Malignancy Of Female Genital Tract Research Articles

Cerebrospinal fluid cytology: A theragnostic and prognostic tool- Experience from a tertiary cancer care centre in central India

: CSF examination is the gold standard for diagnosing leptomeningeal metastases. Malignant cells may access the subarachnoid space by hematogenous dissemination, spreading directly from parenchymal brain lesions, or spreading along the spinal cord or cranial nerves. Cytological detection of malignant cells in CSF is still a crucial decision point for systemic and intrathecal chemotherapy, and it has prognostic significance even with improvements in biochemical analysis and CNS imaging. Over the course of two years, a total of 397 patients—regardless of gender and age—were investigated. There were sixty-four cases with involvement of the central nervous system documented, comprising 42 hematologic malignancies and 22 solid tumors. Cell centrifugation (Cytospin) method were used to prepare smears and cell blocks where prepared, as feasible and indicated. : A cytological analysis of the cerebrospinal fluid showed that metastatic tumors were much more prevalent than primary central nervous system tumours. Lung tumors were the most frequent primary site in our analysis, with breast, gastrointestinal, and female genital tract malignancies following closely behind. CNS involvement has been reported in patients with Lymphoma (DLBCL) and Leukemia (most commonly ALL, but also AML and JMML) among hematological malignancies. Two cases of Retinoblastoma and one each of Medulloblastoma and an Atypical teratoid/rhabdoid tumor were observed in the pediatric age group.: Cerebrospinal fluid cytology is a simple and useful method, used as a primary diagnostic method in the evaluation of leptomeningeal metastases. This helps in the early detection of secondary CNS lesions and allows for timely intervention, prognosis, and prediction of overall survival.

Study of histopathological spectrum of ovarian tumors in a tertiary care hospital in India

Abstract Background: Ovarian tumors rank as the third leading cause of mortality among female genital tract malignancies. This study examined the histopathological spectrum of ovarian neoplasms based on our center’s 2020 World Health Organization (WHO) classification. Materials and Methods: This descriptive study was carried out over 5 years at our tertiary healthcare hospital, including 406 cases of ovarian neoplasms. After proper fixation and gross examination, sections were routinely processed and examined. The histopathological spectrum of ovarian neoplasms was analyzed according to the 2020 WHO classification. Results: Out of the 406 cases studied, 329 (81.03%) were benign, 65 (16.01%) were malignant, and 12 (2.95%) were borderline. The cases included 326 (80.29%) surface epithelial tumors, 58 (14.28%) germ cell tumors, 19 (4.68%) sex cord-stromal tumors, and 2 (0.49%) metastatic tumors. The majority of ovarian tumors (n = 340, 83.74%) occurred in the 20–60 years age group. Conclusion: The study reveals that benign tumors were more prevalent than malignant ones, with serous tumors being the most common among the benign cases. We observed a higher incidence of malignancy in women over the age of 40. Therefore, early and accurate histological diagnosis is crucial for initiating an appropriate management plan.

Clinicopathological Characteristics of Multiple Primary Malignancies Involving Female Genital Tract at a Tertiary Cancer Institute of Northeast India.

The term "Multiple Primary Malignant Neoplasms (MPMNs)" refers to two or more unrelated primary malignant neoplasms that originate from single or different organs and occur in one patient. MPMNs have been divided into synchronous and metachronous based on time duration after first malignancy. This was a hospital-based retrospective study conducted at a tertiary cancer institute in Northeast India. Clinicopathological factors of patients with multiple primary malignancies with at least one female genital tract malignancy attending the gynecological oncology outpatient department were observed. Those with ambiguous status of primary malignancy and incomplete treatment of first primary malignancy were excluded from the study. A total of 57 patients with MPMN, including one case of triple primary malignancy, were included in the study. 59.18% of cases had metachronous, and 40.81% had synchronous malignancies. The median time to the development of second primary malignancy was 60 months. Among the first diagnosed malignancies, cervix was the most common site (26.5%), followed by endometrium (20.4%) and ovary (14.28%), whereas ovarian malignancy was more commonly diagnosed second malignancy (38.77%), followed by endometrium (14.28%) and cervix (10.2%). In an analysis of synchronous malignancies, the most common genital tract involvement was seen with endometrium and ovary, with a predominance of low-grade endometrioid histology in 75% of cases. As the cancer survivor population continues to increase in future, these patients must be comprehensively evaluated on follow-up, and a cognizance of prior treatment taken should be kept. In addition, it is vital that the clinicians keep a lookout for high-risk population in which genetic testing may be beneficial.

