Pelvic Mass Research Articles

HE4 as a Biomarker for Diagnosis of Malignant Ovarian Masses in Bangladeshi Population

Ovarian cancer is one of the commonest cancers in gynecology with very high fatality to case ratio. In approximately 70% of all cases of ovarian cancers, the disease is not diagnosed before reaching an advanced stage. Thus early diagnosis of ovarian malignant tumor becomes a key factor in improving the survival rate of patients. This study was aimed to evaluate HE4 (Human Epididymis 4) biomarker for the diagnosis of ovarian malignancy in admitted patients with pelvic mass of ovarian origin scheduled for surgery from Obstetrics and Gynecology department of different medical colleges of Dhaka city and Bangabandhu Sheikh Mujib Medical University (BSMMU). It was a cross-sectional analytical study carried out by non-probability sampling. For this study, 110 admitted patients with ovarian tumor scheduled for surgery were selected.Purpose and procedure of the study was explained in details and informed written consent was taken from all the study subjects before collection of blood sample. Clinical information was taken from the patients’ hospital notes. Before surgery serum HE4 was measured and after surgery, histopathology reports were collected for each patient.Depending on histopathology reports, patients were categorized as benign and malignant. Diagnostic efficacy of HE4 was evaluated with respect to sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and likelihood ratios considering histopathology report as gold standard. To evaluate the performance of HE4 based on optimal cut-off (34.3 pmol/L), we found better sensitivity, NPV and satisfactory likelihood ratios but low specificity and PPV compared to suggested cut-off. The findings of this study shows that HE4 is not a useful biomarker to help in the assessment and management of patients with suspected ovarian cancer.
 Bangladesh J Med Biochem 2019; 12(1): 11-15

Management challenges for Gestational Trophoblastic Neoplasia in a 54 years old perimenopausal woman ; A case report.

Background: Gestational trophoblastic diseases (GTD) are pregnancy-related disorders that originate from trophoblast cells. They include benign and aggressive tumors, such as invasive moles, choriocarcinomas, placental site trophoblastic tumors, and epithelioid trophoblastic tumors. Gestational trophoblastic neoplasia (GTN) mostly occur in women of reproductive age, whereas it is extremely rare in postmenopausal women. Case presentation: A 54-year-old woman presented with prolonged bleeding, abdominal fullness, and pelvic mass with a history of a missed abortion two months prior to the onset of the symptoms and was medically managed. Her general and systemic examination findings were unremarkable. On abdominal examination, the uterus was 14 weeks in size. On speculum examination, the cervix and vagina were normal. On bimanual examination, the uterus was 14 weeks, mobile, and the adnexa were normal. Investigations included serum beta-human chorionic gonadotropin (hCG), abdominopelvic magnetic resonance imaging, and chest computed tomography. Her initial hCG was 179,000 mIu/ml with a bulky uterus and endometrial mass of approximately 6 cm and multiple bilateral chest metastatic nodules. The patient was scored as stage III:10 and started on etoposide, methotrexate, actinomycin alternating with cyclophosphamide, and vincristine (EMACO). She received 11 cycles of EMACO. Her management included repeated transfusions, granulocyte-stimulating factors administration, and ICU admission. Discussion: Gestational trophoblastic neoplasia accounts for rare gynecological malignancies in postmenopausal women. The risk of GTD progressing to GTN is 5% in younger women and five-fold higher (27%) after 45 years. Conclusion: GTN is a rare gynecological malignancy in postmenopausal women. The presentation mimics other gynecological malignancies. Hence, a high index of suspicion is required. Histopathological confirmation is mostly unavailable. It carries a poor prognosis compared with younger women with a high incidence of metastatic, recurrent, and low tolerance to standard multi-agent chemotherapeutic drugs.

Anatomical Variations of the External Genitalia in Posterior Cloaca: Clinical Consequences of Misdiagnosis-A Systematic Review of the Literature and the ARM-Net Consortium Experience.

