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P1068 Benign abdominal metastasizing leiomyoma – A case report
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
group. Of the 315 cases in the LSIL group CIN I was found in 47.1%, CIN II in 11.1% and CIN III in 11.7%. No invasive carcinoma was found. Metaplasia was found in 16.3% of cases. There were no pathological findings in 13.8%. Of the 576 cases in the HSIL group CIN I was found in 17.2%, CIN II in 23.8%, CIN III in 46.1% and invasive carcinoma in 3% (n = 7) of cases. Metaplasia was found in 5.6% of cases. There were no pathological findings in 4.3%. Sensitivity of cytology was 65.4% and specificity 79.6%. Positive predictive value was 73.1% and negative predictive value 73.0%. Odds ratio with corresponding 95% CI was 7.4 (4.4–11.6). Conclusion: Cytology quality in the national cervical screening program seems to be satisfactory, although sensitivity of cytology needs to be improved. P1066 Visual inspection of cervix with acetic acid (VIA) as a screening method for cervical neoplasia in low resource setting S. Mehrotra, U. Singh, H. Gupta. Dept of OB&GYN CSMMU (Formerly KGMU) Lucknow, India Objective: The purpose of this study was to reach a consensus on appropriateness of VIA as an alternative cancer screening technique, and confirming it by colposcopic examination. Material and Method: This study was prospective study. A total of 236 women were selected from the OPD at Dept of OB&GYN, CSMMU, Lucknow for this study. The women were specifically selected on the basis of contact bleeding p/v, discharge p/v, backache and dysparunia. Following gynaecological examination the women were subjected to VIA. For VIA 3% acetic acid was applied liberally and gently and then inspected for acetowhite area. The low grade lesion (shiny grey), high grade lesion (dull oyster white) and no acetowhite area as normal were noted. Thereafter all women were subjected for colposcopy which was taken as reference standard. Results: Total 236 women were screened. The age group of women were 30–50 years. The sensitivity of VIA was 81.8%, specifity was 96.2% and accuracy was 91.4% for low grade lesions. For high grade lesions the sensitivity of VIA was 63.5%, specifity was 96.4% and accuracy was 88.3%. Conclusion: VIA is an inexpensive, simple test with results available immediately (positive or negative) allowing an algorithm of further investigations to be carried out for identification. P1067 Cutaneous metastasis from squamous cell cervical cancinoma: an ominous prognostic sign S. Mehrotra, U. Singh, H. Gupta. CSMMU (formly King George Medical University) Lucknow, U.P., India Objective: Skin metastasis from carcinoma cervix is rare. The reported incidence ranges from 0.1% to 2%. Metastasis to skin seems to be more frequent in patients with adenocarcinoma and undifferentiated carcinoma. Methods: We present a case of 40 years old woman with cervical cancer reoccurrence with skin metastasis. The malignant nodule on the abdominal wall appeared after 3 years of radical surgery and postoperative radiotherapy. This was biopsy proven metastasis from patient’s primary cervical carcinoma Chest x-ray ultrasound abdomen reported metastatic nodule in the lungs and liver. Chemotherapy was initiated. Cis platin and 5 Fluro-uracil was given. The patient died of progressive disease 2 months later. Conclusion: Skin metastasis from cervical cancer is rare and represent a poor prognostic sign.
