Publications by authors named "Debabrata Barmon"

17 Publications

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Carcinoid ovary with synchronous carcinoid tumour of the appendix: report of a rare occurrence with review of literature.

BMJ Case Rep 2022 Jun 24;15(6). Epub 2022 Jun 24.

Gynaecologic Oncology, Dr B Borooah Cancer Society Trust, Guwahati, Assam, India.

Carcinoid tumours are present in a wide range of organs but most frequently involve the gastrointestinal tract and rarely reported in gynaecological organs. Literature reports that the prevalence of ovarian carcinoid is 0.3%-1% of ovarian neoplasms and accounts for only 5% of ovarian teratomas. The pathogenesis of neuroendocrine tumours associated with synchronous primaries is undetermined and many theories have been proposed, such as existence of a common carcinogenic effect or a common stem cell undergoing similar genetic mutation. Paracrine or autocrine growth loop effect by the secretory peptides of the neuroendocrine cell tumours is also suggested. Since carcinoids are variably positive in neuroendocrine and organ-specific markers, there are no immunohistochemistry markers to delineate the definite primary site of origin versus metastasis. We report a rare case of carcinoid ovary with synchronous carcinoid tumour of the appendix. In our case, the presence of contralateral teratomatous elements may hint primary struma carcinoid instead of being metastatic from the appendix. A strumal carcinoid component was also highlighted by PAX8 positivity. This led us to conclude the case as concurrent appendix carcinoid with struma carcinoid as two independent primaries with uncertain pathogenesis. Histologically, as both tumours are well differentiated with Ki-67 of less than 3%, the decision of the joint tumour board was to keep the patient on surveillance, with no adjuvant treatment needed. The patient is currently on surveillance and the follow-up period of 24 months to date has been uneventful.
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http://dx.doi.org/10.1136/bcr-2022-248869DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9234792PMC
June 2022

Choriocarcinoma in Post-Menopausal Women- 3 Case Reports with Review of Literature.

J Midlife Health 2021 Oct-Dec;12(4):319-322. Epub 2022 Jan 20.

Department of Gynecological Oncology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India.

Gestational trophoblastic neoplasia is of uncommon occurrence in postmenopausal women, unlike in the reproductive age group. The diagnosis is based on levels of beta-human chorionic gonadotropin (hCG) in serum. The management is similar to that in premenopausal women. First case, fifty-two-year-old, P8 L4A3 postmenopausal female, presented with postmenopausal bleeding. Diagnosis of choriocarcinoma was made in view of raised serum betah-CG levels with uterine lesion with lung metastasis. The patient started on Multi-agent chemotherapy. The patient succumbed to death due to Grade III hematological toxicity while on the first cycle of the EMA/CO regimen. Second case, forty-two-year-old, P2 L2, postmenopausal, with a history of Choriocarcinoma 20 years, back presented with postmenopausal bleeding. After metastatic workup, the patient started on EMACO regimen. She is asymptomatic and on regular follow-up after 8 cycles of chemotherapy. Third case, forty-seven-year-old, P4 L4, postmenopausal, presented with histopathology report suggestive of choriocarcinoma after hysterectomy. After evaluation, lung metastasis was detected. The patient responded to eight cycles to Multi-agent chemotherapy and is on regular follow-up. Choriocarcinoma is a rare gynecological malignancy in postmenopausal women. High index of suspicion is required for its diagnosis. The prognosis of the disease is not encouraging as compared to the premenopausal woman.
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http://dx.doi.org/10.4103/jmh.jmh_38_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8849146PMC
January 2022

Rare Sites Metastasis in Ovarian Carcinoma: a Compilation of 3 Case Reports.

Indian J Surg Oncol 2020 Mar 23;11(1):150-153. Epub 2019 Oct 23.

Dr. B Borooah Cancer Institute, Campus, AK Azad Road, Guwahati, Assam 78016 India.

