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Aims: Extra ovarian granulosa cell tumor (GCT) is extremely rare tumor, assumed to arise from the ectopic gonadal tissue along the embryonal route of the genital ridge. A case of extra ovarian granulosa cell tumor of omentum in a 69 year old female presented here. Materials and Methods: A 69 years old postmenopausal, hypertensive female presented with complaints of pain in right lumber and iliac region of one month duration. Pain was off and on and intermittent. The patient had a history of hysterectomy 12 years ago for fibroid uterus. Results: Ultrasound examination of abdomen showed a hypoechoic lesion of size 78.1 mm x 57.3 mm in right iliac fossa with mild thickening of surrounding omentum. Another hypoechoic lesion of size 36.7 mm x 22.9 mm was seen in retroperitoneal region in supero-medial aspect of right kidney. CECT abdomen showed heterogeneously enhanced nodular lesion of size 6.6 x 6.8 cm in right lumbar region, mild thickening of surrounded omentum also seen however there was no evidence of infiltration to bowel loop seen. Uterus was not visualized. PET CT whole body revealed mildly metabolically active enlarged nodes in the bilateral level ib an ii, metabolically active large lobulated heterogeneously enhancing soft tissue density lesion in right lumbar region with non enhancing areas of necrosis. The lesion is closely abutting the anterior abdominal wall musculature antero laterally and small bowel loop medially surrounding mesenty shows increased vascularity and haziness. Colonoscopy findings were normal. Trucut biopsy of mass right lumbar region was positive for malignancy likely Round cell Sarcoma. A provisional diagnosis of retroperitoneal sarcoma of right lumbar region was made. She underwent exploratory laparotomy with excision of tumor. As per Operative findings there was approximately 8 x 7 cm, firm, omental mass present right to midline, arising from under surface of greater omentum. Ovaries were normal. Gross examination of omental mass showed nodular mass measuring 8 x 5 x 6 cm. External surface was multinodular and cut surface was grey brown to grey yellow with solid cystic areas and areas of necrosis. Microscopic examination of specimen showed Extraovarian Adult granulosa cell tumor/metastasis from occult granulose cell tumor. On IHC Vimentin, CK, SMA, Inhibin were positive, Ki67:15%, ER/PR were also positive and are negative for calretinin, thromobomodulin. Extensive necrosis was seen. After that she underwent rexploration and total omenectomy. HPE showed fat necrosis in omentum. All investigation showed no evidence of tumor in ovaries and at any other primary site then the patient finally diagnosed as having Granulosa cell tumor involving only omentum post op stage III C. Then patient was given six courses of chemotherapy with Inj Paclitaxel and Inj Carboplatin three weekly. Now patient is on regular follow up and disease free. Conclusion: Extra ovarian adult granulosa cell tumor of omentum is rare tumor. Multimodal treatment approaches including surgery, multi-agent chemotherapy may provide a survival benefit for patients.

Background: Gestational trophoblastic disease is a spectrum of cellular proliferation arising from the placental villous trophoblast. Gestational triphoblastic neoplasia (GTN) is a collective term for GTD that invade locally or metastasize. GTD includes hydatidiform mole (complete and partial) and GTN include invasive mole, choricocarcinoma, placental site trophoblastic tumor and epitheliod trophoblastic tumor. Aim: To evaluate clinicopathological profile, treatment pattern and clinical outcome in patients with gestational trophoblastic neoplasia (GTN). Materials and Methods: Twelve cases of gestational trophoblastic neoplasia treated between 2012 to November 2015 in Department of Radiotherapy – II, PGIMS, Rohtak were evaluated in this retrospective study. Data was analyzed on the basis of age, histopathology, stage, type of treatment received and treatment related toxicities. Disease free survival was estimated. Result: Out of 12 women 7 (58 %) had hydatidiform mole, 4 (33%) invasive mole and 1 (8%) had choriocarcinoma. All the cases were given chemotherapy. Two patients had low risk disease. Among high risk group seven patients had score of less than 7 and five patients had risk score of 7 or higher. Five patients were given single agent methotrexate, seven patients received multidrug regimens. All patients are on regular follow up. One patient (high risk group) expired as she did not receive treatment. Conclusion: GTN are rare and proliferative disorders with proper diagnosis and treatment most of the cases are amenable to treatment with favorable outcome.

Aims: To analyze pattern of distant failure, site of metastases, number of metastases and duration in patient with carcinoma of cervix treated with concomitant chemoradiation. Materials and Methods: From May 2011 to December 2015, 73 patients of carcinoma cervix who treated with radical treatment (concomitant chemoradiation followed by 3 session of HDR brachytherapy) with distant metastases presented at Department of Radiotherapy-II, Pt BDS PGIMS, Rohtak were evaluated retrospectively. Results: Most of the female with metastases were in age group of 50-59 years (82%), 12% were in age group >60 and 6% were in < 50 year age group. Initial stage of presentation was 40% (29/73), 48% (35/73) and 12% (9/73) in stage II, III and IVA respectively. Out of which 93% had squamous cell carcinoma histology and 7% were having adenocarcinoma at time of presentation. Among them 49/73 (67%) had solitary metastases, 19/73 (26%) had two metastatic sites and 5/73 (7%) had multiple metastatic sites. Commonest site of distant metastases was paraaortic lymphnodes in 40% of cases, followed by liver, lungs, brains, cervical lymph nodes and one case of cutaneous metastases was also seen. Paraaortic lymphnodes, liver and lung metastases present in maximum number of patient with multiple metastases. Salvage chemotherapy given in 51 cases, palliative radiotherapy (30 Gy or 20 Gy) in 37 cases whereas in 5% of cases single session with 8 Gy was given. Conclusion: A regular and long term follow up of patients with carcinoma of cervix is necessary to detect distant metastases. With early and proper diagnosis and treatment a better outcome could be achieved.

Background: Pelvic radiotherapy may damage the vagina and cause vaginal stenosis. Its incidence in the literature ranges from 1.2% to 88%. To prevent vaginal stenosis, routine vaginal dilation is recommended during and after pelvic radiotherapy. Materials and Methods: The objective was to examine critically the evidence behind this guideline. Searches included the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and Google scholarly articles. All the relevant articles were included in the study. Discussion: Various studies gave recommendations on dilation during or immediately after radiotherapy. Literature does not support routine vaginal dilatation during or immediately after pelvic radiotherapy. Occasional penetration might prevent the sides of the vagina adhering to each other, and dilation might be valuable once the inflammatory and psychological scarring has settled. Two trials demonstrated that encouraging vaginal dilation increased patient compliance, but no difference was found in sexual function scores in the first trial. One retrospective study reported that dilation lowered stenosis rates, but the control group is not comparable. One study involving 89 women revealed that the median vaginal length was 6 cm, six to ten weeks after radiation therapy, but women tolerated a 9-cm dilator/measurer after 4 months of dilation experience. One trial showed no significant advantage by inserting mitomycin C. A study of five women reported that vaginal stenosis can be treated by dilation even many years after radiotherapy. Dilation during or immediately after radiotherapy can cause damage, and there is no evidence that it prevents stenosis. Dilation might stretch the vagina if commenced after the inflammatory phase. Dilation has been associated with traumatic rectovaginal fistulae and psychological consequences. Conclusion: Vaginal dilation might help treat the late effects of radiotherapy, but it must not be assumed that this applies to the acute toxicity phase. Routine dilation during treatment is not supported by good evidence. Prophylactic and therapeutic dilation therapy needs to be considered separately and research is needed to determine when dilation therapy should start on a large population.