PCOS in adolescence: effect of metformin on menstrual irregularities

Background: PCOS is an endocrine disorder affecting women across lifespan, initially a disease of the females in the child bearing age group, nowadays maximum adolescent females also present with PCOS. Adolescence PCOS is a heterogenous endocrine disorder diagnosed in 5% to 10% of adolescent girls and is one of the major causes of adolescent hyperandrogenism and menstrual irregularity. Thus, this study was carried out to study the effect of Metformin on adolescent patients with PCOS on Weight reduction and Regularization of Menstrual cycle. Secondary objective is to study the occurrences of various manifestations in patients with PCOS.Methods: Patients aged 10-20 years diagnosed PCOS attending the outpatient department of OBGY over a period of two years were included in the study. Out of 100 patients, 20 patients were excluded because of other causes of anovulation viz thyroid abnormalities, prolactin level abnormalities and patients who did not turn up for follow up. Study was done on 80 patients of PCOS. Patients were divided into two groups A and B. Group A (n=40) received 500 mgs Metformin and Group B (n=40) received placebo. Results were analysed using statistical package of social sciences (SPSS) 21.0. Statistical significance was set at p ≤0.05.Results: In the present study Irregular cycle was the commonest occurring menstrual irregularity. Menstrual Cycle was regularised in 95% of the study group while only 35% of the control group. 85% patients in the present test group had lost weight at the end of 6 months while only 55% in the control group had lost weight in 6 months. Thus A 6-month course of metformin improves menstrual cyclicity in women with the PCOS.Conclusions: In patients with PCOS, the addition of insulin sensitizers viz metformin along with diet and lifestyle modifications has resulted in significant weight loss and improvement in cyclicity of menstrual cycle. Thus, Insulin-sensitizing agents provide a rational approach to the treatment of the metabolic and endocrine abnormalities in PCOS women    

A rare case of leiomyosarcoma arising from vault post-hysterectomy

Fibroid/Leiomyoma is the most common benign tumor of the uterus, arising from uterine smooth muscle. Atypical leiomyomas are rare forms of Myoma (fibroid uterus), of which recurrent atypical leiomyoma post hysterectomy is rarer and its converting in leiomyosarcoma arising from vault is rarest.  Here we report an unusual case of a 76yrs female, with leiomyosarcoma in an atypical leiomyoma arising from vault post-hysterectomy. A 76-year-old P3L3 patient presented with pain and distension of abdomen, post hysterectomy done 4 years back for chronic inversion and cervical fibroid polyp she was diagnosed as atypical leiomyoma. Laparotomy was done with a provisional diagnosis of leiomyosarcoma. Though Rarest (0.13-0.26%), a differential diagnosis of neoplastic changes should be kept in mind in patients with atypical leiomyoma, in patients presenting with any mass/pain abdomen, irrespective of any gynaecological complaints. This case shows that though it is unexpected after hysterectomy, leiomyosarcoma has to be considered in a case of abdominal mass. Atypical leiomyoma develops approximately in one to five cases out of 1,000 women with fibroid and it getting converted in leiomyosarcoma is rarest. Hence, diagnosis of leiomyosarcoma should always be kept in mind though the patient is hysterectomised

Degenerated fibroid - a diagnostic challenge

Leiomyoma of the uterus is the most common type of tumor affecting the female pelvis and arises from uterine smooth muscle. The size of leiomyoma varies from microscopic to giant; giant myoma is exceedingly rare. We report an unusual case of a large, cystic, uterine leiomyoma mimicking a primary malignant ovarian tumor on sonography and CT. A 39 year old infertile nulliparous woman presented with a history of lump in abdomen since 2 years and 6 months of amenorrhea. Sonography and CT examination showed a large mass that filled the abdomen. A preoperative diagnosis of a primary malignant ovarian tumor was made. The patient underwent laparotomy with total abdominal hysterectomy preserving tubes and ovaries. The histology revealed a leiomyoma with extensive hyaline degeneration. The current established management of uterine fibroids may include expectant, surgical, or medical management or uterine artery embolization or a combination of these treatments. A surgical approach is preferred for management of giant leiomyomas. Leiomyomas should be considered in the differential diagnosis of a multilocular and predominantly cystic adnexal mass

The diagnostic significance of hyperfibrinogenemia and thrombocytosis in patients with ovarian tumors/adnexal masses

Background: We aim to study the correlation of thrombocytosis and hyperfibrinogenemia with ovarian tumors and its role in the diagnosis of ovarian malignancy. And to evaluate the platelet and fibrinogen levels in early and advanced stage ovarian disease. Methods: This is a single centre prospective study. We evaluated plasma fibrinogen levels and plasma platelet levels in 250 patients in women presenting in our OPD with adnexal masses/ovarian tumors. Thrombocytosis was defined as a platelet count greater than >410,000/uL. Hyperfibrinogenemia was defined as a fibrinogen level higher than 360 mg/dL. The association between plasma fibrinogen, platelet levels and clinico-pathological, histopathological parameters were investigated in regards to: 1. Malignant or benign ovarian tumor. 2. Early or advanced disease in malignant ovarian tumors. A multivariate logistic regression model was performed to identify an independent association. Results: Thrombocytosis and hyperfibrinogenemia are seen to be associated with malignant ovarian tumors. In a multivariate model, plasma fibrinogen and plasma platelet levels were identified to be independently associated with the malignant ovarian tumours. Within the EOC cohort, patients with advanced stage disease had higher plasma fibrinogen levels than patients with early stage. Conclusions: In this study, we demonstrated that both thrombocytosis and hyperfibrinogenemia were positively associated with malignant ovarian tumors. They were also associated with advanced disease stage, elevated CA125 level and other markers. These finding are in accordance with the previous published data from patients with ovarian cancer, indicating that the platelet and fibrinogen levels increase in parallel with tumor progression and metastasis. Thus confirming the role of elevated platelet and fibrinogen levels in diagnosis and prognosis of ovarian Malignancy

Degenerated fibroid - a diagnostic challenge

Leiomyoma of the uterus is the most common type of tumor affecting the female pelvis and arises from uterine smooth muscle. The size of leiomyoma varies from microscopic to giant; giant myoma is exceedingly rare. We report an unusual case of a large, cystic, uterine leiomyoma mimicking a primary malignant ovarian tumor on sonography and CT. A 39 year old infertile nulliparous woman presented with a history of lump in abdomen since 2 years and 6 months of amenorrhea. Sonography and CT examination showed a large mass that filled the abdomen. A preoperative diagnosis of a primary malignant ovarian tumor was made. The patient underwent laparotomy with total abdominal hysterectomy preserving tubes and ovaries. The histology revealed a leiomyoma with extensive hyaline degeneration. The current established management of uterine fibroids may include expectant, surgical, or medical management or uterine artery embolization or a combination of these treatments. A surgical approach is preferred for management of giant leiomyomas. Leiomyomas should be considered in the differential diagnosis of a multilocular and predominantly cystic adnexal mass