Primary Ewing sarcoma of the uterine cervix is an exceptionally rare and aggressive malignancy, with only 34 cases reported in the literature. Early recognition and prompt multimodal treatment are essential due to its poor prognosis. We report a case involving a 32-year-old multiparous woman who presented with foul-smelling vaginal discharge and irregular bleeding. Clinical examination revealed a 6×6 cm friable cervical mass extending into the upper vagina. Imaging demonstrated an FDG-avid cervical mass with regional lymphadenopathy. Histopathological analysis, supported by immunohistochemistry and fluorescence in situ hybridization, confirmed Ewing sarcoma with EWSR1 gene rearrangement. The patient received neoadjuvant chemotherapy with VDC (vincristine, doxorubicin, cyclophosphamide) and PIE (cisplatin, ifosfamide, etoposide) regimens, followed by surgical resection, adjuvant chemotherapy, and pelvic radiotherapy. Although initial disease control was achieved, the patient experienced disease recurrence with distant metastases after a 7-month disease-free interval and succumbed to the illness 9 months after diagnosis. This case underscores the importance of including Ewing sarcoma in the differential diagnosis of rapidly growing cervical tumors, particularly in young women. A multidisciplinary approach involving early molecular diagnostics and aggressive combined therapy is critical to improving clinical outcomes in such rare and aggressive cases.

Serous ovarian cancer is the most common malignant ovarian tumour. Traditional management consists of surgical resection with postoperative chemotherapy. Currently neoadjuvant chemotherapy is offered to patients with advanced stage disease. The present study aims to analyse the histomorphological alterations in serous ovarian cancer following neoadjuvant chemotherapy. Correlation of these morphological alterations with survival is also presented here. Serous ovarian cancers from 100 advanced stage cases were included; 50 were treated with pre-surgery chemotherapy. Semi-quantitative scoring was used to grade the alterations in tumour morphology. Survival data was correlated with the final morphological score. Tumour morphology was significantly different in cases treated with neoadjuvant chemotherapy (CT group) as compared to cases with upfront surgery. The CT group cases showed more fibrosis, calcification, and infiltration by lymphocytes, plasma cells, foamy and hemosiderin-laden macrophages. The residual tumour cells had degenerative cytoplasmic changes with nuclear atypia. Patients with significant morphological response had a longer median survival, although it did not attain statistical significance in the current study. With the increasing use of neoadjuvant chemotherapy in management, the pathologist needs to be aware of the altered morphological appearance of tumour. Further studies are required to establish a grading system to assess the tissue response which can be helpful in predicting the overall therapeutic outcome and the prognosis of patients.