All types of cloacal malformations may be associated with anatomic variations of the external genitalia, including hypoplasia of the labia minora and enlarged clitoris; these variations could be even higher in posterior cloacas (PCs). If a careful physical examination is not performed, patients may be misdiagnosed with ambiguous genitalia (AG), leading to subsequent unnecessary testing, surgeries, or even wrong gender assignment. The aim was to analyze data of patients with PC within the ARM-Net registry, focusing on the description of the genitalia, gender assignment, and its consequences. Additionally, we investigated the presence of AG diagnosis in utero or at birth in patients with PC in the literature. The ARM-Net registry was scanned for PC cases and data on diagnosis were collected. A systematic literature search was conducted using the PubMed, EMbase, and Web-of-Science databases. Descriptive statistics was used to report data. Nine patients with PC were identified in the ARM-Net registry. Five patients (55%) were diagnosed with AG, two (22%) were assigned as males and only two patients were correctly assigned as females and diagnosed with PC with respective variations of external genitalia. All patients diagnosed with AG had extensive blood testing including karyotype and hormonal studies. One of the patients who was diagnosed as a male, had surgery for pelvic cystic mass removal, which ultimately led to unaware salpingo-oophorectomy, hysterectomy, and vaginectomy. In the literature we identified 60 patients, 14 (23%) with AG, 1 with clitorolabial transposition and 1 with undeveloped vulva and vagina; 4 patients had normal anatomy. In 40 (67%) patients the anatomy of genitalia was not mentioned. Patients with PC are at high risk of being diagnosed with AG or even assigned the wrong gender at birth. In our series two patients were assigned as males, and consequently one of them underwent a highly mutilating surgery. A thorough physical examination together with a high index of suspicion and laboratory workup are mandatory to identify these variations, avoiding further investigations, unnecessary surgeries, and parental stress.

Uterine fibroids and longitudinal profiles of the vaginal microbiota in a cohort presenting for transvaginal ultrasound.

Bacterial vaginosis, characterized in part by low levels of vaginal Lactobacillus species, has been associated with pro-inflammatory cytokines which could fuel uterine fibroid development. However, prior work on the associations between uterine fibroids and vaginal bacteria is sparse. Most studies have focused on assessment of individual taxa in a single sample. To address research gaps, we sought to compare short, longitudinal profiles of the vaginal microbiota in uterine fibroid cases versus controls with assessment for hormonal contraceptives (HCs), a possible confounder associated with both protection from fibroid development and increases in Lactobacillus-dominated vaginal microbiota. This is a secondary analysis of 83 reproductive-age cisgender women who presented for transvaginal ultrasound (TVUS) and self-collected mid-vaginal swabs daily for 1-2 weeks before TVUS (Range: 5-16 days, n = 697 samples). Sonography reports detailed uterine fibroid characteristics (N = 21 cases). Vaginal microbiota was assessed by 16S rRNA gene amplicon sequencing and longitudinal microbiota profiles were categorized by hierarchical clustering. We compared longitudinal profiles of the vaginal microbiota among fibroid cases and controls with exact logistic regression. Common indications for TVUS included pelvic mass (34%) and pelvic pain (39%). Fibroid cases tended to be older and report Black race. Cases less often reported HCs versus controls (32% vs. 58%). A larger proportion of cases had low-Lactobacillus longitudinal profiles (48%) than controls (34%). In unadjusted analysis, L. iners-dominated and low-Lactobacillus profiles had higher odds of fibroid case status compared to other Lactobacillus-dominated profiles, however these results were not statistically significant. No association between vaginal microbiota and fibroids was observed after adjusting for race, HC and menstruation. Results were consistent when number of fibroids were considered. There was not a statistically significant association between longitudinal profiles of vaginal microbiota and uterine fibroids after adjustment for common confounders; however, the study was limited by small sample size.

