<p style="text-align: justify;">The correct diagnosis and management of patients with uterine inversion will always remain as a challenge to any obstetrician. Two cases of puerperal uterine inversion managed differently are presented. In the first patient, there was delay in the diagnosis of uterine inversion and patient had to undergo hysterectomy. In contrast, there was early recognition of uterine inversion in the second patient prompting immediate manual repositioning.p>
Human ; Female ; Young Adult ; Adolescent ; Uterine Inversion ; Hysterectomy ; Obstetric Labor Complications

Endometrial carcinoma can develop in patients less than 40 years old especially in the presence of chronic anovulation and infertility due to polycystic ovarian syndrome. Standard treatment involves staging laparotomy, including hysterectomy. However, this option may not be acceptable to a young patient who is still desirous of having children. Several trial of hormonal treatment as a means of conservative treatment in select patients has shown very good success rates. This is a case report of a twenty-five year old nulligravid with well-differentiated endometrioid adenocarcinoma of the endometrium who presented with anovulatory bleeding. Megestrol acetate was gicen at 160mg daily dose for three months. Sampling of the endometrium after the treatment showed regression of the carcinoma. Ovulation induction with clopmiphene citrate was done. Pregnancy was achieved seven months after carcinoma regression.
Human ; Female ; Adult ; ADENOCARCINOMA ; ENDOMETRIAL NEOPLASMS

It is said that ultimate fulfillment of a woman is the capability to bring forth to the world a new life. However, in the presence of a malignancy in any part of the reproductive tract, this capability is threatened and this ultimate fulfillment may forever be unrealized.
Human ; Female ; Adult ; OVARIAN NEOPLASMS

Objective: To determine the knowledge, attitude and practice involved in the decision making on prophylactic oophorectomy among women awaiting hysterectomy for a benign disease. Methods: Pre-menopausal women scheduled for hysterectomy in a tertiary government hospital were interviewed regarding their views on prophylactic oophorectomy, menopause and hormone replacement therapy. Results: Seventy percent of women consented to outright hysterectomy with bilateral salpingoophorectomy. Almost half (49%) of the women consenting to oophorectomy have no idea as to the benefits of retaining the ovaries after a hysterectomy. Some women (14%) talked about the long term outcome of oophorectomy such as prevention of ovarian cancer but no women mentioned osteoporosis, breast or cardiac disease and dementia. Others (19%) expressed the fear of having another disease on the ovaries if it will be left behind. Majority of women had no idea about menopause and hormone replacement therapy. Sixty percent of the women left the major influence in making the decision to undergo hystertomy alone or oophorectomy with hysterectomy to their physicians. Conclusion: Most these women are under-informed regarding the benefits the benefits or disadvantages of retaining or removing the ovaries, menopause and hormone replacement therapy. It has become a routine practice to recommend oophorectomy based on age alone. Women who consented to outright oophorectomy relied on the decision of their physicians to proceed with the surgery. In this day and age, patients are far less empowered with information that will make them assume the role of a primary decision maker.
Human ; Female ; Middle Aged ; Adult ; OVARIECTOMY ; MENOPAUSE ; HORMONE REPLACEMENT THERAPY

A case of a 26 year-old primigravid with central hypothyroidism resulting from transphenoidal excision surgery (TSE) for an adrenocortic-producing pituitary macroadenoma is presented. Free thyroxine level was low 8 months post TSE and patient was started on levothyroxine therapy. Fortunately, she became pregnant 18 months after levothyroxine medication was started. Repeat cranial Magnetic Resonance Imaging (MRI) did not show any evidence of tumor recurrence. She was also diagnosed with diabetes mellitus type 2 and hypertension and was maintained on premixed insulin and methyldopa. Patient's prenatal course was uneventful with essentially normal antenatal surveillance tests and normal thyroid function tests. Patient was admitted on her 38 1/7 weeks age of gestation for labor induction because of a non-reactive stress test. She delivered a live baby girl, weighing 2600 grams, 37 weeks by pediatric aging with an APGAR score of 9 becoming 9, via assisted vaginal delivery under epidural anesthesia. Postpartum courses were both unremarkable.
Human ; Female ; Adult ; HYPOTHYROIDISM ; ADRENOCORTICOTROPIC HORMONE ; PITUITARY NEOPLASMS ; PREGNANCY

