Insights into neoadjuvant chemotherapy efficacy for stage 1B3 locally advanced cervical cancer: case series

Cervical cancer remains a leading cause of mortality among women worldwide, particularly in developing nations. While radical surgery is the established standard of care for early-stage disease, pelvic relapse post-surgery remains a concern. Neoadjuvant chemotherapy (NACT) preceding radical surgery has emerged as a promising approach, aiming to reduce tumor burden and improve surgical outcomes. We present three cases of stage 1B3 cervical cancer treated with three cycles of NACT repeated three weekly followed by radical hysterectomy. Post-operatively two patients received radiotherapy (External beam radiotherapy and brachytherapy) and one patient got lost to follow-up for 6 months and did not receive post-operative radiotherapy now under observation and regular follow-up. All the patients exhibited significant tumor reduction following chemotherapy, enabling successful surgical intervention. All patients remained in remission post-treatment. NACT showed effectiveness in reducing tumor size and facilitating successful radical surgery in patients with stage 1B3 cervical cancer. Our case series highlights the potential of NACT followed by radical surgery as a promising therapeutic strategy for stage 1B3 cervical cancer. NACT facilitated successful surgical intervention with favourable outcomes. Further research is warranted to elucidate the optimal patient selection criteria and the long-term benefits of this approach in improving survival rates and quality of life for cervical cancer patients

Breaking barriers: the evolution of portable colposcopes in cervical health

Global calls for cervical cancer elimination prompt urgent focus on low-income countries where screening challenges persist. While high-income nations utilize advanced methods like human papillomavirus (HPV) testing and colposcopy, many low-resource settings rely on cost-effective approaches like visual assessment with acetic acid (VIA) performed on the same day as screening and treatment. This review explores the feasibility of implementing improved visual assessment methods in low and middle-income countries (LMICs), considering challenges posed by systemic factors. Emphasizing the vital role of visual inspection, particularly in high-income countries where colposcopy guides biopsies and treatment decisions, the article advocates for tailored screening pathways. Unlike extensive multi-step processes in high-income countries, LMICs face limitations in clinic visits, making simple VIA crucial. The article evaluates the potential of cervical imaging devices for low-resource settings, aiming to enhance cervical cancer screening in line with global elimination goals

A comprehensive review of mucinous ovarian cancer: insights into epidemiology, risk factors, histological characteristics, and clinical outcomes

Mucinous ovarian cancer (MOC) represents a rare subtype within the spectrum of epithelial ovarian carcinoma (EOC). In contrast to a uniform approach applied to all EOC subtypes, MOC stands out as a distinctive entity. A nuanced understanding of the pathological features and genomic profile of MOC holds the potential for enhancing management strategies and, consequently, prognostic outcomes. The differentiation between primary MOC and metastatic mucinous carcinoma poses a challenge but is imperative for accurate clinical decision-making. Notably, early-stage MOC exhibits a favourable prognosis, while advanced disease is characterized by a less favourable outcome. Surgical intervention assumes a pivotal role both in the early stages and metastatic scenarios. Chemotherapy is typically initiated from stage II MOC onwards, with the conventional gynaecological protocol commonly employed; however, there is also precedent for the application of gastrointestinal (GI) regimens. Given the association of MOC with diverse molecular alterations, the consideration of targeted therapy emerges as a potential therapeutic avenue for this unique disease entity. The main tool used for this literature review was PubMed. MOC stands as a distinct entity within EOC subtypes, distinguished from GI mucinous carcinoma by its unique clinical behavior, pathological features, molecular profile, prognosis, and response to standard treatment. The challenges lie in both the diagnosis and treatment of MOC, emphasizing the complexity and specialized considerations required for managing this particular subtype of OC

Collision tumour of ovary: a rare combination of fibrothecoma with serous cystadenoma

A collision tumour is defined by presence of two separate tumors in one organ on gross, microscopic and immune-histochemical studies without any admixture. These tumors are reported from oesophagus, stomach, liver, lung and thyroid glands. Such tumors are extremely rare in ovary. In case of ovaries most common histological collision reported between mucinous tumors and teratomas. We are reporting a rare combination of fibrothecoma with serous cystadenoma in right ovary of a premenopausal woman. Both gynaecologist and pathologist should be aware of such combination. It is important to differentiate such tumors from malignant ovarian tumors. Frozen section and scrape cytology are important tools which help in appropriate management of such cases intraoperatively

Ascites and Adnexal Mass with Raised CA125: How Arduous can be the Path of Diagnosis

Ascites, adnexal mass and elevated CA125 levels almost always suggest advanced ovarian carcinoma. We present a case of a 37 years old multiparous lady who presented with such a classical picture. Radiological picture was suggestive of ovarian carcinoma with peritoneal metastasis. However ascitic fluid cytology was negative for malignant cells. A differential diagnosis of tubercular mass was made. Ascitic fluid was sent for adenosine deaminase test that was negative. Fine needle aspiration cytology failed to reveal any sufficient sample for evaluation. Open laparotomy and biopsy was done that showed granulomas suggestive of tuberculosis. Category one anti tubercular treatment was started and symptoms resolved within one month.  Keywords: Adenosine Deaminase; Ovarian carcinoma; Pelvic tuberculosis. | PubMe

Ascites and Adnexal Mass with Raised CA125: How Arduous can be the Path of Diagnosis