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http://dx.doi.org/10.1007/s13193-019-00988-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7064725PMC
March 2020

A survival study of uterine cervical patients in the North East India: Hospital-cancer registry-based analysis.

J Cancer Res Ther 2018 Jul-Sep;14(5):1089-1093

Department of Cancer Epidemiology and Biostatistics, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India.

Background: Uterine cervical cancer constitutes a major proportion of cancer in females of our population. The objective of this study was to conduct a clinical study of uterine cervical cancers including their survival from hospital-cancer registry data.

Materials And Methods: Data of uterine cervical cancer patients diagnosed from January 1, 2010 to December 31, 2010 and that were treated at a regional cancer center in North East (NE) India was recruited. The cases were analyzed for age group distribution, stage, and treatment types. Survival from the date of first diagnosis and hazard ratios (HRs) was estimated. Survival probability and HRs were calculated by Kaplan-Meier method and Cox-proportional regression analysis, respectively. Active follow-up was done for the survival analysis.

Results: One hundred and ninety-three patients (53.4%) were included for the analysis. Median age was 48 years, 56.5% (108/193) of patients were in the age group of 45-64 years, 56.5% (109/193) were Stage II patients, radiotherapy alone was the main treatment modality in 65.8% (127/193) of cases, 5-year overall survival (OS) was 40.7%, median survival was 44 months, early staged and advanced stage patients had 47.7%, and 29.4% 5-year OS (P = 0.002), respectively, and HR for advanced stages was 1.8 (P = 0.003, confidence interval (CI) = 1.2 to 2.7).

Conclusion: Describing the clinical characteristics and survival of uterine cervical cancer patients is important for planning and identifying the gaps for its control in the NE India.
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http://dx.doi.org/10.4103/0973-1482.184516DOI Listing
October 2018

Neoadjuvant chemotherapy in advanced epithelial ovarian cancer: A survival study.

Indian J Med Paediatr Oncol 2015 Jan-Mar;36(1):38-42

Department of Medical Oncology, Dr. B. Borooah Cancer Institute (RCC), Guwahati, Assam, India.

Context: Patients with advanced ovarian cancer have a poor prognosis in spite of the best possible care. Primary debulking surgery has been the standard of care in advanced ovarian cancer; however, it is associated with high mortality and morbidity rates as shown in various studies. Several studies have discussed the benefit of neoadjuvant chemotherapy in patients with advanced ovarian cancer.

Aims: This study aims to evaluate the survival statistics of the patients who have been managed with interval debulking surgery (IDS) from January 2007 to December 2009.

Materials And Methods: During the period from January 2007 to December 2009, a retrospective analysis of 104 patients who underwent IDS for stage IIIC or IV advanced epithelial ovarian cancer at our institute were selected for the study. IDS was attempted after three to five courses of chemotherapy with paclitaxal (175 mg/m(2) ) and carboplatin (5-6 of area under curve). Overall survival (OS) and progression free survival (PFS) were compared with results of primary debulking study from existing literature. OS and PFS rates were estimated by means of the Kaplan-Meier method. Results were statistically analyzed by IBM SPSS Statistics 19.

Results: The median OS was 26 months and the median PFS was 18 months. In multivariate analysis it was found that both OS and PFS was affected by the stage, and extent of debulking.

Conclusions: Neoadjuvant chemotherapy, followed by surgical cytoreduction is a promising treatment strategy for the management of advanced epithelial ovarian cancers.
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http://dx.doi.org/10.4103/0971-5851.151781DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363849PMC
March 2015

Continuous low-dose oral chemotherapy in recurrent and persistent carcinoma of cervix following chemoradiation: a comparative study between prolonged oral cyclophosphamide and oral Etoposide.

Indian J Palliat Care 2014 Sep;20(3):208-11

Department of Gynaecologic Oncology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India.

Aim: To compare the efficacy and toxicities of low-dose oral cyclophosphamide and oral etoposide in patients with persistent and recurrent cervical cancer with gross pelvic disease following full course of chemoradiation therapy.

