A challenging case of twin pregnancy with complete hydatidiform mole and co-existing normal live fetus - A case report and review of the literature.

Hydatidiform mole coexisting with a normal live fetus in a twin pregnancy is extremely rare. Management of these cases is challenging due to the risk of severe antepartum and post-partum complications. Herein, we report the case of a 24-year-old gravida 2 para 1 who presented at 28 weeks gestation with severe preeclampsia, vulvar edema and a serum ß-HCG of 285,000 IU/mL. Ultrasonography demonstrated a single live intra-uterine pregnancy with concurrent hydatidiform mole. Conservative management with magnesium sulfate and anti-hypertensive medications was initiated however the patient developed HELLP syndrome and required urgent delivery at 33 weeks. Copious molar tissue was removed from the uterus during delivery. Four weeks post-partum, her ß-HCG had dropped to 14,000 IU/ml and continued to decline at 6 weeks (2900 IU/ml). However, at eight weeks, it increased to 3500 IU/ml and the patient was treated with nine cycles of intramuscular methotrexate. Current guidelines for management of a twin pregnancy with coexistent mole recommend close clinical monitoring if the mother and fetus are stable and urgent delivery in the setting of complications. During the postpartum period, careful follow up with clinical evaluation and serial serum ß-HCG is important for the diagnosis and treatment of persistent trophoblastic disease.

Prevalence of Cervical Intraepithelial Neoplasia in four Upazila of Dhaka Division.

This cross-sectional and population based study was carried out in four randomly selected Upazila of four districts of Dhaka division by the department of Obstetrics and Gynaecology of Dhaka Medical College Hospital (DMCH) and Bangabandhu Sheikh Mujib University (BSMMU), Dhaka, Bangladesh from October 2014 to March 2015 to detect the prevalence of Cervical Intraepithelial Neoplasia (CIN) among women in four Upazila of Dhaka division of Bangladesh. Married women ages between 25-55 years, mentally able to provide informed consent were recruited. Women with chronic illness, pregnancy and women with previous treatment for CIN were excluded from the study. During 6 months of study period, a total 1165 cases were examined. Most of the attendants were between 30-35 years. Muslim participants were more than Hindus (95.27% vs. 4.37%) and 0.34% attendants were from Christian religion. Among the participants majority (42.37%) of them were up to primary level. Most (98.45%) of the women were house wife and most (54.5%) of them had monthly family income between Tk. 5001-10000. It was observed that 6.5% of their husband had 2 wives and 1.2% had 3 wives. Regarding their living status, 90.6% were living together, 8.6% of their husband was living at their work place & 0.7% was living abroad. About 30.4% of their husbands were farmer others were businessman, unemployed, driver and other service holder. It was found that 67(5.8%) out of 1165 cases were diagnosed as VIA +ve cases. Among 1165 cases 94.2% were normal, 4.7% were diagnosed as CIN I, 1% were CIN II and none of them was CIN III. Colposcopy guided punch biopsy were taken from all CIN cases and found that among 67 cases of colposcopically diagnosed CIN, histopathologically 28(2.4%) cases were diagnosed as normal, 32(2.7%) cases were CIN I, 4(0.3%) cases were CIN II & 3 (0.3%) cases were CIN III. In this study, crude prevalence of CIN I, CIN II and CIN III were 2.7%, 0.3% and 0.3% respectively. This study provides the first population-based prevalence of CIN in Bangladesh which will guide the Government of Bangladesh to upgrade the activities of already existing cervical cancer screening programme.

Rectal perfusion parameters normalised to tumour-free rectal wall can predict response to neoadjuvant chemoradiotherapy.

AIMS: To evaluate absolute changes in quantitative and semi-quantitative perfusion parameters using a newer approach of comparing these parameters with tumour-free normal rectal wall (i.e., relative/normalised change) in predicting complete pathological response to chemoradiotherapy. MATERIALS AND METHODS: Perfusion parameters measured before and after treatment of 10 patients with histopathologically proven rectal cancer that showed complete treatment response (Group 1) were compared with 10 patients with residual tumour on histopathology following treatment (Group 2). Quantitative perfusion MRI parameters (Ktrans: volume transfer coefficient reflecting vascular permeability, Kep: flux rate constant, Ve: extracellular volume ratio reflecting vascular permeability, integral of area under the curve (IAUC); Toft model) were quantified by manually delineating a region of interest in the upper, mid and lower third of the tumour (1 cm2), in addition similar parameters were obtained from the normal rectal wall at least 1 cm away from the potential resection margin, absolute as well as relative perfusion values normalised to that of the normal rectal wall were evaluated. The differences in absolute and normalised qualitative parameters were compared within each group using paired t-tests and between each group using analysis of variance (ANOVA). RESULTS: Wash-in, wash-out, positive enhancement integral (PEI), Ktrans, IAUC in the complete pathological responders when compared to the adjacent normal rectal wall showed ratios approaching 1, suggesting that rectal perfusion is similar to the adjacent normal rectal wall in complete pathological responders. The difference in the normalised values in the responders and non-responders was statistically significant. CONCLUSION: Perfusion parameters can be used in predicting response to treatment, when normalised to the adjacent normal rectal wall.

Adenoid cystic carcinoma: a rare breast carcinoma.

Adenoid cystic carcinoma is a rare neoplasm accounting for <0.1% of breast carcinomas. The mean age of presentation is fifth to sixth decade of life and it generally presents as a painful breast lump. The histological features are characteristic with cribriform and acinar pattern of basaloid cells. It is triple negative tumor with CD117 and p63 positivity and excellent prognosis.