A prospective observational study on the effectiveness of risk of malignancy index score (RMI 3) in a tertiary care centre in Eastern India

Background: Adnexal mass is a common presentation in today’s gynecological practice. The incidence of ovarian cancer is increasing day by day and diagnosis is often difficult to be made pre operatively with inadequate surgical exploration is a regular occurrence. Aims and Objectives: To assess and validate the importance of RMI-3 score as pre-operative diagnostic tool of differentiating benign from malignant adnexal mass for starting first line therapy of ovarian cancer and to find out the incidences of ovarian malignancy among study population. Material and Methods: The study was conducted in the Department of Gynecology and Obstetrics on (n=115) patients attending GOPD and indoor with adnexal mass fulfilling the inclusion and exclusion criteria using purposive sampling technique. All the selected cases underwent ultrasonography and serum CA- 125 level estimation necessary for calculating RMI score. A score of >200 was taken as suggestive of malignancy and confirmatory diagnosis was performed by histopathological examination obtained from staging laparotomy of adnexal mass. The individual scores were then correlated with final outcomes with statistical analyses. Results: The study revealed benign ovarian tumors are more under 50 years (78.46%) and patients with normal BMI are diagnosed with maximum of malignancy (n = 28). History of tubal ligation carried less risk of malignancy (p<0.0001). Histologically malignant tumors found mostly in 71.4% postmenopausal group whereas 94.1% benign pathology were present in perimenopausal group and there is no association found between parity and histopathology (p=0.058). Bilateral (p=0.013), multilocular (p=0.000) tumors with solid areas (p<0.0001) and thick papillary projections (p<0.0001) had statistically significant association with malignant lesions. RMI score (>200) had more efficacy than serum CA-125 level (>46) in differentiating malignant lesions from benign one in terms of specificity (96% vs 83.87%) and positive predictive value (95% vs 79.17%). Conclusions: RMI-3 score is a simple, reliable and effective tool in differentiating benign from malignant adnexal masses thereby help in quick referral and management of cases with increase chances of survival of the patients.

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Study of ovarian cancer at a tertiary care centre

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20203300 ◽

2020 ◽

Vol 9 (8) ◽

pp. 3228

Author(s):

Jayashree Mulik ◽

Swapnil Khadse

Keyword(s):

Ovarian Cancer ◽

Tertiary Care ◽

Case Fatality ◽

Final Diagnosis ◽

World Health ◽

Ca 125 ◽

Tertiary Care Centre ◽

History Of ◽

Associated Risk Factors

Background: Despite major advances in case management, ovarian cancer continues to have the highest case fatality rate of all gynaecologic malignancies. There is paucity of meaningful screening and diagnostic protocols. Present study was planned with the objective of assessment of the prevalence of ovarian cancer and the associated risk factors at a tertiary care centre.Methods: The present prevalence study was conducted at a tertiary care government hospital and entailed analysis of data of 73 patients of ovarian cancer. All the participants were subjected to comprehensive history taking, followed by general, systemic, per-speculum and per-vaginal examination. Serum tumour markers of the patients were assessed. Imaging studies including ultrasound, CT or MRI abdomen/pelvis were done as per need. Final diagnosis was confirmed on histopathology and the cases were classified according to histological classification of World Health Organization.Results: Majority (41, 56.2%) were aged more than 45 years and above, most of them with one to two previous issues (64.3%). The disease was observed to be more common in postmenopausal women (65, 89%). Three fourth participants had negative family history of ovarian or breast cancer. Out of 73 patients, 31 had value of CA 125 between 150-400 U/mL and 42 had values >400 U/mL. Epithelial ovarian cancer (serous- 33, 45.2%, mucinous- 18, 24.7%) was observed to be the commonest histological type.Conclusions: To diagnose ovarian tumours early using multipronged approach with focussed risk factor identification and screening with CA-125 is very important and is strongly recommended.

