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Aims: The aim of this study is to identify clinicopathological features associated with increased morbidity and mortality in cases of “ultra-high risk” gestational trophoblastic neoplasia (GTN) and to compare initial low-dose etoposide-cisplatin (EP) induction chemotherapy with respect to etoposide methotrexate adriamycin cyclophosphamide vincristine (EMACO) regimen. Settings and Design: This was a retrospective study of patients of high-risk GTN from January 2012 to December 2016 with criteria mentioned as “ultra-high-risk group;” pathological or suspected diagnosis of choriocarcinoma, multiple (>20) pulmonary metastases or associated with hemoptysis, brain metastases, large-volume liver metastases, profuse vaginal bleeding, human chorionic gonadotropin >1000,000 IU/L, interval since the last antecedent pregnancy of >2.8 years. Subjects and Methods: Comparison between the two groups of chemotherapy regimens and the median number of chemotherapy courses required to achieve complete remission was done Statistical Analysis Used: Data were analyzed using the SPSS software version 18 and Fisher's exact test with P value statistically significant at the level of 0.05. Results: Thirty-seven cases were high-risk GTN and 24 were “ultra-high risk.” The higher percentage of patients underwent remission of disease following low-dose induction chemotherapy as compared to primary EMACO therapy, 71.4% versus 58.8%. No resistance to second-line chemotherapy was noted, and no surgical intervention was required in the patients receiving low-dose induction chemotherapy before EMACO. Conclusions: We noted a decrease in the proportion of patients developing resistance to primary chemotherapy and lesser adverse effects in those receiving initial low-dose induction EP chemotherapy.

Cardiovascular emergencies especially aortic dissections are rare in pregnancy. We report a case of Stanford Type A aortic dissection at 33 weeks of pregnancy presenting in shock. Rapid multidisciplinary approach and special obstetric considerations led to a successful outcome in this case.

Background Post-radiation sarcoma accounts for 0.5-5.5 % of all sarcomas. We present a rare case of postradiation malignant peripheral nerve sheath tumor (MPNST) of pelvic following radiotherapy for endometrium carcinoma. Case report A 48-year-old woman with diagnosis of endometrioid carcinoma of uterus underwent surgical staging in March 2009. Histopathological report shows endometrioid adenocarcinoma grade II, infiltrating more than half thickness of myometrium (FIGO stage IB GrII). The patient received adjuvant pelvic radiotherapy administered by external beam followed by vaginal brachytherapy till July 2009. The patient was followed regularly without any signs of recurrence till April 2015, and then on PET-CT scan single active lesion near anterosuperior to urinary bladder was found. Wide local excision of tumor was done. Histopathological and immunohistochemistry findings were consistent with malignant peripheral nerve sheath tumor.Conclusion Post-irradiation MPNST should be considered in the differential diagnosis of an enlarging mass in a previously irradiated area. Therefore, careful follow-up after effective radiotherapy should be continued for lifelong for these patients as early diagnosis of second cancer may help in more effective treatment of these tumors.