Pan African Medical Journal

Large intra-abdominal mucinous cystic adenoma: is it of ovarian or mesenteric origin

A 54-year-old female presented with a six year history of increasing abdominal swelling and discomfort and two months of intermittent constipation and difficulty with micturition. She was referred from the gynecological service having been investigated for a pelvic pathology without any positive findings. Her medical history was otherwise unremarkable. Physical examination revealed a non-tender intra-abdominal mass extending from epigastrium to the pelvis with a smooth surface. A large intra-abdominal multi-loculated cyst, separate from the ovaries, was seen on imaging. At laparotomy, the cystic tumour was discovered to arise from the mesentery of the terminal ileum and was resected en bloc. Histopathology revealed the tumour to be a benign mucinous cystadenoma, possibly of ovarian origin. This report aims to raise awareness of the difficulty of distinguishing ovarian from extra-ovarian mucinous cystadenomas on histopathological examination alone.

Primary ovarian parasitic diseases mimicking ovarian cancer in the reproductive system: diagnostic challenges and surgical challenges (a case report)

Primary ovarian parasitic disease is rare and can masquerade as advanced ovarian carcinoma; we report the first detailed case in a post-menopausal woman that underscores this diagnostic trap. A 51-year-old woman with chronic raw-seafood ingestion presented with bilateral adnexal masses (7cm left, 5cm right), low-grade fever, leukocytosis (13.2 × 109/L), markedly elevated C-reactive protein (135mg/L) and CA-125 (69.5U/mL), and imaging suggesting ovarian malignancy with ascites. Intra-operatively, a "frozen pelvis" with dense adhesions, multiple abscesses and omental cake was found; frozen section excluded neoplasia, leading to total hysterectomy, bilateral salpingo-oophorectomy, appendectomy and abscess debridement guided by infectious-disease principles. Histopathology revealed chronic suppurative granulomatous inflammation with parasitic remnants consistent with echinococcal disease, and the patient remains disease-free at 5 years. Clinicians should include parasitic infection in the differential of complex pelvic masses in patients with raw-food exposure; complete excision adhering to anti-infective surgical protocols prevents misdiagnosis as malignancy and avoids unnecessary oncologic overtreatment.

Ovarian relapse in a child with B-ALL: a case report

This case presents an 8-year-old girl diagnosed with B-cell acute lymphoblastic leukemia (B-ALL), who relapsed after 3 years of treatment and 1 year of complete remission, with an unusual extramedullary relapse in the ovary. Ovarian relapse of B-ALL is extremely rare in children, making this case noteworthy in scientific literature. The patient had an initial diagnosis of B-ALL with a deletion of chromosome 12, a genetic alteration previously associated with the ETV6-RUNX1 fusion gene, which is typically linked to a favorable prognosis but also carries a 20% risk of late relapse. The relapse was initially asymptomatic and went undetected until clinical symptoms of pelvic pain appeared. Imaging with pelvic ultrasound confirmed the ovarian involvement. The relapse was treated with standard chemotherapy protocols for B-ALL, resulting in a partial response. This case underscores the importance of considering extramedullary relapse in the differential diagnosis for pediatric ALL patients who present with atypical symptoms after remission. It also suggests that routine pelvic ultrasound could be a useful tool for early detection of ovarian and other extramedullary relapses, which are often associated with bone marrow relapse. The main take-away from this case is the necessity for vigilant follow-up, including targeted imaging, in ALL patient's post-remission to ensure early identification of extramedullary relapses, which can otherwise be easily overlooked. The presence of chromosome 12 deletion and its association with late relapse highlights the need for ongoing surveillance even in patients with initial favorable genetic abnormalities.

Human pappilomavirus-based cervical precancer screening with visual inspection with acetic acid triage to achieve same-day treatments among women living with human immunodeficiency virus infection: test-of-concept study in Ibadan, Nigeria

cervical precancer screening with same day treatment facilitates maximization of benefits of secondary prevention of cervical cancer. This is particularly important for women living with human immunodeficiency virus (WLHIV) infection because of their exceptional risk for cervical cancer. The availability of HIV programmes in low- and middle-income countries (LMICs) provide unique opportunity for possible introduction "human papillomavirus (HPV) screening followed by visual inspection after application of acetic acid (VIA) with same day treatment of eligible patients". This study piloted this concept. in this prospective, cohort study, 98 WLHIV had HPV and VIA screening for cervical precancer lesions in a HIV clinic in Nigeria. Participants positive to HPV and/or VIA had biopsies from the visible lesions or quadrant of transformation zone. Participants positive to VIA and/or HPV16 or HPV18/45 had same-day thermal ablation treatment and the number of cases documented. The HPV, VIA and scenario of HPV followed by VIA results were compared with histologically confirmed cervical lesion grade 2 or worse statistically. same day treatment was achieved in 95.0% of eligible cases. Statistically, sensitivity and specificity of VIA was 25.0% and 50.0% and HPV had 95.5% and 75.0%, respectively. In the HPV screening with VIA triage, sensitivity dropped to 45.5% but specificity improved to 100.0%. triaging HPV positive test with VIA for same-day treatment in cervical precancer screening among PLWHIV looks feasible. The improved specificity will reduce the overtreatment rate, loss to follow-up associated with repeat clinic visits and improve completion of continuum of care.

The awareness, acceptability and uptake of cervical cancer vaccination services among female secondary school teachers in Enugu, Nigeria: a cross-sectional study

cervical cancer is a major cause of morbidity and mortality in women and vaccination of adolescents with human papilloma virus (HPV) vaccines is a major preventive strategy for this cancer. Despite the usefulness of cervical cancer vaccines, significant gaps still exist in the level of awareness and acceptability of the vaccine among women. This study aimed to determine the level of awareness, acceptability, and identify the factors associated with the uptake of this vaccine by female secondary school teachers in Enugu, Nigeria. a cross-sectional study of 377 female teachers in Enugu metropolis was undertaken between July and October 2017. A structured interviewer-administered pretested questionnaire was used for data collection and SPSS used for analysis. less than half (41.9%) of the respondents had good knowledge of the cervical cancer vaccine. The majority of the respondents (93.6%) accepted the vaccine and will recommend it for their children and students. Only 14.6% and 9.0% of the respondents have taught their students about cervical cancer or HPV vaccines and had a programme in their school that addresses cervical cancer or cervical cancer vaccination respectively. Only 3.4% of the respondents have been vaccinated while 5.6% of their children or relatives have received the HPV vaccine. Previous vaccination of participants (p = 0.000), existing programmes addressing cervical cancer in schools of respondents (p = 0.000), participants having taught students about cervical cancer (p = 0.025) and high economic status (p = 0.013) significantly increased the likelihood of participants vaccinating their adolescent daughters/relatives. Extremes of age (p = 0.001) and being the head of their families (p = 0.002) significantly reduced the likelihood of the daughters/relatives to be vaccinated. Only previous history of vaccination of the respondents predicted the vaccination of their children and relatives (AOR = 6.069; 95% CI; < 0.0001-0.041). the overall knowledge of the HPV vaccine was low but the acceptability was high among respondents who were aware of the vaccines. Vaccine uptake among children/family members of the respondents was low. The introduction of cervical cancer vaccination education of the teachers in the secondary schools will help improve cervical cancer vaccination and the uptake among adolescent´s populations in the country.

Bilateral borderline ovarian brenner tumor coexisting with low-grade appendiceal mucinous neoplasm in a perimenopausal woman: a case report

Borderline ovarian Brenner tumor (BOT-B) accounts for less than 2% of all ovarian neoplasms. It is typically unilateral and large, with non-specific imaging features. Synchronous extra-ovarian neoplasia is rarely documented. A 47-year-old gravida 2, para 2 woman presented with intermenstrual bleeding and lower abdominal discomfort. Transvaginal ultrasound and pelvic magnetic resonance imaging (MRI) revealed a 9 cm right adnexal complex mass without ascites or elevated serum tumor markers. Intraoperative findings identified bilateral, firm, lobulated ovarian tumors (right: 5 cm; left: 7 cm) and an inflamed, hydropic appendix. Frozen section analysis of the left ovary indicated a borderline Brenner tumor with focal atypia; carcinoma could not be ruled out. Following informed consent, the patient underwent laparoscopic bilateral salpingo-oophorectomy, appendicectomy, omentectomy, and peritoneal biopsy. Final histopathology confirmed bilateral BOT-B without stromal invasion and a synchronous low-grade appendiceal mucinous neoplasm (LAMN) with negative margins. No adjuvant chemotherapy was administered. Imaging at three-month follow-up showed no evidence of recurrence. This represents the first reported case of synchronous bilateral BOT-B and LAMN. It highlights the following: i) the critical importance of comprehensive surgical exploration for atypical adnexal masses; ii) that BOT-B can present bilaterally and at a smaller size than classically described; and iii) that complete, conservative fertility-sparing surgery with strict adherence to a tumor-free technique is an adequate management strategy for borderline Brenner tumors, associated with excellent short-term outcomes.

A study of HER2 expression in endometrial carcinoma: a single centre experience

endometrial carcinoma (EC) is the seventh most common cancer in females in Malaysia, of which the majority is composed of lower grade type I EC. Although less prevalent, type II EC which is of higher grade has poorer outcome and prognosis. Human epidermal growth factor receptor 2 (HER2) is one of the possible prognostic molecular markers which can be a target for immunotherapy. This study aimed to assess the expression of HER2 in common type of EC in the local population and to determine its correlation with the clinicopathological features. a total of 53 cases of endometrioid type of EC were selected within a six-year period comprising of 22 cases of grade 1, 25 cases of grade 2 and six cases of grade 3 carcinoma. The selected whole tumour tissue sections were immune-stained with HER2 antibody. The scoring was semi-quantitatively analyzed based on 2013 American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAPs) guidelines for the scoring of HER2 in breast cancer. all cases regardless of grades of endometrioid carcinoma showed negative expression of HER2 (score 0). there was no significant HER2 expression in endometrioid carcinoma. However, a follow-up study with a larger number of samples from different type of endometrial carcinoma is needed. Testing of several tumour tissue blocks to assess possible tumour heterogeneity, as well as correlation with HER2 gene amplification status by in-situ-hybridisation, are also recommended.

