Clinical and Pathological Characteristics and Outcomes of Clear Cell Carcinoma of Ovary: A Tertiary Cancer Centre Data Introduction Clear cell carcinoma of ovary is a rare disease. Historically, they have been treated in lines of serous ovarian cancer. But available evidence shows different outcomes in these cancers. There is a paucity of data on the outcomes of clear cell carcinoma from India. Here were present the outcomes from a tertiary cancer centre. Methodology This was a retrospective study. All patients diagnosed with clear cell carcinoma of the ovary in our centre between 2011 and 2017 were analysed. Only those who had pathological confirmation in our hospital were included. Their clinical and pathological characteristics and outcomes were analysed and compared between subsets using Kaplan–Meier method and log-rank test. Results A total of 46 patients were included in the analysis. Median age was 51.6 years (range 29–69 years). The mean baseline CA-125 was 541.52 U/ml (range 6–6137 U/ml). Stage distribution was FIGO stage I, 63%; stage II, 6.5%; stage III, 24%; and stage IV, 6.5%. Median follow-up of the study was 19.5 months (range 2–104 months). The estimated median recurrence-free survival of the overall population was 31 months, and the estimated median overall survival of the overall population was 71 months. For stages I and II and stages III and IV who are clubbed together, the estimated median recurrence-free survival was 79 months and 12 months (P = 0.0003 by Mantel–Cox log-rank test) and overall survival was 14 months and 11 months, respectively (P = 0.007). Conclusion Majority of our patient population were at an early stage. The mean CA-125 level was higher compared to Western literature. The outcomes of early stage were much better compared to historic outcomes of serous ovarian cancer; however, the outcomes of advanced stage stay dismal. Prospective studies are needed for generating higher quality of evidence.

Awareness of Ovarian Cancer and Its Symptoms and Risk Factors Among Women of Reproductive Age at a Tertiary Care Hospital in Goa, India Abstract Purpose Ovarian cancer is the seventh most common cancer in world among women and a leading cause of mortality among all gynaecological malignancies. This is because majority of the ovarian cancer patients are diagnosed at advanced stage of the disease. The lack of specific symptoms and effective screening techniques makes ovarian cancer an extremely fatal disease. The present study was undertaken to assess the awareness of ovarian cancer; its symptoms, risk factors, treatment and prognosis among women of reproductive-age group admitted in the Obstetrics and Gynaecology (OBG) wards of Goa Medical College. Methods A hospital-based cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Goa Medical College, from December 2018 to February 2019. A total of 426 women above 20 years of age admitted in all the obstetrics and gynaecology wards were interviewed and assessed using a structured questionnaire. A score of more than 70% was considered as good level of awareness, 50–69% indicating fair level of awareness and a score of less than 50% indicating poor level of awareness of ovarian cancer. Results About one-third of the women had ever heard of ovarian cancer; however, only 3.5% women had good level of awareness, 13.4% had fair level of awareness, and 83.1% women had poor level of awareness of ovarian cancer. Most of the respondents (84.5%) were aged  < 40 years, married (90.1%), Hindu (76%), had at least secondary education (81.6%)and socio-economic class III and above (78.9%), and were from rural areas (59.2%). Most of the women interviewed (63.4%) had no knowledge about ovaries and their function. Only 14.1% of the women knew about symptoms of ovarian cancer, and hardly 2.8% were aware of its risk factors. The most commonly known symptom of ovarian cancer among these women was abdominal pain (71.8%), while the most commonly known risk factor reported was family history of ovarian cancer (67.6%). A large percentage (43.7%) of women had poor awareness of screening, treatment and prognosis of ovarian cancer. Conclusion There is poor awareness of ovarian cancer and its symptoms and risk factors among women in Goa and a high mortality associated with the disease. Health education about the disease among women is the need of the hour in order to facilitate screening, detection and treatment for ovarian cancer.