A five-year retrospective study was conducted to determine the fertility and clinical outcomes of ovarian cancer patients undergoing fertility-sparing surgery (FSS). Medical records were evaluated. Menstrual, fertility and clinical outcomes were measured. Of the 44 cases evaluated, 41 (93.18%) were stage I, while 3 (6.82%) had advanced stages. Complete surgical staging was done in 19 (43.18%) patients. All had restoration of menses 1-2 months after surgery with no significant amenorrhea among those given platinum-based chemotherapy. There were 15 successful pregnancies (83.33%). There were only 5 patients (27.78%) with infertility, and 8 (18.18%) cases of tumor persistence/recurrence, all of malignant germ cell tumors without adjuvant chemotherapy. This study confirms FSS as a safe and acceptable treatment for reproductive-age women < 30 years old with no history of infertility, with either stage I epithelial tumors (low malignant potential and frank carcinoma) or malignant germ cell tumors with assured adjuvant chemotherapy.
OVARIAN NEOPLASMS

<p style="text-align: justify;">OBJECTIVE: The development and progression of cervical cancer are likely to be associated with uncontrolled proliferation and recent interest has focused on immunohistochemical detection of cell proliferation. This study aimed to determine if there is a correlation between Ki-67 expression with tumor recurrence and survival rates in patients with Stage IB1or IIA cervical cancer.p> <p style="text-align: justify;">METHODS: Paraffin-embedded cervical tumor tissues of patients with Stage IB1 and IIA cervical cancer treated with radical hysterectomy with or without bilateral salpingooophorectomy and lymph node dissection with corresponding adjuvant treatment, both with histologically proven tumor recurrence (CASES) and with no evidence of disease (CONTROLS) were immunohistochemically stained for expression of Ki-67. The mean percentages of cells with immunoreactivity to Ki-67 were then compared to determine if those cases that had tumor recurrence had a higher Ki-67 proliferative index.p> <p style="text-align: justify;">RESULTS: Six cases with no evidence of disease were included in the study. Ki-67 proliferative index mean levels for the squamous cell carcinoma were 20% and 80% for the cases and controls, respectively. On the other hand , the mean levels of Ki-67 proliferative index for the adenocarcinoma were 73.33% and 90% for the cases and controls, respectively.p> <p style="text-align: justify;">CONCLUSION: This preliminary study did not demonstrate the general statement that tumors with higher proliferative indices have more aggressive behavior than tumors with lower proliferative indices. This study also did not show any association between the Ki-67 proliferative index and disease recurrence in early satge cervical carcinoma.p>
Human ; Female ; Middle Aged ; Adult ; GLASSY CELL CARCINOMA OF THE CERVIX ; UTERINE CERVICAL NEOPLASMS

<p style="text-align: justify;">OBJECTIVE: This prospective study was conducted to determine the correlation between preoperative serum CA 125 levels and the presence of surgicopathologic prognostic factors in endometrial cancer. Subsequently, the study also aimed to determine the CA 125 cutoff value which best predicted the prognostic factors to which it had a significant correlation.
METHODS: Patients diagnosed with endometrial cancer at a tertiary gynecologic oncology unit from October 2006 until July 2008 who were eligible for primary surgical treatment were included in this analysis. Blood was extracted for serum CA 125 determination using a chemiluminescent enzyme immunoassay (CLEIA) prior to surgery. All patients underwent exploratory laparotomy, peritoneal fluid cytlogy, extrafascial or radical hysterectomy with bilateral salpingooophorectomy, bilateral pelvic lymph node dissection and para-aortic lymph node sampling. All specimens were examined for tumor differentation, lymphovascular space invasion, depth of myometrial invasion, cervical, adnexal, and vaginal involvement pelvic and para-aortic lymph node metastases, and peritonneal fluid cytology. Statistical analysis was performed using the Pearson r correlation test to evaluate the correlation of preoperative serum CA 125 with the different surgicopathologic prognostic factors mentioned. A receiver operating characteristics curve (ROC) was used to determine the optimal cutoff value of preoperative CA 125. Sensitivity, specificity, accuracy and likehood ratios were calculated.
RESULTS: A total of 90 patients with endemetrioid type endometrial adenocarcinoma underwent co,plete surgical staging from October 2006 until July 2008. Of the different surgicopathologic prognostic factors, pre-operative serum CA 125 was demonstrated to be significantly correlated with deep myometrial invasion (correlation coefficient 0.24, p=0.02), adnexal metastasis (correlation coefficient 0.26, p=0.01), pelvic lymph node involvement (correlation coefficient 0.31, p=0.01) and para-aortic lymph node involvement (correlation coefficient 0.43, p 0.01. The test likewise significantly correlated with the presence of extrauterine disease with a coefficient of 0.26 (p=0.01). A cutoff value of 55 U/ml has been calculated to predict extrauterine spread with a sensitivity of 53.85% , specificity of 84.38%, and accuracy of 75.56%. Using this cutoff, the odds of the positive test is 3.44, and the odds of negative test is 0.54.
CONCLUSION: Pre-operative serum CA 125 has a statistically significant correlation with the presence of deep myometrial invasion, adnexal metastasis, pelvic and para-aortic lymph node involvement, and extrauterine disease at a determined cutoff value of 55U/mL. It is recommended that serum CA 125 determination be adopted as an integral part of the routine pre-operative work-up of patients with endometrial cancer.p>
Human ; Ascitic Fluid ; Laparotomy ; Prognosis ; Endometrial Neoplasms ; Lymph Node Excision ; Lymphatic Metastasis ; Lymph Nodes ; Hysterectomy ; Immunoenzyme Techniques ; Adenocarcinoma