Awareness, knowledge and screening for cervical cancer among women of a faith-based organization in Nigeria

cervical cancer is the second most frequent cancer among women in Nigeria. With proper screening, the disease can be detected early enough and properly managed. However, there seems to be limited knowledge of cervical cancer among women and several barriers might prevent them from accessing the screening services. We determined the awareness, knowledge and screening for cervical cancer among women of a faith-based organization in Nigeria. we employed descriptive survey research design and purposively sampled a Catholic Parish in Nsukka Local Government Area of Enugu State, Nigeria. All consenting women in the Parish were used for the study. We utilized researchers' structured instrument titled 'Awareness and knowledge about Cervical Cancer and Screening' to collect data. Frequencies, percentages and logistic regression were employed for data analysis. awareness of cervical cancer (70.8%) and its screening (68.1%) are high but there is generally poor level of knowledge (65.3%) of different aspects of cervical cancer among the women. Age (aOR: 7.183, 95% CI 1.769-29.168; p=.006), number of children (aOR: .074, 95% CI .009- .631; p=.017), and occupation (aOR: .032, 95% CI .004-.260; p= .001 and aOR: .050, 95% CI .007-.347; p=.002) were significantly associated with knowledge of cervical cancer. Majority of the women studied had never been screened for cervical cancer (91.7%) and the reasons for not screening ranged from lack of knowledge of; where to go for screening (69.7%) and the importance of being screened (40.9%) to not feeling susceptible to cervical cancer (18.2%). there was generally poor knowledge of cervical cancer and its screening; and very poor screening practice. There is, therefore, an urgent need to improve women´s knowledge of cervical cancer and address the identified barriers in order to improve screening practices of the women.

Yolk sac tumor of vagina: a rare cause of vaginal bleeding in adolescents-a case report

Yolk sac tumor (YST) is one of the malignant germ-cell tumors (MGCT) that usually occurs in the ovaries and testes of young patients. Its occurrence in the vagina is extremely rare. We present a rare case of extragonadal YST occurring in the vaginal region. A 12-year-old girl, presented with vaginal bleeding and pain in the perineal region. Physical exam identified a limited pelvic mass, 5 x 4cm in size. Abdominal ultrasound and magnetic resonance imaging (MRI) showed a heterogeneous mass in cervico-vaginal region. The patient was taken to the surgery, where an excisional biopsy was obtained. The diagnosis of YST is confirmed by histopathology and immunohistochemistry studies. However, the tumor marker (alpha fetoprotein and BHCG) was normal. The patient was treated according to the French TGM-95 protocol. Surgery was done after chemotherapy, hysterectomy in front of the cervical invasion, with a good decline at 2 years of end of treatment.

A rare mixed ovarian tumor associating borderline endometrioid component and borderline serous component

Correlates of patients' satisfaction with antenatal care services in a tertiary hospital in Abakaliki, Ebonyi state, Nigeria

antenatal care is a specialized pattern of care organized for pregnant women to improve their chances of a safe delivery. Assessment of patients' perception of healthcare services is one of the ways of measuring the quality of healthcare as satisfied patients are likely to come back for the services they need and to recommend the services to others. this is a cross-sectional study. Two hundred and eighty-four booked antenatal attendees were randomly selected at the antenatal clinic of Federal Teaching Hospital, Abakaliki in November 2016 and interviewed using semi-structured questionnaire. Items in the questionnaire included sociodemographic and obstetric variables, assessment of amenities, total time spent, services and level of satisfaction. Data obtained were analyzed using Epi info TM 7.1.3.10 and presented with a simple percentage and chi-square. Main outcome measure: satisfaction with antenatal care. the mean age of the respondents was 28.2 ± 4.2 years, majority 130 (45.8%) were within the 25-29 age bracket. Most had tertiary education (146, 51.4%) and less than 10% are grand multipara. In general, 89.4% of the respondents were satisfied with the quality of antenatal care services. Majority of the respondents 170 (59.9%) were unsatisfied with the water supply while 128 (45.1%) were unsatisfied with cervical cancer prevention discussion during the health talk. The mean total time spent in the antenatal clinic was 4.1 hours ± 1.2 hours (range 2-7 hours). Being married and multiparous significantly affected satisfaction with the quality of antenatal care services as represented by P-value of 0.015 and 0.005 respectively. majority of pregnant women were satisfied with the care they received. Health providers should, however, improve the state of sanitary facilities and ensure the provision of adequate information on cervical cancer screening during health talks.

Impact of neoadjuvant chemotherapy in improving operative intervention in the management of cervical cancer in low resource setting: a preliminary report

There is paucity of data on interventions to improve cancer outcome in the low-resource setting. This study aims to determine the effect of Neoadjuvant Chemotherapy (NACT) in improving operative outcomes of cervical cancer. This was a longitudinal intervention study of patients diagnosed with FIGO stage IIB - IIIA cervical cancer that had NACT. Patients were re-evaluated after treatment with 4 cycles of chemotherapy for operability. McNemar test was used to determine changes in operability of the tumour. There was a significant difference in the number of patients that converted from inoperable to operable tumor post-chemotherapy. This study shows some promise for NACT for FIGO stage IIB - IIIA cancer of the cervix, especially in low-resource settings, where radiotherapy is scarce.

“It is what i tell her that she will do”: a mixed methods study of married men´s knowledge and attitude towards supporting their wives´ cervical cancer screening in rural South-East Nigeria

cervical cancer is a leading cause of death among Nigerian women. Women often require spousal support before attending cervical cancer screening services. This study assessed married men´s knowledge and attitude towards male involvement in cervical cancer screening of their wives. a cross-sectional study using a mixed methods approach was conducted among 245 married men in Izzi, Local Government Area of Ebonyi State, South-East Nigeria. Quantitative data collected using structured, interviewer-administered questionnaires and qualitative data from focus group discussions were triangulated. Data analysis was done using IBM SPSS version 20. Qualitative findings were analysed using thematic analysis. the mean knowledge of cervical cancer was 2.06±0.55. Only 2.9% of the respondents had adequate knowledge of risk factors for cervical cancer. Up to 89.8% were willing to approve screening for their spouses. Majority (76.3%) considered screening important in cervical cancer prevention, while 91.4% were willing to pay for the screening test. Most of them exhibited patriarchal tendencies and insisted that their wives must obtain their consent before screening as depicted by the statement "It is what I tell her that she will do". Previous spousal screening was a predictor of good knowledge (OR = 10.94, 95% CI = 2.44-48.93; P=0.002). married men in this study had poor knowledge of cervical cancer. However, they were willing to support cervical cancer screening conditional on their pre-information and consent. Awareness creation activities on cervical cancer screening should incorporate active engagement of husbands in order to promote screening uptake by their wives.

Parental willingness to vaccinate adolescent daughters against human papilloma virus for cervical cancer prevention in western Nigeria

cervical cancer, which is vaccine preventable, is the commonest gynaecological cancer worldwide. This study aimed to assess parental willingness to vaccinate adolescent girls against human papillomavirus (HPV) for cervical cancer prevention. this was a descriptive cross-sectional study among 301 parents of adolescent girls who reside in Surulere Local Government Area in Lagos, Nigeria. A pretested, semi-structured interviewer-administered questionnaire was used to collect data and analysis was done using Epi-info™ version 7. The chi-square (or Fisher's exact) test and the t-test were used to test for associations between categorical and continuous variables respectively. The level of significance was set at 0.05. over half (53.5%) of the respondents had heard of cervical cancer. Of these, two thirds (62.1%) were aware that it could be prevented, 19.0% had good knowledge of cervical cancer prevention, only 4% had their daughters vaccinated though 79.2% were willing to vaccinate. The poor vaccine uptake was mostly due to lack of awareness of vaccination centres and the high cost of the vaccine. Willingness was significantly associated with level of education (p = 0.047) and knowledge of HPV vaccination (p < 0.001), however once aware, most parents were willing to get their daughters vaccinated. awareness about cervical cancer prevention was high though uptake was low. A high level of education and good knowledge of cervical cancer prevention were facilitators of willingness to vaccinate, though once aware parents were willing. Creating awareness and educating parents about cervical cancer prevention is essential in improving the uptake of the vaccine.

Quality of life among cervical cancer patients undergoing radiotherapy

There has been an increasing rate of the incidence and mortality of cervical cancer in Ghana. Cancer and the treatment's side effects have adverse effects on the patients and this affects patient's well-being and lifestyle during and after radiotherapy. The study sought to assess the impact of demographic and clinical characteristics on Quality of Life (QoL) among cervical cancer patients undergoing radiotherapy in Ghana. A cross sectional quantitative study design was carried out on 120 cervical cancer patients who were conveniently sampled from the study site. The data was collected between the months of December, 2017 and February, 2018. QoL was measured using the FACT-G questionnaire. The mean scores of QoL were determined, whiles the chi-square test was used to determine the impact of socio-demographic and clinical characteristics on the QoL of the patients. The mean age of the patients was 56.8 years. Majority of the patients reported stable QoL. The social well-being of the older patients was more affected than other patients. The unmarried, widows and patients who underwent surgery with radiotherapy were emotionally affected. Majority (56%) of the participants had stable QoL whiles 22% each had poor and good QoL. Significant association was found among 35-39 age group with physical well-being and overall QoL (p=0.017 and 0.029) respectively. There is a need to embrace a QoL assessment instrument in the study site so as to help the oncology team in the identification and addressing of specific indicators that affect the QoL of cervical cancer patients.

Human papillomavirus genotype profiles and cytological grades interlinkages in coinfection with HIV

The study aimed to examine and characterize human papilloma virus (HPV) cytological grade trends and genotypes among HPV/HIV co-infected/cases and HPV monoinfected/control women attending Kisii Teaching and Referral Hospital, Kenya. HIV positive co-infected with HPV (HPV/HIV) and HIV negative women monoinfected with HPV profiled as co-infected/cases and monoinfected/control arms respectively were enrolled. HPV subtypes were assayed by Xpert Low grade intraepithelial lesion (LSIL) was the most predominant cytological grade across cases and controls with a prevalence of 32 (38.1%) while high grade squamous intraepithelial lesion (HSIL) was highest among HPV/HIV co-infected with a prevalence of 23 (27.38%). Among the monoinfected (controls) the predominant lesion was low grade intraepithelial lesions (LSIL) with a prevalence of 23 (27.38%). HPV type 16 had the highest prevalence 26 (30.8%) among the VIA positive women in the overall study participants followed by combinations of HPV types (16, 18/45) at 19 (22.6%). High risk HPV types 16 and 18/45 were the most predominant in the established cytological grades and among the co-infected women. Routine screening using both cytological and HPV testing should be embraced and/or reinforced as early screening and preventive strategies in the covered geographical region population. Provision of the currently available vaccines to these women at an early age would provide effective protection since the HPV type profiles in this population are covered by such vaccines.

