Priyanka Garg

Pseudomyxoma peritonei leading to “jelly belly” abdomen: a case report and review of the literature

Abstract Background Pseudomyxoma peritonei is an infrequent condition with a global annual incidence of only one to two cases per million people. Mucinous neoplasms, widespread intraperitoneal implants, and mucinous ascites characterize it. Currently, most clinicians misdiagnose this condition, which leads to delayed management. Case presentation A 44-year-old North Indian female presented with a 1.5-month history of an abdominal lump. Physical examination revealed a sizeable abdominopelvic mass at 36 weeks. Contrast-enhanced computed tomography showed a massive multiloculated right ovarian cystic mass measuring 28 × 23 × 13 cm with mild ascites and elevated carcinoembryonic antigen levels (113.75 ng/ml). A provisional diagnosis of ovarian mucinous neoplasm was made, for which the patient underwent laparotomy. Intraoperatively, there were gross mucinous ascites, along with a large, circumscribed, ruptured right ovarian tumor filled with gelatinous material. The appendicular lump was also filled with mucinous material along with the omentum, ascending colon, right lateral aspect of the rectum, splenic surface, and small bowel mesentery. Cytoreductive surgery was performed along with an oncosurgeon, including total abdominal hysterectomy with bilateral salpingoophorectomy, omentectomy, right hemicolectomy, lower anterior resection, ileo-transverse stapled anastomosis with proximal ileal loop diversion stoma, excision of multiple peritoneal gelatinous implants, and peritoneal lavage. Histopathology and immunohistochemistry confirmed the presence of intestinal-type mucinous carcinoma. Postoperatively, the patient was given six cycles of chemotherapy. She tolerated it without any specific morbidity and had an uneventful recovery. Postoperative follow-up at 15 months revealed normal tumor marker levels and abdominal computed tomography findings and no signs suggestive of local recurrence or distal metastases. Conclusions Pseudomyxoma peritonei is a rare disease that is frequently misdiagnosed in the preoperative phase. Therefore, radiologists and clinicians should maintain a high index of suspicion for accurate diagnosis and multidisciplinary management.

Vulvar leiomyoma in an adolescent girl: a case report and review of the literature

Abstract Background Vulvar leiomyoma is a rare soft tissue tumor, with only around 300 cases described in the literature. Owing to its low incidence of just 0.03% of all gynecological tumors, it often poses a great diagnostic challenge, especially in teenagers. We report this rare occurrence of vulvar leiomyoma in a teenage girl who was primarily left untreated due to cultural taboos and fear of loss of virginity. The main aim in presenting such rare case studies is to raise awareness and expand the diagnostic horizon of the surgeon for appropriate management. Case presentation We describe a case of a 15-year-old North Indian, sexually inactive unmarried girl, who presented with a history of painless swelling in the left labia majora for the last 1 year, which gradually increased in size. There was no associated pain or any other difficulty. Local examination revealed a 14 × 10 cm solid, unilateral nonpedunculated mass on the left labia majora with superficial vascularity. Differential diagnoses of sarcoma, lipoma, Bartholin cyst, and fibroid were kept in mind. Ultrasonography revealed a solid mass with superficial vascularity with normal internal genitalia. The mass was enucleated with an intact capsule under anesthesia. Histopathology confirmed it to be benign vulvar leiomyoma. The patient was discharged after 3 days in a satisfactory condition. Conclusion Leiomyoma of the vulva is an exceptionally rare tumor and is seldom seen in teenagers. It is often misinterpreted as a Bartholin cyst and should be kept as one of the differential diagnosis in teenage girls presenting with unilateral vulvar swelling. Vulvar leiomyoma can be completely cured by surgical removal if diagnosed timely without compromising virginity, so should never be missed in adolescents.

Aggressive (deep) angiomyxoma of the vulva: a case report

Abstract Background Aggressive angiomyxoma of the vulva is a benign, slow-growing tumor originating from myxoid cells of connective tissue. The tumor is known for multiple local recurrences with a low tendency to metastasize. Only around 350 cases have been documented in the scientific literature so far. Case presentation We report a case of a 40-year-old North Indian, unmarried woman with a swelling on the left labium majora for 7 years, along with surface ulceration over the mass. Local examination showed a well-circumscribed, 8 × 8 cm pedunculated  mass arising from the left labium majora with an overlying ulcer measuring 6 cm × 4 cm. After taking informed written consent, wide local excision of the mass and surrounding margins was done under anesthesia. Histopathology was suggestive of aggressive angiomyxoma. Immunohistochemistry was done, which was positive for estrogen and progesterone receptors. Her postoperative recovery was uneventful. The patient was given three doses of gonadotropin-releasing hormone agonist (injection, leuprolide 3.75 mg) once a month. No recurrence has been reported so far on follow-up visits for 1 year. Conclusion Aggressive angiomyxoma is one of the differential diagnoses for vulvovaginal growth in a female. As the tumor is well known for local recurrences, correct diagnosis and appropriate management using a multidisciplinary approach are crucial to managing such patients.

