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From Diagnosis to Management: A Rare Case of Disseminated Low-Grade Endometrial Stromal Sarcoma with Extensive Extrauterine Spread

Wed, 01 Jan 2025 00:00:00 GMT

Title: From Diagnosis to Management: A Rare Case of Disseminated Low-Grade Endometrial Stromal Sarcoma with Extensive Extrauterine Spread Authors: Djatikusumo, Adrian; Prastisia, Yulian; Effendi, Iwan Kurnia; Wasystha, Wina Kanya Abstract: Objective: To report a rare case of low-grade endometrial stromal sarcoma; which was found not only in the uterus but also in several extrauterine sites, such as the ovary, omentum, and jejuno-ileum. In this article, we provided the management performed, based on appropriate literatures. Methods: Case report. Case: A 44-year old para 2 complained of abdominal enlargement since 3 months. Patient also complained of pelvic pain. The patient has never received treatment before and has never been diagnosed with endometriosis. Abdominal examination revealed a 20-cm mass in the lower to umbilical region and positive shifting dullness. Bimanual pelvic examination revealed immobile and smooth masses in both sides of adnexa, with pain during palpation. Computerized tomography (CT) scan of the abdomen revealed complex cystic masses suspected for right and left ovaries-origin (±11 & 15 cm respectively) Surgical resection and staging, frozen section, cytology examination, and immunohistochemistry (IHC) test were performed, revealing consistent result of endometrioid stromal sarcoma, low grade. Five-months postoperative followup through abdominal CT-scan in the patient revealing no abnormalities. Conclusion: We know that LG-ESS is one of the rare types of endometrial stromal sarcoma. Moreover in this case extrauterine manifestations make it more challenging in clinical management. Risk factors and history of endometriosis are important to explore when meeting ESS cases. Further research needs to be done regarding the exact mechanism and the association between endometriosis or other risk factors and the development of ESS, especially the EESS type to allow intervention.

Initial Management of Acute Pulmonary Edema in Pre-Eclampsia: A Case Report

Wed, 01 Jan 2025 00:00:00 GMT

Title: Initial Management of Acute Pulmonary Edema in Pre-Eclampsia: A Case Report Authors: Gunawan, Yuliana Wydia; Purwoatmojo, Sunarko; Prasetyo, Anton Tri; Pamungkas, Bambang Abstract: Objective: Describe the initial management for acute pulmonary edema in pre-eclampsia. Methods: A case report. Case: 41-year-old woman, G5P4A0, unknown gestational age, admitted with headache, dyspnea, and unconsciousness. The patient denied a history of past illness. Crisis hypertension, tachypnea, tachycardia, low oxygen saturation, audible lung crackles, pretibial edema, and 3+ proteinuria were found on examination, consistent with the diagnosis of pre-eclampsia with severe features. For initial management of acute pulmonary edema, the patient was given oxygen with Jackson-Rees bagging and furosemide injection, while nicardipine drip and MgSO4 injection were also given to treat pre-eclampsia. After the right initial management, patient was fully conscious, stable, then treated in the intensive care unit using non-invasive positive pressure ventilation. The patient underwent vaginal delivery and gave birth to male, BW 2900gram, BL 47cm, APGAR 3/8. Discussion: Initial emergency management focuses on providing adequate oxygen is the main management of pulmonary edema in preeclampsia. A non-invasive positive pressure ventilation is required as the main flow of oxygen delivery because it’s not invasive and is more convenient. Additional therapy such as diuretics, antihypertensive, and anticonvulsant are also needed. Close monitoring in the intensive care unit was also required for best results. Conclusion: Initial management of acute pulmonary edema in pre-eclampsia patients should be done correctly, consequently decreasing maternal and perinatal morbidity and mortality.

Leptin Expression in High-Grade Serous Ovarian Carcinoma: The Controversy of Leptin Paradox in Ovarian Cancer

Wed, 01 Jan 2025 00:00:00 GMT

Title: Leptin Expression in High-Grade Serous Ovarian Carcinoma: The Controversy of Leptin Paradox in Ovarian Cancer Authors: Ham, Jonathan; Masadah, Rina; Nasser, Andi Sitti Halija Diawanti; Rauf, Syahrul; Nelwan, Berti Julian; Cangara, Muhammad Husni Abstract: Objectives: To analyse the characteristics and expression patterns of Leptin in High-grade serous epithelial ovarian carcinoma (HGSC), the most prevalent subtype of ovarian carcinoma, and to compare them with overall serous ovarian carcinoma population. Methods: A cross-sectional study was performed on a total of 77 paraffin-embedded HGSC tissue samples from patients over a period of 3 years. Immunohistochemical analysis was performed using a polyclonal Leptin antibody to samples. Data were analyzed using SPSS version 22.0. Results: Among HGSC patients, the majority (64.3%) were over 50 years old, and a significant portion (39.3%) were obese. Leptin showed a strong cytoplasmic expression in 69.6% of HGSC tumor cells and in 100% of LGSC tumor cells (p-value = 0.004). There was no correlation between lymphovascular space invasion and leptin expression. Interestingly, leptin expression in overall serous ovarian carcinoma patients exhibited a protective effect against metastasis (p-value = 0.047), suggesting a leptin paradox exists in this type of cancer. However, this association was no longer significant when the analysis excluded the LGSC group (p-value = 0.193). Conclusion: This study suggest that leptin expression is not a significant prognostic factor in HGSC. Comparison of HGSC with the overall serous ovarian carcinoma population reveals that the results of several previous studies were likely confounded by the inclusion of heterogeneous tumor morphologies within their samples. The presence of low-grade serous carcinoma within the population may have inadvertently led to the observation of a seemingly protective effect of leptin, a phenomenon sometimes referred to as the 'leptin paradox'.

The Age as a Risk Factor for Advanced Stage in Cervical Cancer Patients: A Retrospective Multivariate Study

Wed, 01 Jan 2025 00:00:00 GMT

Title: The Age as a Risk Factor for Advanced Stage in Cervical Cancer Patients: A Retrospective Multivariate Study Authors: Kusuma, Fitriyadi; Suryoadji, Kemal Akbar; Purwoto, Gatot; Wulandari1, Anisa Saphira; Soloan, Garry; Sini, Kieran Pasha Ivan Abstract: Objectives: To evaluate the relationship between age and the occurrence of advanced-stage cervical cancer in a national referral hospital setting as a step towards effective prevention, early detection, and management. Methods: This research adopts a retrospective study design based on the Cancer Registration database of Dr. Cipto Mangunkusumo General Hospital focusing on cervical cancer patients from 2019 to 2022. Multivariate analysis was conducted with age as the primary independent variable, considering parity and employment status in the analysis. The FIGO classification of cervical cancer stages was used to categorize patients into early and advanced stages. Results: Out of 512 cervical cancer cases, 492 were included in this study. The distribution of cervical cancer stages shows Ninety-one subjects (18.4%) were classified as having early-stage cervical cancer, while 401 other subjects (81.6%) were classified as having advanced-stage cervical cancer. The age distribution of patients is 273 cases (55.4%) in the 18-54 years old group and 219 cases (44.6%) in the >54 years old group. The multivariate analysis of the relationship between cervical cancer stage and age shows an increased risk towards the occurrence of higher cervical cancer stages, and is statistically significant (p<0.05) with an odds ratio of 2.13, particularly in individuals aged >54 years. Conclusion: Age over 54 years is a significant risk factor for advanced-stage cervical cancer. Although there is no significant association with parity and employment history, these findings support preventive and early detection efforts in the older population. Increased screening programs and education are expected to reduce cases of advanced-stage cervical cancer in the future.