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CA-125: A potential screening tool for benign and malignant lesions in post-menopausal females presenting with adnexal mass at a tertiary care center in Saurashtra region

International Journal of Clinical and Diagnostic Pathology ◽

10.33545/pathol.2021.v4.i3c.408 ◽

2021 ◽

Vol 4 (3) ◽

pp. 158-161

Author(s):

Prakhar Gupta ◽

Dr. Dhwani Pandya ◽

Nandini J Desai

Keyword(s):

Screening Tool ◽

Adnexal Mass ◽

Care Center ◽

Tertiary Care ◽

Ca 125 ◽

Tertiary Care Center ◽

Malignant Lesions ◽

Post Menopausal

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Pre-operative Assessment of Ovarian Tumor in Patients Presenting with Adnexal Mass on the Basis of Risk of Malignancy Index (RMI)

Journal of Shaheed Suhrawardy Medical College ◽

10.3329/jssmc.v9i2.37266 ◽

2018 ◽

Vol 9 (2) ◽

pp. 69-73

Author(s):

Sanjukta Chowdhury ◽

Raunak Jahan ◽

Dina Layla Hossain ◽

Fahmida Sharmin Joty ◽

Sumana Rahman ◽

...

Keyword(s):

Predictive Value ◽

Adnexal Mass ◽

Malignant Tumors ◽

Menopausal Status ◽

Ca 125 ◽

Cross Sectional ◽

Gynaecologic Cancer ◽

Ultrasound Findings ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index

Background:Ovarian cancer is the second most common gynaecologic cancer in developing countries. Five-year survival of ovarian cancer varies according to stages, hence, screening, detection and treatment in earlier stages are of great importance. The Scottish Intercollegiate Guidelines Network (SIGN) recommends use of Risk of Malignancy Index (RMI) for preoperative assessment of ovarian tumours. It is a scoring system based on menopausal status, ultrasound findings, and serum CA 125 level in adnexal mass.Objective:To investigate the accuracy of RMI as a predictive method of discriminating benign from malignant ovarian tumour.Methodology: Fifty patients, 30 years or older, with adnexal mass, admitted for laparotomy in Obstetrics and Gynaecology Dept. from April’13 to September’13were randomly assigned in this cross-sectional descriptive study. RMI was calculated for each patient based on menopausal status, CA125 level and ultrasound findings of bilateral lesion, multilocular cyst, solid areas, ascites and metastases.Results:Among 50 women, 18 cases (36%) were postmenopausal showing more malignant tumors (77.78%) in this group. Depending on histopathological reports, 82% benign and 18% malignant diseases.The best performance of RMI was obtained at cut-off value of 230 with sensitivity of 100%, specificity of 95.2%, positive predictive value (PPV) of 80% and negative predictive value (NPV) 100%. Conclusion:Compared to previous studies, RMI was highly sensitive in detecting malignant disease, though not as specific in excluding benign lesions, particularly endometriosis.J Shaheed Suhrawardy Med Coll, December 2017, Vol.9(2); 69-73

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A novel decision tree model based on chromosome imbalances in cell-free DNA and CA-125 in the differential diagnosis of ovarian cancer

The International Journal of Biological Markers ◽

10.1177/1724600821992356 ◽

2021 ◽

pp. 172460082199235

Author(s):

Weina Zhang ◽

Yu-min Zhang ◽

Yuan Gao ◽

Shengmiao Zhang ◽

Weixin Chu ◽

...

Keyword(s):

Ovarian Cancer ◽

Differential Diagnosis ◽

Decision Tree ◽

Copy Number ◽

Malignant Tumors ◽

Copy Number Variations ◽

Ca 125 ◽

Benign Tumors ◽

Cell Free Dna ◽

Free Dna

Objective: CA-125 is widely used as biomarker of ovarian cancer. However, CA-125 suffers low accuracy. We developed a hybrid analytical model, the Ovarian Cancer Decision Tree (OCDT), employing a two-layer decision tree, which considers genetic alteration information from cell-free DNA along with CA-125 value to distinguish malignant tumors from benign tumors. Methods: We consider major copy number alterations at whole chromosome and chromosome-arm level as the main feature of our detection model. Fifty-eight patients diagnosed with malignant tumors, 66 with borderline tumors, and 10 with benign tumors were enrolled. Results: Genetic analysis revealed significant arm-level imbalances in most malignant tumors, especially in high-grade serous cancers in which 12 chromosome arms with significant aneuploidy ( P<0.01) were identified, including 7 arms with significant gains and 5 with significant losses. The area under receiver operating characteristic curve (AUC) was 0.8985 for copy number variations analysis, compared to 0.8751 of CA125. The OCDT was generated with a cancerous score (CScore) threshold of 5.18 for the first level, and a CA-125 value of 103.1 for the second level. Our most optimized OCDT model achieved an AUC of 0.975. Conclusions: The results suggested that genetic variations extracted from cfDNA can be combined with CA-125, and together improved the differential diagnosis of malignant from benign ovarian tumors. The model would aid in the pre-operative assessment of women with adnexal masses. Future clinical trials need to be conducted to further evaluate the value of CScore in clinical settings and search for the optimal threshold for malignancy detection.