Frequency and pattern of female genital tract malignancies in patients presenting with gynecological problems

Introduction: Significant morbidity and mortality is caused by cancers in women all over the world. Cancers of the female reproductive organs are called genital tract cancers. They include cervical cancer, ovarian cancer, endometrial cancer, vaginal carcinoma, cancer of the fallopian tubes and gestational trophoblastic tumor. After breast carcinomas, they account for the second most common carcinomas in females. 
 Methodology: This cross-sectional study was conducted from 1 June 2018 to 31 May 2022. After taking written informed consent, 256 patients presenting to Gynae A Unit, Ayub Teaching Hospital, Abbottabad, were included in the study. Patients with a history of menstrual irregularities, vaginal bleeding, abdominopelvic pain or mass were included, while those presenting with other gynecological problems were excluded. The confirmed diagnosis was made based on histopathology reports by the consultant pathologist of the laboratory in the hospital after the patient's surgery.
 Results: Out of the 256 patients, 30 (11.71%) had female genital tract malignancies. The mean age was 48.79 years, and the standard deviation was 12.93 years. 17 patients (56.66%) had ovarian cancer, 5 (16.66%) had cervical cancer, 7 (23.33%) had endometrial cancer, and 1 (3.33%) had vaginal cancer. Ovarian cancer was the most common (56.66%), followed by endometrial cancer. Serous adenocarcinoma of the ovary was the most frequent type (26.66%). 
 Conclusion: The percentage of female genital tract malignancies in patients with gynecological problems is relatively high with serous adenocarcinoma of the ovary being the most common malignancy. Developing and implementing an effective policy regarding early cancer detection is necessary.

Identification of predictive biomarkers for endometrial cancer diagnosis and treatment response monitoring using plasma metabolome profiling

BackgroundEndometrial cancer (EMC) is the most common female genital tract malignancy with an increasing prevalence in many countries including Japan, a fact that renders early detection and treatment necessary to protect health and fertility. Although early detection and treatment are necessary to further improve the prognosis of women with endometrial cancer, biomarkers that accurately reflect the pathophysiology of EMC patients are still unclear. Therefore, it is clinically critical to identify biomarkers to assess diagnosis and treatment efficacy to facilitate appropriate treatment and development of new therapies for EMC.MethodsIn this study, wide-targeted plasma metabolome analysis was performed to identify biomarkers for EMC diagnosis and the prediction of treatment responses. The absolute quantification of 628 metabolites in plasma samples from 142 patients with EMC was performed using ultra-high-performance liquid chromatography with tandem mass spectrometry.ResultsThe concentrations of 111 metabolites increased significantly, while the concentrations of 148 metabolites decreased significantly in patients with EMC compared to healthy controls. Specifically, LysoPC and TGs, including unsaturated fatty acids, were reduced in patients with stage IA EMC compared to healthy controls, indicating that these metabolic profiles could be used as early diagnostic markers of EMC. In contrast, blood levels of amino acids such as histidine and tryptophan decreased as the risk of recurrence increased and the stages of EMC advanced. Furthermore, a marked increase in total TG and a decrease in specific TGs and free fatty acids including polyunsaturated fatty acids levels were observed in patients with EMC. These results suggest that the polyunsaturated fatty acids in patients with EMC are crucial for disease progression.ConclusionsOur data identified specific metabolite profiles that reflect the pathogenesis of EMC and showed that these metabolites correlate with the risk of recurrence and disease stage. Analysis of changes in plasma metabolite profiles could be applied for the early diagnosis and monitoring of the course of treatment of EMC patients.

