Internal jugular vein thrombosis presenting as paraneoplastic syndrome in benign cystic teratoma of ovary: a case report

Internal jugular vein thrombosis is a rare vascular disease that can be overlooked or misdiagnosed and is generally seen in persons with intravenous drug abuse or in patients with prolonged central venous catheterization due to iatrogenic trauma. The most common germ cell tumour of the ovary is benign (mature) cystic teratoma, occurring in adolescents and young women. We are presenting a case of a 50-year-old premenopausal woman, diagnosed to have right internal jugular vein thrombosis extending into the right subclavian and axillary vein. Her laboratory investigations revealed no predisposing cause of thrombosis. Four months later she was evaluated for menorrhagia and imaging studies showed multiple uterine fibroids with left ovarian mass (ovarian teratoma) with moderate ascites and her tumour markers levels of CA125 was elevated. She underwent staging laparotomy, total abdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic lymph node dissection with infracolic omentectomy. Pathologically, ovarian cyst showed mature thyroid tissue with islands of bone, muscle tissue and fatty tissue consistent with benign cystic teratoma. Postoperatively her tumour marker CA125 level returned to normal levels and there was no reaccumulation of fluid. As there were no predisposing factors for internal jugular vein thrombosis, it was concluded to be a paraneoplastic syndrome preceding the diagnosis of benign cystic teratoma. To the best of our knowledge this is the first case report in the literature with an association between internal jugular vein thrombosis and benign cystic teratoma with raised serum tumour marker CA 125

A 3 year retrospective study on gestational trophoblastic disease in a government obstetrical tertiary care centre

Background: The aim of this study is to assess the post diagnostic outcome of Gestational Trophoblastic Disease, a heterogeneous group of disorders, in a government obstetrical tertiary care centre.Methods: The study was conducted in the Institute of Obstetrics & Gynecology, Madras Medical College as a retrospective study. A total of 75 cases were studied over a 3 year period from January 2012 to December 2015. The parameters which were studied included age group, antecedent pregnancy, beta hCG values, histopathological types and Treatment profile.Results: Of the 75 cases, 55 cases (73%) were in the 21-39 age group. The spectrum of disorders that were studied included 69 cases of complete mole, 2 cases of partial mole, 1 case of twin pregnancy with single live foetus and partial mole, 1 case of triplet pregnancy with two live foetuses and partial mole, 1 case of epithelioid trophoblastic tumour and 1 case of choriocarcinoma. Of the 75 cases, 16 cases underwent chemotherapy. No mortality was observed during the study period.Conclusions: Close monitoring and follow up with beta hCG values is of utmost importance in the management of Gestational trophoblastic disease. In cases of gestational trophoblastic neoplasia (GTN), WHO/FIGO scoring should be done and managed with chemotherapy according to the risk assessment

Steroid cell tumour of the ovary: a case report with review of literature

Virilising ovarian tumours account for less than 5% of all ovarian tumours. A steroid cell tumour (SCTs) of the ovary comes under the sex cord stromal tumours and accounts for only 0.1% of all ovarian tumours. Almost 75% are functioning tumors with production of androgenic hormones causing virilisation and cushingoid features. They are usually unilateral, benign with only 25-45% malignant cases. Here authors report the incidence of steroid cell tumour in our institution and discuss about a 37-year-old woman with steroid cell tumour, not otherwise specified who presented with oligomenorrhea followed by amenorrhea, secondary infertility and signs of virilisation

A rare case report of congenital high airway obstruction syndrome presenting in a 23 weeks foetus

Congenital High Airway Obstruction Syndrome or CHAOS is a blockage of the foetus’s trachea or larynx due to many factors including narrowing of the airway, a web-like membrane or even tracheal atresia. In the uterus, the foetal lungs constantly produce fluid and as a result of this airway blockage in the trachea, the lung fluid cannot escape out of the foetal mouth. Because of this the foetus’s lungs become distended with fluid and over distended lungs can put pressure on the heart and affect the heart’s ability to function. If the heart cannot function effectively hydrops or congestive heart failure can occur. We present a rare case of CHAOS diagnosed prenatally at about 23 weeks by USG in our hospital

Single tertiary care centre experience of ovarian granulosa cell tumour in Chennai, India: a retrospective analysis

