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Aims: To evaluate the role of modified RMI (RMI 5) in pre-operative evaluation of ovarian tumor. Methods: It was a prospective cross sectional study done in Paropakar Maternity and Women’s Hospital from May to August 2018. During the study, 72 women with ovarian tumor were analyzed. RMI5 was calculated using the ultrasound score, Doppler score, menopausal status and CA125. Cut-off of 200 was used for malignancy discrimination. Chi square test was used to calculate the statistical significance which was set at 0.05. Receiver Operator Characteristics curves for RMI and its individual parameters were plotted using SPSS. Results: There were 72 ovarian tumors operated in four months and mean age was 36 years with 10 (14%) at post-menopause. The mean value of RMI 5 was 38 for benign tumors, 80 for borderline tumors and 899 for malignant tumors. The area under curve for RMI 5 was 0.993 for cut-off of 200. The diagnostic accuracy of RMI 5 was 94.4 which was similar to that of Doppler score 2 (94.7) while it was much higher than that of the rest of the parameters (CA125: 72, ultrasound score: 87 and postmenopausal status: 88.9). Conclusions: RMI 5 is better for malignancy prediction of ovarian masses instead of individual parameters like menopausal status, CA125 and ultrasound score. [ABSTRACT FROM AUTHOR]

Aims: To find out the accuracy of Risk of Malignancy Index (RMI-3) to predict ovarian malignancy pre-operatively. Methods: Intention to treat cross sectional study at Paropakar Maternity and Women's Hospital in Kathmandu in 2018-2019. Cases with ovarian mass were taken pre-operatively with serum tumor marker (CA-125) and ultrasound report, and histopathology report post-operatively. Pregnancy and diagnosed malignancy were excluded. Sensitivity, specificity, positive and negative predictive values of RMI-3 were calculated at different cut-off values using Receiver operator characteristics (ROC) curve. Results: 36 cases of ovarian tumor from 15 to 60 years (mean=35) were studied. There were 31(86.1%) premenopausal and 5 (13.9%) in menopausal state; 26 (72.2%) were married and 10 (27.8%) unmarried; 19 (52.8%) were multiparous, 9 (25%) were nulliparous and 8 (22.2%) uniparous; 34 (94.4%) presented with pain in lower abdomen; 16 (44.4%) had lump in lower abdomen; 8 (22.2%) had bloody vaginal discharge. Eight out of 36 (22.2%) had malignant histopathology. Taking histopathology to diagnose ovarian malignant tumor RMI 3 score >200 has sensitivity, specificity, positive and negative predictive value of 75%, 92%, 75%, 92% respectively. Taking the cut off value of RMI 3 at >190.5, AUC is 0.906 for ovarian malignant tumor the sensitivity, specificity, positive and negative predictive values were 75%, 93%, 55% and 96% respectively. Conclusions: Risk of Malignancy Index RMI-3 value of 190 or more is the best predictive cut-off to predict ovarian malignancy pre- operatively. [ABSTRACT FROM AUTHOR]

Aims: To analyze rare female genital tract malignancies. Method: This is retrospective descriptive study as a census of all rare female genital tract malignancies in two years from 2017 to 2019 at Paropakar Maternity and Women's Hospital in Kathmandu. Data were retrieved from medical record and entered into Microsoft Excel and SPSS 16 window for analysis. Results: There were 156 cases of female genital tract malignancies including 128 common types and 28 rare types. Majority fell under 41- 50 years (n=44; 28.2%) followed by over 60 (n=41; 26.2%) and 51-60 years (n=34; 21.8%). Among ovarian tumors, the rare varieties were adult granulosa cell tumor (n=4), immature teratoma (n=3) and single case each of yolk sac tumor, dysgerminoma, malignant mixed germ cell tumor, carcinoid tumor, juvenile granulosa cell and sertoli cell tumor. There were one case each of carcinosarcoma, serous carcinoma and endometrial stromal carcinoma; two cases each of leiomyosarcoma and choriocarcinoma while there was a single case of placental site trophoblastic tumor. The rare cervical malignancies were small cell (n=2), and clear cell carcinoma (n=1). There were single cases each of basal cell carcinoma of vulva, verrucus carcinoma, fibromyxoid sarcoma of Bartholin's gland and malignant melanoma of vagina. Conclusion: Rare female genital tract cancers were found mostly from the ovary followed by uterus; 18% of total cancers were rare types. [ABSTRACT FROM AUTHOR]