A giant ovarian mass

Reduced cervical cancer screening in Zimbabwe as an indirect impact of the COVID-19 pandemic: implications for prevention

The COVID-19 pandemic has brought unprecedented challenges to healthcare for women, including disruption of cervical cancer screening services. Zimbabwe is a high cervical cancer burden country, with the cancer being the leading malignancy among women. The disruptions in screening could have long-term negative impacts on cervical cancer burden reduction in Zimbabwe. Factors related to institutions, policy, clients and healthcare workers have contributed to the decline in screening and need to be addressed urgently to restore this essential service.

Well-differentiated squamous cell carcinoma of the clitoris: a rare case report

Squamous cell carcinoma (SCC) can impact many different organs, including the vagina and vulva skin, that are covered with squamous epithelial lining. With a yearly prevalence as low as 2.6 per 100,000 people, Vulvar carcinoma is a rather uncommon type of gynecological neoplasia. It commonly manifests in people 70 years of age and older. Our case study is about the well-differentiated squamous cell carcinoma (WDSCC) of the clitoris in a female patient who is 65 years of age. However, there is an increasing number of women aged 35 to 45 who are being diagnosed with this type of cancer. The biopsy of the clitoris revealed severe dysplastic squamous epithelial cells, diagnostic for WDSCC of the clitoris. In the past, the gold standard for treating even mild invasive vulva carcinomas involved a radical vulvectomy with a wide margin of tumor excision, an en bloc resection of the inguinal and frequently the pelvic lymph nodes. At the moment, a less drastic and more customized course of action is advised.

Acquired vulvar lymphangioma cicumscriptum after cervical cancer

Cervical cancer and precancerous cervical lesions detected using visual inspection with acetic acid at Livingstone Teaching Hospital

cervical cancer (CaCx) is the second most common malignancy in women world-wide. Precancer screening aided by visual inspection with acetic acid (VIA) is an early diagnosis method used to detect the lesions that are high indicators of cancer in women. cervical cancer is more prevalent in the developing world affecting mainly women in the reproductive age group and is the commonest cancer among Zambian women. Therefore, the study aimed to determine the prevalence and factors associated with a positive VIA at Livingstone Teaching Hospital (LTH). this was a cross-sectional study conducted at LTH among 329 women from Livingstone district aged 18 and above, who were coming for routine cervical cancer screening using VIA between 2019 and 2020. Demographic and clinical data were collected from the CaCx clinic. A positive VIA (precancerous cervical lesions) and cervical cancer were the primary and secondary outcome variables. A positive VIA was defined by presence of a dense ulcerative acetowhite area in the transformation zone of the cervix. Cervical cancer diagnosis was defined by presence of cancerous cells on histological examination by a qualified pathologist. Data were analyzed using Statistical package for social sciences (SPSS) version 22.0. Chi-square test, Mann-Whitney and logistic regression were the statistical methods used. the participants had a median (interquartile range) age of 37 (29, 44) years. Prevalence of CaCx and positive VIA were 6% (95% confidence interval (CI) 4, 9) and 19% (95% CI: 15, 24) respectively. At multivariable analysis, the factors associated with a positive VIA were alcohol consumption [odds ratio (OR) 0.30 (95% CI: 0.12, 0.74)] and HIV infection [OR 0.37 (95% CI: 0.19, 0.70)]. the study showed that precancerous cervical lesions are common among our study participants and it was influenced by alcohol consumption and HIV status. There is therefore need to enhance the screening programs using VIA in order to identify cancerous lesions at an early stage for early intervention in resource limited settings.

Human papillomavirus type 16 (HPV-16) IgG antibody among women of reproductive age presenting at a healthcare facility in Central Nigeria: a pilot study

Approximately, 70% of cervical cancer cases worldwide are attributable to HPV-16 and HPV-18, with HPV-associated cancers being the second most common infection-related cancers globally. However, there´s paucity of data about this infective agent in Central Nigeria. In a cross-sectional study, we evaluated the seroprevalence of HPV-16 immunoglobulin G (IgG) and risk determinants among women in Central Nigeria as a first step towards evaluating anti-HPV IgM antibody for active cases and determining incidence. Blood samples were collected between August 2016 and January 2018, from 400 consenting women of childbearing age (15-49 years) who completed structured questionnaires. Samples were analyzed using HPV-16 specific IgG ELISA kits (Cusabio Co. Ltd, Germany). Statistical analysis was performed to determine predictors. Overall, we found that 128 (32.0%) had IgG antibody against HPV-16. Seroprevalence by age was 50.0% (15-19 years), 55.0% (20-24 years), 12.9% (25-29 years), 50.0% (30-34 years), 32.1% (35-39 years), 18.2% (40-44 years) and 19.4% (45-49 years) respectively. Factors associated with infection were age (P=0.0002; 95% CI 5.06-31.51), occupation (P<0.0001; 95% CI 1.4-12.6), number of sex partners (P=0.0037; 95% CI 1.27-49.93), history of genital warts (P=0.0203; 95% CI 1.34-9.55) and education level (P<0.0001; 95% CI 3.89-60.11). In addition, forty six (11.5%) reported having the history of genital warts with 268 (67.0%) and 132 (33.0%) subjects being married and single respectively. Individuals who were either artisans or civil servants were 260 (65.0%), whereas 140 (35.0%) were students. Majority, 324 (81.0%), had either primary, secondary or tertiary education with 76 (19.0%) of the subjects having no formal education. In respect of sexual behaviour, 196 (49.0%) reported having at least two sexual partners, out of which 64 (16.0%) had three or more. These findings provide high serological evidence of exposure to HPV-16 in Central Nigeria with implications for national and regional intervention initiatives.

Malignant nodular melanoma of the vulva: a rare and aggressive tumour of the female genital tract (case report)

Malignant melanoma of the vulva is a rare and aggressive tumour with dismal prognosis. It tends to recur and metastasize early. Surgical excision with or without regional lymph node dissection is still the treatment of choice with adjuvant therapy decided on a case by case. Furthermore, HIV infection has been associated with more aggressive disease. Herein we present a 45-year-old HIV-infected female patient on antiretroviral therapy who presented with vulval ulcer for one year. On examination, she had ulcerated nodule on the labia majora. Radiology showed vulvovaginal tumour without involvement of the adjacent organs. Malignant melanoma was confirmed on both the incisional biopsy and vulvectomy. She responded poorly to radiotherapy. Furthermore, she presented with recurrence and metastatic disease a month after surgery. She was lost to follow-up clinic.

Mélanome malin vulvaire: à propos d´un cas observé à l´Hôpital du Cinquantenaire de Lubumbashi

Primary malignant melanoma of the female genital tract is an extremely rare tumor. It most commonly affects the vulva then the cervix and the vagina. Vulvar cancer accounts for about 1% (all sites) of melanomas. In order of frequency, it occurs in the vagina, uterus and ovary. Less than 200 cases of vulvar cancers have been described worldwide. We here report a clinical case of malignant vulvar melanoma in a 72-year-old postmenopausal woman. Partial hemivulvectomy and bilateral superficial inguinal lymphadenectomy were performed. The postoperative course was favorable and the patient was discharged on postoperative day 15.

Carcinome épidermoïde de la vulve chez une patiente infectée par le VIH-1 en échec de traitement antirétroviral de première ligne

Vulvar cancer has been rarely reported in the literature. In young women, it is most often caused by human papillomavirus (HPV), whereas in postmenopausal women, in whom this cancer is more common, it would be caused by estrogen deficiency. Moreover, HIV infection increases the risk of developing vulvar cancer in HIV-positive women as a consequence of the high prevalence of HPV infection in these subjects. Thus, in patients with suspected vulva lesion, biopsy followed by anatomo-pathological examination should be performed in order to establish the diagnosis. We here report a case of vulvar squamous cell carcinoma in a HIV-1-positive patient with first-line antiretroviral therapy (ARV) failure.

Fibroblastic variant of low grade endometrial stromal sarcoma mimicking an inflammatory pseudotumor: a case report

The World Health Organization currently divides endometrial stromal sarcomas into 4 different entities, based on their clinical and pathological features: endometrial stromal nodule, low-grade endometrial stromal sarcomas (LG-ESS), High-grade endometrial stromal sarcomas, and undifferentiated uterine sarcoma. The fibroblastic variant of LG-ESS is rare and is usually made of small tumoral cells of oval to fusiform shape, demonstrating low cytologic atypia and low mitotic activity, which can lead to confusion with a benign myofibroblastic proliferation. We hereby report a rare case of a fibroblastic variant of LG-ESS in a 37-year-old woman presenting abundant metrorrhagia, which was initially misdiagnosed as an inflammatory pseudotumor before proofreading in our laboratory, along with a review of a histological and immunohistochemical findings, aiming to help pathologists avoid this diagnosis pitfall.

Serous endometrial intraepithelial carcinoma: a case report

Serous endometrial intraepithelial carcinoma (SEIC) is a rare but highly aggressive form of uterine endometrial cancer. We report two cases of post-menopausal, 58-year-old patients with abundant vaginal bleeding and pelvic pain. The first patient had a history of surgical hysteroscopy in 2019 for an endocervical polyp. The second patient had a history of breast resection, axillary lymph node dissection, chemotherapy, radiation therapy, and tamoxifen therapy for breast carcinoma 6 years ago. An abdominal hysterectomy was performed in both patients. The pathological assessment showed serous endometrial intraepithelial carcinoma. Diagnosis of a serous proliferation of the uterus implies the exploration of other genital tract organs as well as distant locations in search of metastatic disease.

Clinicopathological and ultrasound features of endometrial cancer in postmenopausal women: a retrospective study in a single institute in South Korea

endometrial cancer is the most common type of cancer in the female genital tract. Most patients are diagnosed during postmenopausal periods. This study aimed to investigate the demographic characteristics as well as cutoff value of endometrial thickness and ultrasound characteristics of endometrial cancer in postmenopausal patients. we retrospectively analyzed 244 postmenopausal women who underwent endometrial sampling from February 2016 to December 2019. Information of patients was obtained through medical records. The patients were divided into two groups according to histopathological results. Group A included patients with endometrial cancer and group B included patients with non-malignant lesions. Data were summarized based on demographic and ultrasound characteristics. hypertension and history of endometrial hyperplasia were associated with the incidence of endometrial cancer in this study. Endometrial cancer was diagnosed in all ranges when the endometrial thickness was ≥5 mm. Endometrial fluid collection, with increased endometrial thickness, was a risk factor associated with endometrial cancer. regardless of symptoms and risk factors, endometrial histological confirmation in postmenopausal women should be conducted immediately if endometrial abnormalities such as an endometrial thickness ≥5 mm or endometrial fluid collection are detected by transvaginal ultrasound.

