Journal of Nepal Medical Association

Conjunction of ovarian dermoid cyst in a patient with Pituitary Micro Adenoma: A Case Report

Pituitary adenomas are common intracranial tumors, and ovarian dermoids are frequently encountered benign gynecological lesions. While both conditions are individually prevalent, their co-existence is rare and infrequently reported. This unusual combination may pose diagnostic challenges and warrants further exploration to determine any potential underlying link. We present a case of a 42-year-old Hindu female who was diagnosed case of a pituitary adenoma with a leftsided ovarian dermoid cyst resulting in a gynecological and hormonal imbalance. The diagnosis was confirmed by subsequent related investigations and the patient has been getting symptomatic treatment.This case underscores the importance of a comprehensive differential diagnosis in patients presenting with related symptoms and highlights the value of a multidisciplinary approach for timely diagnosis, effective management, and improved patient outcomes. Despite advancements, the relationship between elevated prolactin levels and the pathophysiology of ovarian dermoid cysts remains unclear. The synchronous occurrence of these two conditions is rare and continues to pose a diagnostic and therapeutic challenge for clinicians.

A Paraurethral Vaginal Mass in Rural Setting: A Case Report

Paraurethral vaginal leiomyoma is the infrequent case to be described. Approximately 300 cases have been described so far. Imaging modalities aid in identifying the morphological, structural characteristics of the mass and its relationship to the surrounding structures. Thirty-six years old married women presented with a vulvar mass of (3x5) cm2. Her associated complaints were left shift of the urinary stream and dyspareunia. Ultrasonography and cystography revealed a mass with no relationship with bladder or uterine structure. Surgical excision was performed. The histopathological report confirmed the diagnosis of paraurethral vaginal leiomyoma. Surgical excision is the treatment of choice and diagnosis is confirmed by histopathological examination.

Vaginal Neoplasm in a Breast Cancer Survivor: A Case Report

According to GLOBOCAN 2022 data, Carcinoma breast is the second most common malignancy worldwide after lung and ranks 4th in mortality worldwide. Breast cancer can metastasize to various organs. The incidence of vaginal metastasis in carcinoma breast is 1-2%. Here we present a patient with post menopausal bleeding with vaginal mass. She had a history of Triple negative carcinoma left breast 3 years back, treated by Modified Radical Mastectomy followed by chemo radiotherapy. Vaginal biopsy was suggestive of a metastatic carcinoma breast. MRI and PET CT showed isolated vaginal growth. Due to poor performance status and multiple medical comorbidities, decision was taken to treat her with single agent Paclitaxel 3weekly until disease progression. This case report points out the necessity for thorough gynaecological examination in a cancer survivor, either via clinical examination, routine PAP smear or imaging.

Prevalence of Cervical Cancer among Cervical Biopsies in a Tertiary Care Center

Introduction: Cervical cancer is one of the most common cancer among the female population inNepal. The incidence and mortality rate due to cervical cancer is higher in developing countrieslike Nepal due to a lack of proper screening and early diagnosis. This study aims to find out theprevalence of cervical cancer among cervical biopsies in a tertiary care center.
 Methods: A descriptive cross-sectional study was conducted among the hospital records of cervicalbiopsies from the department of pathology of Shree Birendra Hospital from 1st May 2018 to 30thApril 2019. Ethical approval was taken from the Institutional Review Committee in February 2020.This study was conducted among 146 cervical biopsies by using convenience sampling method.Point estimate at 95% Confidence Interval was calculated along with frequency and proportion forbinary data. Data were analyzed using excel 2016 software.
 Results: The prevalence of cervical cancer among 146 cases included in our study is found to be6 (4.11%) at 95% Confidence Interval (0.90-7.32). Among those cases of cervical cancer, 4 (66.67%)were squamous cell carcinoma, 1 (16.67%) was adenocarcinoma, and 1 (16.67%) was of other type.Maximum cases of cervical cancer were prevalent among higher age groups.
 Conclusions: Cervical cancer-related morbidity and mortality are different in different parts ofthe world. It’s burden is primarily seen in developing countries where there is a lack of effectivescreening programs.

