A rare case of primary fallopian tube carcinoma in a woman with post-menopausal bleeding

Primary fallopian tube carcinoma (PFTC) is a rare tumor accounting for about 0.5% of all gynecological cancers. The rarity of the tumor with its non-specific clinical presentation and radiological findings lead to a low suspicion of PFTC by the attending clinician. We present a case of this tumor in a 62 years post-menopausal parous woman who presented with intermittent vaginal bleeding with normal clinical examination and an adnexal mass on USG and MRI. She underwent laparosopic total hysterectomy with bilateral salpingo-oophorectomy, infracolic omentectomy and staging biopsies followed by adjuvant chemotherapy. Primary fallopian tube carcinoma should be considered in the differential diagnosis of peri and postmenopausal women who present with an adnexal mass, unexplained bleeding per vaginum, pelvic pain, or a cervical smear with abnormal glandular cells. The treatment is similar to epithelial ovarian carcinoma, which includes total hysterectomy with bilateral salpingo-oophorectomy and comprehensive surgical staging.

Mucinous cystadenoma of ovary: are mammoths really extinct?

The most common ovarian tumours are epithelial tumours. 80% of all tumours are benign, 10% borderline and 10% are malignant. Mucinous tumours represent 8-10% of the epithelial tumours; they may reach enormous size filling the entire abdominal cavity. We report here a case of a huge benign mucinous cystadenoma in a 57-year-old female. Ultrasound and MRI scan showed a large left ovarian cyst. CA-125 was 132 IU/ml. She underwent total abdominal hysterectomy and bilateral salpingo-opherectomy with appendicectomy and infracolic omentectomy. Her post-operative course was unremarkable.

Gliomatosis peritonei arising in setting of immature teratoma of ovary: a case report

A 14 years old girl presented to the gynecology OPD with pain abdomen and huge abdominal lump since 2 months. On clinical examination, a large mass of 20x15 cm size was found extended upto the xiphoid process. Serum studies showed rise of CA-125 up to 406.9U/mL and LDH up to 310U/L. USG shows right ovarian cyst of 14.8x14.1x12.8 cm with internal calcification. MRI revealed a well encapsulated mass of 21x19x17cm with solid and cystic mass and upward peritoneal extension. Exploratory laparotomy was performed with right sided salpingo- ophorectomy with infracolic omentectomy, as the omentum appeared granular. She had an uneventful post-operative recovery. Subsequently HPE showed immature teratoma NORRIS grade 3 with co-existent peritoneal gliomatosis (grade 0). She is under regular follow-up and decided to give six cycles of combination chemotherapy with BEP at regional cancer hospital.

Selective Infracolic Omentecomy and Fixation Reduces Complications after Laparoscopic Assisted Peritoneal Dialysis Catheter Placement

Introduction Peritoneal dialysis (PD) as a treatment for patients with end-stage renal disease (ESRD) provides a competitive alternative to hemodialysis (HD). Long-term catheter survival remains challenging and techniques are not standardized. Advanced laparoscopic placement with fixation and omentectomy might increase catheter survival. The goal of our study was to evaluate if selective infracolic omentectomy and fixation reduced complications after CAPD catheter placement. Materials and Methods A prospective database of patients with CAPD catheter placement from March 2004 to March 2015 was analyzed. All procedures were performed laparoscopically assisted and under general anesthesia by a single surgeon. 78 patients were included, there were no exclusion criteria. Statistical analysis was performed with SPSS. Fisher exact test and log-rank test with calculation of P-value was executed. P-value of <0.05 was considered significant. Results Of the 78 patients who underwent catheter placement, 53 (68%) were males and 25 (32%) were females. The mean age was 54 (ranged from 13 to 88 years). Selective infracolic omentectomy was performed in 32 patients if the momentum reached beyond the promontory. Non-resorbable sutures to fix the catheter were applied in 33 patients. The average duration of peritoneal dialysis was 21 months (range from ten days to 84 months). Omentectomy significantly reduced the incidence of catheter obstruction (3 vs. 11%, P=0.028) but not of catheter dislocation (19 vs. 30%, P=0.101). Omentectomy did not significantly increase the incidence of peritonitis (22 vs. 31%,P=0.133) or exit-site infection (16vs 17%, P=0.238). Catheter fixation with non-resorbable sutures reduced catheter dislocation (21 vs. 23%, P=0.226) and catheter obstruction( 12 vs.17%,P=0.223) with a significant reduction of peritonitis (15 vs. 29%, P=0.044) and no effect on exit-site infection (15 vs. 17%,P=0.251). Conclusion Laparoscopic PD catheter placement with selective omentectomy and fixation of the catheter to the abdominal wall is safe and feasible and leads to fewer complications. Key words: peritoneal, dialysis, catheter, complications, laparoscopy, omentectomy.

