Aim:To assess the nutritional status of gynecological cancer patients using scored Patient Generated Subjective Global Assessment (PG-SGA) then compare it with the body mass index (BMI), hemoglobin, serum albumin, and approximate percentage weight lost in last 1 month so as to find any one parameter that can be used in place of the comprehensive assessment tool.Materials and Methods:Sixty gynecological cancer patients were assessed for their nutritional status using BMI, serum albumin, hemoglobin, percentage weight lost in last 1 month, and scored PG-SGA. Correlation, sensitivity, specificity, and predictive values of the former four parameters compared to scored PG-SGA were calculated.Results:88.33% of cases were at risk of or had some degree of malnutrition according to scored PG-SGA. Serum albumin level ≤ 2 g/dl had highest specificity and positive predictive value at 1, whereas percentage weight lost in last month had better overall sensitivity, specificity, and positive and negative predictive values of 0.5833, 0.9444, 0.875, and 0.7727, respectively. The Pearson's correlation coefficient between scored PG-SGA and percentage weight lost in last 1 month was 0.784, highest among all the parameters.Conclusion:88.33% of gynecologic cancer cases had some degree of malnutrition or were at risk of malnutrition. Approximate percentage weight lost in last 1 month, that is, ≥ 5% may be used in place of the comprehensive scored PG-SGA to triage the patients in case the latter is not used for some reason. Severe hypoalbuminemia ≤ 2 g/dl is an indicator of severe malnutrition in gynecologic cancer cases.

Presacral teratoma is extremely rare in adults. A 35-year-old lady was diagnosed with presacral teratoma on MRI abdomen and pelvis. The tumour was enucleated laparoscopically, this being the first such case to be reported in India and fifth case in world literature. Though traditionally, anterior approach of the presacral tumours meant laparotomy, but recently, laparoscopy has been reported as a safe and effective option for these tumours with the advantages of a magnified view in the narrow pelvis, easier development of natural planes by pneumoperitoneum, faster recovery and less complications if expertise is available.Keywords Presacral teratoma in adult . MRI . Laparoscopic removal . Advantage Sacrococcygeal teratoma in adults occurs at a rate between 1 in 40,000 and 63,000 with a female preponderance of 3:1 [1]. According to Altman Classification, they are of four types: type I tumours are predominantly external; type II are predominantly external but have a small but intrapelvic component; type III are predominantly intrapelvic, with a small external mass; and type IV tumours are entirely internal, otherwise known as retrorectal or presacral teratoma. Type IV tumours are excised by posterior (perineal), anterior (abdominal) or combined approach. Laparoscopic management of such cases is a new addition in surgical armamentarium. Very few cases have been reported to be successful in this endeavour. Case ReportA 35-year-old lady presented with dull aching pain in the lower abdomen. On per rectal examination, lower part of a tense cystic mass was palpated which was nontender and had restricted mobility; rectal mucosa was not involved. There was no evidence of neurologic involvement. Transvaginal sonography followed by MRI abdomen and pelvis showed "well defined lesion of about 6.7X4.4X4.7cm size, in presacral space extending inferiorly posterior to the anal canal. It appeared hypointense on T1 weighted imaging with multiple calcific foci and hyperintense in T2 weighted images. There was no evidence of post contrast enhancement of the lesion, involvement of adjacent structures or intraspinal extension (Fig. 1)." Serum tumour markers, including human chorionic gonadotropin, alpha-fetoprotein, carcinoembryonic antigen, lactate dehydrogenase and CA 125 were in normal range. The patient was taken up for laparoscopic excision based on clinical and radiological findings. In brief, the patient was placed in the modified lithotomy position. Access was gained with a 10-mm supraumbilical port followed by two 5-mm ports in the left and right lower quadrant 2 cm medial and above the anterior superior iliac spine and another 5-mm port 1 cm lateral to midline at the same level. The abdomen was insufflated to a pressure of 12 mmHg with CO2. Uterus was anteverted and deviated to the right with a vaginal manipulator and the rectum was deviated to the right side with a rectal probe. The mesorectal dissection from the sacral promontory was continued up to the level of the levator ani muscles keeping medial to the left uret...

Locally advanced cervical cancer with the involvement of para-aortic lymph nodes (PALN) is a common occurrence in low-income and low-middle-income countries. With the incorporation of PALN in the recent FIGO staging, therapeutic management becomes crucial. There are varied presentations of this group which may range from microscopic involvement to extensive lymphadenopathy. Various imaging modalities have been studied to accurately diagnose PALN metastases without surgical intervention, while some investigators have studied the survival benefit of para-aortic lymph node dissection for accurate staging and guiding extent of radiation. With recent advances in radiation therapy, its application to treat bulky nodal metastases and the role of prophylactic irradiation have been reported. In this review, the available evidence and the scope of further interventions is presented.

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Only one case of primary extra uterine vaginal choriocarcinoma and one case of primary vulvar choriocarcinoma have been reported in literature. This is a case of 27 year old lady who presented with a 10cm × 7cm× 5cm vulvar mass with pain abdomen since 1 month, to the Gynecologic oncology outpatient. The mass was smooth, hard and fixed to underlying structures. Multiple bilateral inguinal lymph nodes were enlarged. Vulvar biopsy with Immunohistochemistry proved it to be choriocarcinoma. CT scan thorax, abdomen and pelvis showed multiple bilateral lung metastases, empty uterine cavity and normal sized uterus with a vaginal mass extending up to introitus encasing urethra and anal canal with multiple enlarged pelvic & inguinal lymph nodes. Final diagnosis of Primary Vulvovaginal choriocarcinoma FIGO stage III and WHO score-12 was made. Multidrug chemotherapy with Etoposide, Methotrexate, Actinomycin-D, Folinic Acid, Cyclophosphamide and Vincristine (EMA-CO) was started then shifted to Etoposide, Methotrexate, Actinomycin-D, Folinic Acid and Cisplatin (EMA-EP) regimen followed by Paclitaxel & Carboplatin, because of poor response. Patient’s βHCG became 1.57IU/L with resolution of all lesions after 5 three weekly cycles of Paclitaxel & Carboplatin. Now she is planned for three more cycles of chemotherapy. This case highlights another atypical presentation of choriocarcinoma. [Int J Reprod Contracept Obstet Gynecol 2013; 2(3.000): 470-472