Journal/Magazine Articles

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This collection contains original research articles, review articles and case reports published in local and international peer reviewed journals by the staff members of the Faculty of Medicine

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Subject: search.filters.subject.Ovarian Neoplasms

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    An Atypical presentation of an ovarian lymphoma: a case report
    (BioMed Central, 2018) Ekanayaka, C.D.; Punchihewa, R.; Wijesinghe, P.S.
    BACKGROUND: Ovarian lymphoma has a varied clinical presentation and rarely presents with heavy menstrual bleeding. It may occur de novo or secondary to systemic disease and macroscopically appear as solid ovarian tumors. CASE PRESENTATION: A 32-year-old Tamil woman presented with heavy menstrual bleeding of 4 months' duration. On examination she was anemic with no lymphadenopathy. A large immobile pelvic mass and three firm nodules were found involving her vaginal walls. Ultrasonography suggested a fibroid uterus with two large pedunculated fibroids. Following preoperative optimization an endometrial sampling and biopsy of the nodules were done. Subsequently, histology revealed proliferative phase endometrium. The vaginal nodules showed lymphoid tissue. She presented a week later with an undulating fever and features of acute abdomen with clinical evidence of ascites. During an emergency laparotomy two large solid ovarian masses, gross ascites, pelvic lymph nodes, para-aortic lymph nodes, mesenteric lymph nodes, omental deposits, and a 24-week-size uterus were found. Bilateral oophorectomy was done. Laboratory investigations revealed raised lactate dehydrogenase with normal serum β-human chorionic gonadotropin, alpha-fetoprotein, and cancer antigen-125 levels. Histology of ovarian specimens revealed a diffuse large B cell lymphoma. A bone marrow biopsy revealed more than 80% infiltration with lymphoid cells. Two weeks after the laparotomy a computed tomography of her chest, abdomen, and pelvis revealed a pelvic mass, gross ascites, omental deposits, hepatosplenomegaly, and enlarged lymph nodes above and below her diaphragm. Immunohistochemistry confirmed the diagnosis of B cell lymphoblastic lymphoma. She was classified as stage IV E non-Hodgkin's lymphoma on the Ann Arbor staging system. CONCLUSION: This is an atypical presentation of an ovarian lymphoma. The atypical presentations of ovarian lymphomas can lead to diagnostic dilemmas.
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    Positive peritoneal fluid cytology in ovarian malignancies with metastasis:a descriptive study
    (Sri Lanka College of Obstetricians and Gynaecologists, 2005) Hewavisenthi, S.J.de S.; Palihawadana, T.S.; Fernando, W.S.; Wijesinghe, P.S.
    Detection of malignant cells in peritoneal fluid and peritoneal washings obtained at laparotomy is useful in predicting the presence of peritoneal metastasis in ovarian cancer. It will help in tumour staging, planning of further management as well as predicting the prognosis. The accuracy of such predictions will depend on the diagnostic accuracy of cytology in detecting metastasis, which is expressed by sensitivity, specificity and positive and negative predictive values. We tried to determine the said parameters in a series of patients with ovarian cancer who underwent laparotomy at a tertiary care teaching hospital. Forty two consecutive patients with malignant ovarian tumours were studied with respect to differentiation, grade and size of tumour. The peritoneal fluid obtained was assessed for the presence of malignant cells and the nature (serous or blood stained) of the fluid. The accompanying omentectomy specimens were examined for histological evidence of metastasis. Nineteen out of 42 patients had histologically proven omental tumour deposits. Of these only 11 yielded positive cytology. One specimen was cytology positive in the absence of histological evidence of peritoneal deposits. The sensitivity of peritoneal fluid cytology was 57.9%, specificity was 95.7%, positive predictive value was 91.7% and negative predictive value was 76.7% in our series. Any of the characteristics in the tumour or the peritoneal fluid failed to demonstrate a significant association with positive cytology. The sensitivity of peritoneal fluid cytology in detection of peritoneal spread was low (measured against histologically proven omental deposits), which highlights the need of other adjunct methods such as biochemical markers and fluorescence in situ hybridisation to improve the diagnostic accuracy.