Immature Teratoma in Pregnancy: A Case Report

Immature teratoma is one of the rare malignant germ cell tumours presented in pregnancy. Here, we present 26-year-old pregnant women who had an incidental finding of left adnexal mass in an anomaly scan at 19 weeks of pregnancy. Laparotomy with peritoneal fluid cytology, left salpingo-oophorectomy and omental biopsy at 20 weeks of pregnancy revealed immature teratoma stage 1A, grade 2 in the histopathology report. However, she followed up with the metastatic mass in the pouch of Douglas at 30 weeks of pregnancy in magnetic resonance imaging despite being counselled for possible chemotherapy and surveillance. A baby with a good Apgar score and grade 3 immature teratoma in the metastatic mass was revealed following the exploratory laparotomy and cesarean section at 36 weeks of pregnancy. Fertility-sparing surgery with chemotherapy during pregnancy for high-grade tumours may result in a good prognosis.

Immunohistochemical Expression of P16 in Cervical Lesions: An Observational Study

Introduction: Cervical cancer is the leading cancer and the predominant cause of cancer-associated deaths among women worldwide. Human papillomavirus infection is the foremost cause of cervical cancer. P16 tumor suppressor protein is overexpressed in high-risk HPV infected cells. This has led to the development of P16 as a reliable predictive biomarker to identify women with cervical dysplasia who are at risk of progressing to high-grade cervical intraepithelial neoplasia and invasive cancer. The study aimed to determine the expression pattern of P16 in lesions of the cervix. Methods: This observational study was conducted at Paropakar Maternity and Women’s Hospital, Nepal, from June 2025 to August 2025. All patients who visited the Gynecology outpatient department for abnormal cervical screening were included in the study. An immunohistochemistry test for P16 was performed in histologically confirmed pre-invasive and invasive lesions. Results: Of 88 cervical biopsies, 34 (38.63%) lesions were preinvasive, and 20 (22.72%) lesions were invasive. P16 immunohistochemistry was performed in 52 (59.09%) histologically confirmed dysplastic and invasive cervical lesions. Among 52 dysplastic lesions, 37 (71.15%) cases were P16- positive. Out of 37 P16-positive cases, 17 (45.95%) were preinvasive and 20 (54.05%) were invasive lesions. In pre-invasive group, 1 (10 %) were CIN1 lesion, 2 (28.57%) CIN II lesions, and 14 (93.33%) CIN III lesions were P16 positive, and among 20 invasive lesions, 20 (100%) were P16 positive. Conclusions: P16 expression was found to increase with the severity of cervical dysplasia and was positive in all invasive cervical cancer cases.

Mature Cystic Teratoma at Fallopian Tubes: A Case Series

Benign tumors of the fallopian tube are uncommon. Teratomas are most frequently found in the ovary and fallopian tube teratoma is extremely rare. To date, around 70 cases have been described, and most of them were discovered by chance. Here we present two cases of fallopian tube dermoid cyst. The first case is of a woman who was unable to conceive for 4 years with a right ovarian dermoid. She was managed with laparoscopic cystectomy when she was found to have a small teratoma-like lesion at the fimbrial end of the left fallopian tube. The second case is of a female who underwent elective caesarian section and was found to have a teratoma-like lesion at the right fallopian tube. Histopathology of both cases were reported as mature cystic teratoma. These cases suggest the need for careful examination of the pelvic organs for other pathology apart from the primary surgical sites.

Broad Ligament Leiomyomata - An Important Differential Diagnosis in Huge Abdominal Mass: A Case Report

Leiomyomas are a common gynaecological condition affecting 20-30% of women over the age of 35, with prevalence decreasing following menopause. Leiomyomas are most commonly found within the uterus. Rarer extra-uterine locations include the broad ligament, cervix, and vagina. We present an unusual case of multiple Left Broad Ligament Leiomyomata that extended from Left Iliac Fossa and Hypogastrium to Epigastric region in a 50- year-old female. Our case highlights the importance for extra-uterine leiomyoma to be considered as a differential diagnosis in patients presenting with huge abdominal mass suspicious of adnexal tumor or malignancy.