Selective Infracolic Omentecomy and Fixation Reduces Complications after Laparoscopic Assisted Peritoneal Dialysis Catheter Placement

Peritoneal dialysis (PD) as a treatment for patients with end-stage renal disease (ESRD) provides a competitive alternative to hemodialysis (HD). Long-term catheter survival remains challenging and techniques are not standardized. Advanced laparoscopic placement with fixation and omentectomy might increase catheter survival. The goal of our study was to evaluate if selective infracolic omentectomy and fixation reduced complications after CAPD catheter placement.

Leiomyosarcoma in a Posthysterectomy Patient

ABSTRACT Leiomyosarcoma is an aggressive soft tissue sarcoma derived from smooth muscle cells. Uterus is the commonest location for a leiomyosarcoma. They may either arise de novo from uterine musculature or the connective tissue of uterine blood vessels, or in a pre-existing benign leiomyoma and are associated with poor outcome. A 45 year patient presented with mass per abdomen. She had under gone laparoscopic hysterectomy three years back for menorrhagia. A provisional diagnosis of ovarian neoplasm was made based on the ultrasonography and CT scan report, but tumour markers were negative. Staging laparotomy was done, mass removed in toto, infracolic omentectomy, appendectomy and bilateral ureteric dissection was done. Post operatively, patient recovered well. Histopathological analysis was suggestive of leiomyosarcoma FNCLCC grade 3. Patient was advised radiation and is on regular follow up with the oncosurgeon. How to cite this article Agarwal M, Hegde S, Sawapure N. Leiomyosarcoma in a Posthysterectomy Patient. Int J Gynecol Endsc 2017;1(1):50-52.

Metastatic malignant ovarian melanoma: A case report

Background. Malignant melanomas of the female reproductive system are rare. These are biologically highly aggressive tumors with poor prognosis. Preoperative establishment of the diagnosis is practically impossible. Therapeutic approach and treatment of patients with metastatic ovarian melanoma are highly dependent on precise histological analysis. Case report. A woman aged 48 was admitted to the clinic for occasional pains in the lower abdomen and suspected myomatous changes of the uterus. The patient underwent surgery for melanoma on her right arm five years ago. Classic hysterectomy with bilateral adnexectomy with infracolic omentectomy and selective iliac lymphadenectomy were performed. Macroscopic examination revealed an oval tumefaction on the left ovary sized 12.5 x 10 x 3.5 cm of solid structure. Tumor tissue was yellowish-brown colored, of solid structure and mostly localized subcortically with central edema. Microscopic examination showed positive reaction for HMB-45, anti-Melan-A and S-100 protein, but negative immunoreactivity for estrogen and progesterone receptors. Malignant disease caused death after a 4-year follow-up period following gynecological operation. Conclusion. The previous diagnosis of skin melanoma is also indicative of metastatic ovarian tumor, while immunohistochemical analyses confirmed the histopathological diagnosis.

A Case of Endometrial Stromal Sarcoma with Synchronous Bilateral Adenocarcinoma of Ovary

Endometrial stromal tumor is a rare mesenchymal uterine tumor. We report the case of a patient with endometrial stromal sarcoma and concomitant bilateral endometrioid adenocarcinoma of the ovary in the context of pelvic endometriosis. The patient underwent a complete cytoreduction including total hysterectomy and bilateral adnexectomy, pelvic lymphadenectomy, appendicectomy, infracolic omentectomy, and pelvic peritonectomy. This is the first report to our knowledge that describes a synchronous endometrial stromal sarcoma and bilateral endometrioid adenocarcinoma of the ovary.

Management of Borderline Ovarian Neoplasms

Over the last decades, the management of borderline ovarian tumors (BOTs) has changed from radical surgery to more conservative therapy as a result of the need for fertility-sparing surgery and the increasing use of laparoscopy. The question is whether this is good clinical practice from an oncologic point of view. Here, recent literature regarding management of borderline ovarian neoplasms is reviewed, and oncologic concerns are discussed with emphasis on the mode of surgery and the possibility of fertility-sparing surgery and its consequences. Proper staging is defined as an exploration of the entire abdominal cavity with peritoneal washings, infracolic omentectomy, and multiple peritoneal biopsies as the cornerstone of a successful treatment, and this is only possible through a midline incision. For stage I disease, conservative surgery consisting of unilateral salpingo-oophorectomy or cystectomy in case of bilateral ovarian involvement or when the disease develops in the only remaining ovary is a valuable alternative in a number of young patients who want to preserve their fertility. Patients with advanced-stage disease or who are finished childbearing are treated with radical surgery consisting of peritoneal washings, total abdominal hysterectomy, bilateral salpingo-oophorectomy, infracolic omentectomy, complete peritoneal resection of macroscopic lesions, or multiple peritoneal biopsies; in case of mucinous BOTs, patients also are treated with an appendectomy.