Müllerian adenosarcoma mimicking cervical carcinoma in a 79-year-old woman: diagnostic challenges and laparoscopictreatment: a case report

Uterine Müllerian adenosarcoma rarely presents as a cervical “cancer-like” mass; we report the first detailed case in a 79-year-old woman whose 5-cm exophytic lesion mimicked advanced cervical carcinoma on imaging. She presented with 2 weeks of post-menopausal bleeding and a friable polyp protruding through the cervical os; MRI described a bulky cervical tumour extending into the lower uterine segment, while tumour markers remained normal. Initial biopsy was inconclusive; subsequent excision and hysterectomy revealed FIGO stage Ib1 low-grade adenosarcoma originating from the lower uterine segment with superficial cervical involvement. Laparoscopic total hysterectomy with bilateral salpingo-oophorectomy was performed uneventfully, and at 7 months she remains disease-free. The case underlines that adenosarcoma can masquerade as cervical cancer, emphasises the need for generous tissue sampling and WT1/ER-based immunohistochemistry to define tumour origin, and confirms excellent outcomes with complete surgical excision for stage I disease.

Risk factors for cervical cancer in Morocco: a case-control study

Cervical cancer (CC) is one of the most common malignancies among women in Morocco. This study aims to evaluate the risk factors associated with CC in Moroccan women aged 18 to 62. this was a case-control study of 169 women who received radio-chemotherapy and 100 controls. Statistical analyses were performed using SPSS version 29.0.10 to determine associated factors at a significance level of ≤0.05. significant associations were found between CC and the following factors: educational level (OR= 9.167), sexual activity during menstruation (OR= 2.351), previous occurrences of sexually transmitted infections (OR= 2.173), and history of multiple sexual partners by the husband (OR= 6.305). However, family history of cancer, consanguinity, number of sleeping hours, and stress did not show any significant association with CC. HPV infection was detected in 33.81% of cases and 8% of controls, with HPV16 being the most prevalent genotype (59.57%), followed by HPV53 (14.79%). Other genotypes were found at lower frequencies. The phylogenetic analysis of HPV isolates showed that the distribution of HPV sequences in Moroccan women with cervical cancer is mainly linked to European, Saudi Arabian and North African epidemiological conditions, suggesting recombinant HPV forms. Additionally, American isolates formed two distinct outgroups, likely due to geographical distance, indicating variations in HPV strains by region. Morocco faces a significant burden of CC, with HPV being the primary cause. Lifestyle risk factors like low education, male sexual behavior, multiple pregnancies, and sexual intercourse also contribute.

Molar pregnancy in the perimenopausal period: a case report

Molar pregnancy is an uncommon diagnosis in perimenopausal women and poses a high risk of complications, including hemorrhagic shock and malignant transformation. We report the case of a 51-year-old woman who presented with severe abdominal pain and profuse vaginal bleeding. Imaging revealed a markedly enlarged uterus with a large intracavitary mass, and serum β-hCG levels were elevated. The patient developed hemorrhagic shock and underwent an emergency hemostatic hysterectomy. Histopathological examination confirmed a complete hydatidiform mole with early invasive features, without choriocarcinoma. Postoperative imaging showed no metastases, and the patient received methotrexate-based chemotherapy with favorable response, evidenced by a progressive decline in β-hCG levels. This case underscores the importance of considering gestational trophoblastic disease in the differential diagnosis of abnormal uterine bleeding in perimenopausal women. Early recognition and timely surgical intervention, followed by appropriate chemotherapy and monitoring, are crucial to avoid potentially life-threatening complications.

Parental acceptance of human papillomavirus vaccine for female adolescents in Abia State, southeastern Nigeria: a pre-implementation study

cervical cancer is the second most common cancer amongst women in Nigeria, with an incidence rate of 26.2 per 100,000 and mortality rate of 14.3 per 1000 adult women. Vaccination is the primary prevention if initiated prior to Human Papillomavirus (HPV) infection. However, vaccine hesitancy remains a threat to the uptake of the HPV vaccine. This study identified the pattern and predictors of parental acceptance of HPV vaccines for their female adolescents in Abia State, Nigeria prior to state level introduction. we conducted a community-based cross-sectional study between August and September 2023 among parents of female adolescents residing in Abia State. A multistage sampling technique was used to select the study respondents. An interviewer-based, semi-structured questionnaire was administered to the respondents. Analysis was done using IBM SPSS version 26. Univariate analysis was used to present the socio-demographic characteristics of the respondents in frequencies and proportions. The association between parental acceptance and the independent variables was assessed using the chi-square test. Logistic regression was used to identify the independent predictors of parental acceptance of HPV vaccination. The level of significance was 5%. a total of 1,016 respondents participated in this survey, with a mean age of 42.2 ± 10.5 years. The prevalence of parental HPV vaccine acceptance was 63.0% (95% CI: 59.8 - 66.0). The major sources of information on the HPV vaccine were the healthcare workers (43.0%) and social media (37.8%). Among respondents who would accept the HPV vaccine for their female adolescents, the commonest reason was for the prevention of HPV transmission (58.3%). Most of the respondents who declined willingness reported lack of information (63.9%), followed by fear of adverse effects (32.9%) as the triggers for non-acceptance of the vaccine. The most preferable source of HPV vaccine recommendation mentioned by the respondents were healthcare workers (92.7%). Female (aOR=1.44, 95% CI: 1.02 - 2.03), good knowledge of HPV infection (aOR=2.87, 95% CI: 1.82 - 4.53) and good knowledge of HPV vaccine (aOR=18.52, 95% CI: 10.52 - 32.61) were the predictors of HPV vaccine acceptance. prior to the introduction of HPV vaccine into the routine immunization of Abia State, Nigeria, most parents surveyed indicated that they would accept HPV vaccine for their female adolescents. Sex, knowledge of HPV infection and HPV vaccine were the independent predictors of parental acceptance of HPV vaccine. We recommend the raising of awareness campaign on HPV vaccine benefits and safety, prioritizing healthcare workers and the social media as the major channels of communication to support HPV vaccination.

Postmenopausal woman with 24 kgs ovarian mucinous cystadenoma: a rare case report

A case of a 53-year-old postmenopausal woman presenting a giant ovarian cystic mucinous tumor weighing 24 kg is reported here. When she was seen first at our outpatient clinic, she had gross abdominal distension since 2 years, and she complained of unbearable aggressive pain. Her computed tomography (CT) scan was done which came suggestive of ovarian serous cystadenoma of large massive size 35 x 40 x 32 cm with moderate ascites. On exploratory laparotomy, a giant, totally cystic, vascularized and smooth mass attached to the right ovary was encountered. On the postoperative tenth day, she was discharged without any problem. Histopathology report of the right ovarian cystic mass came suggestive of multiloculated cyst with capsule intact with Borderline Mucinous tumor of right ovary weighing 24 kg. This is both one of the largest known examples in the literature and the largest ovarian cyst ever seen at our institution.

Cervical cancer in Morocco: a literature review on risk factors, prevalence, and healthcare challenges

Cervical cancer (CC) stands as the second most prevalent cancer among women in Morocco, with an estimated annual incidence of 2165 cases and over 1199 associated deaths. However, the lack of a comprehensive national registry requires caution in interpreting these figures. This review highlights the examination of the epidemiological profile, diagnostic modalities, risk factors, treatment, and prevention related to CC screening within the context of Morocco. High-risk subtypes of the human papillomavirus (HPV) are the etiological cause of the disease in most cases. Underscoring the urgent need for a thorough understanding of its epidemiological landscape. Other risk factors as age of sexual debut, sexual partners and sexually transmitted infections, immunosuppression, smoking, and parity should be studied comprehensively. Treatment modalities for CC are contingent upon disease staging at diagnosis and the availability of local healthcare resources. Options encompass radical hysterectomy and chemoradiation. The Ministry of Health's endorsement of the vaccine in 2022 marked a significant milestone in combating cancer through prevention and treatment, as it integrated the HPV vaccination into the national vaccination program, targeting girls aged 11 years. Morocco's healthcare landscape underwent significant reforms, culminating in the implementation of compulsory basic medical coverage in 2020 to ensure equitable access to healthcare services for all citizens. Consequently, this proactive approach holds promise for enhancing care standards and substantially curtailing mortality rates attributable to cancer across Morocco in the coming years.

Religious leaders’ willingness to promote the uptake of human papillomavirus vaccine among their congregants in Mavoko Sub-County, Machakos County, Kenya

cervical cancer is a significant health challenge in Kenya and sub-Saharan Africa, with high mortality linked to late presentation and low awareness. Despite its prevalence, preventive interventions like human papillomavirus (HPV) vaccination face low utilization. Religious leaders play a pivotal role in influencing health decisions, yet their attitudes toward HPV vaccination remain understudied. Therefore, this study aims to determine religious leaders' willingness to promote HPV vaccine uptake in Mavoko Sub-County, Machakos County, Kenya. a cross-sectional study involving 198 religious leaders chosen through systematic random sampling method was done in the month of December 2023 in Machakos County, Kenya. Data on socio-demographics and attitudes towards HPV vaccination were collected using structured, self-administered questionnaires. Attitudes were gauged on 11 statements. Analysis was performed using IBM SPSS 22.0, employing descriptive statistics and Chi-square tests to assess associations, with significance set at p < 0.05. Results were visually presented using tables, charts and graphs. the study had a 96.6% response rate. Majority were male (51.5%), Protestant Christians (48%), and pastors (29.8%). Most participants had positive attitudes towards the HPV vaccine, with no significant socio-demographic associations found. the study reveals positive attitudes among religious leaders towards promoting HPV vaccine uptake among their congregants. Despite some concerns and misconceptions, the majority of participants expressed willingness to advocate for vaccination.