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HISTOPATHOLOGICAL EVALUATION OF WHO CLASSIFIED MULTIBACILLARY LEPROSY CASES IN A TERTIARY CARE CENTRE, SOUTH KERALA

10.36106/ijsr/9403958 ◽

2021 ◽

pp. 32-34

Author(s):

Anita Sanker ◽

G Nandakumar ◽

Swapna Balkrishnan

Keyword(s):

Immune Response ◽

Histopathological Examination ◽

Tertiary Care ◽

Newly Diagnosed ◽

Epithelioid Cells ◽

Tertiary Care Centre ◽

Medical College ◽

Leprosy Patients ◽

Epidermal Atrophy ◽

Multibacillary Leprosy

There are signicant differences in the histopathology of leprosy lesions which is inuenced by the host immune response to Mycobacterium leprae. Objective - To nd the histopathological changes in newly diagnosed multibacillary leprosy(MB) cases registered in the skin department Government Medical College, Thiruvananthapuram. Method- skin biopsy performed in 40 multibacillary leprosy cases and histopathological ndings were evaluated. 70% showed epidermal atrophy. Granulomas, composed of sheets of foamy macro Results- phages, lymphocytes and epithelioid cells, were seen in 21 cases & twenty two cases were AFB positive. Eight cases each were lepromatous, borderline tuberculoid, mid boderline, borderline lepromatous types. Conclusion- Presence of 60% cases of borderline leprosy indicates the unstable immune response in leprosy patients. Majority were either borderline lepromatous or lepromatous showing the infective nature of multibacillary leprosy. Histopathological examination with Fite- Foroco staining is a crucial method and the gold standard for accurate diagnosis and typing of leprosy.

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SPECTRUM OF HISTOPATHOLOGICAL LESIONS OF FEMALE GENITAL TRACT - STUDY IN A TERTIARY CARE CENTRE

10.36106/ijsr/8118624 ◽

2021 ◽

pp. 19-21

Author(s):

Naik Viraj R ◽

Manjusha Jindal ◽

Siddhi D. Naik

Keyword(s):

Genital Tract ◽

Malignant Tumors ◽

Benign Lesion ◽

Tertiary Care ◽

Female Genital Tract ◽

Screening Methods ◽

Tertiary Care Centre ◽

Chi Square ◽

Histopathological Lesions ◽

Female Genital

Introduction: (1) The female genital tract is constituted by the ovaries, fallopian tubes, uterus (body/corpus and cervix), vagina, and vulva. Female genital tract lesions can be benign or malignant. Our study was carried out to nd out the frequency of various histopathological lesions including neoplasms of female genital tract. Materials and Methods: Our study is retrospective conducted over 2 years period. Data was collected from case records of patients presenting to Goa Medical College and histopathology reports obtained from Dept of pathology. Data was represented in form of charts and tables. The analysis of statistical data of variables was done using SPSS software version 22. Signicance was calculated using chi square test. Value of p <0.05 was considered signicant. Results: Out of total 270 subjects studied, 229 were having benign lesions and 41 had malignant lesions.The mean age was 49.5 years. Leiomyoma was diagnosed in (40.58%) cases. In abnormalities of endometrium proliferative endometrium was seen in 37.6%. Chronic cervicitis was seen 78.74% cases. Among the ovarian lesions, 67.74% cases were simple follicular cysts. Cervical cancer was found in 73.17% cases followed by ovarian malignancies in 19.51 % cases, endometrial carcinoma in 4.87% cases and vulvar cancer in 2.44% cases. Among the malignant tumors (58.54%) cases were postmenopausal women. Conclusion: Microscopic assessment and clinico-pathological correlation of lesions is necessary as grossly identiable benign lesion may harbour a focus of malignancy. It aids to appropriate management in the postoperative period. A concerted effort should be done towards prevention of cancers, by creating awareness through health education in addition to implementation of screening methods.

