Menopausal Lady Research Articles

Uterine Leiomyosarcoma (uLMS): A Malignancy in Disguise

Uterine leiomyosarcoma mimics leiomyoma of the uterus clinically and on ultrasound imaging. The clinical course and prognosis are however markedly different .The entity may commonly present as a pelvic recurrence after initial surgery for unsuspected leiomyosarcoma. The rarity of this clinical entity renders pre-operative diagnosis to be often missed. The staging of this uncommon variant is significantly influenced by the histopathologic diagnosis. Preoperative suspicion and relevant imaging is needed to improve diagnosis and thereby prognosis through proper surgical staging/sampling and optimal surgical resection as there are no specific tumour biomarkers yet. This is a case report depicting prospectively the outcome of a post-menopausal woman who underwent Total abdominal hysterectomy and bilateral salpingo-oophorectomy for a large fibroid which was confirmed histopathologically as Uterine Leiomyosarcoma( uLMS). After the histologic confirmation of uLMS, the patient was advised Combination chemotherapy, but she declined the adjuvant treatment. After 4 months of primary surgery with no initiation of Chemotherapy , she developed pelvic recurrence with invasion of bladder as detected by CT scan. The patient received 3 cycles of palliative combination Chemotherapy with Inj. Doxorubicin , Inj. Ifosfamide and Inj. Mesna ,Inj. Neukine after the detection of recurrence. She sadly succumbed a few days after completion of the third cycle of chemotherapy. This case report highlights the necessity to suspect the possibility of leiomyosarcoma in a post –menopausal lady with fibroid presenting for surgical management.
 Bangladesh J Obstet Gynaecol, 2021; Vol. 36(1): 69-73

Comparison of intraocular pressure and retinal nerve fibre layer thickness in pre-menopausal and post-menopausal women attending outpatient department of BSMMU

In a menopausal lady, a reduced level of estrogen hormone leads to changes in the intraocular pressure (IOP) and retinal nerve fiber layer (RNFL) thickness in the eyes. This comparative study was carried out in the Outpatient Departments (OPD) of the Community Ophthalmology and Ophthalmology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from April 2017 to June 2019 to identify any difference in IOP and RNFL thickness in pre-menopausal and post-menopausal women aged 40-65 years. In this study, 60 pre-and post-menopausal women were included. Participants 40-50 years old with irregular menstruation were classified as group A, while those 51-65 years old with no menstruation for at least 12 months were classified as group B. More than one-fourth (26.7%) of participants had HTN in group A and 53.3% in group B. HTN was significantly associated with group B. The rise in menopausal age had a significant impact on the mean IOP and RNFL. The mean IOP in right eye (RE) was 11.80 (3.31) mm of Hg in Group A and 15.63 (3.01) mm of Hg in Group B. The mean IOP in left eye (LE) was 12.27(3.78) mm of Hg and 15.47(2.84) mm of Hg in Group A and Group B, respectively. The mean IOP of both eyes was 12.03±3.48 mmHg in Group A and 15.55±2.82 mmHg in Group B. The mean difference of IOP in RE, LE and both were statistically significant between the two groups. The mean RNFL in RE was 103.97±7.42 μm in Group A and 98.90±}6.21 μm in Group B. The mean RNFL in LE was 101.87±6.69 μm and 97.97±6.65 μm in Group A and Group B, respectively. The mean RNFL of both eyes was 102.92±7.77 μm in Group A and 98.45±7.86 μm in Group B. The mean RNFL was statistically significant between the two groups. Post-menopausal women are at an increased risk of developing elevated IOP and thin RNFL than premenopausal women. BSMMU J 2022; 15(2): 61-64

Evaluation of the Result of Dynamic Hip Screw Along with Postoperative Vitamin D Supplementation in Stable Trochenteric Fracture in Elderly Female