The interplay between programmed death ligand 1 (PD-L1) expression and human papillomavirus (HPV) genotypes in cervical carcinomas: findings of a Nigerian Tertiary Hospital

cervical cancer is primarily driven by high-risk human papillomavirus infections. It is a leading cause of cancer-related deaths among women globally. The emergence of immunotherapeutic approaches, particularly programmed death ligand-1 (PD-L1) inhibitors, has shown promise in various cancers. This study aims to investigate the correlation between PD-L1 expression and HPV status in cervical carcinoma samples from a Nigerian tertiary hospital. the study was conducted in the Department of Pathology of our hospital. The study materials were 101 cases of archival formalin-fixed paraffin-embedded (FFPE) tissue blocks that met the study criteria recruited retrospectively from January 2012 to December 2016. Immunohistochemistry for PD-L1 was done and real time PCR for HPV DNA was done using CFX96. The data were then analyzed using SPSS version 23. P < 0.05 was considered significant. high-risk HPV detection rate was 51%. The two most common genotypes were HPV 16 (84.3%) and HPV 35 (17.6%). The predominant infections were single genotypes occurring in 80.4% of the cases. There was no correlation of HPV status with PD-L1, histological grade or type of cervical carcinoma. High-risk HPV did not show any distribution pattern with age groups of patients. human papillomavirus 16 is the most predominant cause of cervical carcinoma. There are some environmental variations in the frequency of other genotypes with HPV 35 being relatively more common than HPV 18 in this study. Programmed death ligand-1 was positive in 47% of the cases but did not show any correlation with the HPV infection status.

A rare case aggressive of uterine leiomyosarcoma: a case report

Uterine leiomyosarcoma is a rare aggressive uterine malignancy that arises from a smooth muscle of the uterus which accounts for 2-5% of all uterine malignancies. Definitive treatment is surgery with a high rate of recurrences. Our patient presented with lower abdominal pain and mass per abdomen which was diagnosed to be uterine leiomyosarcoma. A 56-year-old woman of East Indian origin presented with abdominal pain and a huge rapidly growing suprapubic abdominal mass with an almost monthly doubling. Her CA 125 and Lactate dehydrogenase (LDH) level was elevated and Computed Tomography (CT) scan showed a large irregular-shaped abdominopelvic solid heterogeneously enhanced lesion with focal central hyperdensity and areas of necrosis causing mass effect. A primary cytoreductive surgery was performed and the histopathology report confirmed the diagnosis of uterine leiomyosarcoma. A combination chemotherapy of six cycles was given to prevent recurrence. No recurrence was detected during her more than two years follow-up period. As the cases are rare in nature, screening is impractical. Hence, the diagnosis of uterine leiomyosarcoma is done by histopathologic examination after surgery.

Postoperative discovery of molar pregnancy

Cervical cancer screening and treatment costing in Senegal

in Senegal, cervical cancer is the leading cause of cancers among women. This study estimated the costs associated with cervical cancer screening and treatment for precancerous lesions from the health system perspective. we estimated costs for screening, diagnostics, and treatment. We conducted a cross-sectional study in seven regions with primary data collected from 50 health facilities. Data collection included structured questionnaires, with secondary data from the Ministry of Health and other sources. A mixed-methods approach combined ingredients-based costing and financial expenditures to estimate direct medical and non-medical costs. All costs are reported in 2019 USD. average costs were $3.71 for visual inspection with acetic acid, $16.49 for Pap smear, and $46.65 for human papillomavirus deoxyribonucleic acid (HPV DNA) testing. Screening cost drivers were clinical exam supplies and clinical equipment for visual inspection with acetic acid, offsite processing of specimens for Pap smear, and lab equipment costs for HPV DNA procedure. The average cost of diagnosis via colposcopy alone was $25.73, and colposcopy with biopsy/endocervical curettage was $74.96. The average cost of treatment followed by one visit for pre-cancerous lesions was $195.24 for loop electrosurgical excision, $47.35 for cryotherapy, and $32.35 for thermal ablation. Clinical equipment and lab costs were the largest contributors to colposcopy and endocervical curettage/biopsy expenses. Clinical equipment made up the largest portion of cryotherapy, loop electrosurgical excision, and thermoablation costs. this study is the first to estimate the costs of HPV screening and treatment in Senegal, which can be used to inform decision-making on cervical cancer investments.

Prevalence of precancerous lesions and other cervical abnormalities among internally displaced women in Benue State Nigeria

visual inspection is a low-cost screening strategy that can be used to prevent cervical cancer in women. These techniques can improve screening health outcomes for internally displaced women (IDW) who have poor sexual and reproductive health and rights' behaviors and outcomes. This study aimed to determine the prevalence of precancerous lesions and other clinical features using a visual inspection with acetic acid (VIA) technique during a cervical cancer screening campaign in two internally displaced people (IDP) camps in Benue State, Nigeria. this was a cross-sectional study of 166 IDW who voluntarily participated in the study during a VIA cervical cancer screening campaign in two IDP camps in Benue State, Nigeria the screening was done by a group of qualified and trained healthcare workers and data was collected using a structured, pretested questionnaire. a total of 99(60%) of the women had a first sexual experience at 16 years, while 78(47%) had more than 5 full-term pregnancies. Although only 72(43.4%) of the women acknowledged having more than one sexual partner, over 70% of the women stated that their sexual partner had another sexual partner. The prevalence of precancerous lesions among women was 10.8%. Smoking(p=0.003), age at menarche (p≤ 0.001) and sexual behaviors (p=0.009, p=0.004) were factors that had a statistically significant relationship with the presence of a precancerous lesion among the IDW. The study also highlights the high rate (95%) of cervicitis among the women and the relatively high rate (5.4%) of leukoplakia. the majority of IDW had sociodemographic and lifestyle characteristics that predisposed them to developing cervical cancer More targeted interventions aimed at improving the sociodemographic and lifestyle characteristics of IDW are recommended. In addition, there is a need to create awareness about cervical cancer among IDW and make screening available in camp facilities for early detection and management.

Cervical precancerous and cancerous lesions screening using Pap smear test at Provincial Referral Hospital of Bukavu, Eastern DR Congo: profile and recommendations to stakeholders

cervical cancer is a health concern worldwide. The South Kivu Province in the Eastern DR Congo is facing many cases of this disease but poorly screened and reported. The objective of this was to determine the prevalence of cell abnormalities at cervical cytology in a tertiary teaching hospital in Bukavu and their association with common risk factors of cervical cancer. a cross-sectional study was conducted on 142 women attending the Provincial Referral Hospital of Bukavu (HPGRB) from February to December 2021. Quantitative variables were described by their median following their asymmetric distributions and the qualitative variables in absolute and relative frequencies. Then the Chi-square test was used for the comparison of proportion. forty-five percent of the participants had between three and five children. Twenty-two (15.5%) of the 142 patients reported to have two or more sexual partners and 17.5% reported the use of hormonal contraception. The prevalence of cell abnormalities at cervical cytology was 17% of which Low- Grade Squamous Intraepithelial Lesion (LSIL) was the most representative (12.9%). There was no statistically significant association between the common cervical risk factors and the occurrence of cell abnormalities. cervical pre-cancerous lesions are frequent in South Kivu province. The Pap smear test remains an early and affordable screening method and constitutes a secondary prevention strategy in women of 18 years and older in a low-income country such as DR Congo where vaccination against HPV is still hypothetic.

La chronologie d’évolution des modes de dépistage et de traitement des néoplasies intra épithéliales du col utérin adoptés au Maroc

In Morocco, the purpose of the National Cancer Prevention and Control Plan (PNPCC) is to decrease the incidence, mortality, and morbidity attributable to cervical cancer (CC), including the general objective which is to improve women´s care by setting up an organized system for screening, early diagnosis and treatment of this disease, and as operational objectives an: 1) achievement of at least 30% of the annual coverage rate by cervical cancer (CC) screening; 2) achievement of at least 80% of the rate of participation in CC screening per screening cycle; 3) achievement of 100% of the treatment rate for precancerous lesions screened within the framework of the program. CC screening concerns all women aged 30 to 49 years old. Women who have already had CC and pregnant women from the 8

Mothers of adolescent girls and Human Papilloma Virus (HPV) vaccination in Western Kenya

human papilloma virus (HPV) which is preventable is the main cause of cervical cancer and it targets mostly young adolescents. The study was to determine the practice desire, attitude and knowledge of mothers of adolescent girls on HPV vaccination in Western Kenya. this was a descriptive cross-sectional study design. Data was obtained using semi-structured questionnaires and analyzed using both descriptive and inferential statistics at 95% confidence level using the SPSS software version 22. A p-value ≤ 0.05 was considered statistically significant. ninety five percent of the mothers had intentions to vaccinate their daughters and also had a positive attitude and their response to HPV vaccination was significantly lower than those without intentions p=0.02, 95% CI, OR=0.48 (0.90-0.89). Vaccination against HPV was low at 9.4% with a mean age of 34 years. Our results found a high level of cervical cancer awareness (85.0%), HPV and vaccine awareness respectively (62.0%, and 64.0%). "Vaccination of my daughters will prompt early sexual activity and the cost of HPV vaccination being a barrier to vaccination" had a statistically significant influence on the practice of vaccination. Negative attitude to daughters´ early onset of sexual activity significantly reduced up take while positive attitude to cost of HPV vaccine significantly increased up take of HPV vaccination with p value of 0.007 and 0.04 respectively. awareness of HPV and HPV vaccine prevention is low among mothers of adolescent girls in Western Kenya. There was a positive attitude and high desire towards the use of HPV vaccination therefore a need for awareness, policy and unify efforts to reduce cervical cancer burden.

Cervical cancer screening practice and associated factors among women employees in Wolaita Zone hospitals, Southern Ethiopia, 2017: cross sectional study

cervical cancer is a global public health problem affecting women worldwide. There is very low participation rate in screening practice for cervical cancer in low-resource countries like Ethiopia. So the aims of this study is to assess cervical cancer screening practice and associated factors among women employees in Wolaita Zone hospitals, Southern Ethiopia. facility based cross-sectional study design was conducted from March 1-April 30, 2017. Simple random sampling technique was employed to select 401 study participants. Pre-tested self-administered questionnaire was used. Logistic regression was performed to assess association between dependent and independent variables with 95% confidence interval (CI) and p-value less than 0.05 was set to declare association. about 120 (30.5%) participants were screened for cervical cancer. Age, source of information from health professions, being adherence supporter, sex with more than one partner, sexual transmitted infection, increase in attitude and knowledge score were significant predictors of cervical cancer screening practice. magnitude of cervical cancer screening practice among age eligible women is still low. Age, being adherence supporter, source of information from health care professionals, history of multiple sexual p artners, sexually transmitted infection, knowledge and attitude were important predictors of cervical cancer screening practice. Hospitals in collaboration with town administration should put priority on cervical cancer prevention by establishing cervical cancer screening campaign.