Wnt/β-catenin Signaling in Endometrioid Endometrial Cancer and Precursor Lesions

Endometrioid endometrial carcinoma (EEC) is most common invasive malignancy of female genital tract. In spite of advances in diagnosis and treatment, incidence of EEC has been rising because of increasing aging population and prevalence of obesity. Therefore, there is need of research exploring the underlying molecular mechanism of EEC and its precursors. Wnt/ β-catenin signaling are involved in the progression and invasion of EEC. However, the potential role of Wnt/ β-catenin signaling and its effectors in endometrial cancer and precursor lesions remains to be investigated. In the present study a total of 95 samples of endometrial biopsies were assessed histopathologically along with β-catenin expression by immunohistochemistry and promoter methylation of adenomatous polyposis coli (APC) gene by bisulfite method. Women age ranged from 35 to 70 years whose endometrial biopsy and resected samples were obtained. Expression of β-catenin was observed in 28/39; 72% of EEC, 23/37; 62% of precancer cases and 4/19; 21% of normal proliferative endometrium. APC promoter was completely unmethylated in all controls (14/14) and precancer (10/10) groups, however, only one case (1/13, 8%) of cancer was methylated. The present study showed that expression of β-catenin was upregulated in EEC and precursor lesions suggesting involvement of Wnt/ β-catenin signaling from an early stage of development of cancer from precancer. The information might offer a potential therapeutic target for EEC and could also be used as a screening tool in endometrial hyperplasia (EH) cases for detecting potentially precancerous lesions.

ESTRO/ESGO/SIOPe Guidelines for the management of patients with vaginal cancer

Primary vaginal malignancies are rare, comprising only 2% of all female genital tract malignancies in adults and 4.5% in children. As part of its mission to improve the quality of...

ESTRO/ESGO/SIOPe guidelines for the management of patients with vaginal cancer

Primary vaginal malignancies are rare, comprising only 2% of all female genital tract malignancies in adults and 4.5% in children. As part of its mission to improve the quality of care for women with gynecological cancers across Europe, the European Society of Gynaecological Oncology (ESGO) jointly with the European Society for Radiotherapy & Oncology (ESTRO) and the European Society of Pediatric Oncology (SIOPe) developed evidence-based guidelines in order to improve the management of patients with vaginal cancer within a multidisciplinary setting.ESTRO/ESGO/SIOPe nominated practicing clinicians who are involved in the management of vaginal cancer patients and have demonstrated leadership through their expertise in clinical care and research, their national and international engagement and profile as well as dedication to the topics addressed to serve on the expert panel (13 experts across Europe comprising the international development group). To ensure that the statements were evidence based, the current literature was reviewed and critically appraised. In the case of absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the international development group. Prior to publication, the guidelines were reviewed by 112 independent international practitionners in cancer care delivery and patient representatives and their comments and input were incorporated and addressed accordingly.These guidelines cover comprehensively the diagnostic pathways as well as the surgical, radiotherapeutical and systemic management and follow-up of adult patients (including those with rare histological subtypes) and pediatric patients (vaginal rhabdomyosarcoma and germ cell tumours) with vaginal tumours.

Pathology-Based Tumour Registry Analysis of Cases of Female Genital Tract Malignancies

Objective: To study the frequency and distribution of Female genital tract (FGT) malignancies through data recouped from the tumour registry of Armed Forces Institute of Pathology, Rawalpindi Pakistan.
 Study Design: Retrospective longitudinal study.
 Place and Duration of Study: Histopathology Department, Armed Force Institute of Pathology, Rawalpindi Pakistan, from 2009-2018
 Methodology: A total of 1586 cases of malignant tumours of FGT were retrieved from the AFIP tumour registry, and data were analyzed in terms of the age of the patients' site of the tumour. It was also compared with regional and international data. 
 Results: Thirty-seven thousand seven hundred ninety-three malignant cases were reported at AFIP from 2009-2018, out of which 1586(4.19%) were of the female genital tract. Ovarian malignancies were most frequent among FGT tumours,637(40.1%), followed by uterine tumours 519(32.6%). Carcinoma of the cervix was found in 237 cases (15%). Vulva and vaginal cases were seen in only 7.7% patients. The FGTs ranked fourth among the top ten commonest tumours in females.
 Conclusion: The most common malignancy of the female genital tract was ovarian cancer. Endometrial carcinoma was the second most frequent gynaecological malignancy, followed by cervical carcinoma. Ovarian malignancies were in fourth position among the top ten commonest female tumours in the current analysis as well, as in the previous analysis from AFIP.