Background: Recently trochenteric fracture is one of the common cause of morbidity in the geriatric group. Its mainly affect the elderly group who risk the loss of independence. Frequency of trochenter fracture is increasing with population aging. Treatment is usually surgical of various sorts. ORIF by DHS, PFN, DCS, Arthoplasty all coming in the way. Choice of implant need to focusing on the technical details. Among them DHS is one of the oldest and common devices that used in trochenter fracture. To evaluate the effectiveness of DHS along with Vitamin D in stable trochenter fracture in geriatric group female. Materials and methods: This study was done for the period January 2019 to December 2020 among 36 elderly post menopausal lady with stable trochenter fracture admitted in different private hospital in Chittagong. Case selection was done after proper screening criteria. All patient were treated by ORIF by DHS under c-arm after preoperative evaluation. Post operatively all were treated with oral vitamin D supplement to enhance the union with implant. All the patient were followed up monthly both clinically and radiologicaly. Both the functional and clinical outcome was evaluate after 6 month of operation. Results : Total 36 elderly female with stable trocahnteric fracture with the age range (52-95years) were taken for the study. Open reduction and internal fixation done under c-arm by DHS and oral vitamin D given to all. Final assessment done after 24 weeks, out of 36 patient 50% patient had no limping, 11% regained previous walking ability, 8.3% unable to bear weight. Radiological improvement in healing showed in 91.7% case. Final outcome reveals excellent and good result in total 75% case which is very satisfactory surgical result. Where as only 3 case had a poor outcome those who not able to bear weight even after 24 weeks of operation. Conclusion: The treatment of trochanter fracture by DHS simplifies nursing care, allows early mobilization and reduces mortality and morbidity specially in geriatric group. Stable fixation along with post operative vitamin D supplementation enhance the healing. IAHS Medical Journal Vol 5(1), June 2022; 70-73

Factors to Consider in Midwifery Care during Climacteric and Monopause Period

This study discusses the management of climacteric obstetrics and menopause. Menopause is the final feminine cycle or when the final monthly cycle happens, one of the mental viewpoints of changing self-concept amid menopause is unquestionably menopausal ladies ended up on edge around their bodies and frame self-concept approximately how their bodies are. The side effects experienced by ladies some time recently menopause cause the mother to be ill-equipped approximately physical and mental changes. To decrease this, ladies must get ready themselves both physically and mentally for menopause. Ladies who are going through menopause go through the primary stages counting premenopause, perimenopause, menopause, and postmenopause, and menopause for the most part happens in ladies matured 45-50 a long time.

Biomarkers: An Important Tool for Diagnosing and Treating Breast Cancer

Breast cancer is a type of tumor in which individual cases deviate from each other in morphology, protein expression, molecular phenotype, genetic characteristics, and prognosis. Worldwide, breast cancer is the most-common invasive cancer in women. A patient with breast cancer may have the following symptoms:- lumps, skin dimples, nipple discharge, nipple height, nipple withdrawal, pain and burning sensation. There are many causes and risks of breast cancer, including family history (heriditary), obesity, active smoking, early and late childbearing, breast feeding for less than two weeks, exposure to estrogen and oral contraceptive pills. Most breast cancers are diagnosed through estrogen receptor (ER) -positive determination and rely on estrogen for cell growth and survival. Breast cancer treatment has encountered a few progressions in the previous decades with the revelation of explicit prescient prognostic biomarkers that make conceivable the use of individualized treatments. Blocking estrogen biosynthesis by aromatase inhibitors (AI) has, subsequently, become a first-line endocrine treatment for menopausal ladies with ER-positive breast disease. Various conventional diagnosing and treating methods of breast cancer is available but there have limitation of accuracy and treating. For that reason now a day’s various biomarkers like Molecule or Biochemical biomarkers like Estrogen receptor, Progesterone receptor, human epidermal growth factor receptor 2 (HER2), human Mammaglobin (H-MAM), Osteopontin, Fibroblast Growth Factor Receptor 2 (FGFR2), Phosphatase and tensin homolog (PTEN), Physiologic Biomarkers like Carcinoma Antigen 15-3(CA 15–3), Cancer Antigen 125 (CA 125), Prostate specific antigen (PSA) and Anatomic Biomarkers Oncotype Dx, and Cystic fibrosis Trans-membrane conductance regulator (CFTR). These biomarkers are of great importance in the evaluation and diagnosis process, which leads to better patient’s care and protection of the patients. Due to its various advantages, biomarkers are considered as an innovative tool in the progression of breast cancer diagnosis and treatment.