S711
P1068 Benign abdominal metastasizing leiomyoma – A case report R. Meneni, A. Farrow, A. Hearn, H. Fawzi. South Tyneside Foundation Trust, Newcastle, United Kingdom Background: Leiomyomatosis peritonealis disseminata (LPD), or benign metastasizing leiomyoma, is a rare condition in females [1] and is characterised by numerous widespread smooth muscle tumours seeding in the peritoneal cavity, and occasionally supradiaphragmatically. [2] In younger women a conservative approach to management is recommended. [1,3] The etiology of LPD is unknown but associations with oral contraceptive use, pregnancy, hormone replacement treatment and endometriosis have been found. [4] In exceptional circumstances multiple leiomyomas have been reported years after hysterectomy. [5] Several hypotheses have been proposed for the pathogenesis of this phenomenon. Methods: We report on the case of a 36 yr old women presenting to pelvic mass clinic in 2008 with a history of dyspareunia, abdominal distension and increased urinary frequency for six months. She had undergone a laparoscopic subtotal hysterectomy in 2006 for fibroid uterus and was not taking any hormone augmenting treatment. A transabdominal ultrasound scan noted a large heterogeneous mixed solid and cystic mass extending from the umbilicus into the pelvis. Tumour marker CA125 was marginally elevated. Assuming a diagnosis of ovarian cyst, an explorative laparotomy with removal of ovarian cyst and omentectomy was planned. Results: At laparotomy three regions of multinodular masses were removed from both adnexa and sigmoid colon. The tissue sections extracted were suspected to be fibroids and this was later confirmed by histology, which also showed the presence of adenomyosis within the leiomyomata. The postoperative period was uneventful and the patient was asymptomatic at the six week review. Conclusion: Although rare, benign metastasizing leiomyoma should be considered as a differential diagnosis of pelvic mass in a patient having a history of uterine leiomyoma, even after hysterectomy. LPD has associations with exogenous steroid hormone use, [5] but must still be considered in patients without this risk factor. Reference(s) [1] Ramesh L. et al. ‘Not all disseminated intra-abdominal lesions are malignant: A case of leiomyomatosis peritonealis disseminata.’ Journal of Obstetrics and Gynaecology (2005) 25 (4): 409. [2] Sapmaz F. et al. ‘Benign metastasizing leiomyoma.’ Lung (2008) 186: 271–273. [3] Ruscalleda N. et al. ‘Leiomyomatosis peritonealis disseminata.’ European Journal of Radiology (2006) 16: 2879–2882. [4] Herrero J. et al. ‘Leiomyomatosis peritonealis disseminata associated with endometriosis: a case report and literature review.’ European Journal of Obstetrics and Gynaecology and Reproductive Biology (1998) 76 (2): 189–191. [5] Kumar S. et al. ‘Disseminated peritoneal leiomyomatosis: an unusual complication of laparoscopic myomectomy.’ Archives of Gynaecology and Obstetrics (2008) 278: 93–95.
P1069 Is blood enough? A prospective randomized trial comparing the use of blood and intravenous iron therapy in locally advanced cervical cancer patients with iron deficiency anemia prior to chemoradiation therapy A. Mostert, G. Dreyer. University of Pretoria, Dept of Obstetrics and Gyanecology Introduction: Cervical cancer is highly prevalent in South Africa and these patients often present with severe iron deficiency anemia. Packed red cells are not always readily available and the transfusion of blood products is associated with risks such as infectious diseases and transfusion reactions. We looked at alternative means of optimizing haemoglobin levels. The aim of this study was to assess the feasibility of replacing red cell transfusion
group. Of the 315 cases in the LSIL group CIN I was found in 47.1%, CIN II in 11.1% and CIN III in 11.7%. No invasive carcinoma was found. Metaplasia was found in 16.3% of cases. There were no pathological findings in 13.8%. Of the 576 cases in the HSIL group CIN I was found in 17.2%, CIN II in 23.8%, CIN III in 46.1% and invasive carcinoma in 3% (n = 7) of cases. Metaplasia was found in 5.6% of cases. There were no pathological findings in 4.3%. Sensitivity of cytology was 65.4% and specificity 79.6%. Positive predictive value was 73.1% and negative predictive value 73.0%. Odds ratio with corresponding 95% CI was 7.4 (4.4–11.6). Conclusion: Cytology quality in the national cervical screening program seems to be satisfactory, although sensitivity of cytology needs to be improved. P1066 Visual inspection of cervix with acetic acid (VIA) as a screening method for cervical neoplasia in low resource setting S. Mehrotra, U. Singh, H. Gupta. Dept of OB&GYN CSMMU (Formerly KGMU) Lucknow, India Objective: The purpose of this study was to reach a consensus on appropriateness of VIA as an alternative cancer screening technique, and confirming it by colposcopic examination. Material and Method: This study was prospective study. A total of 236 women were selected from the OPD at Dept of OB&GYN, CSMMU, Lucknow for this study. The women were specifically selected on the basis of contact bleeding p/v, discharge p/v, backache and dysparunia. Following gynaecological examination the women were subjected to VIA. For VIA 3% acetic acid was applied liberally and gently and then inspected for acetowhite area. The low grade lesion (shiny grey), high grade lesion (dull oyster white) and no acetowhite area as normal were noted. Thereafter all women were subjected for colposcopy which was taken as reference standard. Results: Total 236 women were screened. The age group of women were 30–50 years. The sensitivity of VIA was 81.8%, specifity was 96.2% and accuracy was 91.4% for low grade lesions. For high grade lesions the sensitivity of VIA was 63.5%, specifity was 96.4% and accuracy was 88.3%. Conclusion: VIA is an inexpensive, simple test with results available immediately (positive or negative) allowing an algorithm of further investigations to be carried out for identification. P1067 Cutaneous metastasis from squamous cell cervical cancinoma: an ominous prognostic sign S. Mehrotra, U. Singh, H. Gupta. CSMMU (formly King George Medical University) Lucknow, U.P., India Objective: Skin metastasis from carcinoma cervix is rare. The reported incidence ranges from 0.1% to 2%. Metastasis to skin seems to be more frequent in patients with adenocarcinoma and undifferentiated carcinoma. Methods: We present a case of 40 years old woman with cervical cancer reoccurrence with skin metastasis. The malignant nodule on the abdominal wall appeared after 3 years of radical surgery and postoperative radiotherapy. This was biopsy proven metastasis from patient’s primary cervical carcinoma Chest x-ray ultrasound abdomen reported metastatic nodule in the lungs and liver. Chemotherapy was initiated. Cis platin and 5 Fluro-uracil was given. The patient died of progressive disease 2 months later. Conclusion: Skin metastasis from cervical cancer is rare and represent a poor prognostic sign.
