Divya

Abstract

Introduction: Choriocarcinoma ovary is a rare neoplasm. It is gestational or nongestational. Very few cases of NGCO have been reported. Case Report: We describe a case of a multiparous 31 year old woman who came to gynae receiving room with acute pain abdomen in shock. On examination abdominal distension with ascitis was present. On pervaginal examination uterus was bulky, os was closed and tenderness in right fornice was present. Her UPT was positive and blood was aspirated in culdocentesis. Emergency laprotomy was done with a provisional diagnosis of ectopic pregnancy, followed by right sided salpingoophrectomy with left sided tubal ligation. A right ovarian mass around 6X7 cm was found ruptured and was bleeding profusely. There was 2 liters of haemoperitoneum. Patient was transfused 2 units of PCV and 4 units of FFP. Postoperative period was uneventful. Her βhcg levels were 42,416, 48 hours postsurgery. Histopathological and immunohistochemical report were suggestive of nongestational Choriocarcinoma ovary showing sheets of cytotrophoblastic and syncytiotrophoblastic cells and extensive areas of haemorrhage and necrosis. Patient was started on BEP chemotherapy. Computed tomographic scan revealed no brain or lung metastases. Though she took 3 cycles and went LAMA.She was followed up on phone and was reportedly alive and healthy. Keywords: Choriocarcinoma, Non gestational, Ovarian cancer.

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Introduction: We present a case report of mucinous cystadenoma ovary in a 27 year old multiparous female who presented in SJH gynae outpatient department. Case Report: Patient presented with abdominal mass which was rapidly growing and associated with pain abdomen since 2 months. On General examination patient’s condition was fair and she was thin built. On palpation- an abdominal mass of around 20 cm size whose lower margins could not be reached and was firm in consistency. Tumor mass was moving side to side, it’s margins were ill defined and extending till xiphisternum and reaching iliac fossa both sides. Her CA125 levels were 219 IU/ml and S.LDH level was 553 IU/ml. All other tumour markers are normal. Ultrasound examination showed entire abdomen and pelvis was occupied by a multicystic mass which showed septae within it. No significant omental thickening noted. Uterus is normal and shows ET-4mm. ovaries cannot be visualised separately. CECT whole abdomen and pelvis showed large multiloculated multicystic lesion appears to be originating from the right adnexa of size ~19.8*10.5*21.8cm in the abdomino-pelvic region with enhancing septae and internal vascularity was seen. Few of the septae appears thickened. Another small solid cystic lesion of size 86*40*85mm is seen in left adnexa with enhancing solid component and enhancing thickened septae with internal vascularity within. Uterus is seen separately and appears normal.There is no free fluid in abdomen. Explorative laprotomy was planned. A midline incision was given and after excision of mass the specimen was sent for scrape cytology and findings were suggestive of malignant epithelial tumour (possibly mucinous) of ovary. Excision of Left sided ovarian mass and total hysterectomy with partial omentectomy was performed. The ex­amination of the pelvis, abdominal walls, diaphragmatic sur­face, and peritoneum did not show any implants or me­tastases but omental metastases were present. Free fluid was absent in the abdomen. There was no normal ovarian tissue on both sides so bilateral salpingo-oopho­rectomy was performed. Histopathological examination gave confirmatory diagnosis of mucinous cystadenoma of the ovary. Patient and relative were counselled for further treatment and prognosis. On 14th day suture removal done and patient sent for chemotherapy and was discharged in good condition. Keywords: Bilateral, Mucinous cystadenoma, CA125.

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Introduction: Rupture in an unscarred uterus prior to onset of labor in third trimester is a rare event and very few cases have been reported in literature so far. Case Report 1: We describe a case of a primigravida who presented in emergency with pain abdomen with placenta praevia and severe oligominos. An ultrasound was conducted which reported bicornuate unicollis uterus with single live foetus 33+4 weeks having severe oligohydromnios (AFI=2) with placenta anterior and reaching upto internal os in one cornua, the other cornua was empty. A MRI was conducted, which was also inconclusive. She was taken up for laprotomy, peroperatively pregnancy was present in left horn of uterus which had ruptured with intact amniotic sac and was covered with omentum, the placenta was covering the lower half of the left horn and the right horn looked like normal uterus and was empty. The omentum was carefully separated and baby that was delivered weighed 700gms. The left horn was excised and then uterus was closed in layers. Patient was followed up for 6 months, mother was doing well, though baby was 5 kg which was less than the weight for that age and had slow developmental milestones. Case Report 2: Our second case was a 30 years old gravida 5, para 2, abortion 2 woman with 8 months amenorrhea. She was referred with chief complaint of pain abdomen. On examination, she looked almost stable. Even though she was pale; vital signs were within normal parameters. An ultrasound was conducted which showed single live intrauterine foetus 29+2 weeks with absent liquor with placenta praevia with placenta acreta. Emergency laprotomy was decided in view of placenta acreta. It was found to be an abdominal pregnancy. Amnion along with omentum and blood clot matting sac like structure sitting over the fundus with placenta perforating the fundus small incision was given at the fundus and baby weighing 1.15 kg delivered through it. Placenta did not separate and so decision of hysterectomy taken. Conclusion: Rupture in a non laboring unscarred uterus is a very rare condition and needs high index of suspicion for diagnosis it should be kept in differential diagnosis of pregnancy with abdominal pain of any degree. Keywords: Advanced abdominal pregnancy, Ectopic pregnancy, Silent rupture.

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