Volumetric Estimation of Femur Bone for Detecting Osteoporosis

Osteoporosis is a diminishing of the bone that prompts break with least compel. It influences postmenopausal ladies and elderly of both sexual orientations. Bone Mineral Density (BMD) is one of the parameter identified with bone quality. Double Energy X-beam Absorptiometry (DXA) is at present considered as the “highest quality level” for measuring BMD. Morphometric analysis of femur bone is done on both radiographic images and Computed tomography image. An aggregate number of 50 (n = 50) Indian ladies, 18 solid pre menopausal ladies (n = 18, 36.3±8.7 years) and 32 post menopausal ladies (n = 32, 58±9.1 years) whose age extended from 20–85 years were incorporated. The patients are subjected to take X-ray, CT and DXA. The outcomes gotten by DXA found that 20% and 34% of the Indian ladies were having osteoporosis and osteopenia separately. Using SPSS software, the morphometrics analysis like neck of the bone, width of the neck, thickness of shaft, width of acetabular bone is measured and in CT images using MIMICS software the Hounsfield is measured in neck of femur, trochanter head and shaft. Est volume is calculated through measured Hounsfield unit. These qualities were observed to be diminished by −29%, −23%, −17%, −15%, and −10% separately, when contrasting with typical Indian ladies. The obtained square of the correlation coefficients (r2) were 0.22, 0.25, 0.23, 0.41, and 0.34 respectively. In osteoporotic women, The estimated volume of femur neck were significantly reduced by 71.8% and in measured BMD DXA value is reduced by 36.7% compared with normal women. Further, osteoporotic women, the mean values of BMD-DXA as well as Est-vol. BMD of trochanter were significantly (p = 0.01) reduced by 45.7% and 80.2% respectively, when comparing to normal healthy women. The femur neck and aggregate hip BMD and Singh’s list were lesser by 41.6% and 33.7%, 40% (p < 0.01) individually in osteoporotic post-menopausal ladies, contrasting with typical post-menopausal ladies. The mean estimations of range and the volume of the proximal neck were diminished −20% and −21% in the osteoporotic Indian ladies than in typical Indian ladies.

Primary Breast Sarcoma in a Middle Age Lady: A Rare Presentation

Sarcoma is an aggressive, malignant condition of a breast. It is a rare condition, which makes it difficult to diagnose at clinicopathological study. We are reporting a case of a primary breast sarcoma in a 54-year-old menopausal lady that came with painless fast growing right breast lump within 6 months of duration. Clinically, there was a huge mobile painless right breast lump without discoloration of skin noted. Both axilla and supraclavicular lymph node were not palpable. A mammogram showed large lobulated dense mass 8.3cm x 10.0cm in size occupying right upper outer quadrant correspond to BIRADS 4 lesion. A trucut biopsy reported as a papillary lesion. Repeated trucut biopsy reported as mesenchymal lesion with smooth muscle differentiation. With this histopathology report, she was diagnosed with mesenchymal tumor of right breast. She underwent an uneventful mastectomy. Histopathological examination of the surgical specimen reported as tumor with mesenchymal differentiation which requiring further confirmation by breast-endocrine pathologist as primary breast sarcoma. She was subjected to post op radiotherapy to the chest wall followed by adjuvant chemotherapy.

MON-LB044 Bilateral Ovarian Hyperthecosis: A Benign and Unusual Cause of Postmenopausal Hirsutism

