Spontaneous vaginoperitoneal fistula as a rare complication of carcinoma ovary: a case report

Background Spontaneous vaginoperitoneal fistula formation in a case of carcinoma ovary is a very rare occurrence and has never been reported. Case presentation A 55-year-old postmenopausal lady presented with complaints of abdominal distention and mass coming out of the vagina for the last 10 days. On examination, she had tense ascites, uterovaginal prolapse and hard, fixed mass felt anteriorly on per-rectal examination. Biochemical investigations and radiological imaging suggested advanced stage ovarian neoplasm. She was planned for neoadjuvant chemotherapy. During the second cycle of chemotherapy, she developed spontaneous vaginoperitoneal fistula which was confirmed on exploratory laparotomy where interval debulking surgery was performed in collaboration with gastro-surgeons on a semi-emergency basis. The postoperative course was uneventful. Conclusion Spontaneous vaginoperitoneal fistula is a rare complication and should be kept in mind while managing advanced ovarian neoplasm.

Response evaluation of locally advanced carcinoma ovary to neoadjuvant chemotherapy at a tertiary care centre

Background: Clear cell and mucinous types of epithelial ovarian cancers are relatively chemo resistant and have a poorer prognosis compared to other histologies. Aim of the study was to study the biochemical and histopathological response and surgical outcome of various histologies to standard platin based chemotherapy.Methods: All 42 cases of locally advanced carcinoma ovary who received several cycles of neoadjuvant chemotherapy (NACT) followed by, interval cytoreductive surgery (ICS) were included in this study. Serum CA125 levels before and after neoadjuvant chemotherapy, the ability to achieve optimal cytoreduction and the presence of residual tumour in the surgical specimen were the parameters measured. Continuous variables were compared by one-way ANOVA. Categorical variables were compared by the Pearson chi-square test. Significance was defined by p values less than 0.05. Survival analysis was done using Kaplan-Meier estimation.Results: There was a 95,84% reduction in serum CA125 levels for papillary serous carcinoma compared to clear cell and mucinous varieties, which had 81.2% and 78.5% reduction, respectively. More number of papillary serous tumours were able to achieve optimal cytoreduction (72%) compared to mucinous variety (25%). Residual tumour was present in 68% of serous papillary tumours compared to 87.5% in mucinous and 80% in clear cell histology.Conclusions: Our study concludes that mucinous and clear cell types of EOC are relatively chemo resistant compared to the serous subtype. We recommend more aggressive surgery especially for mucinous tumours. In the case of ovarian cancer, we observed that the mucinous and clear cell types of EOC are relatively chemoresistant compared to the serous subtype. From the results, we recommend the more aggressive strategy of surgery as a preliminary choice of treatment especially for mucinous tumours rather than chemotherapy in patients with EOC.

Paraneoplastic dermatomyositis: a case report from North-East India

<p>Dermatomyositis is a rare autoimmune myopathy with distinctive cutaneous changes. It has been associated with a wide range of malignancies like carcinoma ovary, lung, breast, gastrointestinal tract and non-Hodgkin’s lymphoma. The malignancy can be concurrent or can occur before or after the onset of myositis. We report a case of dermatomyositis in a 63-year-old Indian male with nasopharyngeal carcinoma. The characteristic cutaneous features and muscle weakness developed concomitantly with the onset of nasopharyngeal carcinoma.</p>