Endometrial stromal neoplasia: An uncommon tumor at a tertiary health centre in coastal India

Introduction and Aim: Stromal malignancies of uterus are rare and accounts for 1-3% of all female genital tract malignancies. They are known to pose a diagnostic challenge to the clinicians and the pathologists. They show non-specific clinical features, gross appearance, varying histological and immunohistochemical features. This study highlights the important clinical, morphologic and immunohistochemical features of these tumors. Methodology: Histopathologically diagnosed cases of endometrial stromal neoplasia over a period of 5 years from 2013 to 2017 were retrieved. The cases were analysed based on age, tumor size and histological types. Immunohistochemistry (IHC) was done whenever feasible. Results: During the study period, we found 25 cases of endometrial stromal neoplasia. They were composed of four cases of endometrial stromal nodule (ESN), six cases of low grade endometrial stromal sarcoma (ESS) and three cases of ESS with smooth muscle differentiation. Twelve cases of carcinosarcomas and adenosarcomas and a single case of undifferentiated uterine sarcoma were seen. The mean age at presentation of Mixed epithelial stromal sarcoma (Carcinosarcoma) was 61 years while that of ESS and ESN was 46 and 47 years respectively. The mean size of ESN was 3.6cm (1.5-6cm), ESS was 4.5 cm (2-9.9 cm) and carcinosarcomas was 4.9 cm (2.5-16 cm). Conclusion: Endometrial stromal neoplasia should be diagnosed after proper evaluation of gross morphology, histological features and immunohistochemical findings in correlation with the clinical presentation. In addition, genetic profiling is useful as an ancillary test. The spectrum of endometrial stromal neoplasia is a beginner’s ordeal if not aware of.

Menopausal Status Contributes to Overall Survival in Endometrial Cancer Patients.

Endometrial cancer is the most common female genital tract malignancy in developed countries that occurs predominantly in postmenopausal women. The primary objective of our research was to investigate whether menopause status together with selected conventional prognostic indicators may contribute to overall (all-cause) survival in endometrial cancer patients. For this purpose, we applied the Cox proportional hazards regression model. Patients in advanced FIGO stage showed a relatively poor survival rate. The time since last menstruation and postoperative FSH concentration were identified as unfavorable prognostic factors in our model. Additionally, age at diagnosis, BMI value, adjuvant treatment (brachytherapy), and parity showed no impact on survival. To our knowledge, this is the first study to report a prognostic model for endometrial cancer including exact time from last menstruation as one of the prognostic variables. Due to the fact that there are no stratifying systems to reliably predict survival in patients with endometrial cancer, there is a strong need to revise and update existing models using complementary prognostic indicators. Collection of precise data on various risk factors may contribute to increased accuracy of artificial intelligence algorithms in order to personalize cancer care in the near future.

Role of Frozen Sections in Diagnosing Female Genital Tract Lesions: A Tertiary Centre Study in Chennai, India

Introduction: Female Genital Tract (FGT) malignancies are common with ovarian cancers having high incidence and mortality. The asymptomatic character, difficult location and lack of effective screening methods make Intraoperative Frozen Section (IFS) an effective diagnostic test to guide the surgical decisions. Aim: To assess the performance of IFS, describe the associated demographic, clinicopathological factors and identify the errors leading to discordance when compared with Permanent Section (PS). Materials and Methods: A retrospective study of all the consecutive IFS consultations related to FGT lesions received in the Pathology Department between January 2013 to June 2022 was conducted between July 2022 to September 2022 at ESIC Medical College and Hospital, Chennai, Tamil Nadu, India. Cases with IFS deferred until PS section were excluded. The FS and PS reports, demographic, clinicopathological data, Risk of Malignancy Index (RMI), imaging and biochemical records were retrieved. In-depth descriptive analysis of clinicopathological parameters as frequency and percentage, frequency distribution of PS diagnosis, concordant and discordant categorisation, reasons for the discordance were described and the diagnostic accuracy of Frozen Section (FS) tool was calculated. Mean, Frequency (n) and percentage (%) analysis was done for the complete collected data. Results: Out of the total 35 FGT related IFS consultations received, 32 (91.43%) was for Ovarian Tumours (OT), which included 26 surface epithelial tumours, three sex cord stromal tumours, two germ cell tumours, one Krukenberg tumour. Two cases were deferred due to extensive haemorrhage and infarction. Confirmation of the diagnosis was the most common indication. The mean size of the OT (n=32) was 13 cm and ranged from 2 to 31 cm. RMI was low (<25) in 14 (44%, n=32), intermediate (25-250) in 10 (31%, n=32) and high (>250) in 8 (25%, n=32) of OT. The diagnostic accuracy of FS of all the FGT cases (n=35) was 85.71% (n=35 FGT cases) with an error rate of 14.29% was observed. Five OT cases had discordant FS diagnosis, 3 cases due to sampling error and mis-interpretation error in the remaining 2 cases. Artefacts like poor morphology due to tissue freezing, nucleomegaly, poor sectioning and section folding were observed in the discordant cases. Conclusions: Correct use of IFS along with careful preoperative work-up will help the surgeon intraoperatively. A good rapport among clinicians, pathologists and laboratory personnel will aid to improve the diagnostic accuracy. Periodic assessment of IFS tool is necessary as a quality check.