Introduction-: Postmenopausal hirsutism is a rare presentation. The presentation of clinical hyperandrogenism , its severity and the pace of presentation along with the hormonal profiles help in determining the cause. Once iatrogenic cause is ruled out, one has to assess for the endocrine causes of postmenopausal hirsutism. There are various benign and malignant causes of ovarian hyperandrogenism. Case Presentation- A 62 years post menopausal lady came with complaints of increasing facial hair, coarseness of facial skin and alopecia for two years. She had no significant medical illness and had not received androgens in any form. She had a normal menstrual history during her reproductive years and has two children born of natural conception. Clinically there was no evidence of other endocrine causes of hyperandrogenism like Acromegaly, Cushing’s syndrome, Late onset CAH. Her hormonal profile showed significantly elevated testosterone levels with normal DHEAS levels. Investigations - TSH 1.898 uIu/ml (NR 0.5-5.0); Testosterone 216.10 ng/dl ( NR 20-90); DHEAS 40 mcg/dl ( NR 17-90); USG abdomen and pelvis showed thickened endometrium 8 mms in size and submucosal fibroid. Further investigations-Serum Testosterone 145 ng/dl (NR 20-90); DHEAS 23.8 mcg/dl ( NR 17-90); 17 OH Progesterone 0.86 ng/ml ( NR 0.2- 0.5); Post Dexamthasone 1 mg cortisol < 1.0 mcg/dl (normal response< 1.8- 2.0); Alpha Fetoprotein 2.08 ng/ml ( NR <10 ng); IGF1 71 ng/ml ( NR 70-140) ; Estradiol 10 pg/ml ( NR <30). Her assessment for other causes of hirsutism ruled out Acromegaly, Late onset CAH and Cushing syndrome. MRI abdomen and pelvis revealed normal ovaries and uterus for her menopausal status. In view of persistent symptoms and very high levels of testosterone along with endometrial hyperplasia, patient was counselled to get her ovaries and uterus removed.She underwent a total hysterectomy with bilateral oophorectomy. Postoperatively the patients symptoms have improved, her skin hue is better and the facial hair growth has significantly reduced. The testosterone levels have returned to normal. Postoperative Total Testosterone 16.12 ng/dl ( NR 20-90) and Free Testosterone 1.63pg/ml ( NR 0.3-2). The histopathology showed bilateral ovarian hyperthecosis along with benign endometrial hyperplasia. Conclusion: Polycystic ovaries is a common cause of hirsutism in young women of reproductive age group. It is not commonly seen in the post menopausal state. Even though the hormonal profile points towards an ovarian cause, localisation of an ovarian pathology is sometimes difficult. Diagnostic and therapeutic bilateral oophorectomy points towards the diagnosis which can be unusual and curable like bilateral ovarian hyperthecosis. This was an unusual , curable and rewarding case of postmenopausal hirsutism. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. s presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

An Unusual case of flaccid Quadriplegia

This case describes a 47 years old Obese post menopausal lady with sudden onset flaccid quadriparesis with sparing of posterior column sensation .She has a prior history of Diabetes mellitus ,systemic hypertension ,Dyslipidemia , and hypothyroidism on regular .She was admitted for 1 day history of fever and malaise, laboratory parameters suggestive of a Possible a viral ethnology .She developed sudden onset of weakness, initially started on her Lower limb and progressing to her upper limb within few hours along with bladder involvement which appeared on the next day of hospitalisation prompt thinking of a demyelination like pattern after ruling out mechanical causes with a radiograph .In the background of a fever prompted thinking of a fast progressing demyelination like a GBS/ADEM and even started IVIG as there is always some time delay for MRI to arrive. The MRI report suggested of Thrombosis of ASA territory involving the anterior paramedian aspect of Medulla extending up to the upper cervical cord. She remained quadriplegic thereafter and 6 months later despite receiving antiplatelets, Physiotherapy and other supportive treatments. The case described here elaborates the clinical presentation and outcome of ASA thrombosis. ASA thrombosis though rare is be thought as a differential of acute onset flaccid quadriparesis in an acute setting .The clinical course and devastating nature of illness should be aware off. Its necessary to diagnose this syndrome in the earliest when patient presents with acute onset of motor weakness sparing the posterior column sensation

Effect of Nano silver as Additive by Different Ways to Acrylic Denture Base and its Role in Menopausal Woman Management

