Diffusion Weighted and Dynamic Contrast Enhanced Magnetic Resonance Imaging in Carcinoma of Cervix: Role of Apparent Diffusion Coefficient Value and Time Intensity Curve Pattern in Chemoradiotherapeutic Response Evaluation

Introduction: Magnetic resonance imaging (MRI) is a widely used imaging modality in the imaging evaluation of carcinoma of cervix. The aim of our study was to evaluate the response in carcinoma cervix patients following chemoradiotherapy by Diffusion weighted (DW-MRI) and Dynamic contrast enhanced-MRI (DCE-MRI). Methods: 21 inoperable biopsy proven patients (mean age 48.43 years) of carcinoma cervix were included in the study. All patients underwent MRI (conventional, DW and DCE) of the pelvis thrice. Baseline MRI, Post chemotherapy MRI after neoadjuvant chemotherapy and Post chemoradiotherapy MRI after completion of concurrent chemoradiotherapy. Post treatment apparent diffusion coefficient(ADC) values and Time intensity curve(TIC) pattern were compared with baseline values. Results: Baseline meanADC value of all patients was 0.82 x10-3 mm2/s. After completion of treatment, 18 patients showed complete resolution of tumor and showed 0.50 x10-3 mm2/s increase in meanADC value from baseline MRI which was significantly higher than remaining 3 patients with residual tumor (0.50 x10-3 mm2/s v/s 0.17 x10-3 mm2/s). ADC threshold value of 1.15 x10-3 mm2/s was defined, differentiating the residual tumor from the healthy cervical tissue after chemoradiation. On post treatment MRI, 17 out of 18 patients with complete resolution of tumor showed increasing trend of enhancement on TIC and only one patient showed plateau pattern. 2 of the 3 patients with residual tumor showed washout pattern and one patient showed plateau pattern. Conclusion: ADC values and TIC pattern differ in patients with complete response to chemoradiotherapy from patients with residual tumor, so helps in differentiating residual tumor from cancer free cervix. Keywords: Carcinoma of cervix; Chemoradiotherapy; Diffusion weighted MRI; Dynamic contrast enhanced MRI; Time intensity curve.

Metastatic squamous carcinoma of cervix with tricuspid valve involvement

Objective: To investigate the metastatic tumor with tricuspid valve involvement, and to improve the understanding of the disease and the level of diagnosis and treatment. Method: This article mainly reports a case of a metastatic squamous carcinoma of cervix(SCC) with tricuspid valve involvement patient treated with surgical treatment and followed up one year after surgery . Result: The prognosis of the case was good after surgery.But The short-term effect of the patient was not ideal. Conclusion: Metastatic tumor of tricuspid valve is infrequent,which is difficult to diagnose and treat because of the lack of specific clinical manifestations.To achieve better therapeutic effect, the multi-mode treatment strategy should be considered.

Glassy cell carcinoma of cervix

Objective: to identify the features of the frequency of occurrence, clinical presentation, methods of diagnosis and treatment of vitreous cell carcinomas of the cervix.Materials and methods. The publication highlights 4 cases of diagnosed GCC of the cervix at the N. N. Petrov National Medical Research Oncology Center for a five-year period from 2015 to 2020.Results. The incidence of vitreous cell carcinomas of the cervix is 1.08 % of all cases of cervical cancer. The study included only patients with locally advanced forms of stage II and III diseases. All patients underwent individualized treatment. In three cases, progression of the disease was observed during treatment.Conclusions. The main problem is the rare occurrence of vitreous cell carcinomas of the cervix. The choice of treatment tactics is decided only on a multidisciplinary basis and requires further research.

Glassy cell carcinoma of cervix: A case report

Glassy cell carcinoma of the cervix is a rare subtype of adenosquamous carcinoma associated with aggressive course and poor prognosis. It is considered to originate from the subcylindrical reserve cells of the cervix and has been associated with human papillomavirus. Histologically glassy cell carcinoma is composed of nestes of large cells with ground glass cytoplasm and large vesicular nuclei with prominent nucleoli. Nuclear pleomorphism and tumor giant cells are frequently seen. Mitotic activity is brisk. Infiltration by eosinophils and plasma cells with admixture of lymphocytes is a characteristic feature. Focal squamous and glandular differentiation may be seen. The immunohistochemistry markers are positive for squamous cell carcinoma (p63, CK34) and adenocarcinoma(MUC1, MUC2, CEA).Here we present a case of 49 year old female diagnosed as glassy cell carcinoma histologically and immunohistochemically.

