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ABSTRACTS OF PAPERS AT THE 64TH RESEARCH MEETING OF THE MEDICAL RESEARCH CENTRE OF THE MEDICAL RESEARCH CENTRE OF BOMBAY HOSPITAL ON MONDAY, 8TH FEBRUARY 1999, 2.30 PM IN THE SP JAIN CAFETERIA (CONVENOR DR. HL DHAR)

1. INCIDENCE OF ENDOMETRIOSIS ON LAPAROSCOPY IN 230 CONSECUTIVE INFERTILITY PATIENTS
Vinaya Maiskar, Sadhana K Desai, Malika Masalawalla, Prema Kania

To analyze the causes of infertility and to determine the incidence of endometriosis in infertile patients in a tertiary level teaching hospital.

A retrospective study was conducted to analyze the causes of infertility in 230 patients who underwent diagnostic laparoscopy over a period of one year from July 1997 to July 1998 at Bombay Hospital Institute of Medical Sciences. 17 cases were known cases of endometriosis for review laparoscopy for staging and management. The occurrence of endometriosis, grading and its symptomatology was noted.

The incidence of endometriosis in our study was 22.66%. Of these 10.86% were of severe endometriosis, 19.56% of moderate, 28.26% of mild and 41.3% had minimal endometriosis.

The occurrence of endometriosis is showing an increasing trend, which reflects better and early diagnosis and a changing social pattern.

2. NEONATAL RASH - IS HERPES A RASH DECISION?
Sameer Kamath, Rahul Verma, Prem Sheth, Deepak Parikh

A newborn, born with generalized pustular rash was thought to be caused by Herpes simplex infection, is treated with acyclovir after sending serology. Is it really herpes? Serology for herpes is negative, though the child does improve after oral acyclovir after 14 days. Currently the rash though less is persistent.

3. MULTIPLE SUBCUTANEOUS ABSCESSES - UNCOMMON AETIOLOGY
Sameer Kamath, Rahul Verma, Prem Sheth, Deepak Parikh

A young girl presents with a three month history of subcutaneous swellings on the right forearm and back. Immunodeficiency was ruled out. The aetiology was surprising. Histopathology revealed cysticercosis. CT scan of the head ruled out neurocysticercosis. Child is on a three week course of albendazole. (Special remarks by Dr. Kishore Adhyanthaya).

4.DERMOID CYST - STRUMA OVARII
Rekha Patil, PB Pai Dhungat, Shashi Goyal

Upto 20 to 25% of all ovarian tumours are of germ cell origin. Of these 15% are malignant while 95% are benign. Benign cystic teratoma is the commonest benign germ cell tumour accounting for 95% of adult germ cell tumours. In monodermal teratomas, a single tissue element predominates. Struma ovarii is a special type of monodermal teratoma composed of more than thyroid tissue. It arises in a benign cystic teratoma in post menopausal women. We are reporting a rare case of dermoid cyst with struma ovarii.

45 years perimenopausal patient was admitted with complaint of something coming out of vagina, pain in abdomen since 3 months. No bowel or bladder complaints. Normal LMP. All full term delivery, last delivery 22 years back. She was with complaint of hyperthyroidism and undergone semithyroidectomy, 10 years back. She was on Tab. neomercazole 5 mg 1 tid. No other significant surgical or medical history. On examination, she was averagely built. Afebrile P-120/min, BP - 140/80 mmHg, no pallor. S/E - CVS - Tachycardia - clear. P/A - soft. P/S - Cervix and vagina was healthy, II prolapse, P/V - UtRV, NS, mass of 8 x 8 cm was palpable in Lt. fornix.

Movement of the cervix were not transmitted to the mass and vice versa. So clinical diagnosis of ovarian cyst wasmade. Investigations done were Hb, blood sugar, renal and liver function tests, pap smear, ECG and ESR. All were normal. The ultrasound scan revealed bulky uterus with case of large 8 x 8 cm sized complex predominately cystic mass arising from left ovary. Tumour markers FP, bhCG, CA 125 were normal. Her T3, T4 were normal but TSH was reduced. Patient was referred to endocrinologist and cardiologist for pre op fitness. They started her on Tab propranolol 20 mg 6 days for her tachycardia and dose of neomercazzole was increased.

Vaginal hysterectomy with left ovarian cystectomy was done under GA. Tissue was sent for HPR. The histopathological findings were proliferative endometrium with adenomyosis. Endocervicitis of cervix left ovary showing nodular aggregates of colloid filled thyroid follicles. Varying amount of adenomatous strong cystic spaces with flattened epithelial lining struma ovarii.

Struma ovarii consists of thyroid tissue similar to that of a thyroid adenoma. The tumour is solid, consisting almost entirely of thyroid tissue and should be clearly distinguished from a dermoid cyst with thyroid tissue in its wall. To the naked eye the tumour resembles a small pseudomucinous cystadenoma, but the material contained in the vesicles is colloid and gives the reactions for iodine. Some cases lead to the development of thyrotoxicosis. Most of the tumours are innocent but malignant thyroid tumours have been recorded.

5.SPINDLE CELL TUMOUR - A CASE PRESENTATION

Tumours of uterine ligaments are very rare and we are presenting such rare case of myxomatous spindle cell tumour arising from the uterosacral ligament.

A 37 year old patient was seen in Bombay Hospital as a part of routine gynaec examination, patient was asymptomatic. Menstrual history is regular and normal. Obstetric history - para - 3, living 3, all full term normal delivery. There was a history of IUCD perforation, so laparoscopic Cu-T removal was done 14 years back. There was no other medical or surgical illness in the past. On examination, patient was averagely built and nourished. Afebrile pulse - 84 min. BP - 120/70 mmHg. No pallor, clubbing, icterus or cyanosis. RS/CVS examinations were normal. PA - soft, PS - Cervix and vagina healthy. PV - uterus anteverted/just bulky/smooth, firm, mobile. Fornices were free with some fullness in pouch of Douglas suggestive of vague mass.

Investigations - Hb, blood sugar, renal and liver profile, tumour markers (CEA, CA 125), Pap smear, X-ray chest and ECG done. All were normal.

Ultrasonography revealed right ovarian cystic mass size 10 cm. found behind the uterus and was separate from the uterus. Exact origin of the mass could not be ascertained. Hence MRI was done which showed large multiloculated cystic lesion with hyperintense foci inseparable from right ovary suggestive of benign ovarian neoplasm probably dermoid.

Exploratory laparotomy was performed in view of right ovarian neoplasm on laparotomy 15 x 12 x 12 cm size multicystic grapes tumour was found attached to the right uterosacral ligament with a pedicle, uterus, both tubes and both ovaries were normal. Tumour was excised and sent for frozen section. Frozen section report was benign myxomatous spindle cell tumour. Final histopathology report was also the same.

Broad ligament tumour such as fibroma, fibromyoma and lipoma are rarely seen but it is extremely rare to see spindle cell tumour arising from uterosacral ligaments. Pelvic ligament is made up of pelvic cellular tissues and pain muscle fibres derived from uterus. Immunohistochemistry would have been the diagnostic procedure for determining the origin of the tumour but it was not done in this case as it was a benign tumour and immunohistochemistry was not going to alter the management of this case.


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