Background and aim: Polymethyl methacrylate (PMMA) is broadly used as a removable prosthesis denture base. Silver Nano-particles (AgNPs) had been included to PMMA because of their antibacterial homes and higher thermal conductivity, at the same time as it had a destructive effect on the flexural strength and coloration stability that is probably resulted from the inhomogeneous combination. The motive of this research changed into to discover whether the addition of (AgNPs)to PMMA either in liquid form or in powder nation can enhance the flexural strength and the shade balance of PMMA. Also evaluating an edentulous menopausal lady as a multidisciplinary control after wearing a denture made from silver nanoparticles added to (PMMA) denture base. Materials and methods: Fifty specimens of heat cure acrylic resin had been organized for flexural strength and color stability. Twenty-five for each test that become divided into 3 groups. Group 1 was the control group (unmodified acrylic resin specimens) and group 2 turned into Nano silver introduced within the form of powder to the polymer of (PMMA), while group 3 was Nano silver brought in the form of liquid to the monomer of (PMMA). Group 2 and 3 specimens had been break up into subgroups A and B 5 each, with 0.2%, and 0.4 % wt. of Nano silver addition to (PMMA) respectively. A flexural strength was measured via the usage of an Instron regular testing machine. A double beam ultra-violet visible spectrophotometer was checked to the degree of coloration stability. One edentulous menopausal woman that present process treatment below a gynecologist for menopausal signs and symptoms was selected as a case report and received denture made out of silver nanoparticles added to acrylic resin and patient satisfaction became evaluated after 4 months. The results have been gathered tabulated and statically analyzed. Results: There has been a massive distinction in the flexural power values among all corporations (p< 0.05) relative to the non-changed heat treatment (control group). Acrylic resin samples with 0.2% in liquid additive form (3A) ended in more flexural power then 0.4% addition (3B) in comparison to different changed groups .The samples with 0.4 % in powder form(2B) had a lowest flexural strength in comparison to the all groups (p< 0.05). In comparing the color variations (ΔE) comparable to control group, group 3A and group 3B, showed lowest color variations respectively. At the same time group 2Aand 2B ended in highest shade distinction . Conclusion: Set up on the effects of this results, modifying PMMA with Nano silver debris led to lower in flexural strength and shade stability, addition of Nano silver particles in liquid shape was higher than powder form as concerning flexural strength and better color difference and the addition percentage of 0.2 became better than 0.4. Menopausal pride turned into higher and her complain became managed with the new denture.

Morphometric analysis of X-ray and CT images for evaluating osteoporosis

Osteoporosis is a diminishing of the bone that prompts break with least compel. It influences postmenopausal ladies and elderly of both sexual orientations. Bone mineral density (BMD) is one of the parameter identified with bone quality. Double energy x-beam absorptiometry (DXA) is at present considered as the “highest quality level” for measuring BMD. Morphometric analysis of femur bone is done on both radiographic images and Computed tomography image. An aggregate number of 50 (n = 50) Indian ladies, 18 solid pre menopausal ladies (n = 18, 36.3 ± 8.7 years) and 32 post menopausal ladies (n = 32, 58 ± 9.1 years) whose age extended from 20 to 85 years were incorporated. The patients are subjected to take X-ray,CT and DXA. The outcomes gotten by DXA found that 20 and 34% of the Indian ladies were having osteoporosis and osteopenia separately. Using SPSS software, the morphometrics analysis like neck of the bone, width of the neck, thickness of shaft, width of acetabular bone is measured and in CT images using MIMICS software the Hounsfield is measured in neck of femur, trochanter head and shaft. Est volume is calculated through measured Hounsfield unit. These qualities were observed to be diminished by − 29%, − 23, − 17, − 15, and − 10% separately, when contrasting with typical Indian ladies. The obtained square of the correlation coefficients (r2) were 0.22, 0.25, 0.23, 0.41, and 0.34 respectively. In osteoporotic women, The estimated volume of femur neck were significantly reduced by 71.8% and in measured BMD DXA value is reduced by 36.7% compared with normal women. Further, osteoporotic women, the mean values of BMD-DXA as well as Est-vol.BMD of trochanter were significantly (p = 0.01) reduced by 45.7 and 80.2% respectively, when comparing to normal healthy women. The femur neck and aggregate hip BMD and Singh’s list were lesser by 41.6 and 33.7, 40% (p < 0.01) individually in osteoporotic post-menopausal ladies, contrasting with typical post-menopausal ladies. The mean estimations of range and the volume of the proximal neck were diminished − 20% and − 21% in the osteoporotic Indian ladies than in typical Indian ladies.