Cervical pre-cancer screening by visual inspection of the cervix after application of acetic acid in rural Burkina Faso: evaluation of women's knowledge, screening practice habits, acceptability and prevalence of risk factors and lesions in Boussé health District

cervical cancer is a major public health problem among women in sub-Saharan Africa. The disease can be controlled through early diagnosis through simple cost-effective methods such as visual inspection of the cervix after application of acetic acid or lugol´s iodine. However, screening for cervical cancer is still underused particularly in rural areas of Burkina Faso. The objective was to estimate the prevalence of cervical pre-cancer cancer in rural health district of Boussé, Burkina Faso. we conducted a cross-sectional study in the health district of Boussé in Northern-Central Burkina Faso from July to August 2014. Women aged 23-50 years were interviewed about their knowledge of cervical cancer and their screening practice and subsequently screened for cervical cancer by VIA. a total of 418 participants were included with a median age of 34 years IQR (30-40 years). Two screening by VIA is feasible in rural Burkina Faso, but there is a poor knowledge on cervical cancer amongst the women. There is a need to set up a comprehensive, systematic, affordable and efficient cervical cancer program including an information campaign and making screening accessible in rural remote areas.

Human Papillomavirus (HPV) vaccination in view of the National Cancer Control Plan 2020-2029 in Morocco

In Morocco, cervical cancer represents a major public health problem. It ranks second, after breast cancer in Moroccan women, in terms of incidence and mortality. Each year, more than 3,300 new cases and nearly 2,500 deaths are recorded. A Moroccan national program to fight against cervical cancer (CC) based on the practice of visual inspection after application of acetic acid was set up in 2010, allowing screening and possibly of immediate treatment of premalignant lesions of the cervix. In September 2022, a partnership circular between the Ministry of Health and Social Protection (MSPS) and the Ministry of National Education, Preschool and Sports was launched. it announces that the MSPS will integrate the HPV vaccine using the quadrivalent vaccine into the Moroccan National Immune Program (PNI), the vaccination will be aimed to 11-year-old girls, mainly those in school, who will receive two doses separated by at least a period of 6 months.

Etude du profil épidémio-clinique du cancer du col utérin au Maroc: cas de la région du Gharb

Ovarian adenocarcinoma metastasis mimicking psoas abscess on imaging: a case report

Malignant psoas syndrome (MPS) is very rare with poor prognosis, and usually occurs in patients with advanced and recurrent cancer. Authors report herein the case of a 48-year-old female with history of neoadjuvant chemotherapy has been performed before hysterectomy with bilateral adnexectomy and ovariectomy for ovarian adenocarcinoma. She presented 18 months posttreatment with MPS due to a psoas abscess mimicking metastasis confirmed on computed tomography guided fine needle aspiration cytology.

A giant ovarian mucinous tumor in a 58-year-old postmenopausal patient with persistent abdominal pain and high serum levels of CA 19-9

Ovarian cancer is the seventh most commonly diagnosed cancer among women in the world and epithelial ovarian cancer is the most predominant pathologic subtype. Tumor markers are widely used in clinical practice to determine therapeutic efficacy, to detect recurrence and to predict prognosis in known cancers. CA-19-9 antigen is mainly elevated in cases of gastrointestinal tract malignancy, including of the pancreas, colorectum, and biliary tract. However, CA 19-9 antigen can also be elevated in ovarian mucinous neoplasms. We report herein the case of a 58-year-old woman who presented with an abnormally high level of CA 19-9 antigen associated with ovarian mucinous borderline tumor.

Risk predictors of early recurrence in women with epithelial ovarian cancer in Lagos, Nigeria

epithelial ovarian cancer (EOC) is the most lethal gynaecological cancer with a recurrence rate as high as 85% after an initial treatment. However, there are currently no reliable means of predicting the risk of recurrence after first-line treatment. This study investigated the risk factors that predict early recurrence of EOC after primary treatment among women in Lagos, Nigeria. this was a retrospective cohort study involving the review of all histologically confirmed EOC patients managed at the Lagos University Teaching Hospital, Lagos, Nigeria over a 7-year period from January 2010 to December 2016. A study proforma was used to retrieve relevant information and descriptive statistics were computed for all data. The associations between variables were tested and multivariate analysis was done to adjust for all the possible characteristics that predict early EOC recurrence. the rate of recurrence of EOC was 76.4%. Suboptimal debulking surgery is the only independent predictor of early tumour recurrence. women should be adequately counselled and encouraged to report their symptoms early to ensure optimal primary treatment. Strategic efforts should also be made to further improve subspecialty training programs and skills development in gynaecological oncology in Nigeria and sub-Saharan Africa.

Exploring therapeutic aspects and prognosis of Moroccan patients with vaginal cancer: a retrospective cohort study at the University Hospital of Fez

Primary vaginal cancer is rare, making up 1% to 2% of all female reproductive tract cancer. In Morocco, human papillomavirus (HPV) infection is the main factor. Given its low incidence, there is no consensus on the appropriate management of this cancer. The aim of our study was to assess the global management of vaginal cancer in the Radiotherapy Department, at Hassan II University Hospital, Fez, Morocco. We conducted a retrospective study of vaginal cancer cases treated at the radiotherapy department of Hassan II University Hospital between January 2012 and December 2022. Twenty-five cases of vaginal cancer were identified during the study period. In our study series, the median age was 62 years old with a range from 34 to 81 years. The average diagnostic delay was 12 months, 88% were multiparous and the notion of risky sexual behavior has been affirmed by none of them. Out of the patients we observed, 21 had squamous cell carcinoma of the vagina, one adenocarcinoma, and 3 cases of melanoma. The primary mode of treatment for the majority of our patients was concomitant radio chemotherapy, which was administered to 21 patients. Surgery was not performed on any of the patients. In the absence of consensus in the literature on the optimal treatment, concomitant radio chemotherapy remains the standard treatment for locally advanced vaginal cancer. Currently, interests are focused on the role of HPV in the genesis of vaginal cancer and on the HPV vaccine to prevent virus-induced lesions. In fact, the emphasis should be on primary prevention with prophylactic HPV vaccination.

Aspects clinique-thérapeutiques et pronostiques des tumeurs germinales malignes de l'ovaire: expérience tunisienne de 21 ans

malignant germ cell tumors of the ovary (TGMO) are rare ovarian tumors. Each histological type can have clinical and therapeutic particularities which it is important to know. The objective was to report and analyze the particularities of the epidemiological, diagnostic, anatomopathological, therapeutic and prognostic data of TGMO in Tunisian context. this study is a retrospective descriptive and analytical survey carried out at the Gynecology-Obstetrics departments of the CHU FARHAT HACHED in Sousse over a period of 21years collecting all the cases of patients having been treated for TGMO. a total number of 30 files was eligible for our study. The average age of our patients was 22years. The majority of patients were in a period of genital activity. The reason for the consultation was mainly represented by abdomino-pelvic pain followed by an increase in abdominal volume. Abdominopelvic ultrasound was performed in 80% of our patients showing a suspicious appearance of malignancy in 100% of them. For our patients, 70% were approached by median laparotomy given the tumor volume and only 30% by laparoscopy. 76.7% had conservative treatment. The predominance of stage I was noted while there was no case in stage IV. The overall survival for all stages was 96.7% at 2years and 85.7% at 5years and 75.8% at 10years. The prognostic factors of the TGMOs isolated from our series were the consultation time greater than 6 months, the age greater than 30years, the tumor size greater than 20cm and the tumor stage. it would be more interesting to bring together the other cases of TGMO diagnosed in other cancer registries in the country in order to establish a national register of rare ovarian tumors.

Pitfall of I-131 whole body scan: a mucinous adenocarcinoma of the ovary

False positive radioiodine uptake following thyroidectomy for differentiated thyroid cancer has been reported in some cases. A 57-year-old female patient was referred for ablative radioiodine treatment four weeks after undergoing total thyroidectomy for papillary thyroid carcinoma. Posttherapeutic I-131 scintigraphy showed uptake in the neck and large focus in the lower abdomen and pelvis. Pathology revealed a mucinous adenocarcinoma of the right ovary.

Association rare d'une tumeur ovarienne maternelle et d'une tumeur cérébrale néonatale: à propos d'un cas

Fetal brain tumors are rare. Teratoma is the most common histological type. Their evolution is often fatal. Ultrasound and magnetic resonance imaging allows for early antenatal diagnosis. However, definitive diagnosis is based on histologic examination. Placental metastases are rare and complicate more often the course of malignant melanomas, hemopathies, breast and bronchial cancers. In pregnant women who have recently had a cancer, anatomopathologic examination of the placenta should be requested to detect tumor invasion. Similarly, neonatal assessment and extended pediatric follow-up are required. The establishment of registries collecting all cancer cases diagnosed among pregnant woman is essential for a better understanding of the epidemiology of these cancers as well as of maternal and paediatric prognostic factors. We here report a case of fetal brain tumor in a woman with recurrent ovarian cancer.

Surgical excision of vaginal cysts presenting as pelvic organ prolapse: a case series

Vaginal cysts are rare, benign, predominantly cystic lesions of the anterior vaginal wall, with a prevalence of 1 in 200 women. Large vaginal cysts can occasionally present as symptomatic genital prolapse; these cases may be challenging to diagnose due to their rare clinical appearance. In symptomatic large vaginal cysts, surgical excision via vaginal approach is the recommended management with good anatomical results and patient satisfaction. The series of three consecutive adult women were referred for bothersome bulging prolapse. They were found to have a sizeable vaginal cyst at the anterior wall, associated with other symptoms. All patients (mean age 37±8.5 years) underwent total trans-vaginal surgical excision of the lesion. They were followed up in the out-patient department at six weeks and six months with no recurrences mentioned. Vaginal cysts are usually solitary, small, and asymptomatic; however, they can increase in size, easily mimic other pathologies, and are misdiagnosed as cystocele. Therefore, complete surgical vaginal excision of the symptomatic vaginal lesion is feasible and constitutes a good management option.