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Histopathological Study of Lesions of the Nasal Cavity, Paranasal Sinuses and Nasopharynx in a Tertiary Care Centre, Visakhapatnam over a Period of 2 Years

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/557 ◽

2021 ◽

Vol 8 (33) ◽

pp. 3054-3059

Author(s):

Rajendra Prasad Jagannadham ◽

Lakshmi Latchupatula ◽

Sravani Ponnada ◽

Neelima Lalam ◽

Raghunadhababu Gudipudi ◽

...

Keyword(s):

Nasal Cavity ◽

Paranasal Sinuses ◽

Histopathological Examination ◽

Tertiary Care ◽

Histopathological Study ◽

Histopathological Diagnosis ◽

Malignant Tumours ◽

Tertiary Care Centre ◽

Female Ratio ◽

Male Predominance

BACKGROUND A variety of non - neoplastic and neoplastic conditions involve the nasal cavity, paranasal sinuses and nasopharynx and these are very common lesions encountered in clinical practice. Histopathological examination of these lesions is the gold standard for diagnosis because management and prognosis vary among different lesions. The aim of the present study was to evaluate the histopathological study of the lesions of the nasal cavity, paranasal sinuses and nasopharynx in relation to their incidence, age, gender and site wise distribution and to compare the results with the available data. METHODS A study of 88 cases was conducted for a period of 2 years from August 2017 to July 2019. After fixation, Processing and Haematoxylin and Eosin staining and special stains histopathological diagnosis was made. RESULTS Among 88 total cases, 58 were males and 30 were females. A male predominance was observed with a male to female ratio of 1.93 : 1. They were more common in third, fourth and fifth decade of life. Malignant nasal lesions were seen after fourth decade of life. Nasal lesions were more common in nasal cavity (67.05 %), followed by paranasal sinuses (18.18 %) and nasopharynx (14.75). Out of 88 total cases, 39 (44.32 %) were non - neoplastic, 30 (34.09 %) were benign and 19 (21.59 %) were malignant nasal lesions. CONCLUSIONS Sinonasal lesions and nasopharyngeal lesions can have various differential diagnoses. A complete clinical, radiological and histopathological correlation helps to categorize these sinonasal lesions into various non - neoplastic and neoplastic types. But histopathological examination remains the mainstay of definitive diagnosis. KEYWORDS Nasal Cavity, Paranasal Sinuses, Nasopharynx, Benign Tumours, Malignant Tumours, Histopathological Examination

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Clinico-Pathological Study of Ocular Surface Squamous Neoplasia in a Tertiary Care Centre of Western Region of Nepal

Journal of Universal College of Medical Sciences ◽

10.3126/jucms.v7i1.24677 ◽

2019 ◽

Vol 7 (1) ◽

pp. 9-13

Author(s):

Sushila Patel ◽

Binita Bhattarai Pokharel ◽

Anita Shah ◽

Manita Sunam Goda ◽

Saraswati Khadka Thapa

Keyword(s):