Risk of Ovarian Malignancy Algorithm and Pelvic Mass Score for the prediction of malignant ovarian tumors: a prospective comparative study.

Ovarian cancer is the seventh most common female cancer worldwide. Nevertheless, there is no available universal screening method for malignant ovarian masses. This study compares the value of the Risk of Ovarian Malignancy Algorithm (ROMA) and Pelvic Mass Score (PMS) scoring systems in the diagnosis of malignant ovarian masses. This prospective comparative study was conducted from March 2021 until April 2022. A total of 258 women diagnosed with ovarian mass and eligible for surgical intervention according to institutional guidelines were enrolled in the study. Ultrasound was performed for the assessment of masses, ascites and metastases, also color flow Doppler was done to measure the resistance index of the mass vasculature. Preoperative venous blood samples were collected to measure CA 125 and HE4. PMS and ROMA scoring systems were calculated for each patient. All women were subjected to a surgical intervention (according to applicable institutional guidelines), using either open or laparoscopic techniques. Histopathological examination of the removed specimens was done, and in line with the recognized gold standard, the results were compared with the pre-operative diagnosis of both scoring systems. Both PMS and ROMA showed a high predictive probability for ovarian malignancies (AUC = 0.93, sensitivity = 83.3%, specificity = 90.37%; AUC = 0.91, sensitivity = 84.4%, specificity = 95.56%, respectively), yet no statistical significant difference was found between the two scoring systems (p = 0.353, 95% CI -0.025 to 0.070). Both PMS and ROMA seem to be promising scoring systems for discriminating benign from malignant ovarian masses, but more research is needed to determine the optimum diagnostic pathway, especially one yielding the least false-negative results.

A Personal Healthcare Knowledge Graph Framework for Diagnosis of Pelvic Masses Diseases.

A Personal Health Knowledge Graph (PHKG) facilitates the efficient integration of potential diagnostic clues from patients' electronic health records with medical knowledge, establishing diagnostic reasoning paths and ensuring accurate, individually interpretable results in the diagnosis of pelvic masses.

18 F-FDG PET/CT Findings of Ovarian Myxoid Chondrosarcoma.

Ovarian myxoid chondrosarcoma is a rare and aggressive tumor. We present 18 F-FDG PET/CT findings of ovarian myxoid chondrosarcoma. The images not only demonstrated a pelvic mass with increased FDG uptake, but also a mass with increased FDG uptake in the right lower abdominal wall. Ovarian malignancy with abdominal wall metastases was suspected. An extraskeletal myxoid chondrosarcoma was diagnosed histopathologically after the mass excision.

Zinner syndrome in pediatric patients: rare disease leading to challenging management.

Zinner syndrome (ZS) is the association of seminal vesicle cysts, ipsilateral ejaculatory duct obstruction, and ipsilateral renal agenesis. This condition is very rare in children and both diagnosis and treatment may be challenging. We reviewed the clinical presentation and treatment describing our experience with a series of three patients. From January 2016 to January 2021, three patients (patients 1, 2, and 3) with symptomatic ZS, aged 2, 15, and 17 years, respectively, were diagnosed and treated. All three patients were symptomatic, manifesting pelvic pain and dysuria. The diagnosis was made by physical examination, ultrasonography, and abdominopelvic MRI. Patient 1 underwent open surgery, while for patients 2 and 3, laparoscopic excision was performed. The renal agenesis regarded the left side in patients 1 and 3, and the right side in patient 2. In all cases, the cystic complex was excised. The mean operating time was 4 h and the mean hospitalization time was 5 days (range 4-6 days). The mean follow-up period was 5 years (range 2-5 years). Patients 1 and 3 showed a complete resolution of the symptoms during postoperative follow-up. In patient 2, clinical symptoms relapsed because of the persistence of a 9 mm cyst requiring a redo laparoscopic excision. Seminal vesicle cyst with ipsilateral renal agenesis, even if rare in pediatric age, should be suspected in young male patients presenting with pelvic cystic masses, pelvic pain, dysuria, and ipsilateral renal absence. Conservative management should be reversed to asymptomatic patients. Surgical treatment is mandatory in symptomatic cases and the preferred approach is minimally invasive surgery to magnify the operating field to spare anatomical structures, primarily the contralateral vas deferens. Radicality is crucial to avoid the persistence of symptoms and the need for reintervention.