Ascites, adnexal mass and elevated CA125 levels almost always suggest advanced ovarian carcinoma. We present a case of a 37 years old multiparous lady who presented with such a classical picture. Radiological picture was suggestive of ovarian carcinoma with peritoneal metastasis. However ascitic fluid cytology was negative for malignant cells. A differential diagnosis of tubercular mass was made. Ascitic fluid was sent for adenosine deaminase test that was negative. Fine needle aspiration cytology failed to reveal any sufficient sample for evaluation. Open laparotomy and biopsy was done that showed granulomas suggestive of tuberculosis. Category one anti tubercular treatment was started and symptoms resolved within one month. Keywords: Adenosine Deaminase; Ovarian carcinoma; Pelvic tuberculosis. | PubMe

EFFICACY OF SEE AND TREAT IN A CERVICAL SCREENING PROGRAM WITH VISUAL INSPECTION WITH ACETIC ACID (VIA)

<p>SEE and TREAT at Colposcopy has been described in cytology based screening when a high-grade lesion in association with a high grade abnormality in the Pap smear is treated by Large Loop Excision of the Transformation Zone (LLETZ) to minimize loss to follow-up in the multiple step management protocol for CIN. With a vast burden of cervical cancerin developing countries, our aim was to study the efficacy of this approach in patients coming to colposcopy clinic after a positive VIA test. Women in the age group of 25-50years and coming to the general gynecology clinichad opportunistic screening with VIA those who were found VIA+ underwent Colposcopy. Ifcolposcopy suggested a high-grade lesion, SEE and TREAT using LLETZ was performed.Colposcopy was carried out for 688VIA positive womenof whom 101 had a high-grade lesion and underwent LLETZ. All of them had CIN on histopathology. Thirty-five (34.6%) had CIN 1, 55 (54.5%) had CIN 2 and 11 (10.9%) has CIN 3. Treatment was described as effective if there was CIN of any grade in the LLETZ specimen overtreatment if there was no CIN. The SEE and TREAT approach was effective in all with no overtreatment. Complete excision was achieved in 96.04%women, 3.96% had positive resection margin.There were no major complications. Thus we conclude that a SEE AND TREAT approach in a low-resource setting with VIA followed by Colposcopy and treatment can help in reducing the number of visits and loss to follow-up.</p> <p> </p&gt

Vulval premalignant lesions: a review article

Vulvar intraepithelial neoplasia (VIN) is a noninvasive squamous lesion that is a precursor of vulvar squamous cell cancer. Currently, no screening tests are available for detecting VIN, and a biopsy is performed to confirm the clinical diagnosis. Despite sharing many risk factors with cervical intraepithelial neoplasia, the diagnosis of VIN is poses challenges, contributing to its increasing prevalence. This study aimed to analyze the underlying risk factors that contribute to the development of VIN, identify specific populations at risk, and define appropriate treatment approaches. Differentiated VIN (dVIN) and usual VIN (uVIN) are the classifications of VIN. While dVIN is associated with other vulvar inflammatory disorders, such as lichen sclerosis, the more prevalent uVIN is associated with an underlying human papillomavirus infection. Patients with differentiated VIN have an increased risk of developing invasive malignancies. Few effective surveillance or management techniques exist for vulvar intraepithelial neoplasia, a preinvasive neoplasm of the vulva. For suspicious lesions, a thorough examination and focused biopsy are necessary. Depending on the specific needs of each patient, a combination of surgical and medical approaches can be used

Diagnostic Efficacy of Enhanced Visual Assessment [Visual Check] for Triaging Cervical Cancer Screen Positive Women

Introduction: Colposcopy is important for triaging any abnormal cervical screening test. Scarcity of trained colposcopists and colposcopy centers is a big hurdle to screening programs in low- and middle-income countries. Objectives of the Study: The objective was to assess the performance of the artificial intelligence incorporated into the mobile optical device technologies (ODT) Enhanced Visual Assessment (EVA visual check) against physician colposcopic diagnosis and the gold standard of histopathology. Materials and Methods: It was a cross-sectional observational study conducted on women referred to a colposcopy clinic following an abnormal screening test. Colposcopic examination was performed by colposcopists using the MobileODT EVA system. Physician’s impression and Visual Check analysis were compared with the final histopathological analysis or cytology. Cases with normal cytology and normal colposcopy did not undergo biopsy, and these were considered normal. Results: A total of 2050 women were screened, and 147 screen-positive women were recruited in the study. EVA Visual Check had a sensitivity of 86.8% (75–95), specificity of 28.7% (20–39), positive predictive value (PPV) of 40.7% (32–50), negative predictive value (NPV) of 79.4% (62–91), and diagnostic accuracy of 49.7% (41–58) for diagnosing cervical intraepithelial neoplasia (CIN) 1+ lesions. EVA Visual Check has a sensitivity of 89.3% (72–98), specificity of 26.1% (18–35), PPV of 22.1% (15–31), NPV of 91.2% (76–98), and diagnostic accuracy of 38.1% (30–46) for CIN 2+ lesions. Conclusion: MobileODT EVA colposcope with AI has sensitivity comparable to physician’s diagnosis, whereas specificity, PPV, and NPV were less than that of physician’s diagnosis. It could prove valuable for triage of screen-positive women for further management