An assessment of mismatch repair deficiency in ovarian tumours at a public hospital in Johannesburg, South Africa


 
 
 
 Background. Epithelial ovarian carcinomas (EOCs) are lethal female genital tract malignancies with high-grade serous, low-grade serous, endometrioid, clear cell, mucinous and malignant Brenner subtypes. The lifetime risk for developing ovarian carcinoma (OC) is 15% in females who have mismatch repair deficiency (MMR-d). MMR-d is associated with Lynch syndrome, a cancer predisposition condition. Patients who have MMR-d may benefit from immunotherapy. To the best of the authors’ knowledge, MMR-d testing of OCs in South Africa (SA) has not been undertaken to date.
 Objectives. To assess the clinicopathological characteristics and mismatch repair (MMR) status of non-serous EOCs at a single institution in SA.Methods. Following ethical clearance and application of exclusion criteria, 19 cases of non-serous EOC from the Department of Anatomical Pathology at Charlotte Maxeke Johannesburg Academic Hospital were retrieved and assessed. Four immunohistochemical markers (MLH1, MSH2, MSH6 and PMS2) were used to evaluate MMR status.
 Results. Most tumours were early-stage, unilateral, mucinous EOCs, without capsular breach or lymphovascular invasion (LVI). A single case of grade 1, stage I, unilateral, endometrioid EOC showed MMR-d for MLH1 and PMS2 MMR proteins. This patient had been diagnosed with endometrioid endometrial carcinoma 2 years prior to the diagnosis of OC.Conclusion. Our study documented a lower proportion of MMR-d OCs compared with international studies. However, our results are concordant with global studies regarding tumour subtype, laterality, grade, stage, LVI and capsular breach. Larger studies are required to estimate the true incidence of MMR-d OCs in SA and to direct effective treatment options globally.
 
 
 

ANALYSIS OF GENITAL TRACT MALIGNANCIES IN POSTMENOPAUSAL FEMALES – A HOSPITAL-BASED STUDY

Introduction: Female genital tract malignancy is common carcinoma. In the developed countries, ovarian cancer is the most common cancer and in developing countries, carcinoma cervix is the most common malignancy. Menopause does not cause cancer, but the risk of developing cancer increases as women ages. Therefore, women who have been through natural menopause are more likely to develop cancer because they are older. A woman who experiences menopause after age 55 has increased risk of ovarian, breast, and uterine cancers. The risk is greater if women also began menstruating before age 12. This is because a woman who menstruates longer than normal during her lifetime is exposed to more estrogen and has more ovulation. Hence, aims and objectives of our study are: (1) To determine the incidence of different genital malignancies in postmenopausal females and (2) to analyzes diagnosis and treatment of genital malignancies in postmenopausal females. Methods: 1. Data were collected using predesigned proforma; consent was taken from every participant, 2. After collection of data, it was tabulated. Statistical calculation and subsequent analysis was made has been presented in the form of Tables and graphs. Results: A total of 401 cases reported to the institute during a period of 1 year. Out of which, 107 patients were that of genital carcinoma. Incidence of female genital tract carcinoma was 26.68%. Approximately 73.87% (82 patients) of cases were that of cervical cancer. Conclusion: Hence, from above study, the most of the patients were diagnosed in advanced stage of malignancy. Carcinoma cervix was the most common female genital tract cancer with ovarian cancer taking the second rank. This is unfortunate as cancer cervix is preventable to a large extent as it takes a decade or more to progress from pre-invasive to invasive lesion, there are various screening modalities to diagnosed the cervix in pre-invasive age, that is, when it still curable.