Study on Post Menopausal Ladies with Ovarian Mass – Management &amp; Outcome

Study on Post Menopausal Ladies with Ovarian Mass – Management &amp; Outcome

Meckel’s diverticulum (Gastrointestinal stromal tumors)-two rare case reports

Introduction: Meckel’s Diverticulum is the most common congenital anomaly of the gastrointestinal tract (incidence: 0.6%-4%). Gastro Intestinal Stromal Tumors originate from multipotential stromal cells of Cajal (pacemaker cell of gastrointestinal tract). The GISTs of Meckel’s diverticulum are extremely rare,especially if you consider that only 2% of the population has this kind of diverticula confirmed by autopsy studies, with a percentage that varies between 0.4 and 4.5%. Case Reports: We report two cases, a 53 year old post menopausal lady and a 45 year old peri menopausal lady, both clinico radiologically diagnosed as ovarian masses, found to have a tumor arising from Meckel’s Diverticulum intraoperatively, that were histopathologically proven to be Gastro Intestinal Stromal Tumors. A thorough literature review was done and all the previously quoted case reports are listed. Our literature search revealed a total of 42 case reports of GIST of Meckel’s Diverticulum including ours. Perforation is the most common presentation of a Meckel’s GIST (13 case reports). Meckel’s GIST presenting as a pelvic mass mimicking an ovarian pathology has been reported in the literature (6 case reports). Conclusion: Meckel’s diverticular tumours, though rare, may mimic other pathologies of the abdomen, therefore should be taken into consideration during the differential diagnosis of abdominal and pelvic tumours, especially in cases where imaging modalities doesn’t pinpoint adefinitive diagnosis.

Lippes Loop Inserted 45 Years Back: The Dilemma to Remove It or Leave It in situ. A Case Report with Review of Literature.

IUD's like Lippes Loop (LL), intended for long term use are retained for years and menopausal ladies often present with LL in situ either deliberately or forgotten. We report a case of Lippes Loop removal inserted 45 years back in a woman complaining of post menopausal bleeding. The inserted LL thread was incidentally discovered during clinical examination and Ultrasonography. We also reviewed literature to determine the evidence for and against removal of an inert IUD.

Carcinoma of Vagina in Utero-Vaginal Prolapse: A Rare Presentation &amp; Literature Review

Primary vaginal carcinoma is a rare entity in gynaecological oncology. Genital prolapse associated with primary carcinoma of vagina is even more rare. We here report two cases of early stage of vaginal carcinoma associated with utero-vaginal prolapse treated by surgery &amp; radiotherapy and the review of literature of same entity. A 65 yrs old post menopausal lady presented with irreducible utero-vaginal prolapse &amp; foul smelling per vaginal discharge. A fungating growth was present on the middle part of rt. antero-lateral wall of vagina. Biopsy was taken from the growth &amp; histopathology showed squamous cell Ca. A 75 yrs old multiparous lady presented with long standing ulcer in association with second degree uterovaginal prolapse. Biopsy of the ulcer revealed squamous cell Ca of vagina. As one of the most complicated therapeutic problems in gynaecological oncology, this disease had been deemed to be untreatable until the end of 1930s. Presently as a result of technological improvements in radiotherapy &amp; radical surgery, more favourable prognosis are to be achieved. A patient with a long history of uterine prolapse must be treated with care due to the risk potential for malignant change. Any lesion associated with utero-vaginal prolapse need careful evaluation &amp; should be subjected to biopsy to rule out the underlying carcinoma.&#x0D; JCMCTA 2014 ; 25 (2) : 61-64

Thyroid type papillary carcinoma arising in a mature teratoma.

Struma ovary is a monodermal ovarian teratoma which contains mature thyroid tissue. We present an unusual case of papillary carcinoma arising in struma ovarii. A 52year old post menopausal lady presented with a large right adnexal mass preoperatively diagnosed as a dermoid cyst. She underwent staging laparotomy and the histopatholgy report showed follicular variant of papillary carcinoma thyroid arising in a mature teratoma. She subsequently underwent total thyroidectomy to enable follow up with serum thyroglobulin and iodine scan. On follow up there is no evidence of disease recurrence.

Tuberculous Salpingitis: A Case Report

Tuberculosis (TB) of the genital tract commonly occurs secondary to a primary lesion. The mode of spread is via the lymphatics, the haematogenous route or less commonly by a peritoneal spread. The fallopian tubes are the first targets, followed by the pelvic organs. Isolated cases of TB which occur in a unilateral fallopian tube are rare, particularly with it as a primary site. The aim of this study was to report a rare case of TB of the left fallopian tube in a post menopausal lady with no positive history, clinical or laboratory finding to suggest it to be a secondary focus. As the pre-operative diagnosis was that of a right ovarian neoplasm, the patient underwent staging laparotomy. TB of the left fallopian tube was diagnosed, as there were numerous typical granulomata throughout the fallopian tube.

