgery received adjuvant radiotherapy. No complication was seen in patients post-radiation. But, 6.25% patients post-surgery developed lymphocyst and 18.75% patients developed wound necrosis (p > 0.05). CONCLUSION: Vulvar cancer is not a common malignancy of the female genital tract that presents in sixth and seventh decades of life and often with palpable inguinal lymph nodes. Though early stages of Ca vulva are treated by surgery, the incidence of immediate postoperative complications in our study was more as compared to post-radiotherapy. Also, maximum patients in the present study post-surgery received adjuvant radiotherapy. Thus, radiotherapy can be considered as the primary treatment modality for patients with early as well as advanced vulvar carcinoma.