Endometrioma mimicking ovarian malignancy in a post-menopausal woman

Endometriosis is an estrogen dependant disorder of reproductive-age women. It is uncommon after menopause, however, peripheral estrogen production may account for endometriosis in post-menopausal women. We reported a case of a 68 year old post-menopausal woman with an adnexal mass suspected malignant ovarian tumor on imaging and normal serum CA 125 levels. Total hysterectomy with bilateral salpingo-oophorectomy was done. The final histopathology revealed the diagnosis of ovarian endometriosis. Rarely, ovarian endometrioma can mimic ovarian malignancy in a post-menopausal woman.

Diagnostic Accuracy and Appropriate Cut Off Value of Risk of Malignancy Index in Preoperative Discrimination Between Malignant and Benign Ovarian Tumors: Prospective Cross-sectional Study

BackgroundRisk of malignancy index (RMI) is scoring system which was introduced to differentiate between benign and malignant ovarian tumor. It incorporates CA-125, ultrasound score and menopausal status for prediction of ovarian malignancies in preoperative period. There is no universal screening method to discriminate between benign and malignant adnexal masses yet. So, this study was conducted to determine the diagnostic accuracy of RMI and determine best cut off value for RMI.MethodsProspective cross-sectional study was carried out among women with ovarian mass admitted to Gynecology ward and operated from September 1, 2019 to June 30, 2020.Data analysis was carried out using SPSS version 26. CA-125 level, menopausal status and ultrasound score were used to calculate RMI. Finally, RMI score was compared to histopathology result used as gold standard.ResultsNinity nine patients were enrolled in this study. Prevalence of benign ovarian tumors were 61.6% (61/99) and that of malignant ovarian tumors were 38.4% (38/99). The mean age for benign tumors was 30±9yrs and the mean age for malignant tumors was 50.6±10.8yrs. Among benign tumors, serous cystadenoma was the most common (36%), followed by dermoid cyst (32.9%), mucinous cyst adenoma (14.8%). The most common malignant ovarian tumor was serous cyst adenocarcinoma (63.2%), followed by mucinous cystadenocarcinoma (23.8%) and dysgerminoma (5.3%). Overall, using RMI score cut off value 220 has good sensitivity (84.2%), specificity (77%), PPV (69.5%), NPV (88.7%) and diagnostic accuracy (79.8%) for discriminating between benign and malignant ovarian tumors.ConclusionFrom this study there were high proportion of women with RMI>=220 in malignant ovarian tumors group. The study shows that there is significant role of RMI in prediction of ovarian malignancy thus helping in deciding which patients need referral to a center where gynecologic oncologists are available. It is good practice to use it in developing countries including our country because of its simplicity, safety and applicability in initial evaluations of patients with adnexal mass.

Successful treatment of clear cell carcinoma of ovary during pregnancy: a case report

The incidence of malignant ovarian tumor is rare during pregnancy. Most women hope to maintain the pregnancy and preserve fertility thus increasing the need for standard guidelines regarding surgery and chemotherapy for safe oncologic and fetal outcomes. Here we present a 30-years-old primigravida, diagnosed with bilateral ovarian mass during routine ultrasound imaging at 8 weeks of gestation. CA125 was 14.2 U/ml. MRI pelvis taken at 13 weeks showed bilateral complex cystic masses with internal septations. The patient underwent bilateral salphingo-oopherectomy and infracolic omentectomy during 18th week of gestation, the histopathology showing clear cell carcinoma with capsular invasion and microscopic omental deposit thus staged as IIIA. She was planned for adjuvant chemotherapy comprising of paclitaxel and carboplatin during the 21st week along with serial ultrasounds for fetal monitoring. After 5 cycles, at 37 weeks of gestation, she was taken up for elective LSCS followed by completion of surgery for ovarian malignancy, that is, hysterectomy with bilateral pelvic lymphadectomy. Endometrium showed gestational changes with all lymph nodes being negative for tumor deposits. A healthy male child weighing 3.4 kg was delivered. She was given 6th cycle of chemotherapy post-surgery and two years later, mother and baby are doing well and on regular follow up. Thus, the successful treatment of clear cell ovarian carcinoma in this woman with safe pregnancy outcomes can be attributed to timely diagnosis and feasibility of surgery and chemotherapy during second trimester.

Granulosa cell tumor complicated by torsion, rupture and hemoperitoneum

Granulosa cell tumor, a sex cord stromal estrogen secreting tumor presents with vaginal bleeding and is seen in all ages. It accounts for <5% of all ovarian neoplasm. We reported a rare case of granulosa cell tumor in a postmenopausal woman undergoing staging laparotomy with total abdominal hysterectomy and bilateral salpingo-oopherectomy for malignant ovarian tumor, which was complicated by torsion, rupture and hemorrhagic ascitis. Any ovarian tumor with vaginal bleeding should arouse suspicion of granulosa cell tumor in the background of postmenopausal woman. For most patients, surgery alone is sufficient primary therapy, Radiation and chemotherapy are reserved for the treatment of recurrent or metastatic disease.