Extra Uterine Postmenopausal Fibroid with Torsion

Extra uterine leiomyomas are rare and present greater diagnostic challenge. Here we present a case of a 65yr old postmenopausal woman with an adherent calcified pedunculated broad ligament fibroid with torsion who presented as pelvic pain. The case was successfully managed by adhesiolysis and excision of the broad ligament fibroid followed by pan hysterectomy. 2 , they are found in association with similar uterine tumours and their pathology and complications are the same as fibroids. Among the extrauterine fibroids, broad ligament fibroids are the most common to occur 3 although its overall incidence being rare. The incidence of broad ligament fibroid is <1%. II. Case report A 65yr old P2L2 post menopausal lady came with complaints of pain lower abdomen since 1month which was gradual in onset, intermittent and dull aching in nature, with no radiation. No history of bladder/bowel disturbance. No history of sudden weight loss/anorexia/fever. No history of bleeding per vaginum. No history of malignancy in the family. On physical examination, patient was afebrile and hemodynamically stable. On per abdomen examination no palpable masses felt and anterior abdominal wall is obese. Tubectomy scar seen. No engorged veins or visible pulsations. On per speculum examination cervix and vagina appear healthy and pushed towards left. no abnormal discharge. On bimanual examination cervix was firm and deviated to left. Uterus was bulky, anteverted, exact size could not be made out and no forniceal fullness or forniceal tenderness. Patient was investigated thoroughly. Ultrasound revealed retroverted bulky uterus. Multiple intramural altered echo pattern noted in fundal, anterior and posterior myometrium with the largest measuring 1.6×1.0 cm in the anterior myometrium which is calcified. Both the ovaries are not visualized. As in our case diagnostic reports were conclusive of multiple degenerated fibroids causing pelvic pain, we went on with elective laparotomy where we were surprised to find a large irregular mass of size 10×6 cm, hard in consistency, nodular with calcifications found behind the uterus probably arising from the right adnexae. Bulky uterus with multiple small seedling sub serosal fibroids is seen anterior and to the left of the mass. The mass was densely adhered posteriorly to the intestines. The adhesions were gently released and the mass intoto was removed along with the uterus and the ovaries. The mass along with omental bits were sent for frozen section. As the frozen section report was given as benign leiomyoma, patient underwent panhysterectomy. Intra operative findings: An irregular calcified mass of size 10×6cm seen arising from the right adnexae, densely adhered posteriorly to the intestines. The pedicle of the tumor was twisted 3times. Uterus was bulky with 1×1cm fibroid in the anterior myometrium and multiple seedling fibroids seen. Bilateral ovaries appeared healthy. Post operative period was uneventful and patient was discharged on day 8

Paraneoplastic Erythrocytosis in a Malignant Ovarian Steroid Cell Tumour

Neoplastic polycythemia is a condition in which high hematocrit levels result from a neoplastic lesion in the body. It is a rare condition and occur because of excess erythropoietin or androgen production by the neoplastic cells. Steroid cell tumours of the ovary though notorious for producing endocrine changes in the body have rarely been associated with polycythemia. We present the case of a post menopausal lady who developed polycythemia and features of virilisation. Further investigations revealed that she had steroid cell tumour of the left ovary. Her signs and symptoms resolved after surgical removal of the tumour.

Uterine C-Kit positive low grade stromal sarcoma

Uterine C-Kit positive stromal tumors are rare, however, there are a few cases reported in literature. A 58-year-old post menopausal lady presented with bleeding per vaginum. An abdominal examination revealed an enlarged uterus. A computed tomography scan of the abdomen and pelvis showed a large myomatous uterus, with a probable subserosal intramural and intracavitary myoma or cervical myoma in the presence of a solitary large aortocaval node, with multiple bone lesions. The biopsy taken from the uterine mass had revealed, a low-grade uterine sarcoma, which was positive for CD117. This case is presented for its rarity and management dilemma.