Awareness about Human Papillomavirus Vaccine and Its Uptake among Women from North India: Evidence from a Cross-Sectional Study

This study aims to estimate the prevalence of human papillomavirus (HPV) vaccine usage and determine the factors for awareness about HPV vaccine among women in reproductive age group. This is a cross-sectional survey under a cervical cancer prevention study. The sample size was 1020 women, aged 15-49 years [550 in Delhi and 470 in Rohtak]. Bivariate analysis and Fisher exact test along with binary logistic regression analysis were used to determine the factors for awareness. About 18.0 % [Delhi: 24.2 % and Rohtak: 10.9 %] of the respondents had heard about the vaccine against cervical cancer. The women aged more than 30 years [AOR: 1.35; CI: 0.94, 1.94] were more likely to be aware of cervical cancer vaccine as compare to women of 30 years and less. However, the women from Rohtak [AOR: 0.90; CI: 0.48, 1.66] were less likely to be aware of vaccine against cervical cancer in reference to women aged 30 years and more [AOR: 1.61; CI: 1.01, 2.56] from Delhi. About 0.6 % [Delhi: 1.1 % and Rohtak: 0.0 %] of the respondents had received HPV vaccine. Women tend to have limited knowledge about cervical cancer vaccine and immunisation practices. The women's demographic makeup varied significantly between the two sites, i.e , Rohtak and Delhi, which had an impact on how well they understood and utilised the cervical cancer vaccination. It is worth mentioning that none of the women from Rohtak had received the immunisation. The awareness of the cervical cancer vaccine among women from the Rohtak was lower than the Delhi women.

Prevalence and Predictors of Cervical Cancer Screening among Reproductive Age Group Women: Evidence from Cross-Sectional Study in Rohtak and Delhi

The present study aims to estimate the prevalence and determine the factors for cervical cancer screening among women in the reproductive age group in Delhi and Rohtak, India. The data were utilized from a survey conducted as part of a larger study to increase the access to cervical cancer screening and care by MAMTA-Health Institute for Mother and Child in collaboration with the Health Departments of Palam, New Delhi, and Rohtak, Haryana between 2015 and 2017. Data pertaining to the socio-economic and demographic information along with the information related to cervical cancer screening were utilized for the present study. The sample size was 1020 women in reproductive age group. Descriptive statistics (percentage and frequency distribution), bivariate analysis along with multivariable analysis were done to represent the results.  The Fisher exact test was used to test the level of significance during bivariate analysis. About 35.2% [Delhi: 44.9% and Rohtak: 23.8%] of the respondents had heard about cervical cancer screening. Further about 3.9% [Delhi-2.9% and Haryana-5.1%] had screened for cervical cancer. Women who had heard about cervical cancer were five times more likely to go for screening [aOR: 5.27; CI: 2.53,10.96]. It was found that women over 30 years of age had 12.04 significantly higher  odds of going for cervical cancer screening in reference to women aged 30 years and less [aOR: 12.04; CI: 3.01,53.20]. Women from households with a monthly income of more than 15000 had 2.98  significantly higher odds of going for cervical cancer screening in reference to women from households with an income of 5000 and less [aOR : 2.98; CI: 1.12,9.09]. Findings suggest that awareness about cervical cancer screening test along with its thorough knowledge about its benefits would be an effective intervention to increase the uptake of cervical cancer screening.

Women’s Knowledge on Cervical Cancer Risk Factors and Symptoms: A Cross Sectional Study from Urban India

Early-stage cervical cancer diagnoses may be the consequence of timely medical care in the presence of symptoms which can be linked to awareness of the symptoms and risk factors. This study aims to determine the knowledge about risk factors and symptoms of cervical cancer and associated factors among women aged 20-49 years. Data were utilized from the survey under the intervention "Increasing access to cervical cancer screening and care through the community-centric continuum of care initiative in India" (2015). The sample size was 1,020 women in the age group of 20-49 years. Descriptive statistics, along with bivariate analysis, was done to represent the preliminary results. Multivariable regression analysis was used to represent the estimates. About 40.1% [Delhi: 56.9% and Rohtak: 20.4%] and 45.5% [Delhi: 52.2% and Rohtak: 37.7%] of respondents had good knowledge about risk factors and symptoms of cervical cancer, respectively. Respondents with primary educational status had an 86% significantly higher likelihood for good knowledge about identified risk factors of cervical cancer [ adjusted odds ratio (aOR): 1.86; CI: 1.12-3.10]. Respondents who were married or widowed/divorced/separated had significantly higher odds for good knowledge about identified risk factors and symptoms of cervical cancer in reference to respondents who were never married. Respondents from Rohtak had 72% and 35% significantly higher odds for good knowledge about identified risk factors [aOR:0.28; CI: 0.21,0.39] and symptoms [aOR:0.65; CI: 0.48,0.88] of cervical cancer, respectively, in reference to respondents from Delhi. Overall awareness about cervical cancer and Human papillomavirus (HPV) as the causative agent was low, more so in Rohtak. This is extremely worrisome as blocking HPV infection is one of the most effective ways to prevent cervical cancer. Moreover, the knowledge about the risk factors and symptoms of cervical cancer is also inadequate, particularly in women from Rohtak.