MRI assessment of ovarian masses and correlating with CA-125.

The combined use of appropriate imaging modalities and serum biomarkers like serum Carcinoembryonic Antigen-125 (CA-125) helps plan treatment strategies and reduce overall mortality. To assess ovarian masses on Magnetic Resonance Imaging (MRI) and correlate them with serum CA-125 values. To derive a new serum CA-125 cut-off value for differentiating benign from malignant ovarian masses. This cross-sectional study was conducted from August 2020 to January 2021 on patients with suspected pelvic masses referred to the department of radio-diagnosis and meeting inclusion and exclusion criteria. Serum CA-125 values and imaging features on MRI were recorded. A total of 37 ovarian masses were included in the study, of which 14 were malignant and 23 were benign. The mean CA-125 values among benign [35.95 ± 25.42 (mean ± SD) IU/ml] and malignant ovarian masses [444.82 ± 232.9 (mean ± SD) IU/ml] were statistically significant (<0.001). Using the reference serum CA-125 value of 35 IU/ml, specificity and accuracy were 61% and 75.68%. A cut-off value of 80.5 IU/ml recorded specificity and accuracy of 95.7% and 94.59%, respectively, with a sensitivity of 92.86% in differentiating benign from malignant ovarian masses. The serum CA-125 cut-off value of 80.5 IU/ml is a sensitive and specific serum biomarker for ovarian malignancies. A combined approach of MR imaging and serum CA-125 correlation can be used in characterizing ovarian malignancies in routine clinical practice.

Fertility-Sparing Surgery and Adjuvant Chemotherapy with Trastuzumab Result in Complete Remission in a Young Woman with Rare Primary Mucinous Ovarian Cancer due to ERBB2 Co-amplification with CDK12 and Chromosome 11q13.3 Amplicon: A Case Report and Literature Review.

Primary mucinous ovarian carcinoma (PMOC) is a rare tumor, accounting for approximately 3% of all epithelial ovarian cancers (EOCs), with clinical risk factors and biologic features distinct from that of EOC. The prognosis for women with recurrent and high-grade PMOC remains poor, likely related to a poor response to conventional chemotherapy for EOC. A 27-year-old Chinese woman sought medical attention in January 2021 for abdominal distention from a large pelvic mass. After extensive investigations and workup, she was diagnosed with PMOC of the right ovary. Following multidisciplinary team (MDT) discussions, the patient underwent fertility-sparing surgery (FSS) (abdominal left adnexectomy, right partial oophorectomy, pelvic lymph node dissection, para-aortic lymph node dissection, omentectomy) as she yearned to preserve her fertility and the contralateral ovary appeared normal. Deep genetic analyses revealed ERBB2 co-amplification with CDK12 and chromosome 11q13.3 amplicon. Treatment with fertility-sparing surgery and adjuvant chemotherapy with trastuzumab results in complete remission. This novel strategy utilizing precise diagnostics and characterization of the histo-type of rare tumors allowed personalized targeting with optimum drug response for women who yearn fertility preservation and remission from the disease, especially when there is very limited clinical experience on management of such rare ovarian tumors.

