Mukurdipi Ray

Paraneoplastic hypercalcaemia induced by ovarian clear-cell carcinoma in a young nullipara: implications for early detection and management

Paraneoplastic hypercalcaemia, an uncommon manifestation in ovarian malignancies, exhibits the commonest association with clear cell carcinoma among epithelial ovarian neoplasms. Patients presenting with severe hypercalcaemia of malignancy are considered oncological emergencies, necessitating prompt and aggressive intervention. We present a case of ovarian clear-cell carcinoma (OCCC) that manifests with severe hypercalcaemia as one of its primary clinical features, posing significant challenges to precise diagnosis and preoperative optimisation. The necessity for aggressive fluid resuscitation, calciuresis and meticulous electrolyte monitoring led to an arduous course in perioperative management. Normalisation of the serum calcium levels was promptly noted following primary cytoreductive surgery. This case underscores the importance of including OCCC in the differential diagnosis of unexplained hypercalcaemia, particularly in women presenting with symptoms suggestive of ovarian malignancy. This also emphasises the critical need for early recognition of these paraneoplastic manifestations, facilitating timely diagnosis and treatment initiation, potentially improving prognostic outcomes.

Meigs syndrome mimicking ovarian carcinoma: a diagnostic pitfall

Meigs syndrome, characterised by a pelvic mass, ascites and pleural effusion, is commonly associated with benign ovarian fibromas. It can mimic ovarian carcinoma both clinically and radiologically, leading to potential misdiagnosis. Early recognition of Meigs syndrome is crucial to prevent unnecessary interventions, such as chemotherapy or extensive surgery. This is a case summary of a woman in her early 50s who presented with abdominal pain, shortness of breath and a pelvic mass, suggestive of ovarian malignancy. Imaging and elevated CA-125 levels raised suspicion for ovarian cancer. However, histopathological examination of the mass revealed an ovarian fibroma, confirming Meigs syndrome. Meigs syndrome should be considered as part of the differential diagnosis in cases of pelvic masses with ascites and pleural effusion, helping to guide appropriate management and avoid unnecessary treatments.

Proposed Nodal Cancer Index (NCI) in ovarian carcinomatosis

Abstract Introduction The nodal positivity in advanced ovarian cancers is approximately 68–70% histopathologically. Even after neoadjuvant chemotherapy (NACT) chance of nodal positivity is around 50–80%. In the prevailing literature, the nodal burden is a neglected entity in both assessment and documentation and complete clearance during the CRS. We aim to highlight the importance of nodal dissection and propose a Nodal Cancer Index (NCI) like PCI for ovarian cancers based on our experience of 105 cases. Materials and methods We included 105 patients with advanced ovarian cancers who underwent CRS. Retroperitoneal lymph nodes and bilateral pelvic lymph node dissection were routinely done in all the cases. For Nodal Cancer Index calculation, the abdomen is divided into 13 zones, zones 1–6 for retroperitoneum, zones 1–6 for Pelvic nodes, and zone 0 for extra-abdominal nodes. Furthermore, a Nodal size score ranging from 1 to 3 has been proposed so that the Nodal Cancer Index ranges from 13 to 39. Results The median age of the patients was 51 years (range 19–71) and the most significant patients were in stage III (65.7%), and 34.3% had stage IV disease at presentation. The lymph nodes were found to be positive in 62 patients (59%), and the positivity rate was higher in patients who underwent upfront surgery 36 (58.1%) as compared to 26 (41.9%) in those who received NACT. The majority of the patients (56.6%) had positive lymph nodes in both the pelvic and retroperitoneal groups, whereas 19.3% had only pelvic nodes positive, and 24.2% had only retroperitoneal nodes positive. The probability of overall survival at 5 years in our patients was 48.9% (95% CI = 35.5–61). Conclusion The results of our analytic observation confirm that systemic lymphadenectomy of all 13 zones proposed by our study should be an integral part of optimal CRS in the advanced carcinoma ovary and this will help us manage these advanced cases in a better objective manner.

Is there a role of cytoreductive surgery with HIPEC in recurrent ovarian granulosa cell tumors? An Indian cancer center experience with review of literature

Abstract Background: Granulosa cell tumors of the ovary represent the most common sex-cord stromal tumors. Though characterized by an indolent course and a good five-year survival rate, they tend to have late recurrences and subsequent poorer survival. The role of hyperthermic intraperitoneal chemotherapy (HIPEC) in women with recurrent granulosa cell tumors with peritoneal dissemination has not been well defined. Methods: All patients with adult or juvenile type granulosa cell tumors who underwent cytoreductive surgery with HIPEC with 70 mg/m2 of cisplatin for 60 minutes over a period of four years were retrospectively evaluated. We also performed a review of the literature on similar cases reported. Results: We identified eight patients with recurrent adult granulosa cell tumors (AGCT) who fulfilled our inclusion criteria. The mean operative duration was 340 minutes, inclusive of the duration of HIPEC. Fifty percent of patients suffered from postoperative morbidity. Grade 4 morbidity was observed in one patient. At a median follow-up of 35 months, four patients experienced disease recurrence. The median disease-free survival was 10 months (range: 6–31 months) and the median overall survival was 11.5 months (range: 7–40 months). Conclusion: Cytoreductive surgery (CRS) and HIPEC provides a unique opportunity for treating peritoneal dissemination in patients with recurrent ovarian AGCTs. This procedure is well tolerated with acceptable morbidity. Prospective studies are warranted to further elucidate the efficacy of this novel therapeutic approach in recurrent ovarian granulosa cell tumors.

Hyperthermic Intraperitoneal Chemotherapy in Locally Advanced and Recurrent Ovarian Carcinoma: Surgical and Oncological Outcomes in the Indian Public Healthcare System

This study analyzed the surgical outcomes after initial implementation of a cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) program in government settings in India.