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Cervical cancer ranks as the fourth leading cause of female cancer in the world, and it is the second most common female cancer in women aged 15–44 years. Strict implementation of screening programs has led to a large decline in cervical cancer incidence and mortality in developed countries. In contrast, cervical cancer remains largely uncontrolled in high-risk developing countries because of ineffective or no screening. Conventional Pap smear method has been the mainstay of most of the screening programs since decades. However, this technique is not without limitations and the sensitivity and specificity of cervical cytology are relatively low. To overcome the limitations of conventional Pap smear, liquid-based cytology was introduced in 1990s as a better tool for processing cervical samples. HPV testing alone or with cytology triage is currently increasingly being used as a primary screening approach for cervical neoplasia. The present study was undertaken to evaluate sensitivity and specificity of conventional Pap smear, liquid-based cytology and HPV DNA in our setting. This study was conducted in Gynecological Oncology unit at Indira Gandhi Institute of Medical Sciences, Patna, Bihar. In total, 1500 women were enrolled in this study and sample was taken for conventional cytology, liquid-based cytology and HPV DNA. The smears were studied in detail and were interpreted as per the Bethesda system of reporting Pap smears. The results were compared and analyzed statistically. Approximately 5% patients having epithelial cell abnormalities on Pap smear, 5.33% on LBC and 6.86% had abnormal report on HPV DNA testing. Unsatisfactory smears were more commonly reported by conventional method (7.2%) than by liquid-based method (1.62%), and this difference is statistically significant. There was no difference in the detection of epithelial cell abnormalities by both the methods. Sensitivity of Pap smear, LBC and HPV DNA was 75.80%, 76.47% and 89.89%, respectively. Specificity of Pap smear, LBC and HPV DNA was 98.05%, 98.93 and 98.00%, respectively. LBC has been found to be more superior to conventional smears only with respect to lesser number of unsatisfactory smears.

Primary malignant melanoma of the female genital tract is very rare, and most of the melanomas reported till date are of the vulva and only less than 2% are accounting for cervical melanomas. The prognosis cervical melanoma is poor regardless of the stage at the time of diagnosis. There is no standard treatment; however, radical surgery is the cornerstone of treatment. We report a case of cervical malignant melanoma who presented with watery discharge per vaginum and occasional postmenopausal bleeding.

To evaluate the incidence of oestrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (Her2/neu) status in newly diagnosed breast carcinoma patients in a tertiary care centre and to compare the pattern of expression with age. This is a prospective study done at IGIMS from June 2015 to June 2016. A total of 120 patients were included in this study. The age of the patients ranged from 24 to 77 years, with a mean age of 47.76 years. ER, PR and Her2/neu expression was seen in 46.29%, 31.48% and 37.5% of cases, respectively. Triple-negative breast cancers constituted 30% of our cases. A significant correlation was found in ER and PR expression, whereas no correlation was found in hormone receptors and Her2/neu expression. ER, PR and Her2/neu positivity increased with advancing age in breast carcinoma patients. The hormone receptor expression appears to be lower in the Indian population as compared to the West.

Postmenopausal bleeding (PMB) requires complete assessment in order to ensure the absence of malignancy and to identify and treat high-risk patients such as those with endometrial hyperplasia. To enumerate the age predilection, histopathological diagnosis, incidence of malignancies, and management of postmenopausal bleeding. This is a prospective study done in department of gynecological oncology of a tertiary care center. A total of 50 patients of PMB were included for study. The mean age of reaching menopause was 48.02 years. The age range of study population was between 40 and 70 years. The mean age of patients was 56.26 with peak incidence of malignancy observed in age-group of 55–70 years. The histopathological analysis showed proliferative endometrium (16%), simple hyperplasia (8%), complex hyperplasia with atypia (6%), CIN 3(6%), and carcinoma in situ of cervix (2%). Incidence of cervical, endometrial carcinoma, sarcoma of uterus, and vulval cancer was 48, 8, 2, and 2%, respectively. Conservative management was done in 26% cases in proliferative endometrium, hyperplasia without atypia and cervicitis. Out of 26 cases of cervical cancer, 20 cases were referred to radiotherapy department as they presented in advanced stage and six underwent Wertheim’s hysterectomy. PMB is a sinister complaint. It requires careful and timely assessment to eliminate the possibility of malignancy. The risk of endometrial malignancy increases with age. High cervical cancer preponderance stresses the need for education of patients regarding screening and early diagnosis.