Circulating microRNAs as Potential Biomarkers for the Diagnosis of Endometrial Cancer: a Meta-Analysis.

Endometrial cancer (EC) is the most common female genital tract malignancy worldwide. Many investigators have confirmed the possibility of using circulating miRNAs to diagnose EC; however, the results were inconsistent. Therefore, we performed the current meta-analysis to systematically evaluate the diagnostic value of circulating miRNAs in EC. We carefully searched relevant articles published prior to February 15, 2022 in the databases of PubMed, Embase, Web of Science, Cochrane Library, Wanfang database, and China National Knowledge Infrastructure (CNKI) based on PRISMA statement. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the curve (AUC) were calculated to test the diagnostic accuracy. Furthermore, subgroup analyses were performed to identify the potential sources of heterogeneity, and the Deeks' funnel plot asymmetry test was used to evaluate the potential publication bias. Twenty-one studies from 12 articles including a total of 2305 participants (1341 EC patients and 964 controls) were included in the current diagnostic meta-analysis. The overall pooled results of miRNA for EC diagnosis were: sensitivity, 0.84 (95% CI: 0.79-0.88); specificity, 0.87 (95% CI: 0.79-0.91); PLR, 6.3 (95% CI: 3.9-10.0); NLR, 0.18 (95% CI: 0.13-0.25); DOR, 35 (95% CI: 17-71); and AUC was 0.91 (95% CI: 0.89-0.94). Subgroup analysis suggested that miRNA cluster, serum type, and large sample sizes showed a better diagnostic accuracy. Moreover, there was no significant publication bias. Circulating miRNAs have great potential as novel non-invasive biomarkers for EC diagnosis.

Factors that affect survival in vaginal cancer: a seer analysis

This study aimed to investigate the factors that affect survival in vaginal cancer by means of a large population-based database that had been monitored over a 42 year period (1975–2017). It was investigated which factors were most predictive in survival. This study evaluated the factors that affect survival in primary vaginal cancer as one of the rarest gynaecological cancers. Relationships were explored between survival and age and race of patient, in situ/invasive behaviour of tumour, histological type, stage, grade, surgical treatment, and year of diagnosis. Survival rate was found to be higher at younger ages and earlier stages, in in situ and squamous cell carcinomas, in the presence of previous surgery, and diagnosis from 2000 onward. It was shown that other causes were more predictive of mortality in older patients and that mortality due to other causes decreased in patients diagnosed from 2000 onward. Mortalities due to cancer were found to be lower in the patients who had underwent surgery. At the end of this study, an estimation model was developed for 10-year survival in vaginal cancer and software was created for the model. Impact Statement What is already known on this subject? Primary vaginal cancer is very rare, accounting for 2% of female genital tract malignancies. Due to its low incidence and difficulty of its final diagnosis, vaginal cancer has the least amount of data among all female genital tract malignancies. It is difficult for clinicians to estimate the survival with already limited data on vaginal cancer in the literature. What do the results of this study add? Survival rate was found to be higher at younger ages and earlier stages, in in situ and squamous cell carcinomas, in the presence of previous surgery, and diagnosis from 2000 onward. It was shown that other causes were more effective in mortality with older age and that mortality due to other causes decreased in patients diagnosed from 2000 onward. Mortalities due to cancer were found to be lower in the patients who had underwent surgery. What are the implications of these findings for clinical practice and/or further research? It is anticipated that such studies will contribute to the transformation of societal data collection methods into a prospective nature and lead the way for stronger survival estimation models to be developed in days to come.

