Journal of Ayub Medical College Abbottabad

COMPARISON OF CLINICOPATHOLOGICAL AND SURVIVAL ANALYSIS OF ENDOMETRIAL DEDIFFERENTIATED, UNDIFFERENTIATED CARCINOMAS AND CARCINOSARCOMAS

Background: Endometrial cancer ranks as the sixth frequently detected cancer and the 14th highest contributor, to cancer-related fatalities, among women globally. High-grade endometrial carcinomas encompass a diverse array of clinically aggressive tumors, including FIGO grade 3 endometrioid adenocarcinoma, uterine papillary serous carcinoma (UPSC), clear cell carcinoma, undifferentiated carcinoma, dedifferentiated carcinoma, and carcinosarcoma. The classification and diagnosis of these tumors pose challenges due to the absence of well-established molecular markers or panels The main purpose of this study is to assess and compare the clinicopathological characteristics of and survival rates of undifferentiated endometrial carcinoma (UEC), dedifferentiated carcinoma (DEC), and carcinosarcoma (CS) in the Pakistani population at SKMCH&RC. Methods: All patients diagnosed with DEC, UEC, and CS were analyzed from January 2011 and December 2022. Clinicopathological and survival data was retrospectively reviewed and analyzed using SPSS version 27. Kaplan-Meier analysis was used to calculate overall survival (OS) and disease-free survival (DFS). Results: Among 71 selected patients, 47.9% had CS, 29.6% had DEC, and 22.5% had UEC. Mean±S.D age at diagnosis was 58.18±11.35 years. A statistically significant association of DEC, UEC, and CS was identified (p-value <0.05) with myometrial invasion (p=0.02), lymphovascular invasion(p=0.006), positive margins(p=0.003), and involvement of adnexa/ parametria/ vaginal /other organ (p=0.01). The commonest pathological stage was pT1 38(53.5%). 56.3% of patients received chemotherapy, 29.6% received radiotherapy, and 38.0% received a combination of chemotherapy and radiation treatment. Recurrence occurred in 19.7% and death occurred in 37.7% of patients. The highest 5-year OS rate for pathological stage 1 was 59.1% (95% C.I: 42.9-81.3%) and 5-year-DFS was 62.2% (95% C.I: 42.9-81.3%). Conclusion: Patients diagnosed at an early pathological stage demonstrate better survival outcomes compared to an advanced stage, as documented in previous studies. Nevertheless, survival rates remain lower than Western population, indicating a necessity for gathering additional clinical data and alter the management strategies in our population.

RARE MANIFESTATION OF ANTI-NMDAR ENCEPHALITIS

N-methyl-d-aspartate receptor (NMDAR) antibody encephalitis is an autoimmune syndrome with the development of antibody production against the NMDAR, affecting synaptic plasticity and cognition. It has a common association with ovarian teratomas with women being affected disproportionately. We present a case of an eight-year-old female child presented with complaints of fever, altered level of consciousness and choreiform movements. Owing to its common occurrence in the developing world, initially, rheumatic fever was kept in the differential diagnosis and was treated accordingly, but through a series of investigations, was diagnosed as a case of N-methyl-d-aspartate receptor (NMDAR) antibody encephalitis. This case report urges the healthcare providers to keep Anti NMDAR encephalitis as a differential in their minds, while dealing with patients, having chorea as their main clinical manifestation. Owing to its rarity, we have primarily reported it here.

ENDOMETRIOMA COEXISTING WITH MATURE CYSTIC TERATOMA IN A SINGLE OVARY: A RARE PRESENTATION

Mature cystic teratomas, commonly known as dermoid cysts, are prevalent benign ovarian tumors that originate from germ cells and mature into diverse tissue types. They are usually asymptomatic but can lead to complications like torsion, rupture, or malignant transformation. Endometriosis is a condition in which endometrial tissue grows outside the uterus and it is commonly associated with pelvic pain and infertility. We report a case of a  27-year-old woman who presented with a history of lower abdominal pain and dysmenorrhea. Initial ultrasonography revealed a complex cyst in the left ovary which, on a later Magnetic Resonance Imaging (MRI) scan, proved to be two distinct cystic lesions within the same ovary. Subsequently, a laparatomy and ovarian resection was done, and histopathologic examination confirmed the coexistence of a mature cystic teratoma and an endometrioma in the left ovary. This case report highlights the unique occurence of these two conditions simultaneously, the challenges of differentiating these coexisting conditions and emphasizes the importance of utilizing multiple imaging modalities to achieve an accurate pre-operative diagnosis.

TREATMENT OUTCOMES OF GESTATIONAL TROPHOBLASTIC DISEASE, EXPERIENCE FROM SAUDI ARABIA

Background: This research aims to assess the treatment outcomes and chemotherapy duration required for the normalization of Human chorionic gonadotropin (HCG) levels in patients diagnosed with Gestational Trophoblastic Neoplasia (GTN), encompassing both benign and malignant forms of the condition. Methods: This retrospective study included GTD patients treated with chemotherapy in a single oncology clinic from January 2016 to May 2022. Clinical data were gathered from electronic records of the patients. Results: During the study period, a total of 24 patients diagnosed with GTD underwent chemotherapy, with a median age of 32 years (range: 18–51). Intramuscular Methotrexate was the primary single-agent chemotherapy utilized in 20 cases (83%) for low-risk disease, while the EMA-CO regimen was the predominant combination chemotherapy employed in 3 cases (13%) for high-risk disease. The median number of chemotherapy cycles administered was 2 (range: 1–16), with a median duration of 4 weeks (range: 1–16) required for Human chorionic gonadotropin (HCG) normalization. Approximately half of the patients (n=10, 47.5%) transitioned to second-line combination chemotherapy, with a median normalization duration of 4 months. Four patients (40%) subsequently received third-line combination chemotherapy using the EMA-CO regimen. Initial complete response was achieved in 11 patients (47%) with first-line treatment, while 10 patients (43%) required second-line chemotherapy and 4 patients (17%) necessitated third-line EMACO chemotherapy. Of the 24 patients, 22 achieved complete response, while 2 patients are currently undergoing treatment. Conclusion: All patients successfully attained complete response with chemotherapy. The median duration of chemotherapy for achieving normalization of HCG was 4 weeks, equivalent to 2 cycles. Notably, only 4 patients necessitated third-line chemotherapy following single-agent chemotherapy in the first and second lines.