EP.TH.717Triple tumour: A myriad of serial incidental findings in a patient presenting with Gallstone pancreatitis

Aim To present a rare incidental synchronous triple tumours - colonic adenocarcinoma, endometroid ovarian adenocarcinoma and benign Brenner tumour in a patient admitted with acute gallstone pancreatitis. Methods A 75-year-old female presented with epigastric pain. Blood-tests and USS abdomen confirmed gallstones and pancreatitis. She was treated conservatively. USS also showed incidental pelvic mass which was further characterised by CT and MR scans. These scans confirmed heterogeneous lobulated mass in the left adnexa. CT scan also picked-up incidental mass in transverse colon, which was confirmed as cancer by colonoscopy. She was offered therapeutic resection after discussion in Colorectal and Gynaecology MDT. Intra-operatively, transverse colonic tumour was invading into the proximal ileum. Laprascopic surgery concluded with extended right hemicolectomy, small bowel resection-anastomosis, omentectomy, total abdominal hysterectomy and bilateral salpingo-oophorectomy. Results The patient had gradual recovery without any complications. Histopathology showed T4N2 poorly differentiated adenocarcinoma of colonic mass, FIGO grade 1 stage 1c endometrioid adenocarcinoma of left ovary and benign brenner tumour of right ovary. Post-operative MDT did not offer adjuvant-therapy due to slow recovery and fraility. So far, two-years of follow-up did not show any recurrence. Conclusion This report adds to the limited literature of triple synchronous tumours, including rare Brenner accounting for 5% of benign ovarian tumours and endometrioid ovarian tumour with an incidence of 4 -7%. Multi-disciplinary approach and combined surgery can achieve a desirable outcome in such complex cases. It is crucial to identify the primary status of the tumours as it will guide the adjuvant treatment.

Other disorders of women’s health

This chapter covers other disorders that are not covered elsewhere in this book. It includes fibroids, endometriosis, chronic pelvic pain, benign ovarian tumours, vulval disorders (cysts, dermatosis, intraepithelial neoplasia, and vulval pain), and female genital mutilation. For each diagnosis it gives definitions, assessment, diagnosis, and treatment regimes. For endometriosis, both surgical and medical treatments are discussed.

The attributes of plakins in cancer and disease: perspectives on ovarian cancer progression, chemoresistance and recurrence

The plakin family of cytoskeletal proteins play an important role in cancer progression yet are under-studied in cancer, especially ovarian cancer. These large cytoskeletal proteins have primary roles in the maintenance of cytoskeletal integrity but are also associated with scaffolds of intermediate filaments and hemidesmosomal adhesion complexes mediating signalling pathways that regulate cellular growth, migration, invasion and differentiation as well as stress response. Abnormalities of plakins, and the closely related spectraplakins, result in diseases of the skin, striated muscle and nervous tissue. Their prevalence in epithelial cells suggests that plakins may play a role in epithelial ovarian cancer progression and recurrence. In this review article, we explore the roles of plakins, particularly plectin, periplakin and envoplakin in disease-states and cancers with emphasis on ovarian cancer. We discuss the potential role the plakin family of proteins play in regulating cancer cell growth, survival, migration, invasion and drug resistance. We highlight potential relationships between plakins, epithelial-mesenchymal transition (EMT) and cancer stem cells (CSCs) and discuss how interaction of these processes may affect ovarian cancer progression, chemoresistance and ultimately recurrence. We propose that molecular changes in the expression of plakins leads to the transition of benign ovarian tumours to carcinomas, as well as floating cellular aggregates (commonly known as spheroids) in the ascites microenvironment, which may contribute to the sustenance and progression of the disease. In this review, attempts have been made to understand the crucial changes in plakin expression in relation to progression and recurrence of ovarian cancer.

TCP1 Regulates PI3K/AKT/mTOR Signalling Pathway to Promote Ovarian Cancer Cell Proliferation

ObjectiveTCP1 is one of the eight subunits of the TCP1 ring complex (TRiC) or the multi-protein mammalian cytosolic chaperone complex. TRiC participates in protein folding and regulates the expression of multiple signalling proteins and cytoskeletal components in cells. Although the clinical importance of its subunits has been clarified in various carcinomas, the function of TCP1 in ovarian cancer (OC) remains unclear. We aimed to identify the association between the expression of TCP1 and epithelial ovarian cancer (EOC) development and patients’ prognosis, and explore the underlying mechanisms of TCP1 on the tumour progression of ovarian cancer cells.MethodsTCP1 protein expression was tested in the various ovarian tissues by immunohistochemistry (IHC), and the correlation between TCP1 expression and clinical physiologic or pathologic parameters of EOC patients was analyzed in this study. The relationship between TCP1 expression and ovarian cancer patients’ prognosis was collected and analyzed using the Kaplan-Meier (KM) Plotter online database. Then, the expression levels of TCP1 was tested in different OC cell lines by Western blot. Furthermore, a model using ovarian cancer cell line A2780 was constructed for studying the functions of TCP1 in human EOC cell growth, migration, and invasion. Finally, possible regulated signalling pathways were discussed.ResultsTCP1 protein expression in ovarian cancer or borderline tissue was significantly higher compared to that in benign ovarian tumours and normal ovarian tissue. The upregulated expression of TCP1 in ovarian cancer was positively associated with and the differentiation grade and FIGO stage, which predicted poor clinical outcomes. Compared with IOSE-80 cells, TCP1 protein was overexpressed in the A2780 cells. TCP1 knockdown using shRNA lentivirus inhibited cell viability in A2780 cells. Western blot showed that the phosphatidylinositol-3 kinase (PI3K) signalling pathway was activated in the tumour invasion of EOC driven by TCP1. ConclusionThe protein level of TCP1 is overexpressed in aggressive histologic types of epithelial ovarian cancer. Upregulated TCP1 is correlated with poor prognosis of patients and TCP1 may serve as a novel prognostic biomarker. The mechanism of cancer progression promoted by TCP1 upregulation may be linked to the PI3K signalling pathway activation and TCP1 may serve as a novel target for ovarian cancer treatment.

