Critical Analysis of Advanced High-Grade Serous Epithelial Ovarian Cancer in Women: An Experience of 100 Cases from a Regional Cancer Center in Northeast India.

Debabrata BarmonOvarian cancer is the sixth most common cancer in women worldwide. Patients with ovarian carcinoma mostly present at an advanced stage with serous type of epithelial ovarian cancers, which is the most lethal of all pelvic malignancies. This study aims to critically analyze high-grade serous epithelial ovarian carcinomas in women from the Northeastern region of India and compare our data with Western literature to modify treatment strategies and improve survival outcomes. This hospital-based retrospective analysis involved data from the records of 100 women with high-grade epithelial ovarian cancer treated primarily with neoadjuvant chemotherapy followed by interval debulking surgery in the department of gynecologic oncology at a tertiary level regional cancer institute from January 2018 to December 2019. The demographic, clinical and pathological profile, and survival outcome were evaluated using descriptive statistics. The overall survival of the study population was calculated using Kaplan-Meier curves using SPSS software (version 24). The majority of women belonged to 41 to 55 years age group. At first presentation to the hospital, 89 and11% patients were in stage III and stage IV of disease, respectively. Clinically, 95% of women had ascites, and 18% had metastasis to lymph nodes. Distant metastasis to lungs and liver was present in 10 and 3% of cases, respectively. A substantial percentage (98%) of women had raised serum Ca125 > 1000 at baseline, ranging from 1,745 to 10,987 IU/mL. Almost two-thirds of the cases had partial-to-complete response to neoadjuvant chemotherapy (78%). In most of the women (72%), there was no residual disease at interval debulking surgery (R0), though 28% women had R1& R2 resection. The median overall survival time was 36 months. High-grade serous ovarian cancer is commonly seen in older age group, but its occurrence in younger population has also been observed. Early diagnosis is crucial in decreasing morbidity and mortality among these patients. Therefore, efforts should be made to identify risk factors for malignancy. Assessing each parameter of statistical information reflecting its own profile may be important for calculating the risk for the development of ovarian cancer, which can help in implementing preventive measures in the future.

Maternal mortality and predictors of adverse outcome in patients with heart disease in pregnancy.

Introduction: Heart disease in pregnancy possesses a great haemodynamic challenge and is a known risk for increased maternal morbidity and mortality. The functional status of the patient is one of the most significant parameters which can impact the feto-maternal outcome. Many predictors have been studied and compiled in various scoring systems time and again. The most updated and validated is the modified WHO classification, according to which the presence of pulmonary artery hypertension (PAH) and severe ventricular dysfunction (ejection fraction <30%) mandates the patient to be under class IV, which along with another important risk factor, i.e., New York heart association (NYHA) class, is revaluated under the present study. The objective of this study is to examine three of the most important predictors of adverse outcomes, i.e., functional status (NYHA class), PAH, and left ventricular ejection fraction (LVEF) in patients with heart disease in pregnancy. Methods: It's a prospective study from January 2016 to August 2017 wherein pregnant patients with heart disease were divided on the basis of NYHA class, PAH, and LVEF, and the feto-maternal outcome was recorded and evaluated in terms of maternal mortality, fetal demise, the occurrence of major cardiac complication, and risk of preterm delivery. Results: A total of three out of 29 (10.34%) maternal deaths were attributed to a cardiac cause. 5.45% of patients with heart disease had maternal mortality, which is in contrast to the 1.12% maternal mortality rate in general at our centre. Three out of 17 (17.64%) patients in NYHA classes 3 and 4 ended in maternal deaths, while there were no mortalities in classes 1 and 2. Intrauterine fetal demise (23.52%), risk of preterm delivery (relative risk = 0.4688; 95% CI: 0.2320 to 0.9470) was significantly higher in patients belonging to NYHA classes 3 and 4 as compared to those in classes 1 and 2. All of the ten (100%) patients who developed cardiac complications belonged to classes 3 and 4. The percentage of abortions (20.00%), intra uterine fetal demise (IUFD) (40.00%), and cardiac complication (80%) in patients with LVEF <44% were significantly more than in patients with better ejection fraction. Pulmonary artery systolic pressure (PASP) ≥ is associated with higher maternal mortality, a greater number of abortions and IUFD (22.62%), cardiac complication (22.72%), and increased risk of preterm birth (0.5769; 95% CI: 0.2801 to 1.188), but these associations are not found to be significant. Conclusion: NYHA class was found to be a very strong predictor followed by left ventricular ejection fraction for poor outcome. Maternal mortality in asymptomatic patients or patients with mild symptoms (NYHA classes 1 and 2) is comparable to that found in the general population. However, pulmonary artery systolic pressure is not found to be significantly associated with worse outcomes in our study.

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.

Coexistent Circumvallate Placenta and Battledore Insertion of Umbilical Cord Resulting in Grave Obstetric Outcome: A Case Report.

BACKGROUND: Various placental and cord abnormalities have been known to adversely affect the obstetric outcome. Circumvallate placenta and Battledore insertion of the umbilical cord are both rare and known to be associated with poor obstetric outcome individually. CASE PRESENTATION: In this case report, the woman presented at 8 months of gestation with preeclampsia with IUFD to North Easter Indira Gandhi Regional Institute of Health and Medical Science Shillong on 22/7/16 and delivered a macerated fetus vaginally. After delivery, examination revealed both a circumvallate placenta and Battledore insertion of umbilical cord. This might have attributed to preeclampsia and ultimately IUFD in this case as she had no other identifiable cause for IUFD. CONCLUSION: If such placental and cord abnormalities are suspected or diagnosed antenatally by ultrasonography, the pregnancy should be regarded as high risk. Such woman would require more stringent follow up in the antenatal period and continuous intrapartum monitoring to avoid any catastrophe and to achieve a favorable maternal and fetal outcome.