Mucinous Cystadenoma of Ovary with Vague Symptoms: A Case Report

Ovarian cyst is a fluid-filled sac in the ovary, common among reproductive women. Mucinous cystadenoma is a common variety of non-functional benign lesions that presents vague symptoms and can mislead the diagnosis. A 26-year-old female presented to the clinic with weakness and lethargy, which lasted for 3 months, along with other symptoms like headache, abdominal pain, bloating, nausea, and constipation. She was managed with iron deficiency anaemia, however, her symptoms did not improve. Later, an ultrasound revealed an ovarian cyst. Laparoscopic left-sided ovarian cystectomy was performed and a biopsy was sent for histopathological examination. The case highlights the various nonspecific symptoms in a case of an ovarian cyst. Gynaecological causes for systemic symptoms should always be considered, along with proper gynaecological history and examination. This helps with the accuracy of diagnosis and treatment options, with minimal costs.

Cervical Cancer Screening Services in Nepal: A Descriptive Crosssectional Study

Introduction: Cervical cancer, the most prevalent cancer among women, is also the primary cause of cancer-related deaths in reproductive age women in Nepal. The study aims to assess the situation of cervical cancer screening services in Nepal.Methods: This cross-sectional study used quantitative methods to understand the situation of cervical cancer screening in 572 health facilities of Nepal. The research was conducted to assess screening facilities, the allocation of separate screening rooms, the availability of screening services on a routine basis throughout the week, screening facilities that are free of charge, human resources, and the availability of treatment. It was conducted in October to December 2022. Results: The research was carried out among 572 healthcare facilities, out of which 134 (23.42%) had provision for cervical cancer screening services. Ethical approval was obtained from the Nepal Health Research Council (NHRC) under reference number 397/2022 P. Amongst those 134, 72 (53.73%) healthcare facilities had assigned separate rooms for screening intentions. One hundred andtwo (76.12%) healthcare facilities provided regular screening services throughout the week, while 112 (83.58 %) had free-of-charge  screening services. Concerning trained personnel, 121 (90.30%) health facilities had personnel trained in visual inspection with Acetic acid, 9 (6.72%) had personnel trained in use of colposcopy, and 5 (3.73%) had personnel trained in use of Loop ElectrosurgicalExcision Procedure (LEEP). Lastly, 31 (23.13%) healthcare facilities offered treatment choices for cervical cancer. Conclusions: Most of the health care facilities did not have provision of cervical screening. Amongstthose who had the provision, personnel trained in loop electrosurgical excision procedure colposcopy.

Encounter with Huge Yolk Sac Ovarian Tumor in a Child: A Case Report

Yolk sac tumour frequently arises in the gonads as a type of germ cell tumour, though rare is a highly malignant ovarian tumour in children and prompt treatment should be done. We hereby report a case of malignant ovarian tumour presenting with an abdominal lump and increased urinary frequency. Different diagnostic modalities were used such as ultrasonography of the whole abdomen, contrast-enhanced computed tomography abdomen pelvis and tumour markers of beta-human chorionic gonadotropin and alpha-fetoprotein. This revealed an 18.2x14.3x10 cm mass likely a neoplastic germ cell tumour with minimal ascites. A tumour mass was found to arise from the left ovary and complete excision of the tumour along the left fallopian tube was done. Adjuvant chemotherapy started immediately. We hereby present a case of a 9-year-old girl with a huge yolk sac tumour of the left ovary which is rare in our setting and is presented here to differentiate any ovarian mass in this age group.