Ocular Surface ◽

Histopathological Examination ◽

Tertiary Care ◽

Western Region ◽

Invasive Squamous Cell Carcinoma ◽

Care Centre ◽

Ocular Surface Squamous Neoplasia ◽

Tertiary Care Centre ◽

Male Predominance ◽

Wide Range

INTRODUCTION: Ocular surface squamous neoplasia (OSSN) consists of a wide range of conjunctival and corneal lesions ranging from dysplastic lesions to invasive squamous cell carcinoma. In recent times, the incidence of OSSN seems to be on the rise, especially in developing countries. The present study was aimed to analyse demographic pattern, clinical characteristics, and histopathology findings of OSSN in a tertiary care centre of western region of Nepal. MATERIAL AND METHODS: It was a retrospective study. We analyzed 94 cases of OSSN who presented to cornea department of Lumbini Eye Institute, Bhairahawa, Nepal over a period 1.5 years from 1st July 2017 to 31st December 2018. All the patients with OSSN, detailed clinical history and examination were recorded. Lesions were excised with a 3 mm margin clearance and sent for histopathological examination. RESULTS: Mean age of our patients with OSSN was 48.89±17.955 years ranging from 17 to 85 years. There were 52 (55.32%) male and 42 (44.68%) female. Mean duration of presentation was 6.34±6.17 months. A solitary nodule at the limbus was the commonest presentation. Right eyes were involved more than left eyes. Lesions were found most commonly on temporal site 52 (55.32%) followed by nasal 36 (38.30%). On histopathological examination benign lesions were found in 31 (32.98%) eyes, preinvasive lesion in 50 (53.19%) eyes and invasive lesions in 13 (13.83%) eyes. CONCLUSION: OSSN were seen more commonly in young adults with male predominance. Benign and pre invasive lesions are found more commonly than invasive lesions.

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Nasomaxillary swellings: our experience at tertiary care hospital

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20210680 ◽

2021 ◽

Vol 7 (3) ◽

pp. 469

Author(s):

Mukesh Rawat ◽

Archana Lall ◽

Kavita Sachdeva

Keyword(s):

Tertiary Care Hospital ◽

Histopathological Examination ◽

Tertiary Care ◽

Final Diagnosis ◽

Inverted Papilloma ◽

Nasal Endoscopy ◽

Common Symptom ◽

Fungal Sinusitis ◽

Care Hospital ◽

Malignant Lesions

Background: A wide spectrum of lesions may present as nasomaxillary swellings ranges from benign to malignant lesions including fungal sinusitis and fibro vascular lesions example: JNA (Juvenile nasopharyngeal angiofibroma) and Inverted papilloma. Many Pathologies ranging from benign to malignant tumors may mimic a simple Nasomaxillary mass. It is diagnostic challenge to determine pathology behind it. A detailed clinical evaluation with nasal endoscopy and relevant pre-operative investigations including radiological imaging and histopathological examination is essential to reach up to final diagnosis. The aim of the study was to do clinicopathological evaluation of patients presenting with nasomaxillary swelling and correlation of clinical, radiological and Histopathological findings.Methods: This was a prospective observational study on 50 nasomaxillary swelling patients who are presented in the Department of ENT and Head and Neck Surgery of N.S.C.B. MCH Jabalpur, a tertiary care Hospital, between March 2018 to August 2019. A detailed history taking and clinical examination with nasal endoscopy and relevant preoperative investigations including CECT Nose and PNS and histopathological examination was done in all patients.Results: 50 Nasomaxillary swelling patients were selected for this study. 30 patients were male and 20 were females. Ages of patients were varied from 12 years to 72 years. 23 patients (46%) were malignant and 27 (54%) were benign. Histopathological examination results shows benign lesions like JNA (6 cases), fungal sinusitis (6 cases), dermoid cyst (1 case), inverted papilloma (3 cases), sebaceous cyst (1 case), jaw lesions (10 cases), (odontogenic like radicular/ infected cyst, dentigerous cyst, cystic ameloblastoma and non-odontogenic like fibrous dysplasia) and malignant lesions like SCC (squamous cell carcinoma) (12 cases), spindle cell sarcoma (2 cases), undifferentiated carcinoma (3 cases), adenocarcinoma (3 cases), adenoid cystic carcinoma (1 case), Invasive pleomorphic sarcoma (1 case) and malignant melanoma (1 case). SCC was most common lesion f/b JNA and fungal sinusitis. Well differentiated SCC was most common histological type (10 out of 12 cases of SCC). Most common symptom was nasal obstruction (66% cases) f/b epistaxis (52% cases) but epitasis was most common symptom among malignant and JNA cases. In 6 cases (3 JNA, 1 inverted papilloma, 1 malignancy and 1 radicular cyst) radiological diagnosis were not correlated with histological findings.Conclusions: Most our cases were malignant nasomaxillary lesions followed by fungal sinusitis and JNA. Most patients presented in advanced stage of disease so rapidly evaluation including nasal endoscopy should be done. CECT scan is essential to determine tumors extent and bony lesions. All patients should undergo hisotopatholigical examination. The final diagnosis should be made on the basis of clinical, radiological and histopathological findings.

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