Bariki Mchome

Ovarian torsion of a large mature cystic teratoma complicating early pregnancy: a rare case report

Introduction and Importance: Adnexal torsion complicating early pregnancy is rare but should be suspected in pregnant women presenting with acute lower abdominal pain. Mature cystic teratomas (MCTs) are common benign ovarian tumors in women of reproductive age, but their occurrence during pregnancy complicated by torsion is rare. MCTs comprise 20% of all ovarian neoplasms and are commonly encountered in patients between 20 and 40 years of age. Early diagnosis is challenging due to overlapping symptoms with common pregnancy-related conditions, yet prompt recognition and intervention are crucial to preserve maternal and fetal outcomes. This case report aims to highlight the diagnostic and management challenges of adnexal torsion complicating early pregnancy. Case Presentation: We report the case of a 21-year-old primigravida from Northern Tanzania who presented at gestational age of 11 weeks and 4 days of gestation with a sudden-onset history of left lower abdominal pain for 6 h that progressively worsened over time. Abdominal ultrasonography revealed a large left adnexal cystic mass with internal echoes, thickened walls, and posterior acoustic enhancement, measuring 14.0 × 10.4 × 9.3 cm, consistent with a complex ovarian cyst. The uterus was enlarged and contained a viable intrauterine pregnancy with a crown–rump length of 48.6 mm, corresponding to 11 weeks and 4 days of gestation with active cardiac activity. The patient underwent an emergency laparotomy, which confirmed a viable intrauterine pregnancy alongside a large, twisted left ovarian cystic mass measuring 19.0 × 14.0 × 10.0 cm, with torsion of its pedicle around the mesovarium. Detorsion and left salpingo-oophorectomy were performed successfully. Histopathological examination confirmed the diagnosis of a MCT. Postoperative recovery was uneventful, and follow-up at 23 weeks showed a viable ongoing pregnancy. Clinical Discussion: MCTs are prone to torsion due to their size and mobility. Early surgical management is critical to prevent ischemic necrosis and ensure optimal maternal and fetal outcomes. In this case, a timely laparotomy and removal of the affected adnexa resulted in a favorable recovery and continuation of pregnancy. Conclusion: Ovarian torsion due to a MCT in early pregnancy is a rare but important differential diagnosis for acute abdominal pain. Prompt recognition and surgical intervention are vital to preserving maternal health and supporting pregnancy continuation.

Management of a Borderline Brenner Tumor of the Ovary in a Premenopausal Woman in Northern Tanzania. A Rare Case Report and Review of the Current Literature

ABSTRACTBrenner tumors are rare ovarian neoplasms that are typically small and unilateral. Most cases are benign; less than 5% of all Brenner tumors are borderline or proliferative. Brenner tumors originate from the follicular epithelium and consist of ovarian transitional cells surrounded by fibrous tissue. Here we present a case of a 49‐year‐old premenopausal woman from Northern Tanzania. This patient presented to our facility with acute abdominal pain. She also reported abdominal distention which was first noticed 12 months prior to presentation. Magnetic resonance imaging (MRI) identified a 21 × 17 × 5 cm complex cyst with a thickened wall on the right ovary. The radiological findings were suggestive of an ovarian cystadenoma; multiple intramural and subserosal uterine leiomyomas were also noted. A total abdominal hysterectomy (TAH) and bilateral salpingo‐oophorectomy (BSO) was performed. Histopathological findings identified an atypical proliferative borderline Brenner tumor of the right ovary. Postoperative recovery was uneventful, the patient was discharged and managed conservatively postoperatively.

A Rare Case of Large Ovarian Thecoma Diagnosed Histopathologically Following Surgical Management in a Premenopausal Woman: A Case Report and Review of the Current Literature

ABSTRACT Ovarian thecomas are rare sex cord‐stromal tumors of the ovary. These tumors are estimated to account for 1% of all ovarian neoplasms. Thecomas are primarily composed of cells that resemble theca cells, which are involved in estrogen production. While thecomas are more frequently observed in postmenopausal women, they can also occur in premenopausal women. This report presents a rare case of an ovarian thecoma in a premenopausal woman and reviews the current literature on the topic. Herein we endeavor to contribute to the current body of knowledge and provide guidance to clinicians managing similar cases. Our patient is 43 years old and was diagnosed with an ovarian thecoma after she presented to our facility complaining of abdominal pain and abdominal distension. She underwent a total abdominal hysterectomy and unilateral salpingo‐oophorectomy. Histopathological examination confirmed a benign thecoma. We demonstrate that it is crucial to consider this benign condition when evaluating solid ovarian tumors in premenopausal women.

