Malignant Transformation in Mature Cystic Dermoid: A Case Series of 8 Cases

Introduction: One of the most common types of ovarian germ neoplasm is Mature cystic teratoma(MCT) which accounts for almost 20% of all ovarian neoplasm. Objective: Analyze patients with Malignant Transformation (Mt) arising from Mature Cystic Teratoma of the ovary to evaluate Clinico-pathological features and treatment modalities. Methods: This is an observational study of 8 patients of Mt in MCT, who had taken complete treatment at GCRI between the period from September 2016 to September 2021. During this observation period, a total of two thousand one hundred and seventy seven ovarian tumors were diagnosed. Out of these patients, 9.32% (203) were MCTs. Of the consecutive cases of 203 ovarian MCTs diagnosed, 3.9% (8) had Mt of MCT, which was our study group. Results: The mean age of patients with Mt in MCT was 47.1 years (27- 65 yrs), while mean age of the patients with MCT was 42 years (35-55 years). Among the 21 postmenopausal, MCT's 28.5% (6) cases developed Mt and only 1% i.e., two cases from premenopausal showed Mt. Abdominal pain as main symptom was seen in 87.5% (7/8) patients. The duration of symptoms ranged from 3 to 6 months. CA125 was elevated in 75% patients. Germ cell markers including beta HCG, AFP, LDH were found to be normal. Conclusion: Diagnosis of malignant transformation of MCT is very difficult. There should be high index of suspicion of malignant transformation if the MCT has been present for a long time; the patient is postmenopausal, age>45 yrs; the tumor diameter is greater than 9.5 cm; or there is thickening of the cyst wall or papillary growth occurs, increased tumor markers

Primary retroperitoneal mucinous cystadenocarcinoma: a rare surgico-pathological entity

Ovarian cancer (OC) is the seventh most common cancer for females in the world. Epithelial OC is the most predominant pathologic subtype (85%-90%), with five major histotypes- serous, mucinous, endometrioid, brenner and clear cell tumour. Each have three pathological subtypes ie benign, borderline and malignant. Mucinous cystadenomas and carcinomas of the ovary are well-established and common tumors. Primary retroperitoneal mucinous cystadenomas and carcinomas are being very rare and histopathogenesis of which is still uncertain. Most pathologists suggest their origin through mucinous metaplasia in a pre-existing mesothelium-lined cyst. An accurate preoperative diagnosis of these tumors is challenging due to lack of established effective diagnostic measures. Hereby presenting a 50-year-old woman, who visited to the hospital with abdominal distension and discomfort since two months. Sonography and computed tomography scans were performed and showed large predominantly cystic lesion arising from right adnexa. Patient underwent exploratory laparotomy for removal of the tumor. Histology and immunohistochemistry revealed primary retroperitoneal mucinous cystadenocarcinoma.

Chemo-resistant gestational trophoblastic neoplasia: a review of cases at a tertiary cancer centre

Background: Gestational trophoblastic neoplasia (GTN) was earlier a dreaded malignancy with high mortality rates. GTN is now considered to be one of the most curable solid tumours in women with cure rates greater than 90% even in the presence of metastases. Despite the high chemo sensitivity, treatment failure or drug resistance has been described in both groups.Methods: In this study, available records of GTN cases over 6 years were reviewed with emphasis on those who were resistant to the first line of chemotherapy. Of these, 37(34.58%) were resistant to the first line of chemotherapy. These cases were studied with respect to age, parity, antecedent pregnancy, interval from antecedent pregnancy, pretreatment β hCG, risk score and presence of metastases. The data was analyzed in order to find any risk factors associated with chemo-resistance.Results: Total number of cases of GTN was 107. Out of these 107 cases, 63 (58.88%) were low risk and 44 (41.12%) were high risk according to FIGO scoring system. Complete response was achieved with first line chemotherapy in 70 (65.42%) patients. The remaining 37 (34.57%) were resistant to first line chemotherapy. In the low risk group, 30 (47.62%) cases, and in the high-risk group, 7(15.91%) were resistant to first line of chemotherapy.Conclusions: Despite the high chemo sensitivity of GTN, resistance to first line chemotherapy may be encountered in up to 40% of cases.  It is important to identify the patients who are at risk to develop resistance, early identification of resistance and change of chemotherapy so as to minimize the exposure of these patients to ineffective chemotherapy.

Early stage cervical cancer with negative pelvic lymph nodes: morbidity and survival patterns following radical hysterectomy and postoperative adjuvant radiotherapy

Background: The objective of the present study was to optimize the role of adjuvant radiotherapy in lymph node negative cervical cancer treated with radical hysterectomy and pelvic lymph node dissection, and to analyse patterns of failure and complication following surgery and radiotherapy in same patients.Methods: This is retrospective analysis of 98 patients of cancer cervix FIGO Stage IB; IIA treated with radical hysterectomy with bilateral lymphadenectomy and adjuvant radiotherapy between the years 2000 and 2007at our hospital. Among all node negative patients who were operated during this period 97 patients were high risk. [High risk-Two or more of following risk factors: primary tumor size >4 cm, cervical stromal invasion ≥1/2, lymph-vascular space invasion, Unfavorable histology,>].Results: Median follow up: 79 months [6 months to 109 months], Recurrence rate: 13.26% [2 Pelvic and 11 distant recurrence] Pelvic control rate: 98 %Radiotherapy Complications: 4 % [Grade 3-4].Conclusions: Adjuvant radiotherapy following radical hysterectomy in high risk node negative early cervical cancer is effective treatment. It reduces pelvic recurrence with acceptable morbidity.

Study of epidemiology, clinicopathological correlation, prognostic factors and management in squamous cell carcinoma of vulva

Background: Carcinoma of the vulva is rare cancer, pruritus is the most common and long-lasting reported symptom. It is found to be associated with HPV and HIV infection. Currently, a more individualized and less radical treatment is suggested. In this study we evaluated epidemiology, clinicopathological prognostic factors, HPV distribution and risk factors for metastases to lymph nodes. We also reviewed multidisciplinary clinical management carried out at our institute.Methods: It is a prospective study of 25 biopsy proven cases of Squamous Cell Carcinoma of Vulva, treated at our center from September 2014 to September 2016. We collected the data regarding the clinical presentation, histological details, treatment given, survival and complications. HPV 16 and 18 testing were done using PCR method. Median follow up of the patients are for 24 months.Results: The mean age of patients was 54.6 years. Commonest presentation was perineal itching (36%). HPV 16/18 were positive in 25% of the patients. Radical vulvectomy with bilateral groin dissection was done in 14/25 (56%) patients. Among these 14 patients, 35.7 % (5/14) has lymph node metastases, disease free survival was 63.6% and overall survival was 81.1% for median follow up of 24 months. About one third of the patient presented with locally advanced disease.  Six (24%) patients received only chemo radiation as a treatment.Conclusions: HPV and HIV infection increase the risk of vulvar cancer. Individualization of treatment is necessary. The use of preoperative chemoradiation in locally advanced disease might have promising results in future.