Cervical Papanicolaou Smear Test Screening among Patients Visiting the Outpatient Department of Gynaecology of a Tertiary Care Centre

Introduction: Carcinoma cervix is the second most common cause of death in women worldwide and the most common cause in developing countries. Cervical cancer is considered a preventable gynaecological problem as it has a long premalignant stage which can be detected by exfoliative cytology like papanicolaou smear test. The papanicolaou smear test is a simple, safe, non-invasive, and low-cost effective method for screening cervical cancer in developing countries like Nepal. The aim of the study was to find out the prevalence of cervical papanicolaou smear test screening among patients visiting the Outpatient Department of Gynaecology of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients visiting the Department of Gynaecology of a tertiary care centre after obtaining ethical approval from the Institutional Review Committee. Data from 14 April 2021 to 22 October 2022 were collected between 11 May 2023 to 26 May 2023 from the hospital records. Papanicolaou smear tests among the age group of 21 years up to 70 years were included in the study. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 11,173 patients, papanicolaou smear test was done in 572 (5.12%) (4.71-5.53, 95% Confidence Interval). Negative for intraepithelial lesion was the most common cytological pattern seen in 518 (90.55%) patients. The low-grade squamous intraepithelial lesion was the most common among abnormal epithelial cells seen in 29 (5.07%). Conclusions: The prevalence of cervical papanicolaou smear test among patients visiting the Outpatient Department of Gynaecology was found to be similar to other studies done in similar settings.

Knowledge of Cervical Cancer Screening and Prevention by Human Papillomavirus Deoxyribonucleic Acid and Human Papillomavirus Vaccination among Women Attending a Tertiary Care Centre

Introduction: Cervical cancer is one of the leading causes of morbidity and mortality among women globally as well as in Nepal. It is attributable to persistent infection by high-risk human papillomavirus, especially human papillomavirus-16 and human papillomavirus-18. The aim of this study was to find out the knowledge of cervical cancer screening and prevention by human papillomavirus deoxyribonucleic acid and human papillomavirus vaccination among women attending a tertiary care centre. Methods: A descriptive cross-sectional study was conducted in patients attending the outpatient Department of Gynaecology in a tertiary care centre from 18 March to 30 April 2023. After calculating sample size and taking a convenience sampling a survey questionnaire on knowledge of Cervical Cancer Screening and Prevention by Human Papillomavirus Deoxyribonucleic Acid and Human Papillomavirus Vaccination was collected. The point estimate was calculated at a 95% confidence interval. Results: Among 508 women, 42 (8.25%) (5.86-10.64, 95% Confidence Interval) had knowledge of cervical cancer screening and prevention by human papillomavirus deoxyribonucleic acid and human papillomavirus vaccination. According to the questionnaires with a total sample of 508, 164 (32.28%) know about cervical cancer, 15 (2.95%) know about HPV infection, 14 (2.76%) know about HPV infection causes cervical cancer, and 21 (4.13%) know about HPV transmitted through multiple sex partners. Conclusions: The knowledge of cervical cancer screening and prevention by human papillomavirus deoxyribonucleic acid and human papillomavirus vaccination among women is very low. This study recommends having a health education and awareness programme on it to increase knowledge.

Paediatric Ovarian Dysgerminoma: A Case Report

Dysgerminoma is the most common malignant germ cell tumour of the ovary. Abdominal pain, abdominal distention, and the presence of a palpable mass are common symptoms at presentation. This is usually detected in youth, before the age of 20 years. Ovarian or adnexal tumours are very rare in patients below the age of 18 years, most of them being functional cysts, only 10% being malignant. Here is a rare case of an 8 years old girl with dysgerminoma who underwent right-sided salpingo-oophorectomy for unilateral involvement with conservation of fertility and now the patient is on chemotherapy as the tumour metastasized to the pre-aortic lymph node.