Synchronous Primary Cancer of Cervix and Non-genital Metastatic Tumor of Ovary: A Rare Case Report Abstract Objective Synchronous malignancies in the female genital tract are uncommon. We here present the first documented case of a synchronous cervical adenocarcinoma with a non-cervical metastatic ovarian tumor. Case Report A 41-year-old woman was admitted with complains of abdominal pain on and off. General physical examination and systemic examination were normal. CT suggested a possibility of complex cystic adnexal masses likely an ovarian tumor. The uterus and cervix appeared unremarkable. A radical abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Based on the histopathological and immunohistochemical findings, a diagnosis of a synchronous metastatic tumor to the ovary (most likely gastrointestinal origin) and primary adenocervical carcinoma was made. Conclusion Multiple genital malignancies often present as a diagnostic dilemma. It is essential to differentiate primary malignancies from metastatic disease as there is great variation in overall survival and management. Immunohistochemistry plays a key role when the histomorphological features fail to decipher the origin of malignancy.

Primary Bartholin’s Gland Adenoid Cystic Carcinoma: Dilemmas Around Adjuvant Treatment Abstract Adenoid cystic carcinoma is an uncommon variant of adenocarcinoma arising from Bartholin’s gland. They are malignant tumours with deceptively benign histologic appearance, indolent clinical course with high chance of recurrence and rare distant metastases. Perineural invasion is more common, which may be attributable to the high chance of recurrence. The symptoms are entirely non-specific and hence often get misdiagnosed as cyst or abscess. There is no clear consensus regarding the optimal treatment guidelines. The role of adjuvant chemotherapy and radiotherapy is also unclear. We report a case of Bartholin’s gland adenoid cystic carcinoma in a postmenopausal woman.

Neoadjuvant Chemotherapy in Advanced Epithelial Ovarian Cancer: An Institutional Experience Abstract Purpose Epithelial ovarian cancer is the second most common gynaecological malignancy among Indian women. Primary debulking surgery remains the standard of care in advanced operable ovarian cancer patients, but is associated with morbidity. Neoadjuvant chemotherapy followed by delayed primary cytoreductive surgery may be a better treatment strategy in advanced ovarian cancer. We present our experience of neoadjuvant chemotherapy in advanced ovarian cancer with special emphasis on treatment outcomes. Methods A retrospective analysis of advanced epithelial ovarian carcinoma (stages III and IV) patients treated at the Department of Surgical Oncology at King George’s Medical University, Lucknow, between 2012 and 2016 was done. Results A total of 128 patients with advanced ovarian carcinoma were treated during this period. Median age at diagnosis was 46 years. Among these patients, 115 underwent surgery, of which 57.4% were optimally cytoreduced. Papillary serous adenocarcinoma was the most common histological subtype (78.1%). Recurrence was seen in 73% of patients, with a median time to recurrence 16 months (range 6.5–37 months). They were managed with second-line chemotherapy and surgery. Median overall survival in this study for optimally cytoreduced stage III patients was 38 months and 17 months for optimally cytoreduced stage IV patients. Median progression-free survival for stage III was 13 months and stage IV was 6 months. Conclusion Neoadjuvant chemotherapy facilitates surgery in advanced ovarian cancer and helps in assessing chemotherapy responsiveness. It provides an opportunity to modify systemic treatment if there is no response to therapy or disease progression.

Excellent Outcome in a Patient with Choriocarcinoma with Spinal Metastasis with Cord Compression

Refractory Bone Marrow Involvement Responding to Ribociclib and Tamoxifen in Advanced Breast Cancer

Expression of PAX2 and PTEN in Oestrogen-Driven Endometrial Hyperplasia and Neoplasia Abstract Background Endometrial hyperplasia is of paramount clinical implication as it is usually seen to precede endometrioid adenocarcinoma. However, clinicians and pathologists have always been uncertain about the distinction between innocuous hyperplasia from their sinister counterparts. This has serious implications, for the latter lesion has a greater propensity for progressing into adenocarcinoma and needs deft clinical intervention in the form of adequate progestational exposure or surgery. Methods Thirty cases diagnosed as endometrial hyperplasia on endometrial biopsies were retrieved from the archives and reclassified as per the EIN criteria. Thirty cases each of proliferative endometrium and endometrioid carcinoma were also included. Immunohistochemistry with antibodies against PAX2 and PTEN was performed, and the extent of loss of expression was scored. Results A total of ten cases of EIN were identified, all of whom were initially diagnosed as complex hyperplasia with atypia. All cases of proliferative endometrium showed retained expression of PAX2 and PTEN. In contrast, all cases of endometrioid carcinoma showed complete loss of PAX2 and PTEN. The EIN cases showed partial loss of both PAX2 and PTEN expression. Loss of PAX2 expression in EIN showed a specificity and positive predictive value of 90% and 83.33%, respectively. Conclusion The advent of the EIN criteria has made identification of clinically significant endometrial precancerous lesion more acceptable and reproducible. However, in cases of ambiguity, the use of antibodies against certain protein molecules which reflect the genes involved in the stepwise carcinogenesis would be of great utility in the hands of the pathologist. In comparison with PTEN, the use of PAX2, which gives a crisp nuclear positivity and has a lower percentage of loss of expression in normal endometrium, can be used as part of the algorithm in accurately identifying the precancerous endometrium.

