ABSTRACT
Background: The coexistence of a granulosa cell tumor with a teratoma is extremely rare and impossible to diagnose preoperatively. For most patients with advanced age and stage, the standard treatment is hysterectomy and bilateral salpingo-oophorectomy; however, fertility-preserving surgery should be considered for young nulligravid women. Case: We present a case of a 24-year-old nulligravid female with bilateral adnexal masses, imaging findings of ovarian teratomas, and normal levels of tumor markers. A laparotomy revealed bilateral dermoid cysts, and solid tissue invaded most of the remaining ovarian parenchyma with no signs of malignancy in the uterus and peritoneum space. Consequently, a bilateral oophorectomy was performed to preserve her fertility. Histopathology examination showed mature cystic teratomas coexisting with granulosa cell tumors on both ovaries. Within six months, there were no signs of recurrence on ultrasonography and tumor makers. Combined oral contraceptive pills were prescribed as hormone replacement therapy. Conclusion: Fertility-preserving surgery can be performed in young women with an ovarian granulosa cell tumor coexisting with a teratoma. Long-term examination, hormone replacement therapy, and in vitro fertilization are required.
ABSTRACT
BACKGROUND: The COVID-19 pandemic and governments' response lead to dramatical change in quality of life worldwide. However, the extent of this change in Vietnamese medical and nursing students has not been documented. OBJECTIVES: The study aims to describe the quality of life and changes in quality of life of medical and nursing students during the COVID-19 pandemic and examine the association of quality of life and changes in quality of life with fear of COVID-19 and other socio-economic and demographic factors. METHODS: The study was a cross-sectional study on all students of Hanoi Medical University from 3 majors: General Medicine, Preventive Medicine, Nursing (3672 invited students); from 7th to 29th of April 2020; using an online questionnaire that included demographic and academic information, the Vietnamese version of the SF-36 Quality of Life questionnaire and the Fear of COVID-19 Scale (FCV-19S). Linear and modified Poisson regression was used to examine the association between quality of life, changes in quality of life and other factors. RESULTS: The number of participants was 1583 (response rate 43%). Among 8 dimensions of the SF-36 (ranged 0-100), Vitality had the lowest score with a median score of 46. The median physical composite score (PCS) of the sample was 40.6 (IQR:20.8-53.2), 33.5% of the sample had an above-population average PCS score. The median mental composite score (MCS) of the sample was 20.3 (IQR:3.8-31.7), and 98.2% had an MCS score below average. 9.9% (95%CI:8.5%-11.4%) of the population reported a significant negative change in the quality of life. Fear of COVID-19 was not associated with significant changes in quality of life, nor MCS while having some association with PCS (Coef:-5.39;95%CI:-3to-7.8). Perceived reduction in quality of life was also associated with: being on clinical rotation COVID-19 (PR:1.5;95%CI:1.05-2.2), difficulties affording health services (PR:1.4;95%CI:1.02-1.95), obesity (PR:2.38;95%CI:1.08-5.25) and chronic disease (PR:1.92;95%CI:1.23-3), typical symptoms (PR:1.85; 95%CI:1.23-2.78) and atypical symptoms of COVID-19 (PR:2.32;95%CI:1.41-3.81). CONCLUSION: The majority of medical and nursing students had below average quality of life, with lower vitality and mental composite health score in the settings of COVID-19. Perceived decrease in quality of life was associated with clinical rotation, difficulties affording healthcare services and was not associated with Fear of COVID-19.
