Abhiram Kanneganti

Extragonadal teratomas in women and adolescent girls: A systematic review

Extragonadal teratomas (EGTs) are rare and the commonest intra-abdominal subtype is omental. We present two cases: 1) a parasitic omental teratoma likely secondary to auto-amputation of an ovarian teratoma with subsequent omental reimplantation and 2) an omental immature teratoma likely due to parthenogenetic activation of displaced primordial germ cells. We subsequently conduct a systematic review to characterise EGTs. We sourced for English, peer-reviewed case reports of extragonadal teratomas in women and female adolescents aged 11 and above published from inception of each database through 31st June 2020 following PRISMA guidelines. Two authors reviewed each case for appropriateness and each case was graded for methodological quality utilising a modified Newcastle Ottawa Scale. PROSPERO Registration Number: CRD42020190131 RESULTS: Upon literature review between 1920-2020, from an initial screen of 818 articles, 67 articles were selected featuring 70 cases. One case featured an immature teratoma while the remaining were mature. Omental EGTs were the most common (56.5 %) followed by Pouch of Douglas and uterosacral ligament (23.2 %) and upper abdomen (14.5 %). There were statistically significant differences in EGT mean sizes between each location with the largest being in the upper abdomen (10.9 cm) and the smallest being in the adnexa or hernia (6.2 cm). Auto-amputation was deemed the commonest cause amongst omental EGTs (55.3 %) and Pouch of Douglas and uterosacral ligament EGTs (37.5 %) while 70 % of upper abdominal EGTs were likely due to displaced primordial germ cells. We characterise clinical features associated with each pathogenic mechanism and imaging characteristics of EGTs. Characterisation of EGT tumour marker profiles was limited as only 42.9 % of cases reported them but 19.2-25.0 % had raised tumour markers. The main risks are torsion, rupture, immature components and potential malignant change of the cell lines. Treatment is largely surgical. The mean size of EGTs approached laparoscopically and via laparotomy was 5.23 cm and 9.16 cm respectively. While rare, EGTs should be considered when evaluating pelviabdominal masses with imaging characteristics consistent with teratomas. Confirmation is usually intraoperative and a laparoscopic approach is reasonable if there is good surgeon comfort and the size is about 5 cm.

Screening of human papilloma virus-related anogenital cancers in immunocompromised women: a systematic review of clinical practice guidelines.

Human papillomavirus-related anogenital cancers disproportionately affect immunocompromised patients due to poor clearance rates and accelerated oncogenicity. This systematic review compares anogenital cancer screening Clinical Practice Guidelines among different subpopulations of immunocompromised women. We conducted a systematic review of guidelines addressing cervical, anal, vaginal, and vulvar cancer screening among immunocompromised women published between 2004 and 2025, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Recommendations were categorized for women with human immunodeficiency virus, transplant recipients, and those with autoimmune conditions. The final review included 26 guidelines. Guidelines for transplant recipients and women with autoimmune conditions were of poorer quality. Only 7 high-quality guidelines addressed resource-limited settings. There was no consensus on cervical cancer screening recommendations regarding initiation, cessation, frequency, methods, and colposcopy referral. Newer guidelines increasingly recommended triennial human papillomavirus testing or co-testing. For anal screening, most guidelines recommended annual cytology starting at age 45 if there is access to high-resolution anoscopy. Otherwise, digital anal rectal examination was recommended. One guideline addressed vaginal cancer screening in post-hysterectomy women with human immunodeficiency virus. It recommended annual vaginal cuff Pap testing and vaginal colposcopy for abnormal cytology or concomitant vulvar lesions. Routine vulvar cancer screening was not recommended. More high-quality guidelines are required for immunocompromised women. Recommendations tailored to low- and lower-middle-income countries are urgently needed. Future guidelines should address the expansion of novel biologics, increased survival among various immunocompromised patient groups (eg, those with end-stage renal disease), and the need for differential screening algorithms according to levels of immunosuppression.