Cancer is a growing and evolving epidemic. Multiple primary malignancies is a documented entity and can be synchronous or metachronous depending on the time of diagnosis of the two malignant tumors. We present a case of synchronous female gynecological malignancies involving the ovary (papillary serous adenocarcinoma) and cervix (squamous cell carcinoma grade III). The different histopathology of the two tumors and the tumor-free intervening endometrium, myometrium and fallopian tubes made it a clear diagnosis of two separate primaries. Thorough examination of all patients of cancer and keeping the possibility of such tumors in mind can help diagnose more such cases and study their pathogenesis and determine their risk factors.

Choriocarcinomas are germ cell tumours formed by trophoblastic elements (Mundkur et al., J Clin Diagn Res 9(1):QD01–2; 2015). Gestational choriocarcinoma can occur after molar pregnancy, tubal pregnancy or antecedent normal pregnancy. Primary extra-uterine choriocarcinoma is very rare. We report here a case of broad ligament choriocarcinoma who presented with a complaint of pain in lower abdomen off and on. She had a history of dilation and evacuation for spontaneous abortion 3 months back and then she had regular menses. Her transvaginal sonography revealed 42 x 35 mm size right adnexal mass which was more consistent with ectopic pregnancy and her serum human chorionic gonadotropin (β-Hcg) level was 1,76,075 mIU/ ml. Finally, patient was diagnosed as ruptured tubal ectopic pregnancy and thus, she underwent laparotomy. On laparotomy, there was purple colored broad ligament mass of size 5x6 cm with highly increased vascularity in right side which was removed with difficulty and massive bleeding occurred. So, total abdominal hysterectomy was done. Histopathological report showed choriocarcinoma of right broad ligament invading myometrium. The patient was given 6 cycles of EMACO regime. Serum β-Hcg levels of the patient gradually declined and eventually became negative after 2 weeks of 5th EMACO. With this case report, we aim to emphasize that while diagnosing the ectopic pregnancy, even very rare, the tubal choriocarcinoma should be kept in mind. We report a case of primary extra-uterine choriocarcinoma that was mistaken for an ectopic pregnancy.

Calcified subserous leiomyoma is a benign tumour in postmenopausal age group. It causes diagnostic dilemma with solid calcified adnexal mass and large bladder calculi at the pelvic region. We present a case of calcified subserous fibroid in a postmenopausal woman. Clinical and radiological diagnoses were confirmed by histopathology of the hysterectomy specimen.

Myths, superstition, and taboos are prevalent in India and often guide the patient’s perceptions about the cause and treatment of diseases. The preformed firm notions make the patients unreceptive to counseling by doctors and often lead them to take wrong decisions from their end. We report a patient with cancer of the ovary who because of her misconception of cancer surgery chose to undergo 21 cycles of chemotherapy and eventually faced near fatal complication after surgery.

Uterine fibroids usually have typical appearance on imaging. However, when fibroids present in unusual locations or undergo degenerations, confusion in imaging studies may arise. Here, we present a case of a 47-year-old woman with a preoperative diagnosis of ovarian malignancy. Surprisingly, a large pedunculated uterine leiomyoma which had undergone extensive cystic degeneration was found on laparotomy. Pedunculated leiomyomas with extensive cystic degeneration should be considered in the differential diagnosis of adnexal mass.