Histopathological Study of Ovarian Cysts in Derna

Ovarian cysts, which are sacs filled with fluid located in the ovaries, represent the primary reason for enlarged ovaries, impacting approximately 20% of women who experience a pelvic mass at least once during their lifetime. The present work was carried out to focus on the frequency, gross appearance and histopathological features of each type of ovarian cysts in Derna-City East of Libya. This work included 54 cases of ovarian cysts, out of 338 samples submitted to Noor-AL-Huda Medical Center Pathology Laboratory in Derna City –East of Libya during the period between January 2022 and April 2023, samples were formalin fixed, processed, then H &amp;E sections were obtained for histologic diagnosis and subtyping. The age of patients ranges from 5 – 68 years, the predominant age group was 30– 39 years, 26 (48.14%) were on the right side, 23(42.59%) were on the left side, 5(9.25%) were bilateral. The commonest presenting symptoms were both incidental in 21(38.8%) and pain in 18(33.33%); the cyst mainly obtained from Cystectomy operation 39 (72.22%). Gross appearance of each type was studied. Out of the included 54 ovarian cysts 29 (53.70%) were non –neoplastic and25 (46.29%) were neoplastic. Follicle cysts represented (37.93%) of the non-neoplastic lesions, while serous cyst adenoma represented (40%) of the neoplastic lesions. We concluded that non-neoplastic cysts are the most common types of ovarian cysts. Among non-neoplastic ovarian cysts, the functional cysts including follicular and corpus luteal cysts were the most common, while serous cysts and teratomas are the common neoplastic cysts. Most ovarian cysts are found on the right side. Histopathological examination is essential for accurate diagnosis and proper management of ovarian cysts.

Autoantibodies, antigen-autoantibody complexes and antigens complement CA125 for early detection of ovarian cancer

BackgroundMultiple antigens, autoantibodies (AAb), and antigen-autoantibody (Ag-AAb) complexes were compared for their ability to complement CA125 for early detection of ovarian cancer.MethodsTwenty six biomarkers were measured in a single panel of sera from women with early stage (I-II) ovarian cancers (n = 64), late stage (III-IV) ovarian cancers (186), benign pelvic masses (200) and from healthy controls (502), and then split randomly (50:50) into a training set to identify the most promising classifier and a validation set to compare its performance to CA125 alone.ResultsEight biomarkers detected ≥ 8% of early stage cases at 98% specificity. A four-biomarker panel including CA125, HE4, HE4 Ag-AAb and osteopontin detected 75% of early stage cancers in the validation set from among healthy controls compared to 62% with CA125 alone (p = 0.003) at 98% specificity. The same panel increased sensitivity for distinguishing early-stage ovarian cancers from benign pelvic masses by 25% (p = 0.0004) at 95% specificity. From 21 autoantibody candidates, 3 AAb (anti-p53, anti-CTAG1 and annt-Il-8) detected 22% of early stage ovarian cancers, potentially lengthening lead time prior to diagnosis.ConclusionA four biomarker panel achieved greater sensitivity at the same specificity for early detection of ovarian cancer than CA125 alone.

Risk of ovarian cancer in women using ovarian induction protocols for infertility treatment.

