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Clitoral mass is not commonly encountered in Gynecology practice and the literature is scanty. Clitoral mass can be due to Cancer, Granuloma, epidermoid cyst, peri-clitoral abscess, fibroid and Neuromas 1 and clinical presentation is overlapping making it difficult to diagnose. Clitoral cancer is a form of vulvar cancer, is an unpleasant dreadful malignancy and is very rare. Rare case reports of pyogenic granuloma of the labia and clitoris in postmenopausal women with similar presentation and diagnosed by histopathology requiring excision. Similarly neuromas of clitoris are also a known entity seen mainly after FGM.Aim : Awareness regarding the rare causes of clitoral mass including malignancy and granuloma with their overlapping symptoms.Materials & Methods : Prospective observational case report. Conclusion:A Multidisciplinary approach is important to diagnose and differentiate the clitoris granuloma from that of malignancy. The clinical examination and imaging can be misleading at times and diagnosis is only by histopathology Clinical Significance: Multidisciplinary team involvement and through counseling is needed. Significance of clitoris is well established as the most vital part in sexual function, there is an urgent need to focus our attention on more and more case reports and reviews on its literature of disease related to clitoris.

Background- Abdominal pregnancy remains a diagnostic and management challenge Objective- Highlighting diagnostic and management dilemmas in secondary abdominal pregnancy Search strategy- MEDLINE, EMBASE, PubMed and Web of Science searched from 1930-2021. Selection criteria- Articles on secondary abdominal pregnancies Data collection and analysis- An illustrative case report of a woman at 13 weeks gestation referred from a primary health centre with vague abdominal pain. Imaging confirmed secondary abdominal pregnancy with hemoperitoneum. Emergency laparotomy revealed significant hemoperitoneum, a live floating fetus in the abdominal cavity and placental attachment to the left cornu and fallopian tube which were removed and cornual repair performed. Recovery was uneventful. We reviewed the literature on secondary abdominal pregnancies, early and advanced from 1930-2021 and summarised management and outcomes of 314 such cases. Main Results- Among the 314 cases reviewed, 295 cases (93.9%) were surgically managed and 19 (6%) required hysterectomy. Post-surgery methotrexate was given in 9 cases (2.9%). Following primary methotrexate administration in 18 patients, 10 required surgery (55.5%). Complete placental removal was achieved in 264 cases (84%), partial in 27 (8.6%) and left in situ in 16 (5.1%). Seventy-four cases (23.6%) required blood transfusion. There were 15 maternal deaths (4.8%). Twenty-seven fetuses (8.6%) were live born, 6 (1.9%) were neonatal deaths and 46 (14.6%) were fetal demise. Conclusion- Maternal mortality and morbidity is of serious concern in abdominal pregnancies requiring a high index of suspicion and management expertise. Funding- None Keywords- abdominal pregnancy, primary peritoneal pregnancy, secondary abdominal pregnancy, hepatic pregnancy, omental pregnancy, diaphragmatic pregnancy.

Germ cell malignancies represent 15% of ovarian cancers in Asians. Choriocarcinoma is a malignant tumor of the ovary with trophoblastic differentiation can be gestational or non-gestational in origin the study is aimed to increase awareness of rare malignant cancer in children that can present in uncommon symptoms and is diagnosed only if the doctor is vigilant. It is a prospective observational case report. Though uncommon a cancer, choriocarcinoma cases have been reported several times in the literature with no definitive treatment plan. The neoadjuvant chemotherapy followed by surgery has proven too successful in the above case. A multidisciplinary approach to juvenile cancer can have a fruitful outcome with high cure rates. The rarity of this cancer makes it difficult to have clear cut diagnosis fixed treatment plan. A good history taking and easy availability of ultrasound with fast-track referral can save many lives from the deadly disease like cancer. Due to paucity of data in regard to pure choriocarcinoma this case report may help in gathering more attention to the research towards this cancer.

Background: Patient satisfaction after a surgical procedure is an important outcome of hospital care. Many of the gynaecological menstrual problems such as abnormal uterine bleeding, postmenopausal bleeding requires endometrial evaluation which is done traditionally by dilatation and curettage. But this procedure is painful and requires appropriate pain management protocol. The aim is to evaluate the post-operative patient satisfaction following dilatation and curettage procedure.Methods: This study was conducted in a tertiary care hospital belonging to a medical college. A total of 236 patients were recruited for the study who subsequently underwent dilatation and curettage with different mode of Xylocaine anesthesia for pain relief. Of them 16 patients were excluded due to valid reasons and the remaining 220 were interviewed face to face following the procedure. The level of anxiety was assessed using Beck’s Anxiety inventory and also perception of satisfaction was documented along with complication related to the anesthesia.Results: The overall level of satisfaction was higher in the group receiving both paracervical block and intrauterine instillation of lidocaine during the procedure of dilatation and curettage. A further analysis showed that increase in level of satisfaction was due to improvement in pain scores due to combined mode of paracervical and endometrial anesthesia.Conclusions: A multimodal pain management protocol which involves pre-procedural sedation, combined cervical and endometrial anesthesia improves overall outcome with respect to reduction in anxiety scores and postoperative satisfaction levels.