Laparoscopic Management of Large Right Paratubal Cyst: A Case Report

Paratubal cysts are generally small but there are rare cases of large paratubal cyst and this case is one of them. Here we report a case of a young female with complains of abdominal fullness since 3 months. On examination, a huge mass (25 x 25 cm) extending from symphysis pubis upto xiphisternum was noted. Ultrasongraphy showed a cystic mass of 27 x 27 cm. Intraoperatively, the cyst was paratubal. It was drained with the help of veress needle and laparoscopic cystectomy was done. A large adnexal cyst extending above umbilicus is traditionally managed by laparotomy. But with the advent of laparoscopy, even a huge cyst can be managed by laparoscopy.

Carcinosarcoma of the Cervix: A Case Report

Cervical carcinoma is the most common cause of mortality due to cancer in Nepal. Carcinosarcoma is a very rare subtype of cervical cancer which is characterized by the presence of both epithelial and mesenchymal malignant component. It constitutes less than 1% of cervical carcinoma. Due to the low occurrence of the disease, most of the data on treatment and prognosis are based on case reports and series. Here, we report a case of 69 years, female with cervical cancer (FIGO IIA2). Histopathological and immunohistochemical analysis of cervical biopsy initially showed primary adenosarcoma of the cervix. The tumor was non-responsive to primary treatment with concurrent chemoradiation. Later she was treated with abdominal hysterectomy and bilateral salpingo-oophorectomy. The final histopathology of the resected specimen showed a sarcomatous component along with carcinomatous changes in the endocervical glands favouring the diagnosis of carcinosarcoma of the cervix.

Late Stage Cervical Cancer among Confirmed Cervical Cancer Cases in a Tertiary Care Centre: A Descriptive Cross-sectional Study

Introduction: Cervical cancer is the leading gynaecological cancer in Nepal. Most of the time, it is diagnosed in the late stage with its associated morbidity and mortality. This study aimed to find out the prevalence of late-stage presentation of cervical cancer among confirmed cases of cervical cancer in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted at a tertiary care centre of Nepal from March 2021 to May 2021 after obtaining ethical clearance from the Institutional Review Board (Reference no.805). A convenient sampling method was used. A descriptive analysis was done of all cases of cervical cancer who were diagnosed within the last 36 months and attended hospital during the study period. The information was collected by interview and hospital record was checked. Analysis was done using Statistical Package for Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Among the 142 confirmed cervical cancer cases, the prevalence of late-stage presentation of cervical cancer was 93 (65.5%) (57.7-73.3 at 95% Confidence Interval). The mean age at diagnosis was 50.6±10.9 years. More than two-thirds of the women were from outside Kathmandu valley 102 (71.8%) and came from >50km distance. The majority of the women 83 (58.5%) were illiterate. Conclusions: The study showed that two-thirds of the women presented in advanced stage and the factors leading to the late stage. This highlights the fact, that the focus should be on the provision of organized screening programs and early diagnosis and treatment of cervical cancer.

Mucinous Ovarian Cancer in a Young Woman: A Case Report

Mucinous ovarian cancer is a rare subtype of epithelial ovarian carcinoma, comprising <5% of all cases. Twenty three years old lady with increasing abdominal fullness and discomfort. Contrast enhanced computed tomography revealed a multiloculated ovoid cystic mass (17.5*21.6*9.1)cm in right adnexa. She underwent staging laparotomy with right salphingo-oophorectomy, peritoneal fluid cytology, bilateral pelvic lymph node dissection, infracolic omentectomy and appendectomy. Histopathology confirmed stage IA, grade 1, (well differentiated) mucinous adenocarcinoma of the ovary. After counseling, patient opted for completion surgery and underwent total abdominal hysterectomy with left salphingo-oophorectomy, repeat peritoneal fluid cytology and supracolic omentectomy. Due to malignant cell in the peritoneal fluid, she received adjuvant chemotherapy. She remains disease-free one year postoperatively. Fertility sparing surgery is oncologically permissible for stage 1A MOC but contraindicated in 1C3 disease. In Nepal, scaling diagnostic capacity, centralizing services, and integrating culturally sensitive councelling are critical to balance fertility preservation with survival.