Abstract: Cancer is rapidly becoming a major cause of morbidity and mortality worldwide, &amp; Infertility has been found to be an important risk factor for ovarian cancer. However, the association between infertility drugs and ovarian cancer needs to be addressed with consideration of other factors such as age, body mass index, parity, genetic factors (i.e. family history for ovarian cancer), and etiology of the infertility, along with longer followup times Aim of the study:To rule out or to prove that; the ovulation induction in infertility treatments and can cause ovarian cancer . Design: Retrospective randomized study Setting: Data were obtained from the patient records of those who were diagnosed as ovarian problem, which indicate surgical intervention, at lamis hospital for infertility &amp; Gyn. Misurata -libya. From January 1, 2017 to December 31, 2023. (seven years). Our study contained 110 patients operated with ovarian tumors &amp; 3608 patients treated for infertility by ovulation induction drugs &amp; icsi . Results: The age range of patients with ovarian tumors in our study was from 24 to 72 years, and the highest incidence of ovarian tumors was seen between 46 to 60 years. Most of the patients were at postmenopaus. More than half of the patient with ovarian pathology (58.2%) were multiparous; while nulliparous &amp; patients delivered up to three kids were 8.2% &amp; 33.6% consecutively. The main complain that the patient with ovarian pathology presented with abnormal vaginal bleeding (38.2%) ,lower abdominal pain (26.4%), abnormal vaginal discharge (23.6%) &amp; pelvic mass (21.8%), Some patients were with more than one complains. Only two patient out of 110 included at this study , received ovulation induction drugs (1.8%), while 98.2% of patient with ovarian pathology they never use any drugs for ovarian stimulation. Out of (110) patient there 38 patient were their diagnosis confirmed by histopathology as ovarian cancer of different types, tow patients were received ovulation induction drugs. Only one of them with history of icsi &amp; ovum retrieval (1/3608) I.e. 0.027%, she also had family history of breast cancer.(3608 are the number of cases done ovum retrieval for icsi at lamis infertility clinic at the period from January 2017 up to December 2023.) Conclusions: Although ,the question of whether ovarian stimulation increases the incidence of ovarian cancer, as an independent factor remains unanswered , We confirmed that ovulation induction drugs as treatment of infertility &amp; ovum retrieval for icsi are not a risk factors for ovarian cancer, and we observed no increase incidence of ovarian cancer , Further larger studies are recommended to confirm such findings

A Large Tuberculous Abscess Mimicking an Abdomino-pelvic Cystic Mass: A Case Report

Introduction: Tuberculosis can involve any part of the gastrointestinal tract or the peritoneum and is the sixth most frequent site of extrapulmonary involvement. The pseudotumoral form is relatively rare and several predisposing factors are mentioned, a significant differential diagnostic problem with malignant tumor pathology is exposed , often considered first when encountering an abdominal or pelvic mass in the context of overall deterioration. Presentation of case: We report a rare case of a huge retroperitoneal TB abscess mimicking an abdomino-pelvic cystic mass. Discussion: Abdominal tuberculosis represents 1 to 2% of all locations and 31 to 58% of abdominal locations. The pseudotumoral form is relatively rare and are uncommon in immunocompetent patients. Tuberculosis abscess can present with variable radiologic features. It is difficult to differentiate it from malignant pathologies. Invasive explorations, such as laparoscopy or laparotomy, play a crucial role in confirming the diagnosis. Peritoneal cavity exploration may reveal whitish granulations, peritoneal nodules, peritoneal hyperemia, filamentous peritoneal adhesions, and intestinal adhesions. Histological examination of biopsies are the key to the diagnosis. The treatment of peritoneal tuberculosis relies on a combined therapy of antitubercular drugs . Conclusion: As TB remains endemic in our country and with the continued increase in multidrug-resistant TB infections, it is important to know various presentations and diagnosis forms features of extrapulmonary TB including TB abscess as the treatment remains basically the same combining anti-tuberculosis drugs and the recourse to surgery.

A A retrospective observational study in assesment of role of sonography in adnexal masses and its histopathological correlation in tertiary care centre.

Background- Adnexal masses (masses of the ovary, fallopian tube, or surrounding tissues) commonly are encountered by obstetrician–gynaecologist and often present diagnostic and management dilemmas. Types of adnexal mass ranges from benign ovarian and non-ovarian to primary and secondary malignant ovarian masses. Although most adnexal masses are benign, the main goal of the diagnostic evaluation is to exclude malignancy. Transvaginal ultrasonography remains the gold standard for evaluation of adnexal masses. The management of the adnexal masses varies according to age at presentation, whether benign or malignant, acute emergency or chronic presentation. Aim- The study aimed to determine the causes of adnexal masses and correlation of ultrasonographic and histopathologic findings of the adnexal masses. Methods- This is a retrospective observational study, performed in the Department of Obstetrics and Gynaecology, in tertiary care hospital. Operative and demographic details of patients operated for adnexal masses over a period of one year was obtained from case records of patient. Results- Among 90 cases studied, 86.66%(78) cases of adnexal masses was of ovarian origin followed by 11.66%(7) was of tubal origin. Among 90 cases of adnexal masses, 91.11%(82) cases were benign , 4.44%(4) were of borderline and malignant. Most common ovarian cause of adnexal mass was endometriotic cyst(22.22%) followed by serous cyst adenoma(20%) The highest sensitivity was found for follicular cyst (87.5%) followed by dermoid and serous cyst adenoma (83.33%). Malignancy was found in 8 cases among which 6 were correctly reported by USG resulting in sensitivity of 75%. Conclusion- It was concluded from the current study findings that sonography was primary modality and best screening tool for evaluation of pelvic masses. Ultrasound has high sensitivity for correctly diagnosing benign versus malignant pelvic lesions. Sonography was observed to be best modality to differentiate between solid and cystic pelvic masses.