EGFR and HER2/NEU immunoexpression in ovarian neoplasms in Bundelkhand Region

Introduction: Ovarian Cancers account for the greatest number of deaths from malignancies of female genital tract and it is the fifth leading cause of cancer fatalities in women. Surface epithelial tumours are the most common, followed by germ cell tumours. Objective: To analyse the expression of EGFR and HER 2neu using Immunohistochemisty in different Ovarian tumours with special reference to surface Epithelial tumours. Material and Methods: 52 cases of different ovarian tumours were studied. Cases included total abdominal hysterectomy with bilateral saphingoophorectomy, oophorectomy, and cystectomy specimens. Expression of EGFR (ErbB1) and HER2-neu (ErbB2) was determined by immunohistochemical reactions performed with the Super SensitiveTM IHC Detection system by the BiogenixTM. Tests were performed according to the instructions of each kit. Results: The mean age of presentation for epithelial tumours was found to be 42.48 years. For malignant epithelial tumours mean age of presentation was found to be 51.1 years. EGFR positivity was found in 28.57 % of surface epithelial ovarians tumours, and HER2/neu positivity was seen in 20% of surface epithelial ovarian tumours. As far as malignant serous papillary adenocarcinoma is concerned, we found 33.3% positivity for HER2/neu and 50% positivity for EGFR.

Mullerian Adenosarcoma of Uterus and Cervix- A Report of Four Cases with Review of Literature

Uterine sarcomas are rare female genital tract malignancies. Mullerian adenosarcoma is a rare biphasic malignant mesenchymal tumor comprising of a benign glandular and malignant (usually low grade) stromal component, both of which are integral and neoplastic constituents of the tumor.[1] This tumor represents less than 8% of uterine sarcomas. About 200 cases have been reported in the literature so far [2] of which 22 case were from India. Adenosarcomas are usually low grade. Sarcomatous overgrowth is defined as the presence of sarcomatous component is more than 25% of the tumor volume. High grade morphology was termed adenosarcoma with sarcomatous overgrowth (i.e, presence of pure sarcoma , without epithelial component comprising 25% of the tumor).The features of high grade sarcomatous overgrowth include severe nuclear pleomorphism, prominent nucleoli , increased mitotic activity and necrosis[2]. Herein, we present four cases of adenosarcoma of the uterine corpus and cervix, discuss their clinico-pathological findings in detail and add a note on the recent and evolving concepts

SPECTRUM OF GYNAECOLOGICAL MALIGNANCIES IN NORTH INDIA : OVERVIEW

Background: Gynecologic cancers form a huge burden of morbidity and mortality around the world. This study was undertaken to study the pattern, histopathological types and relative frequencies of gynaecological malignancy cases reported at four major hospitals and pathology centers in Jaipur region. Method: Retrospective review of records of gynecologic cancers obtained from four major pathology departments in Jaipur region in which histopathological data of all female diagnosed with the genital tract malignancies for a ve year period were included in the study. Results: Most common genital tract malignancy was cervical cancer (51.8%) followed by ovarian cancer (24.6%), uterine cancer (17.6%) and vaginal cancer (3.96%). Mean ages for ovarian, uterine, endometrium, fallopian tube, vulva and cervical cancers were 42.79±15.84, 50.93±13.14, 61.21±7.61, 63.50±19.09, 56.05±17.89 and 51.29±11.95 years respectively. Conclusion & Recommendations: Cervix carcinoma is the most common female genital tract malignancy followed by ovarian carcinoma and uterine cancer. Squamous type of cervical cancer was the commonest type. Hospital facilities for screening and regular gynecological examinations and well-dened follow-up surveillance system can change disease morbidity and mortality.

Primary Vulval Mucinous Adenocarcinoma of Intestinal Type Masquerading as Bartholin's Cyst

Vulval carcinomas are rare and account for 3%–5% of female genital tract malignancies. Primary vulval adenocarcinoma of intestinal type is an extremely rare tumor which is considered metastatic until otherwise proven with very few case reports available in the literature. A 58-year-old woman presented with recurrent swelling in the genital region associated with pain. She had a past history of surgery done for Bartholin's cyst which was reported as adenocarcinoma. She underwent radical vulvectomy for the recurrent tumor which showed features of adenocarcinoma with glandular and papillary pattern with abundant extracellular mucin production and immunohistochemical (IHC) features favoring a diagnosis of primary vulval mucinous adenocarcinoma of intestinal type after excluding metastasis from other sites. As morphology cannot differentiate it from metastasis, a thorough investigation to rule out any primary in the gastrointestinal tract with a minimum IHC panel of markers including cytokeratin (CK) 20, CK7, carcinoembryonic antigen, and caudal-related homeobox 2 can help in confirming the diagnosis.