Barriers to adherence to cervical cancer screening care in Northern Tanzania

Abstract Background Cervical cancer disproportionately affects women in low- and middle-income countries compared to those in high-income countries because of the difference in quality and effectiveness of cervical cancer screening programs. An essential part of effective cervical cancer prevention is the continuum of care for a woman with a suspicious cervical lesion (SCL) consisting of appropriate treatment and, in Tanzania, a follow-up screening one year after treatment. This study aimed at identifying factors associated with non-adherence to the scheduled follow-up after treatment of a SCL. Additionally, the cervical cancer screening results one year after treatment were evaluated. Methods A total of 219 clients treated for a SCL between 2017 and 2021 from 8 centres in the Kilimanjaro region were interviewed. Contact and medical information of the clients was obtained at the facilities. Additionally, 11 in-depth interviews with healthcare providers were conducted. Results In the quantitative study, 143 (65.3%) clients treated for suspicious cervical lesions adhered to the recommended follow-up appointment. Significant factors associated with poor adherence were individual barriers such as failure to understand why they should return and access barriers to the health facility. The health workers mentioned a lack of awareness and financial challenges regarding transportation. Conclusion The complete journey of high-risk women needs attention, otherwise the primary screening will not be effective. Additional efforts are needed to address knowledge gaps and socio-economic problems during the follow-up.

HPV types, cervical high-grade lesions and risk factors for oncogenic human papillomavirus infection among 3416 Tanzanian women

ObjectiveThe objective of the present study was to assess the prevalence and type-specific distribution of cervical high-risk (HR) human papillomavirus (HPV) among women with normal and abnormal cytology, and to describe risk factors for HR HPV among HIV-positive and HIV-negative women in Tanzania.MethodologyA cross-sectional study was conducted in existing cervical cancer screening clinics in Kilimanjaro and Dar es Salaam. Cervical specimens were obtained from women aged 25–60 years. Samples were shipped to Denmark for cytological examination, and to Germany for HR HPV testing (using Hybrid Capture 2) and genotyping (using LiPaExtra). Risk factors associated with HPV were assessed by multivariable logistic regression analysis.ResultAltogether, 4080 women were recruited with 3416 women contributing data for the present paper, including 609 HIV-positive women and 2807 HIV-negative women. The overall HR HPV prevalence was 18.9%, whereas the HR HPV prevalence in women with high-grade squamous intraepithelial lesions (HSILs) was 92.7%. Among HPV-positive women with HSIL, HPV16 (32.5%) and HPV58 (19.3%) were the the most common types followed by HPV18 (16.7%) and HPV52 (16.7%). Factors associated with HR HPV included younger age, increasing number of partners and early age at first intercourse. Similar risk factors were found among HIV-positive and HIV-negative women. In addition, among HIV-positive women, those with CD4 counts <200 cells/mm3had an increased risk of HR HPV (OR 2.2; 95% CI 1.2 to 4.8) compared with individuals with CD4 count ≥500 cells/mm3.ConclusionGiven the HPV distribution among Tanzanian women, the current HPV vaccination in Tanzania using quadrivalent vaccine may be considered replaced by the nonavalent vaccine in the future. In addition, appropriate antiretroviral treatment management including monitoring of viremia may decrease the burden of HR HPV in HIV-positive women.

Tanzanian women´s knowledge about Cervical Cancer and HPV and their prevalence of positive VIA cervical screening results. Data from a Prevention and Awareness Campaign in Northern Tanzania, 2017 – 2019

Initial evaluation of a new cervical screening strategy combining human papillomavirus genotyping and automated visual evaluation: the Human Papillomavirus–Automated Visual Evaluation Consortium

Abstract The HPV-Automated Visual Evaluation Consortium is validating a cervical screening strategy enabling accurate cervical screening in resource-limited settings. A rapid, low-cost human papillomavirus (HPV) assay permits sensitive HPV testing of self-collected vaginal specimens; HPV-negative women are reassured. Triage of positive participants combines HPV genotyping (4 groups in order of cancer risk) and visual inspection assisted by automated cervical visual evaluation that classifies cervical appearance as severe, indeterminate, or normal. Together, the combination predicts which women have precancer, permitting targeted management to those most needing treatment. We analyzed CIN3+ yield for each HPV-Automated Visual Evaluation risk level (HPV genotype crossed by automated cervical visual evaluation classification) from 9 clinical sites (Brazil, Cambodia, Dominican Republic, El Salvador, Eswatini, Honduras, Malawi, Nigeria, and Tanzania). Data from 1832 HPV-positive participants confirmed that HPV genotype and automated cervical visual evaluation classification strongly and independently predict risk of histologic CIN3+. The combination of these low-cost tests provided excellent risk stratification, warranting pre-implementation demonstration projects.