<p style="text-align: justify;">Prolonged bladder catheterization, the conventional management of urinary bladder dysfunction secondary to radical hysterectomy for gynecologic malignancies, is associated with patient discomfort, higher incidence of urinary tract infection, delayed ambulation and moderate cost.
OBJECTIVE: This study aimed to determine the efficacy and safety of solifenacin succinate in the decreasing mean duration of indwelling catheterization after radical hysterectomy.
METHODS: In this non-blinded, no placebo, randomized controlled trial, patients 19 years old and above, diagnosed with early stage cervical cancer and stage II endometrial cancer were randomized to 2 arms: control arm and treatment arm (given solifenacin succinate 5 mg once a day after radical hysterectomy). Bladder function testing on the 3rd postoperative day and weekly thereafter was done on all patients. The primary endpoint was the mean duration of indwelling catheterization until bladder function recovery was obtained. Patients were monitored for adverse drug reactions and development of urinary tract infection.
RESULTS: Each arm had 18 patients. The clinicopathologic profiles of the patients in the 2 arms were comparable. The mean duration of indwelling catheterization was significantly shorter in the treatment arm (13.33 days ± 10.50 SO) than in the control arm (21.33 days ± 11.66 SO) (P = 0.046). No adverse drug reactions were noted.
CONCLUSION: Solifenacin succinate effectively and safely reduced mean duration of indwelling catheterization among patients who underwent radical hysterectomy. Human ; Female ; Aged ; Middle Aged ; Adult ; Urinary Bladder ; Solifenacin Succinate ; Uterine Cervical Neoplasms ; Urinary Catheterization ; Hysterectomy ; Urinary Tract Infections ; Endometrial Neoplasms ; Drug-related Side Effects And Adverse Reactions

Extramammary Paget’s disease (EMPD) of the vulva is a rare vulvar neoplasm but commonly arises during the postmenopausal period. Intraepithelial Paget’s disease may persist for prolonged periods without demonstrating invasion but with high rates of recurrence. Appearance of Paget’s disease in a split-thickness skin graft, is associated with an occurrence outside the grafted area. It demonstrates retrodissemination as the pathologic process hypothesized in the spread of the disease within the skin via lymphatics and vessels creating tissue bridges between sites of involvement. We present a case of an 81-year-old female, the patient came in for complaints of vulvar pruritus beginning at the left inguinal area three years prior to her diagnosis. She consulted with a dermatologist and was initially treated with steroids and emollients. Persistence of symptoms and enlargement of the lesion prompted a vulvar punch biopsy which showed Paget’s disease and referral to the Gynecologic Oncology service. Wide local excision with split-thickness skin grafting was performed. However, one year after her surgery, patient noted vulvar pain and palpable vulvar lesions. Biopsy was done which showed Extramammary Paget’s Disease recurrence. Patient underwent repeat wide local excision with frozen section, and split-thickness skin grafting. With the aid of frozen section, the intraepithelial involvement was noted to spread beyond the grossly apparent lesion. After 6 months post re-excision, patient noted vulvar pruritus and palpable vulvar lesions. Biopsy was done which showed Extramammary Paget’s Disease recurrence. Due to the proximity of the lesion to the sphincter and need for a colostomy, the patient did not consent for re-excision. Imiquimod 5% was chosen as the mode of treatment. The challenges of interventions are to remove or treat disease that may not be visible, without overtreatment and to minimize morbidity from radical surgery. Surgery remains the primary management for EMPD of the vulva. Imiquimod 5% can be used in recurrences. Despite the advances in the knowledge and management of vulvar Paget’s disease the high rate of recurrent disease remains a challenge for optimal management and would require frequent and long-term follow-up.
Paget Disease, Extramammary ; Female ; vulvar neoplasms ;