Study of Histomorphological Patterns of Uterine Leiomyomas: An Observational Study

Introduction: Uterine leiomyoma, also known as a fibroid, is a benign mesenchymal tumor derived from the smooth muscle of the uterus. It is the most common tumor in women with an estimated incidence of 20%-40% in women during their reproductive years. Leiomyoma can occur in any organ, but the most common forms appear in the uterus. This study is conducted to analyze histomorphological patterns of uterine leiomyomas.Methods: An observational cross-section was conducted between 1st June 2021 and 31st May 2023 in the Department of Pathology of a Medical College and Teaching Hospital. Patients with leiomyoma were included in the study. Clinical, sonographic, gross, and histopathology findings were analyzed. Ethical approval for the study was obtained from Institutional Review Committee (Reference Number: LMC10/B-021).Results: There were 100 patients with leiomyoma during the study period, among whom 55 (55%) were 40-49 years old. There were 65 (65%) patients in the group with a parity of two to three. Abnormal uterine bleeding was observed in 60 (60%) of the cases. Histologically 84 (84%) of the cases were simple conventional leiomyoma. The co-existing conditions found were cystic ovarian disease 37 (37%), adenomyosis 19 (19%), and cervical intraepithelial neoplasia 12 (12%).Conclusions: Conventional leiomyoma is the commonest histological subtype and and the most common clinical presentation is abnormal uterine bleeding.

Sertoli Leydig Cell Tumour Initially Misdiagnosed as Polycystic Ovarian Syndrome and Congenital Adrenal Hyperplasia: A Case Report

Sertoli-Leydig cell tumor of the ovary is an unusual neoplasm that belongs to a group of sex cord-stromal tumors of the ovary and accounts for less than 0.5% of all primary ovarian neoplasms. They are often characterized by the presence of mass with androgen production and signs of virilization. Due to the substantially low incidence of Sertoli-Leydig cell tumors, information on clinical behavior, prognostic factors, and optimal management arelimited. Here in, we report a case of aprimary ovarian Sertoli-Leydig cell tumor in a 21-year-old student, previously diagnosed to have polycystic ovarian syndrome and subsequently congenital adrenal hyperplasia, who presented with a large abdominal mass and features of virilization along with elevated serum testosterone levels. Fertility sparing unilateral salpingo-oophorectomy was done and adjuvant chemotherapy was given after histopathology showed moderate to poorly differentiated Sertoli-Leydig cell tumor. Following surgery, her features of hyperandrogenism resolved and serum testosterone levels returned to normal.

Cervical Intraepithelial Lesions in Women with Persistent Inflammatory Smear on Pap Smear: A Descriptive Cross-sectional Study

Introduction: Persistent inflammatory smear is a benign finding on pap test but is associated with premalignant lesion of the cervix. Further evaluation is therefore necessary. This study was done to determine the prevalence of cervical intraepithelial lesions in women with persistent inflammatory smear. Methods: This is descriptive observational study conducted in Department of Obstetrics and Gynaecology of tertiary care centre of Nepal from 15th May 2020 to 14th May 2021 after obtaining ethical clearance from Institutional Review Board (Reference no MEMG/IRC/338/GA). Women with two consecutive pap smear reports showing inflammatory findings were enrolled. Colposcopy was performed and Modified Reid’s colposcopic index was used to grade the lesions. Colposcopic guided biopsy was taken and tissue sent for histopathology for abnormal colposcopic lesions. Data analysis was done using Statistical Package for Social Sciences version 21 and frequency and percentages were used to present data. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Among 115 women, 57 (49.5%) at 95% Confidence Interval (40.37-58.63) had Cervical Intraepithelial lesions. Among them 48 (41.7%) had low grade intraepithelial lesions and 9 (7.8%) had high grade lesions on colposcopy. Conclusions: The prevalence of cervical intraepithelial lesions in women with persistent inflammatory smear on pap was higher in our study compared to other studies.