Gynaecology

This chapter in the Oxford Handbook of Clinical Specialties describes the gynaecology specialty, including history and examination, sexual health and dysfunction, gynaecological anatomy, genital abnormalities, and female genital mutilation. It also explores menstruation, polycystic ovarian syndrome, menorrhagia, premenstrual syndrome, menopause, and HRT (hormone replacement therapy). It discusses pregnancy, including termination, miscarriage, and ectopic pregnancy. It investigates the vulva, vaginal discharge, PID (pelvic inflammatory disease), the uterus, pelvic pain, dyspareunia, fibroids (uterine leiomyomata), and endometriosis. It explores subfertility and ovarian hyperstimulation syndrome. It describes contraception and sterilization, as well as incontinence and prolapse. It investigates vulval lumps, ulcers, carcinoma, and cervical screening. It describes cancer, including vaginal, ovarian, and endometrial, as well as benign ovarian tumours and gynaecological surgery.

Relationship of Age and Different Histological Types of Ovarian Tumors

Background: Ovarian tumours are common problem in gynaecology and have varied age of appearance of different histopathological types. Objective: This study was undertaken to find out the relationship of age and different histological types of ovarian tumors Methods: A retrospective study was carried out in the Department of Obstetrics and Gynaecology and Department of Pathology, Sir Salimullah Medical College and Mitford Hospital, Dhaka, during May 2010 and December 2014. Five hundred forty seven (547) cases of ovarian tumours were studied in respect to their age and histopathological appearance. Results: The range of age of patients with ovarian tumour was 11 – 82 years. About 63% malignant and 73% benign ovarian tumours were found in the age group of 20 – 49 yrs. About 31% malignant ovarian tumours and 15% Benign tumours occurred in menopausal woman (≤50 yrs.). Overall, mean age of presentation of ovarian tumours was 34.29± 12.84 yrs. Mean age of patients with malignant ovarian tumour was 40.29± 14.28 (median 40 yrs; mode 45 yrs.). Mean age of benign ovarian tumour was 34.69 ± 13.08 (median 34 yrs; mode 40yrs) and mean age for borderline tumours 32.75 ± 11.70 mm (median 33 yrs., mode 20 yrs.). Mean age of non tumour ovarian masses / cysts was 31.14± 10.76 yrs (median 29.5; mode 25.4). The difference of mean age of occurance of malignant and benign ovarian tumours were statistically significant P<0.00>. Dysgerminoma (mean age 23.5± 4.43) and yolk sac tumour (mean age 18 .00 ± 5.00 yrs) occurred in younger patients. Serous cyst adenocarcinoma, endometriod carcinoma and poorly differentiated carcinoma occurred around 45 years of age. Mean age of presentation of most of the benign ovarian tumours was between 30 – 37 yrs.; except thecoma which occurred in extremes of age. Conclusion: Most of the patients with malignant and benign ovarian tumours have presented in reproductive age adult women (20 – 49 yrs.); and some specific varieties of tumour (e.g. thecoma) presented in the extremes of age. Bangladesh J Obstet Gynaecol, 2017; Vol. 32(2) : 99-105

Acute abdomen with adnexal masses in the reproductive age group: diagnosis and management

Background: Women with adnexal masses can present with acute symptoms such as abdominal pain, nausea and vomiting. As there is insufficient evidence on the frequency, presentation and management of adnexal masses we conducted this study to evaluate the clinical profile, surgical findings and histopathology of adnexal masses in women presenting with acute abdomen and needing surgical intervention.Methods: In this prospective observational study, history, examination, investigations and ultrasound of abdomen and pelvis were evaluated in women presenting with acute abdomen with adnexal mass and needing surgical intervention. Diagnosis was confirmed from the operative findings and histopathology. Etiology and its correlation with clinical symptoms and signs and radiological diagnosis formed the primary objective of the study.Results: Of the 79 patients enrolled in the study, the mean age was 30.82±6.69 years. Younger women were likely to have ectopic pregnancy while older women (>35 years) other tubal pathologies. Pain abdomen (n=70) and nausea (n=53), bleeding per vagina(n=33), menstrual irregularities (n=18), fever (n=10) abdominal distension (n=10) and dysuria (4) were the common symptoms. Etiology of the adnexal mass was ectopic pregnancy (57%), ovarian mass (34%), tubal mass (7.5%), tube and ovary (2.5%) in 46, 25, 6 and 2 patients respectively. 61% (n=48) of the women underwent laparoscopic management. Women with ruptured ectopic pregnancy were more likely to have abdominal distension, pallor, hypotension, cervical motion tenderness and need for blood transfusions.Conclusions: In women from reproductive age group with adnexal mass and needing surgery, ectopic pregnancies and benign ovarian tumours were the common etiologies. Urine pregnancy test and ultrasound are useful tests to differentiate ectopic from ovarian and tubal pathology.