Clinicopathological Features of Carcinoma of Cervix

Objective: To look at the age, stage at presentation, and morphology of cervix cancer patients. Study Design: Single institutional study. Place and Duration of Study:Department of Radiology, Peoples Medical College, Hospital, Nawabshah, Shaheed Benazirabad, and Sindh, Pakistan from January 1st 2018 to 31st December 2020. Methodology: Five hundred biopsy proven cases of carcinoma cervical cancer were enrolled and age at the time of presentation, histology, and stage after diagnosis were included. Results:68.4% females with cervical carcinoma were between the age of 40 to 59 years and majority of patients were belonged to the rural area with (73.7%). 75.1% of the patients had squamous cell carcinomas, 3.3% had adenosquamous carcinomas, and 17.9% had adenocarcinomas. Female patients have been stratified by stage of the disease in which 46.2 % belongs to the stage II. Conclusion: Majority of females have squamous cell carcinoma predominance over ardenosquamous carcinoma and adenocarcinoma and stage II was the most common in the females with carcinoma of cervix. Key Word Carcinoma, Cervix, Squamous cell

A Rare Case of Synchronous Ovarian Adenocarcinoma and Squamous Cell Carcinoma of Cervix

Synchronous tumours of gynaecological malignancies occur rarely and most of these cases are represented by synchronous ovarian and endometrial cancer. Synchronous malignancies of cervix and ovary are rare with poor prognosis. Only few cases of synchronous cancer of cervix and ovary are found in the literature as case reports. Here, we report a case of a 63 year old patient who was diagnosed with synchronous squamous cell carcinoma of cervix and high grade serous carcinoma of ovary in which her clinical presentation, investigation and intraoperative findings were atypical. Patient presented with postmenopausal bleeding and mass per abdomen. Pipelle sampling revealed squamous cell carcinoma of cervix. Examination under anaesthesia noted endocervical growth measuring 3×4 cm with endoluminal extension into the whole endometrial cavity. Computerized tomography (CT) imaging showed left ovarian mass measuring 10.0×11.7 cm. Uterine corpus involvement in this case mislead us to the initial diagnosis of ovarian metastasis in cervical cancer. The distinct histopathological features of the ovary, cervix and endometrial lesion post operatively helped in establishing the diagnosis of two separate primaries which was synchronous cervical and ovarian cancer rather than metastatic spread of one primary malignancy.

A study of histomorphology and immunohistochemistry of papillary squamotransitional cell carcinoma: A rare variant of squamous cell carcinoma of cervix.

Background: Papillary squamotransitional cell carcinoma is a histopathological subcategory of squamouscell carcinoma of the uterine cervix that often resembles transitional cell carcinoma of the urinary tract.Histologically, it can be misdiagnosed as transitional cell carcinoma or other papillary lesions of thecervix. Stromal invasion on biopsy is difficult to diagnose due to the exophytic papillary growth of thetumor. It also has a propensity for local recurrence and late metastasis. The study is performed to diagnoseand categorize this uncommon variant of carcinoma cervix.Materials and Methods: Eighteen cases of Papillary squamotransitional cell carcinoma were diagnosedon a punch biopsy specimen on routine hematoxylin and eosin-stained sections. The tumors werecategorized into three groups according to the percentage of squamous and transitional components.Further, immunohistochemical evaluation for cytokeratin7 and cytokeratin20 was done.Results: The mean age of the patients was 51.61 years (range 37-62 years). The most common clinicalpresentation was postmenopausal bleeding. All the cases showed papillary architecture with fibrovascularcores. The papillae were lined by three cell types: clear, intermediate, and basaloid. Stromal invasionwas seen in all the cases. All the cases showed positive immunostaining for cytokeratin7 and negativeimmunostaining for cytokeratin20.Conclusions: Papillary squamotransitional cell carcinoma deserves accurate pre-operative biopsydiagnosis due to the risk of misdiagnosis as benign papillary or malignant transitional lesions.Immunohistochemistry plays an important role in the diagnosis of these tumors and is recommended inevery case. Late recurrence and metastasis warrants a longer duration of follow up.