Materials And Methods: 30 patients with recurrent and persistent cervical cancer with gross pelvic disease were enrolled in this trial. The patients were randomly divided into two groups of 15 patients each with one group receiving low dose oral cyclophosphamide (100 mg/day) and the other group receiving low-dose oral etoposide (50 mg/day). Results were statistically analysed by IBM SPSS Statistics 19.

Results: Oral etoposide was not well tolerated with grade 2 neutropenia occurring in 33.3% and grade 3 neutropenia in 6.6% and thrombocytopenia occurring in 13.3%. Oral cyclophosphamide group on the other hand was better tolerated with none of the patients having thrombocytopenia and 6.6% patients having grade 2 neutropenia. There were two complete response (15.38%) and one partial response at the end of study (7.6%) in the cyclophosphamide group whereas there was no complete response and two partial response (16.6%) in the oral etoposide group.

Conclusion: Long-term, low-dose oral etoposide was found to be less tolerated without any significant effect with patients with persistent and recurrent cervical cancer with gross pelvic disease following full course of chemoradiation therapy in contrast to oral cyclophosphamide which was found to be effective and well-tolerated by the patients.
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http://dx.doi.org/10.4103/0973-1075.138396DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4154168PMC
September 2014

Sarcomatoid carcinoma of the cervix with foci of malignant melanoma.

J Midlife Health 2014 Jan;5(1):41-4

Department of Radiology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India.

Introduction: Sarcomatoid squamous cell carcinoma (SSCC) is a rare malignancy of the cervix. Until date around eighteen cases of SSCC have been reported in the literature. It is an aggressive tumor with poor prognosis. The tumor usually presents at an advanced stage. Similarly, primary melanomas of the uterine cervix are rare tumors with not more than 60 cases reported in the world literature. It also has a poor prognosis. There is no reported case of sarcomatoid carcinoma with malignant melanoma. Here, we are presenting a rare case of cervical carcinoma with histopathology suggestive of SSCC with foci of malignant melanoma proven by immunohistochemistry study.

Case Report: The present case report is about a 42-year-old, Mrs. SR, P5 L3 D1 A1 , presented with the complaints of intermittent bleeding per vaginum since last 3 years and severe pain in the right lower limb since 1 month. On examination, there was a proliferative growth in the cervix. Her magnetic resonance imaging (MRI) showed cervical mass lesion with right parametrial extension invading the right ureter and bladder wall causing hydroureteronephrosis with contiguous bilateral pelvic nodes. There were multiple lesions in the left femur. Diagnosis of carcinoma of cervix International Federation of Gynecology and Obstetrics stage IIIB with distant metastasis was made. Histopathology report was suggestive of sarcomatoid carcinoma with foci of melanocytic melanoma. She was planned to be treated with palliative radiation.

Discussion: About 90% of cervical carcinomas are squamous cell carcinoma. Adenocarcinoma constitute about 3-4% of all cervical carcinomas. Other rare pathologies are lymphoma, melanoma, sarcoma and metastatic tumors. Our case is a rare combination of sarcomatoid carcinoma with foci of malignant melanoma of cervix.
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http://dx.doi.org/10.4103/0976-7800.127792DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3955046PMC
January 2014

Prognosis of vulval cancer with lymph node status and size of primary lesion: A survival study.

J Midlife Health 2014 Jan;5(1):10-3

Department of Radiation Oncology, Dr. Bhubaneswar Borooah Cancer Institute, Guwahati, Assam, India.

Introduction: Squamous cell cancer of the vulva is a rare disease with an annual incidence of two to three per 100,000 women. Lymph node metastasis is the most important prognostic factor for the recurrence and survival in vulval carcinoma.

Materials And Methods: It is a retrospective study of 18 cases, operated in our institute from 2006 to 2009 and followed up till July, 2012. These patients were divided into two group of node positive and node negative and compared for recurrence and survival.