Mésothéliome malin de l´ovaire: à propos d´un cas

Primary malignant mesothelioma of the ovary (PMMO) is an extremely rare tumor which can develop from mesothelial cells. This neoplasia is caused predominantly by exposure to asbestos or other cancer-causing agents. Preoperative assessment, based on computed tomography (CT) scan, magnetic resonance imaging and positron emission tomography, is essential for cancer staging. Anatomopathological diagnosis is based on immunohistochemical findings. PMMO is an exceptional disease involving a multidisciplinary therapeutic strategy including the use of chemotherapy which improves the management and prognosis of patients. This study reports the case of a female patient undergoing suboptimal surgery complemented by adjuvant chemotherapy with complete radiological response and 1-year disease-free survival.

Knowledge, attitudes and practices among Brazzaville midwives on cervical cancer screening

cervical cancer is an illness that causes 250,000 deaths worldwide. Data on Health professional's skills is highly important for the elaboration of prevention strategies. Objective: assess the knowledge, attitudes and practices (KAP) among Brazzaville midwives on cervical cancer screening. analytical KAP Study, from May 2 the study included 114 midwives aged 43.07 (± 7.40) years. They had an unsatisfactory level of knowledge (59.64%), favourable attitudes (92.98%) and poor practices (71.05%). The factors linked with best (satisfactory) knowledge were, seniority at workplace (10-27 years) [29.31%] vs. 51, 79%; OR; 2.59 (1.19-5.60)] and age (42-60 years) [31.81% vs. 52.08%; OR 2.32 (1.08-5.01)]. The best knowledge were related to the best practices (good) [16.18% vs. 47.83%; OR a = 2.95 (1.87-4.67)]; Midwives attitudes seem to not impact on their practices (p = 0.53). Brazzaville midwives have little knowledge and practices on cervical cancer screening. Therefore, the need of training them and equipping cervical cancer screening.

The COVID-19 pandemic and its implications for cervical cancer treatment and prevention in Zimbabwe: perspectives and recommendations

Cervical cancer is the leading gynaecological malignancy in Zimbabwe, constituting 33% of all female cancers in 2016. Primary prevention through vaccination and secondary prevention through screening are important public health interventions to reduce the cervical cancer burden. Unfortunately, the ongoing COVID-19 pandemic has brought unprecedented challenges to healthcare delivery, posing threats to prevention efforts at a time when the public health sector is extremely fragile. The fragility of the sector has complicated treatment for cervical cancer before and during the COVID-19 pandemic, and is expected to worsen beyond the pandemic. A multi-sectoral intersection between public health experts, clinicians and communities is urgently required to restore preventive and treatment services for cervical cancer and reduce the increased burden, morbidity and mortality stemming indirectly from the pandemic.

Facteurs associés à la vaccination contre le virus du papillome humain dans un contexte de passage à l´échelle au Sénégal: enquête cas-témoins auprès des parents

after a pilot phase, Senegal is the first country in West Africa to introduce cervical cancer vaccine into its Expanded Program on Immunization. Despite the gratuity and availability of the vaccination, coverage was low. The purpose of this study was to identify factors associated with HPV vaccination coverage in girls . we conducted a case-control analytical study from 4 during this study, 510 cases and 510 controls and 1020 parents/guardians were interviewed. Significant factors associated with vaccination of girls were: parents/guardians' education (OR=1,97; [1,81-2,25]), knowledge of the disease (OR=3,05; [2,75-4,53], high household income (OR=1,21; [1,13-1,85]), fear of side effects (OR=0,35;[ 0,27-0,44]), reception of messages via internet/social networks (OR=0,54; [0,41-0,92]) and vaccination schedules for the community (OR= 2,12 [1,59-2,64]). vaccination of girls can be improved by strengthening parents' knowledge through appropriate channels and a better organization of health services.

Prevalence and correlates of cervical squamous intraepithelial lesions among HIV-infected and uninfected women in Central Kenya

cervical intraepithelial neoplasia the precursor of cervical cancer occurs with increased frequency in women infected with human immunodeficiency virus (HIV). This study aimed at determining the prevalence and correlates of abnormal cervical cytology among HIV-infected women and compare to the uninfected women. a cross-sectional study conducted among HIV-infected and uninfected women enrolled in a HIV study in Central Kenya. All women had baseline Pap smear examination assessed using Bethesda system. Bivariate and multivariate logistic regression methods were employed to assess the correlates of cervical squamous epithelial lesions (CSIL). a total 480 women had an acceptable baseline smear, 373 (78%) were HIV-infected. Median age was 30.2 years [IQR 25.4-35.5]. Overall prevalence of CSIL was 37% (176/480) with the prevalence of low grade squamous intraepithelial lesion (LSIL), atypical squamous cells undetermined significance (ASCUS), high grade squamous intraepithelial lesions (HSIL) and atypical glandular cells (AGC) were 17%, 14%, 4% and 2% respectively. HIV-infected women had a higher prevalence of CSIL at 42% as compared to HIV-uninfected women at 19%. HIV infection was the predictor associated with development of CSIL at multivariate analysis and specifically, HIV-infected women were 3 times (AOR 3.1, 95% CI: 1.8 - 5.4, p<0.005) more likely to have CSIL than HIV-uninfected women. The age 35 - 44 years was protective to developing CSIL (AOR 0.45, 95% CI: 0.24 - 0.87, p=0.018). cervical squamous epithelial lesions is a major problem among Kenyan women. HIV infection confers a higher risk to development of CSIL. Cervical cancer screening should be an established practice in HIV programs.

Registered nurses' perspectives on barriers of cervical cancer screening in Swaziland: a qualitative study

cervical cancer is highly preventable and curable if diagnosed and treated early, however, it is still the leading cause of death among women. Despite efforts to increase cervical cancer screening, its uptake is still low. The purpose of the study was to investigate the perspectives of registered nurses on barriers of cervical cancer screening in Swaziland. an exploratory qualitative design was used for the study. Face to face in depth interviews were conducted with 15 registered nurses using an interview guide. The study was conducted in four clinics from both the private and public sectors, which were purposively sampled. Interviews were captured using an audio recording device, they were transcribed verbatim and then analysed using thematic analysis. four themes emerged which were deterrents to cervical cancer screening. These were perceived client barriers, health care system related barriers, nurse related barriers and the nature of the procedure. these barriers to service provision need to be addressed by extensive health education to women as well as the cervical cancer screening programme to provide all resources required to increase the uptake of screening.

Cervical cancer screening in women living with HIV attending primary care clinics in a health district, South Africa: a descriptive cross-sectional study

globally, cervical cancer remains a public health problem. It is ranked the fourth most common cause of women's cancer. In South Africa, it was the second most common cancer diagnosed in 2012. The disease progresses rapidly in women living with Human Immunodeficiency Virus (HIV), due to immune suppression. The purpose was to evaluate cervical cancer screening in HIV-positive women attending primary health care (PHC) clinics in Ekurhuleni Health District (EHD), South Africa. Aim and Objectives: the study aim was to evaluate cervical cancer screening in HIV-positive women attending PHC clinics for routine care in Ekurhuleni Health District, Gauteng Province, South Africa. Objectives were to describe the cervical cancer screening uptake of HIV-positive women on antiretroviral therapy (ART) who remained in care and were screened, determine the length of time or period from starting ART to the first cervical cancer screening, and describe associations among screening, age, and the period from starting ART. this was a retrospective descriptive cross-sectional study design. A review of clinic records was conducted on women living with HIV and on antiretroviral therapy for at least four years. The study period was from March to September 2020. After a clustered randomization of clinics, 550 records were systematically selected. Stata version 16.1 was used for analysis. the median age was 34, ranged 23-68, with the interquartile range (IQR) of 29-42 years. Nearly a third (32.9%, n= 181) had cervical cancer screening documented. Those with both an ART start date and first screening were 83% (n= 151). The median for ART duration was 5 years and ranged from 4-8 years. The median time to first screening was 43 weeks with an IQR of 16-67 weeks. Women aged 35-44 years or above 45 were more likely to be screened (AOR 3.2, CI: 1.0-9.8, p= 0.05) and (AOR 5.3, CI: 1.7-16.9, p= 0.01), respectively. there was suboptimal uptake and delay in initiating screening in women living with HIV. Nevertheless, the older women were, more likely to be screened. This study suggests poor adherence to policy and highlights the need for accelerated staff training on cervical cancer policy.

Tobacco use among a population of women attending cervical cancer screening programs in primary health care clinics in South Africa: a cross-sectional study

we determined the prevalence, patterns and factors associated with tobacco use among women presenting for cervical cancer screening in primary health care clinics in Gauteng province, South Africa. this study utilized data from an ongoing cross-sectional study commenced in September 2018, in which 749 participants had responded to an interviewer-administered semi-structured questionnaire on socio-demographics, HIV status, tobacco use, family planning methods, sexual and cervical cancer screening behaviours. Data were entered into the web-based research electronic data capture (REDCap). We performed descriptive data analysis and included multivariate logistic regression. We considered a p-value < 0.05 statistically significant. participants´ median age was 38 years (interquartile range: 31-38) with 43.9% (328) reporting being HIV-positive. The prevalence of ever and current tobacco use were 24.3% (182/749) and 17.1% (128/749) respectively. In multivariable logistic regression, participants who self-identified as racial ethnicity other than Black African and those who were HIV positive and not on antiretroviral treatment, had increased odds of reporting current tobacco use ((adjusted odds ratio (AOR)= 5.6, 95% CI: 3.2-9.8) and (AOR= 8.2, 95% CI: 2.0-34.1) respectively). current tobacco use is common among women attending cervical cancer screening programs in primary health care clinics in Gauteng Province. Furthermore, study findings suggest the need to integrate tobacco cessation treatments into women´s health and HIV treatment programs.