Background: Granulosa cell tumours of ovary are rare sex-cord stromal tumours characterized by long natural history and favourable prognosis. The present study was done to evaluate the clinical presentation, treatment, outcome, and prognostic factors for patients diagnosed as granulosa cell tumours.Methods: A Retrospective study of Granulosa cell tumour of the ovary was done for a period of five years from January 2011 to December 2015 at a tertiary care centre, Institute of Obstetrics and Gynaecology, Madras Medical College, Chennai. The clinical data and the treatment details were retrieved from the records of medical oncology department and the data were analysed.Results: Twenty five patients were diagnosed as granulose cell tumours of ovary during the study period. The median patient age was 48 years. The most common clinical presentation at diagnosis was vaginal bleeding (76%) followed by abdominal pain (40%). Mean tumor size was 9.6cm. The majority of patients were diagnosed in FIGO stage Ia (84%, n = 21). Thirteen patients (52%) underwent complete staging laparotomy. Twenty three patients (92%) had Adult Granulosa cell tumour. Two patients (8%)had juvenile Granulosa cell tumour. After surgery, all patients were put on observation except two patients who received adjuvant chemotherapy (EP: Etoposide, Cisplatin). The median followup period was 48 months. Five patients (20%) had recurrence; The average time to relapse was 29.6 months. Patients who had tumour size more than 9.7cm had more recurrence events (Hazard Ratio(HR):1.058), but their association is not significant (P value-0.839). The association between menopausal status, torsion of tumour mass, tumour stage with recurrence rate were not significant. The estimated mean overall survival was 84.8 months. Following univariate Cox regression modeling, survival appeared to be independent of age range, post operative residual tumour and the FIGO stage.Conclusions: Granulosa cell tumours of ovary are rare, often diagnosed in early stage. Patients who had tumour size of more than 9.7cm had more recurrence events. A prolonged post therapeutic follow-up is necessary to pick up the late relapses

Internal jugular vein thrombosis presenting as paraneoplastic syndrome in benign cystic teratoma of ovary: a case report

Internal jugular vein thrombosis is a rare vascular disease that can be overlooked or misdiagnosed and is generally seen in persons with intravenous drug abuse or in patients with prolonged central venous catheterization due to iatrogenic trauma. The most common germ cell tumour of the ovary is benign (mature) cystic teratoma, occurring in adolescents and young women. We are presenting a case of a 50-year-old premenopausal woman, diagnosed to have right internal jugular vein thrombosis extending into the right subclavian and axillary vein. Her laboratory investigations revealed no predisposing cause of thrombosis. Four months later she was evaluated for menorrhagia and imaging studies showed multiple uterine fibroids with left ovarian mass (ovarian teratoma) with moderate ascites and her tumour markers levels of CA125 was elevated. She underwent staging laparotomy, total abdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic lymph node dissection with infracolic omentectomy. Pathologically, ovarian cyst showed mature thyroid tissue with islands of bone, muscle tissue and fatty tissue consistent with benign cystic teratoma. Postoperatively her tumour marker CA125 level returned to normal levels and there was no reaccumulation of fluid. As there were no predisposing factors for internal jugular vein thrombosis, it was concluded to be a paraneoplastic syndrome preceding the diagnosis of benign cystic teratoma. To the best of our knowledge this is the first case report in the literature with an association between internal jugular vein thrombosis and benign cystic teratoma with raised serum tumour marker CA 125

A rare case report of congenital high airway obstruction syndrome presenting in a 23 weeks foetus

Congenital High Airway Obstruction Syndrome or CHAOS is a blockage of the foetus’s trachea or larynx due to many factors including narrowing of the airway, a web-like membrane or even tracheal atresia. In the uterus, the foetal lungs constantly produce fluid and as a result of this airway blockage in the trachea, the lung fluid cannot escape out of the foetal mouth. Because of this the foetus’s lungs become distended with fluid and over distended lungs can put pressure on the heart and affect the heart’s ability to function. If the heart cannot function effectively hydrops or congestive heart failure can occur. We present a rare case of CHAOS diagnosed prenatally at about 23 weeks by USG in our hospital

A 3 year retrospective study on gestational trophoblastic disease in a government obstetrical tertiary care centre

Background: The aim of this study is to assess the post diagnostic outcome of Gestational Trophoblastic Disease, a heterogeneous group of disorders, in a government obstetrical tertiary care centre.Methods: The study was conducted in the Institute of Obstetrics & Gynecology, Madras Medical College as a retrospective study. A total of 75 cases were studied over a 3 year period from January 2012 to December 2015. The parameters which were studied included age group, antecedent pregnancy, beta hCG values, histopathological types and Treatment profile.Results: Of the 75 cases, 55 cases (73%) were in the 21-39 age group. The spectrum of disorders that were studied included 69 cases of complete mole, 2 cases of partial mole, 1 case of twin pregnancy with single live foetus and partial mole, 1 case of triplet pregnancy with two live foetuses and partial mole, 1 case of epithelioid trophoblastic tumour and 1 case of choriocarcinoma. Of the 75 cases, 16 cases underwent chemotherapy. No mortality was observed during the study period.Conclusions: Close monitoring and follow up with beta hCG values is of utmost importance in the management of Gestational trophoblastic disease. In cases of gestational trophoblastic neoplasia (GTN), WHO/FIGO scoring should be done and managed with chemotherapy according to the risk assessment