Rohan Kapoor

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.

Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy in peritoneal sarcomatosis: Therapeutic advancement or clinical controversy? An institutional review

Peritoneal sarcomatosis is a rare and aggressive condition with limited treatment options. Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy has been explored as a potential therapeutic strategy, although its efficacy remains uncertain. We conducted a retrospective analysis of 24 patients with peritoneal sarcomatosis secondary to uterine and retroperitoneal sarcomas treated at a tertiary oncology center in India between 2014 and 2020. Eligible patients underwent cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy, with follow-up extending for at least 5 years. Outcomes assessed included completeness of cytoreduction (CC-0/1), perioperative morbidity, overall survival, and progression-free survival. The cohort comprised patients with 16 uterine sarcoma and 8 patients with retroperitoneal sarcoma. Complete cytoreduction (CC-0/1) was achieved in 92% of cases. The median overall survival was 35 months (uterine: 32 months; retroperitoneal: 38 months), with 1-, 3-, and 5-year survival rates of 75%, 50%, and 30%, respectively. The median progression-free survival was 14 months, with a recurrence rate of 67%. Postoperative complications occurred in 17%, with no 30-day mortality. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy offers a potential survival benefit for select patients with peritoneal sarcomatosis, particularly those with complete cytoreduction. Although recurrence rates remain high, this approach may improve outcomes compared with systemic therapy alone. Further prospective studies are needed to refine patient selection and optimize treatment strategies.