Result: Ten patients had lymph node metastasis and eight had no lymph node metastasis. Recurrence rate was 40% and 12.5% in node positive and negative groups, respectively. Adjuvant radiation when given to node negative bulky tumor showed no recurrence compared to one out of two in the non-irradiated group. Survival was only 25% in node positive recurrent cases.

Conclusion: Lymph node positivity added a great risk for future recurrence. Prophylactic radiation in node negative, bulky tumor is helpful.
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http://dx.doi.org/10.4103/0976-7800.127784DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3955039PMC
January 2014

Gestational trophoblastic neoplasia: A 6 year retrospective study.

South Asian J Cancer 2014 Jan;3(1):33-7

Department of Medical Oncology, Dr. B. Borooah Cancer Institute (RCC), Gopinath Nagar, Guwahati, Assam, India.

Aims And Objectives: To study the clinical presentations of gestational trophoblastic neoplasia and its response to chemotherapy.

Materials And Methods: This is a retrospective study of 28 women of gestational trophoblastic neoplasia evaluated over a period of 6 years from January 2004 to December 2009. Patients were evaluated on the basis of their age, number of deliveries, history of abortion or molar pregnancy, and the treatment received. All patients were scored on the basis of WHO scoring system. Patients with low risk (score /=7) received multiple agent chemotherapy with EMACO regimen. After completion of chemotherapy patients were followed for a minimum of 2 years. The response to treatment was evaluated during follow-up by clinical examination, beta hCG levels and imaging as and when required.

Results: Out of 28 women only 27 could be evaluated, because 1 patient was lost to follow-up. Out of 27 patients, 18 patients (66.67%) achieved complete remission with the first-line chemotherapy and additional 25.92% (7/27) achieved complete remission with second line chemotherapy resulting in complete remission of 92.5% (25/27).

Conclusion: Gestational trophoblastic neoplasia is curable if patient is properly evaluated and scored. It shows good response to chemotherapy.
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http://dx.doi.org/10.4103/2278-330X.126516DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3961865PMC
January 2014

Hybrid capture 2 assay based evaluation of high-risk HPV status in healthy women of north-east India.

Asian Pac J Cancer Prev 2014 ;15(2):861-5

DBT Centre for Molecular Biology and Cancer Research, Dr. B. Borooah Cancer Institute, Guwahati, India E-mail :

Background: High risk HPV (HR-HPV) testing has been recommended as an effective tool along with cytology screening in identification of cervical intraepithelial lesions (CINs) and prevention of their progress towards invasive cervical cancer. The aim of this study was to assess the HR-HPV DNA status by Hybrid Capture 2 (HC2) assay in healthy asymptomatic women of North-East India.

Materials And Methods: This study examined cervical cell samples of forty three (n=43) healthy women by HC2 assay. A High Risk HPV DNA kit (Qiagen) was used which can detect 13 high risk HPV types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68.

Results: The mean relative light units (RLU) for samples was in the range of 141-5, 94, 619. HR-HPV DNA was confirmed in 16% (7/43) of participant women samples. Among demographic and clinical parameters, menstrual irregularity (p=0.039) and infection history (p=0.028) has shown statistically significant differences between the HR-HPV-positive and negative groups. In the HR-HPV positive group, two women were confirmed for CINs after colposcopy and histopathologic examination.

Conclusions: We suggest that there may be an association between irregular menstruation and infection history of the urogenital tract with HR-HPV DNA prevalence in North-East Indian asymptomatic women. HC2 assay can be a valuable tool for HR-HPV screening.
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http://dx.doi.org/10.7314/apjcp.2014.15.2.861DOI Listing
November 2014

A case of cervical tuberculosis mimicking cervical carcinoma.

J Obstet Gynaecol India 2013 Aug 3;63(4):285-7. Epub 2012 Oct 3.

Department of O&G, Gauhati Medical College & Hospital, Guwahati, India.

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http://dx.doi.org/10.1007/s13224-012-0184-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3763053PMC
August 2013

Nested multiplex PCR based detection of human papillomavirus in cervical carcinoma patients of North- East India.