Investigating the accuracy of Johnson’s rule in estimating fetal weight

BACKGROUND: Birth weight has a significant impact on perinatal mortality. Therefore, the estimation of fetal weight greatly influences the policies necessary for care during and after delivery. We aimed to investigate Johnson’s rule in estimating fetal weight. MATERIALS AND METHOD: This study was a single-group longitudinal study that was conducted in 6 months from October 2021 to April 2022 on 150 pregnant women in Isfahan-Iran. The sampling method was accessible. Inclusion criteria include being term, singleton, without abnormality, intact membranes, cephalic presentation, and exclusion criteria include diagnosed polyhydramnios or oligohydramnios and mother’s abdominal or pelvic known masses. After completing the informed consent, fetal weight was estimated by Johnson’s rule and was compared with the birth weight. Descriptive and analytical statistics (mean-standard deviation (SD), number-percentage, t-paired, and Spearman’s correlation coefficient) were used to achieve the objectives of the study. The receiver operating characteristic (ROC) curve was also used to determine the sensitivity, specificity, and positive and negative predictive value of Johnson’s law. RESULT: The mean (SD) birth weight was 3032.88 ± 481.11 g and the mean (SD) estimated fetal weight (EFW) by the clinical method was 3152.15 ± 391.95 g. There was a significant difference between the averages (P &lt; 0.001). The percentage error of EFW showed a significant negative correlation (r = -0.286; P &lt; 0.05) with gestational age (GA) and a significant positive correlation (r = 0.263; P &lt; 0.05) with the fetal head station. The sensitivity and specificity of EFW with Johnson’s rule, in normal fetal birth weight, were higher than in low birth weight fetal. The accuracy of EFW with ± 10% of the actual weight was higher in average for gestational age (AGA) (84.3%) and high-for-gestational-age (LGA) (70%) than in low-for-gestational-age (SGA) (4%). The EFW mean percentage error in SGA was higher than in the other two weight groups. This method, especially for AGA and LGA fetuses, can be a suitable alternative to other weight estimation methods. CONCLUSION: Clinical estimation of weight via Johnson’s rule due to availability and no cost can be a suitable method for managing childbirth based on fetal weight.

Ovarian Low-Grade Papillary Serous Cystadenocarcinoma with Osseous Metaplasia- Case Report and Review of Literature

Introduction: The stromal osseous metaplasia is extremely rare finding in serous cystadenocarcinoma of the ovary. Case report: A 45-year old female presented with pain in lower abdomen of about 2 months, breathlessness of 10days. On physical examination per abdomen, a large pelvic mass identified. She had pleural and pericardial effusion. Pericardiocentesis was done. Abdomen and pelvis ultrasound revealed a large heterogeneous right adnexal ovarian mass measuring 13.5 × 13.1 × 10.8cm, volume about 916 ml. It was well defined, oval, cystic, partially solid mass, the impression of ovarian neoplasm was given. There was no significant lymphadenopathy. The left ovary, uterus, cervix, fallopian tubes and rest of abdominal organs were normal. Serum CA 125 was 75.5 U/ml. She underwent total abdominal hysterectomy. On histopathological findings reported as right ovarian low-grade papillary serous cystadenocarcinoma with osseous metaplasia. Conclusion: The osseous metaplasia in ovarian serous cystadenocarcinoma is extremely rare.