Patterns of Relapse and Survival Analysis of Advanced Epithelial Ovarian Cancers Operated in a Tertiary Cancer Centre Abstract Background Advanced epithelial ovarian cancers have a dismal prognosis with a 5-year survival rate of 29.2%. A relapse rate in excess of 75% is noted in patients who achieve remission following neoadjuvant chemotherapy and cytoreductive surgery. Our study aims to find out the progression-free survival and overall survival of advanced epithelial ovarian cancers in South Indian population. Materials and Methods Demographic data, neoadjuvant treatment and surgery details, recurrence, and survival status of patients operated for advanced ovarian cancer in our department from year 2015 till 2018 were retrospectively collected through medical records. Statistical analyses were performed using SPSS version 25. Results Our study included 111 patients with the majority staged as IIIC (82%). 107 patients received neoadjuvant chemotherapy. Six patients were lost to follow-up. The median pre- and post-chemotherapy CA 125 level was 694 IU/L and 33.5 IU/L, respectively. Optimal cytoreduction was achieved in 87.6% of patients. At a median follow-up of 24 months, median progression-free survival was 30 months (95% CI: 26.5–34.5) in the optimally cytoreduced versus 13 months (95% CI: 10.3–15.4) in the suboptimally cytoreduced patients (P0.005). The median overall survival was 36 months (95% CI: 32–39) in optimally cytoreduced versus 19 months (95% CI: 17.6–20.3) in suboptimally cytoreduced patients (P0.001). Conclusion Patients achieving optimal cytoreduction after neoadjuvant chemotherapy have significantly lower recurrence rates, higher progression-free survival, and overall survival rates than those suboptimally cytoreduced. Results from our centre are equivalent to apex centres in India.

Clinicopathological Correlation of Uterine Corpus Tumors: A Study of 433 Cases Abstract Background Uterine corpus tumors are one of the most common reasons for morbidity and mortality of women around the world, and histopathological diagnosis is the key for better management of the patients. Aims To study the histopathology of uterine tumors, classify them as per WHO 2014 classification and correlate with clinical parameters. Methods A five-year study was conducted on 433 histopathologically diagnosed cases of uterine corpus tumors. Results Benign tumors were the most common (95.6%) followed by malignant (3.9%) and borderline (0.5%). Leiomyoma was the most common benign tumor (91.2%). Majority of the cases were multiparous females (88.6%) in fourth and fifth decades of life (77%) and presenting with heavy menstrual bleeding (35.9%). The most location was intramural (68.9%). Cellular leiomyoma (1.8%) was the most common histologic variant; the secondary change was hyalinization (27.8%). Endometrial carcinoma was the most common malignant tumor (3%) followed by leiomyosarcoma (0.5%) and adenosarcoma (0.2%). Majority of the women with endometrial carcinoma were multiparous (76.9%) and belonging to the age-group of 50–59 years (38.4%). The most common symptom was postmenopausal bleeding (76.9%). Endometrioid carcinoma grade I (75%) was the most common type of endometrial carcinoma. Other lesions were adenomyoma (N = 17), STUMP (N = 2), and one case each of adenomatoid tumor, endometrial stromal nodule and secondary tumor. Conclusion Benign tumors were more common than malignant tumors. Leiomyoma was the most common benign tumor, and endometrial carcinoma was the most common malignant tumor. Many uterine tumors present with similar clinical features. However, histopathology plays an important role in the accurate diagnosis of different types of tumors and thus helps in providing the patient with appropriate management.