S711
P1068 Benign abdominal metastasizing leiomyoma – A case report R. Meneni, A. Farrow, A. Hearn, H. Fawzi. South Tyneside Foundation Trust, Newcastle, United Kingdom Background: Leiomyomatosis peritonealis disseminata (LPD), or benign metastasizing leiomyoma, is a rare condition in females [1] and is characterised by numerous widespread smooth muscle tumours seeding in the peritoneal cavity, and occasionally supradiaphragmatically. [2] In younger women a conservative approach to management is recommended. [1,3] The etiology of LPD is unknown but associations with oral contraceptive use, pregnancy, hormone replacement treatment and endometriosis have been found. [4] In exceptional circumstances multiple leiomyomas have been reported years after hysterectomy. [5] Several hypotheses have been proposed for the pathogenesis of this phenomenon. Methods: We report on the case of a 36 yr old women presenting to pelvic mass clinic in 2008 with a history of dyspareunia, abdominal distension and increased urinary frequency for six months. She had undergone a laparoscopic subtotal hysterectomy in 2006 for fibroid uterus and was not taking any hormone augmenting treatment. A transabdominal ultrasound scan noted a large heterogeneous mixed solid and cystic mass extending from the umbilicus into the pelvis. Tumour marker CA125 was marginally elevated. Assuming a diagnosis of ovarian cyst, an explorative laparotomy with removal of ovarian cyst and omentectomy was planned. Results: At laparotomy three regions of multinodular masses were removed from both adnexa and sigmoid colon. The tissue sections extracted were suspected to be fibroids and this was later confirmed by histology, which also showed the presence of adenomyosis within the leiomyomata. The postoperative period was uneventful and the patient was asymptomatic at the six week review. Conclusion: Although rare, benign metastasizing leiomyoma should be considered as a differential diagnosis of pelvic mass in a patient having a history of uterine leiomyoma, even after hysterectomy. LPD has associations with exogenous steroid hormone use, [5] but must still be considered in patients without this risk factor. Reference(s) [1] Ramesh L. et al. ‘Not all disseminated intra-abdominal lesions are malignant: A case of leiomyomatosis peritonealis disseminata.’ Journal of Obstetrics and Gynaecology (2005) 25 (4): 409. [2] Sapmaz F. et al. ‘Benign metastasizing leiomyoma.’ Lung (2008) 186: 271–273. [3] Ruscalleda N. et al. ‘Leiomyomatosis peritonealis disseminata.’ European Journal of Radiology (2006) 16: 2879–2882. [4] Herrero J. et al. ‘Leiomyomatosis peritonealis disseminata associated with endometriosis: a case report and literature review.’ European Journal of Obstetrics and Gynaecology and Reproductive Biology (1998) 76 (2): 189–191. [5] Kumar S. et al. ‘Disseminated peritoneal leiomyomatosis: an unusual complication of laparoscopic myomectomy.’ Archives of Gynaecology and Obstetrics (2008) 278: 93–95.
P1069 Is blood enough? A prospective randomized trial comparing the use of blood and intravenous iron therapy in locally advanced cervical cancer patients with iron deficiency anemia prior to chemoradiation therapy A. Mostert, G. Dreyer. University of Pretoria, Dept of Obstetrics and Gyanecology Introduction: Cervical cancer is highly prevalent in South Africa and these patients often present with severe iron deficiency anemia. Packed red cells are not always readily available and the transfusion of blood products is associated with risks such as infectious diseases and transfusion reactions. We looked at alternative means of optimizing haemoglobin levels. The aim of this study was to assess the feasibility of replacing red cell transfusion