Ipshita Sahoo

Role of immunohistochemistry in the fertility-sparing management of Sertoli Leydig cell tumour

Ovarian Sertoli Leydig cell tumours (SLCTs) are rare and occur predominantly in young females. Categorised as less common ovarian cancers, they have a favourable prognosis, and fertility preservation is an option in early-stage disease, where fertility is desired. Here, we describe a case of a late adolescent girl, who presented after tumour excision of left ovarian mass. Her initial histopathology report showed mucinous adenocarcinoma of left ovary. Slide review and immunohistochemistry suggested stage IC, intermediate grade Sertoli Leydig cell tumour and the patient was kept on observation. Six months later, she underwent re-surgery with fertility preservation for suspected recurrence. Final histopathology showed no residual tumour. The girl has been disease-free for 4 years. This case highlights the importance of immunohistochemistry and extensive pathology review for diagnosis of this rare tumour. It emphasises that SLCT can masquerade as other poor-grade malignancies owing to histopathological overlap.

Counselling to Screening: Honing an Institutional Cervical Cancer Screening Program

Cervical cancer screening is an important tool in WHO's global strategy for cervical cancer elimination. The objective of the study was to suggest and study the impact of capacity building interventions to increase cervical cancer screening rates in women aged 30-49 years attending the gynecological OPD. As part of a multicentric study, qualitative research was carried out at a tertiary care institute (from September 2021 to June 2022) to gather information regarding the existing cervical cancer screening practices, analyze factors preventing universal screening, and develop troubleshooting strategies. A fishbone analysis was done to identify barriers to cervical cancer screening. Stepwise sequential implementation of seven Plan-Do-Study-Act (PDSA) cycles which included; doctors training, policy formation, dedicated counsellor and reminders on social network groups, OPD card stamps, reading and educational material, screening in all OPD rooms and finally establishment of dedicated screening room. The effect of each on counselling and screening of eligible women was noted. With the implementation of these PDSA cycles, the rates of eligible women being screened increased from 10.6% at baseline to 44.8% at the end of the study period. The percentage of counselled women increased to 70% and it was observed that counselled women were more likely to get screened. Educating women about the importance of cervical cancer screening and the creation of a dedicated screening room were the two most important quality improvement interventions.