Evaluation of Risk of Malignancy Index in the Preoperative Assessment of the Patients with Ovarian Mass

Background: Adnexal masses indicate a variety of gynecological and non-gynecological disorders, which may be benign or malignant. Early detection of malignancy is crucial to a proper planning of treatment and improvement of survival. Objective: The purpose of the study was to evaluate predictive value of risk of malignancy index (RMI) in differentiating between benign and malignant ovarian masses preoperatively. Study Design: Cross sectional (Validation) study. Settings: Obstetrics & Gynecology Department of Madinah Teaching Hospital affiliated with University Medical & Dental College Faisalabad Pakistan. Duration: One year from January 2018 to December 2018. Methodology: Total 86 patients were included in the study. Ultrasound was performed then staging laparotomy done followed by histopathological examination. Results: A total of 86 patients were included in the study. Out of which 50 patients (58.1%) were premenopausal and 36 patients (41.9%) were menopausal. The mean age of the patients was 55.79 years. According to histopathological examination of the specimens 44 were malignant and 42 were benign. The sensitivity of the RMI for malignant ovarian tumor is 70.45% and specificity is 69.05%. Conclusion: RMI was considered to have significant importance in preoperative evaluation and treatment of women with an adnexal mass, and was helpful in-patient referral to higher Centre for suitable and effective surgical intervention.

Rare ovarian neoplasm: Primary precursor B-cell Lymphoblastic Lymphoma involving bilateral ovaries

The involvement of the ovary in lymphomatous processes is rare. However, in the female genital tract, the ovary is a frequent site to be involved by the hematological malignancies. Involvement of the ovary by malignant lymphoma can be primary or secondary and is discovered incidentally during a workup for abdominal or pelvic complaints. Most commonly occurring ovarian lymphoma is diffuse large B cell type, whereas the Precursor B Cell Lymphoblastic Lymphomas are extremely rare and previously only 5 cases have been reported. Here, we report a case of clinically suspected malignant ovarian tumor involving bilateral ovaries, which was diagnosed as a primary precursor B-LBL after surgery in a young female. This case highlights the need for careful evaluation of radiologic and morphologic features along with an extensive immunohistochemical panel to arrive at the correct final diagnosis to guide the chemotherapy. Keywords: Non-Hodgkin Lymphoma; Primary Ovarian Precursor B-Cell Lymphoblastic Lymphoma; Primary ovarian lymphoma; Primary ovarian tumors

HE4 in Various Body Fluids: A Prospective Pilot Study

Introduction: Human epididymis protein 4 (HE4) is a glycoprotein that is a sensitive and specific serum biomarker for patients with suspected ovarian cancer. HE4 is also secreted in different body fluids such as cervical mucus or urine, which could provide an easy alternative for screening purposes. HE4 protein secretion in different body fluids was analysed in 11 healthy controls and in 10 patients with a benign, 10 with a borderline and 22 with a malignant ovarian tumor. Materials and Methods: Preoperative samples of serum, urine, cervical mucus, saliva, and ascites were collected to measure HE4 with an ELISA assay. Urinary creatinine concentration and cervical total protein concentrations were used as reference analytes, and ratios with HE4 were calculated. Results: Median HE4 concentration in urine was higher in patients with epithelial ovarian cancer (EOC) compared to healthy controls and patients with a benign or borderline mass (p=0.02). HE4/creatinine ratio could differentiate healthy controls from EOC and benign ovarian disease from EOC (AUC 0.76, 95% CI 0.58-0.94 and AUC 0.71, 95% 0.52-0.89, respectively). HE4 in ascites was significantly higher in patients with EOC or borderline ovarian mass compared to patients with a benign ovarian mass (p=0.04). HE4 concentrations in cervical mucus and saliva were not significantly higher in patients with EOC. Conclusion: This study shows that HE4 is abundant in body fluids other than blood and suggests that urinary HE4 levels can be used as a non-invasive diagnostic alternative to detect EOC.

Voigt. - Fall von Kaiserschnitt nach Porro in der Schwangerschaft wegen malignen Ovarialtumors nebst Beitrag zur Pathologie des Corpus luteum. (Arch. F. Gyn., Bd. XLIX, Hft. 1). A case of surgery Porro during pregnancy due to malignant ovarian tumor and pathology of the corpus luteum

In a 30-year-old woman, II gravida, an ovarian tumor began to grow strongly. Thanks to the strong pains caused by her, the extreme exhaustion of the patient, and most importantly, the fact that there was no expectation for an arbitrary end of labor, since the tumor filled the pelvic cavity by itself, the ovaryotomy was started.