Asian Pac J Cancer Prev 2013 ;14(2):785-90

DBT Centre for Molecular Biology and Cancer Research, Dr. B. Borooah Cancer Institute, Guwahati, India.

Background: Persistent infection of one or more of about 15 high-risk human papillomaviruses (HR-HPVs), most commonly HPV types 16/18, has a significant role in cervical cancer initiation and progression. There are limited data available from north-east India about HPV prevalence though this region has high incidence rates of cervical cancer. The aim of this study was to investigate the HPV genotypes prevalent in cervical cancer patients of north-east India.

Materials And Methods: We analyzed 107 cervical cancer patient samples. Nested multiplex PCR assays were employed for detection of 13 high risk and 5 low risk HPV types.

Results: HPV was confirmed in 105 samples. The presence of 6 'carcinogenic' HPV types, HPV-16 (88%), -18 (15%), -31(4%) ,-45 (3%), -59 (4%), -58(1%), and one non carcinogenic, HPV-6/11 (6%), was recorded. Among various demographic and clinical factors only tumour stage showed a statistically significant association with HPV type infection (P=0.019).

Conclusions: We suggest that the most prevalent genotype is HPV-16 followed by HPV-18 in cervical carcinoma patients of the north-eastern region of India. Advanced tumour stage may be associated with increased possibility of harbouring multiple HPV genotypes.
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http://dx.doi.org/10.7314/apjcp.2013.14.2.785DOI Listing
July 2014

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

J Midlife Health 2012 Jul;3(2):106-8

Department of Gynaecologic Oncology, Dr. B. Borooah Cancer Institute (Regional Institute for Treatment and Research), Guwahati, Assam, India.

Unlabelled: With the advances in the treatment of cancer, the chances of survival have increased today. The five-year relative survival rate is about 66%. With the increasing survival rate, it is important to identify the late effects of cancer and its therapy. One of the most serious events experienced by cancer survivors is the diagnosis of a new cancer.

Case: A 32-year-old unmarried female diagnosed as ovarian cancer in the year 2010. She was treated with three cycles of chemotherapy followed by surgery. Histopathology was well-differentiated adenocarcinoma. She received three more cycles of chemotherapy after surgery. She was under follow-up and developed vaginal vault carcinoma after a disease-free interval of 2 years. The biopsy was suggestive of squamous cell carcinoma. She was treated with radiation for vaginal cancer successfully. This case indicates that female gynecological cancers with different histology may occur in minimum period of interval even in the absence of any predisposing factors like human papilloma virus infection.
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http://dx.doi.org/10.4103/0976-7800.104476DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3555018PMC
July 2012

Extra mammary Paget's disease of the vulva.

J Midlife Health 2012 Jul;3(2):100-2

Department of Gynaecologic Oncology, Dr. B. Borooah Cancer Institute, (Regional Institute for Treatment & Research), Guwahati, Assam, India.

Extra mammary Paget's disease (EMPD) is a rare condition, which affects postmenopausal women. Wide local excision may not be appropriate in elderly patients with extensive disease. It is an uncommon malignant neoplasia with a high local recurrence rate. The standard treatment is local excision of the affected area with adequate margins; however, 40~45% of cases recur after surgery within 4 years. Although surgery is currently considered the preferred primary treatment for EMPD, it has a high relapse rate due to the multifocal nature of the disease. Hence, RT in selected cases of EMPD of vulva may be beneficial.
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http://dx.doi.org/10.4103/0976-7800.104474DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3555016PMC
July 2012

Aggressive angiomyxoma of the vulva.

J Midlife Health 2012 Jan;3(1):47-9

Department of Gynaecologic Oncology, Debabrata Barmon, Department of Gynaecologic Oncology, Dr. B. Borooah Cancer Institute (Regional Institute for Treatment and Research) Gopinath Nagar, Guwahati, Assam, India.