Acute Urinary Retention due to Hematocolpos: A Case Report

Acute urinary retention is an uncommon occurrence in the pediatric population, usually arising from a mechanical obstruction. It may result from hematocolpos, a gradual accumulation of menstrual blood in the vaginal cavity due to outflow tract disorders, with imperforate hymen being the most prevalent. Despite the simplicity of diagnosing and treating Imperforate Hymen, the occurrence of missed or delayed diagnoses is a common clinical challenge. This issue is attributed to the condition’s low incidence, the presence of nonspecific symptoms, or insufficient physical examinations. We present a case of a 16-year-old patient, presented to the emergency department with a one-day history of acute urinary retention. She had not yet begun menses, and reported a background of cyclical lower back-pain and discomfort during urination. After urethral catheterization, physical examination revealed a regular, resilient pelvic mass and the visual inspection of the external genital tract revealed a thick, bulging, and non-bluish hymen. An ultrasound scan confirmed the diagnosis of hematocolpos. She underwent a hymenectomy using a radial incision and made a good recovery postoperatively. Hematocolpos should be systematically sought in young girls with urinary symptoms and primary amenorrhea. If not managed at time, it may have devasting complication such as tubal adhesion, pelvic endometriosis, and infertility.

Pelvis Metastasis with Rectal Infiltration in Hepatocellular Carcinoma - A Rare Case Report

Background: Hepatocellular carcinoma (HCC) is the most prevalent primary hepatic neoplasm, with approximately 50% of cases eventually developing metastasis. HCC metastasis to the pelvis is exceedingly rare due to the significant anatomical distance and intricate metastatic pathways involved. Case presentation: In this case report, we present a 60-year-old male with HCC metastasis to the pelvis that had infiltrated the rectum. Initially, we suspected the pelvic mass to be a GIST, but histopathological and immunohistochemical examinations revealed it to be HCC metastasis. The dissemination of the tumor was suspected to have occurred through peritoneal implantation following an RFA procedure that the patient had undergone ten months prior. A resection surgery of the sigmoid colon up to the tumor-free mid-rectum was performed. The patient is currently stable and undergoing routine outpatient care, now in the third-month post-surgery. Conclusion: This case report unveils a rare HCC metastasis to the pelvis with rectal infiltration. We conclude that in HCC patients presenting with obstructive symptoms, suspicion of metastasis to the pelvis should be considered, especially in patients who have undergone an RFA procedure. Limited diagnostic support from CT scans and colonoscopy made establishing a definitive diagnosis before surgery challenging. However, patients can attain a favorable prognosis with effective surgical intervention, underscoring the importance of prompt and effective treatment in such cases.

Uterine Cervix Rhabdomyosarcoma : A Case Report

Rhabdomyosarcoma is a malignant tumor that arises from embryonal skeletal muscle cells. It is responsible for 3% of cancer cases among children aged from 0 to 14 and 1% among adolescent and young adult aged from 15 to 19. Embryonal Rhabdomyosarcoma is the most prevalent subtype in the female genital tract and Botryoid sarcomas being a polypoid variant. In young patients, the majority of genital tract rhabdomyosarcomas occur in vagina; however, the most common site being cervix followed by uterine corpus, in adults. We hereby report a case of 24 years lady P2L2 diagnosed as Botryoid Embryonal Rhabdomyosarcoma with evidence of anaplasia without extrauterine metastasis. Embryonal cervical rhabdomyosarcoma is a rare malignant tumor and its typical manifestations are vaginal bleeding and a pelvic mass. However, attention should also be paid to any abnormal vaginal discharge in young unmarried women. Diagnosis of pure rhabdomyosarcoma in uterus involves perfect sampling and histopathological evaluation.