Distribution and trends of cancer in Buffalo City, Eastern Cape Province, 1991-2009: a retrospective study

Despite interventions, cancer remains a global public health concern. Cancer burden continues to grow globally, demanding the implementation of important preventative and control initiatives. Informative reports on existing routine cancer data are therefore required. This study describes the distribution and trends of cancer in Buffalo City (BFC) population, Eastern Cape (EC) Province for the period 1991-2009. Cancer patients were retrospectively surveyed in the database of Frere Hospital Oncology-Radiation Unit. Proportion by sex, race, geographical distribution in the province and top cancer sites were calculated. Direct method of standardisation was used to calculate Age Standardised Rates (ASR) for a subpopulation of patients residing at BFC; age-specific rates were applied to the reference population (World Standard Population). Trends in rates with 95% Confidence Intervals (CI) for two most common cancers in males and females over time adjusted for age and sex and interactions between time and race were assessed using Poisson Regression. A total of 19 737 patients´ records were analysed; 38.8% (7 656) males and 61.2% (12 081) females. Most patients were Black Africans (81.5%), followed by Whites (13.5%), Mixed Race (4.5%) and Asians (0.5%). A larger proportion (46.0%) of the patients were from Buffalo City, while the rest were distributed in other municipalities served by Frere Hospital. Top five cancers in males were lung [22.5%, ASR 21.0], prostate [14.7%, ASR 9.2], larynx [5.8%, ASR 5.0], mouth [4.4%, ASR 3.7] and tongue [3.8%, ASR 2.9 per 100 000] in females; cervix [20.9%, ASR 23.0], breast [23.6%, ASR 20.2], lung [3.4%, ASR 4.7], ovary [2.1%, ASR 3.0] and corpus uteri [3.4%, ASR 2.8]. Trends showed a decrease in lung and prostate cancers in males, while cervix and breast remained stable in females. White males were two times (95% CI: 1.87-2.49) more likely to have lung cancer and five times (95% CI: 3.90-6.21) more likely to have prostate cancer than Black Africans. White females were 0.43 (95% CI: 0.44-0.73) less likely to have cervical cancer and three times (95% CI: 2.45-3.14) more likely to have breast compared to Black Africans. In conclusion, the availability of routine cancer data at Frere Hospital contributes to strengthening of the national cancer notification regulation, as the results of this study suggest that the burden of cancer in the EC Province remains high.

HIV status, knowledge and prevention of cervical cancer amongst adolescent girls and women: a secondary data analysis

the objective of this manuscript was to describe the knowledge profiles and determinants of cervical cancer screening among HIV positive and negative adolescent girls and women in Zimbabwe. we conducted secondary statistical data analysis to explore the determinants of cervical cancer screening among HIV positive and negative adolescent girls and women using Zimbabwe Demographic Health survey for 2015-16. a total of 9054 adolescent girls aged 15-19, and women aged 20-49 were included in the analysis and the majority (63%) of them resided in rural areas. More than two-thirds (65.9%) had attained secondary level of education. The majority (41.3%) of the adolescent girls and women belonged to the Apostolic sect. A number of key determinants have been identified for being ever screened for cervical cancer. The odds of being ever being screened increased by age, OR(CI) 4.38 (3.22-5.94), p<0.001 for women who are 40 years and older when compared to adolescent and young woman who are between 15-24 years. our study reports significant programmatic gaps in the provision of cervical cancer screening and treatment services in the country. The nascent Zimbabwe cervical cancer screening and treatment progamme will benefit from expansion of the number of facilities offering the services and the provision of more efficient health education to adolescent women and girls.

Prevalence of cervical abnormalities among rural women in KwaZulu-Natal, South Africa

despite the availability of screening facilities in South Africa, cervical cancer prevalence and mortality is still high. Most women present to the health facilities at an advanced stage of disease. This study aimed to determine the prevalence of cervical abnormalities using the revised Bethesda System among rural women in KwaZulu-Natal, South Africa. this was a cross-sectional descriptive study using a retrospective medical record review method to collect data on Pap smears from three rural clinics in KwaZulu-Natal. Clinical data and cytology reports were obtained for the years January 2016 to January 2019. Women aged 18-65 years were included. of 246 randomly-selected medical records, 245 Pap smears were analysed. Half (47.8%) of the women were in the age group 30-44 years. HIV, as a risk factor, was found in 41.2% of the women. A total of 48.6% Pap smears were negative for malignancy. Of the 49.8% abnormal screened results, 25.7% women had low-grade squamous intraepithelial lesion, 13.9% high-grade squamous intraepithelial lesion (HSIL), 8.6% atypical squamous cells of undetermined significance, and 1.6% squamous cell carcinoma (SCC). All SCC cases were found in HIV-infected patients. HSIL and SCC were less common among patients younger than 30 years. this study´s results accentuate the importance of well-organised cervical screening programmes. Cervical screening, through Pap smears, is a useful, non-invasive and cost-effective method for early detection of pre-invasive lesions. Women, especially those over 30 years, should be educated on the importance of Pap smears and encouraged to uptake the test.

The magnitude and predictors of cervical squamous intraepithelial lesions among women in Enugu, Nigeria: a cross-sectional study of women in a low-resource setting

the prevalence of cervical squamous intraepithelial lesion is not well appreciated in most low-income countries. The study aimed to determine the level of awareness, prevalence and the pattern of squamous intraepithelial lesions and predictors for abnormal Pap smear reports (development of pre-malignant lesions of the cervix) among women attending various clinics in a tertiary health facility in Enugu, Nigeria. a cross-sectional study of 207 female patients attending various clinics of Enugu State University Teaching Hospital, Parklane, Enugu between June and August 2017 was undertaken. Structured interviewer-administered questionnaires were used for data collection while cervical smears were collected from the patients and sent for cytology. Data analysis was done using the Statistical Package for the Social Sciences (SPSS) version 22.0. The results were presented as means, standard deviations, frequencies and proportions. Pearson´s Chi-square test was used to test for associations between categorical variables and statistical significance was set at a p-value of < 0.05. the levels of awareness of cervical cancer and the screening methods among the respondents were 76.8% and 36.7% respectively. The overall knowledge of cervical cancer and its screening was poor (6.8% and 29.0% respectively). The prevalence of pre-malignant lesions of the cervix among the respondents was 15.0% with low grade squamous intraepithelial lesion (LGSIL) having the highest frequency (38.7%). Among all the other risk factors for the development of premalignant lesions of the cervix among the respondents, a report of abnormal pap (positive) smear report was significantly associated with only age ≥35 years (χ the awareness of cervical cancer and cervical cancer screening was high but the overall knowledge on cervical cancer and its screening was very poor among the respondents. The prevalence of pre-malignant lesions of the cervix was high, and the commonest abnormal smear was LGSIL. Only age 35 years and above correctly predicted the occurrence of abnormal Pap smear reports among the respondents.

Knowledge, attitudes, and practices of adolescent girls regarding cervical cancer: a cross-sectional study in Enugu State, Nigeria

cervical cancer is the second leading cause of cancer death, among women, globally. The majority of the countries with the highest cervical cancer burden are in sub-Saharan Africa, including Nigeria. This study assessed the knowledge, attitudes, and practices regarding cervical cancer among secondary school students in an all-girls school. this cross-sectional study was conducted in Nsukka, Enugu State, Nigeria (April 2021). A 30-item self-administered structured questionnaire was filled by conveniently sampled students in Senior Secondary School (SS 2 and SS 3). Pearson's Chi-square was used to test the association between variables (Statistical significance: P < 0.05). the mean age of the 103 respondents was 16.10 (± 1.00) years. The most common source of information about cervical cancer was mass media (n = 20, 19.4%). Less than half of the respondents had good knowledge of cervical cancer (n = 44; 42.7%) and had favorable attitudes towards the disease (n = 50; 48.5%). More than half of them had good cervical cancer practices (n = 87; 84.5%). They were highly open to screening (n = 92; 89.3%) and vaccination (n = 93; 90.3%). More respondents who had first-hand experience of cervical cancer from family members were aware of the disease compared to those who did not (71.4% Vs. 33.3%; χ the study highlights the need for adolescent girls to be educated about cervical cancer, to improve their knowledge and attitudes towards the disease, so they can make informed decisions about their practices.

Ovarian hyperstimulation revealing a functional gonadotroph adenoma: a case report

Granulosa cell tumor of the ovary: a series of 6 cases

Granulosa cell tumor (GCT) is a rare ovarian malignancy that represents only 2-3% of all cases. There are two subtypes of GCT: juvenile/JGCT (5% of cases) and adult/AGCT (95% of cases). This study aimed to describe a series of 6 GCT cases. The 6 study patients were managed from June 2011 to November 2022 in a private oncology clinic located in Teresina (PI), Brazil. At diagnosis, the mean patient age was 47 years, and symptoms in 5 patients (83%) were pelvic pain and/or increased abdominal volume. The majority of the patients (N=4/67%) had no comorbidities or findings related to GCT on physical examination. The mean tumor size was 11 cm. Five (83%) tumors were stage Ia and one tumor (17%) was stage III. Regarding tumor subtype, 5 (83%) were AGCT and 1 (17%) was JGCT. Surgical treatment consisted of unilateral salpingo-ophorectomy in 2 patients (33%), total hysterectomy and bilateral salpingo-ophorectomy in 3 patients (50%), and cytoreduction (suboptimal) in 1 patient (17%). After a mean follow-up period of 62.7 months, 5 patients (83%) are still alive and free of disease. One (17%) died from disease progression after 126 months. In the current study, disease-free overall survival was 83%, in a mean follow-up period of 62.7 months.

Peritoneal tuberculosis: a benign differential diagnosis of ovarian cancer with peritoneal carcinomatosis (a case report)

Peritoneal tuberculosis is a rare form of tuberculosis which gives a non-specific clinical picture which can be confused with several digestive pathologies. It can also mimic ovarian cancer at the stage of peritoneal carcinomatosis, hence the interest sometimes of a diagnostic laparoscopy which makes it possible to make the diagnosis which is confirmed by an anatomo-pathological study. This is the case of our patient who was initially diagnosed with ovarian cancer and the diagnosis was corrected in peritoneal tuberculosis after a laparoscopy.

Diagnostic and therapeutic challenge of neuroendocrine endometrial carcinoma: a case report

This article reports a 33-year-old woman with neuroendocrine carcinoma of the endometrium (NECE) with a chief complaint of profuse vaginal bleeding. The patient received emergency radiotherapy to control the bleeding and was discharged. She did not return for four months to undergo a scheduled surgery because she had been hospitalized in another hospital with a COVID-19 infection. She eventually returned due to shortness of breath caused by lung metastasis identified from a chest X-ray. She underwent a total hysterectomy, bilateral salpingo-oophorectomy, and concurrent pelvic and paraaortic lymphadenectomy. The final pathology revealed stage IVB high-grade NECE. The patient died four weeks after surgery from the worsening lung metastases. The aggressive spread, challenging diagnostic nature, and rarity of NECE contribute to the high prevalence of metastasis at the time of diagnosis and poor prognosis. A prospective clinical trial must be performed to formulate an urgently needed guideline for treating NECE.