Aggressive angiomyxoma is a rare, benign neoplasm occurring in 3(rd) to 5(th) decade of life that can be mistaken both clinically and on microscopy for several other conditions, it should be included as a differential diagnosis for any vaginal mass. These lesions have a predilection for female pelvic soft tissues, slow in growth, and are characterized histologically by a predominantly myxoid stroma and an abundance of thin and thick walled vascular channels. This is a deep soft tissue tumor, which as the name suggests, may have a locally aggressive course. Most tumors occur in women and are large, usually greater than 10 cm, slowly growing, and painless. Standard of care treatment for angiomyxoma has been surgery. Some authors believe that it is the only possible treatment, but surgery is often radical and can be mutilating, with massive blood loss.
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http://dx.doi.org/10.4103/0976-7800.98820DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3425151PMC
January 2012

Evaluation of carcinoma cervix using magnetic resonance imaging: correlation with clinical FIGO staging and impact on management.

J Med Imaging Radiat Oncol 2012 Feb;56(1):58-65

Department of Radiology, Dr B Barooah Cancer Institute, Guwahati, India.

Aim: To evaluate carcinoma of the cervix using magnetic resonance imaging (MRI), correlate with clinical approach of International Federation of Gynecology and Obstetrics (FIGO) staging system and to study the impact of MRI findings on patient management.

Method And Material: Pathologically confirmed, 75 cases of carcinoma cervix referred to our institute from April 2007 to March 2008 were prospectively studied. Clinical FIGO stage was assigned to each patient by gynaecologists blinded to MRI findings. MRI stage (based on FIGO and TNM) was allotted by radiologists blinded to clinicopathological details. For patients who were operated, histopathological stage was taken as gold standard. For patients who were not operated, gynaecologists decided on a gold standard stage based on all available clinical and imaging data. MR staging was correlated with FIGO staging, with focus on significant alterations in treatment strategy caused due to MRI findings.

Results: MRI staging had an accuracy of 89.3% (67/75), while clinical FIGO staging had 61.3% (46/75) accuracy. MRI staging and FIGO staging concurred in 65.6% of the patients and differed in 34.4% of the patients. In about 30.6% (23/75) of the patients, there were relevant additional MRI findings not suspected clinically. The common significant MRI findings were detection of pelvic lymphadenopathy and clinically unsuspected bowel/bladder invasion. The management protocol was significantly altered in 86.9% (20/23) of the patients with additional MRI findings constituting 26.6% (20/75) of the total population.

Conclusion: MRI is highly accurate in evaluating carcinoma of the cervix. MRI findings significantly altered therapeutic decisions in 26.6% of the patients. MRI should be considered prior to treatment planning in every patient.
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http://dx.doi.org/10.1111/j.1754-9485.2011.02333.xDOI Listing
February 2012

Embryonal carcinoma in androgen insensitivity syndrome.

Indian J Med Paediatr Oncol 2011 Apr;32(2):105-8

Department of Gynecologic Oncology, Dr. B. Borooah Cancer Institute, Guwahati, India.

Embryonal cell carcinoma is a rare clinical entity. We report a case of a 20-year-old patient who presented with lump lower abdomen for last two months with primary amenorrhea and poorly developed secondary sexual characteristics. Ultrasonography (USG) whole abdomen showed lower abdominal mass approximately 15×15×10 cm, probably neoplastic changes in intra-abdominal testis, with mild ascites, no uterus and ovaries. Fine needle aspiration cytology from the tumor mass reported the possibility of non-seminomatous germ cell tumor, possibly embryonal carcinoma. The patient received three cycles of neo-adjuvant chemotherapy (Regime Bleomycin, Etoposide and Cisplatin) followed by laparotomy, at laparotomy (L) orchidectomy with removal of tumor, (R) orchidectomy, omentectomy and appendisectomy was performed. Postoperatively the patient received two more cycles of chemotherapy of the same regime. The patient has been under close follow-up for the last three years with no evidence of disease.
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http://dx.doi.org/10.4103/0971-5851.89794DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3237174PMC
April 2011
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