Vaginal vault carcinoma as second primary in a treated case of ovarian cancer

Shrivastava, Sushruta; Barmon, Debabrata; Kataki, Amal Chandra; Deka, Pankaj

doi:10.4103/0976-7800.104476

Cited by 2 publications

(2 citation statements)

References 4 publications

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“…Most of them are secondary to primary in cervix or vagina; some of them secondary to carcinoma ovary/ breast and only only paper reported first-time presentation in the vault as primary. 5 , 6 …”

Section: Discussionmentioning

confidence: 99%

A Unique Case of Arterial Thrombosis and Recurrent CVA in ICU: Unfathomable Presentation of an Occult Malignancy

Rangappa

Shetty

Denzil

et al. 2020

Indian Journal of Critical Care Medicine

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A bstract Introduction Critically ill patients may present with prothrombotic manifestations. Carcinoma cervix with prothrombotic manifestations are not common. Arterial thrombosis in such cases is very rare. We present a case of carcinoma cervix which posed a diagnostic dilemma and difficulty in localizing primary. This patient also had recurrent strokes and cardiac metastasis with metastatic arterial thrombosis. Case Description A 34-year-old lady presented with a history of acute lower limb ischemia and recurrent strokes. Transthoracic echocardiography showed valvular vegetations. Prothrombotic and infective endocarditis workup were negative. Histopathological examination (HPE) of clot showed metastatic squamous cells. Contrast CT of chest and abdomen only showed mediastinal lymphadenopathy. Endobronchial ultrasound (EBUS) with mediastinal lymph node biopsy showed metastatic squamous cells. As the patient gave a history of hysterectomy, Pap smear from the vault was sent, which was suggestive of high grade squamous intraepithelial neoplasia. Palliative chemotherapy was started. The patient made a good recovery and was discharged home in a stable condition. Conclusion Arterial thrombosis is an uncommon manifestation of occult malignancy. Carcinoma cervix usually does not metastasize to heart, brain, and arteries, which was the case in our patient. A high index of suspicion and systematic evaluation can clinch the diagnosis even when rare complications of malignancy are presented by critically ill patients. Clinical significance Any unprovoked thrombotic episodes should be extensively worked up for occult malignancies. We present a case demonstrating challenges faced by critical care physicians and benefits of methodical evaluation when confronted with unusual presentation of a malignancy. How to cite this article Rangappa R, Shetty RM, Denzil M, Haranahalli PE, Susmita S, Chaurasia S. A Unique Case of Arterial Thrombosis and Recurrent CVA in ICU: Unfathomable Presentation of an Occult Malignancy. Indian J Crit Care Med 2020;24(7):585–588.

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Section: Discussionmentioning

confidence: 99%

A Unique Case of Arterial Thrombosis and Recurrent CVA in ICU: Unfathomable Presentation of an Occult Malignancy

Rangappa

Shetty

Denzil

et al. 2020

Indian Journal of Critical Care Medicine

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“…"History of cervical intraepithelial neoplasia (CIN) is extremely variable and unpredictable when left untreated, CIN may revert to normal", either persist or eventually advance to intrusive cervical malignant growth. The investigation of those that will progress or relapse has critical clinical value [13] P16INK4a, a cancer silencer genetic factor, is a "component of the P16INK4a/cyclinD-cdk4/6/Rb pathway" [14] . It can initiate G1 cell cycle capture by repressing the "phosphorylation of pRb by cdk4 and cdk6" [12] Current investigations demonstrates that immunohistochemical stain techniques with "P16INK4a is a promising marker for dysplastic and cancerous cervical epithelia" [15] .…”

Section: Introductionmentioning

confidence: 99%

Improving Early Diagnosis of Cervical Cancer Lesions Using P16INK4a Biomarkers on Cellblocks from Cervical Smears

M¹

2019

jmscr

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Universally, cancer of cervical is the second utmost regular malignant growth in females after cancer of breast. Timely recognition of pre-malignant lesions is an essential segment for the decrease of related morbidity and mortality. Though Pap test has been a helpful screening device, however hampered by high Intra and inter-observer changeability, false negatives at 20-30% and false positives at 5-70%. Objective:The study determined the role of P16 INK4a biomarker in the identification of low grade squamous intra-epithelial abrasions in cell blocks prepared from Pap smears and subsequently compared previous Pap results with colposcopy and cellblock results Methods: This was a laboratory-based, prospective study with a parallel comparative arm at the Kenyatta National Hospital Reproductive health clinic (66). All patients who had abnormal Pap smear reports and referred for colposcopy, and consented for the study were enrolled. A smear was taken just before taking a colposcopy biopsy. The cytobrush was immediately put in Acid alcohol fixative centrifuged and deposits wrapped in a filter paper and processed histologically to form a cellblock. Colposcopy biopsies were then retrieved from the KNH histology lab and both samples subjected to Routine histological stain and eventually with biomarker P16. Total of 85 samples was collected. Results: There was a significant level of agreement between Pap smears and cellblock findings on the routine Histological stain. Of 58 cases analyzed Colposcopy had (39%) 27 negatives and (45%) 31 positives while cellblock had (48%) 33 negative and (36%) 25 positive for pre and malignancy with a confidence interval of 0.016 as the margin of error. Biomarker Colposcopy had (43%) 30 negativity and (41%) 28 positivity while cellblock had negativity of (46%) 32 and positivity of (38 %) 26. The specificity and sensitivity were based on the true values of colposcopy as the golden standard test for cervical cancer. Biomarker cellblock had the "sensitivity and specificity" of 93.3% and 93.8% respectively, while Haematoxyline and eosin-stained cellblock had sensitivity and specificity of 83.8% and 81.8% respectively. Conclusion:Poor inter-rater agreement resulting to mortality and morbidity associated with false positives and false negatives, cellblock prepared from residues of cytobrush stained with haematoxyline and eosin and biomarker is likely to circumvent all the above, together with minimizing loss to follow up as patients only visit health facility once and they acquire all the results without re-sampling hence drastically reducing the cost of colposcopy, which requires highly specialized equipment and experienced personnel who are very few and difficult to find.

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Vaginal vault carcinoma as second primary in a treated case of ovarian cancer

Cited by 2 publications

References 4 publications

A Unique Case of Arterial Thrombosis and Recurrent CVA in ICU: Unfathomable Presentation of an Occult Malignancy

A Unique Case of Arterial Thrombosis and Recurrent CVA in ICU: Unfathomable Presentation of an Occult Malignancy

Improving Early Diagnosis of Cervical Cancer Lesions Using P16INK4a Biomarkers on Cellblocks from Cervical Smears

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