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Extramammary Paget's disease is a rare neoplasm that may affect the vulva. It usually presents as a pruritic red eczematous lesion with islands of hyperkeratosis that is often mistaken for other benign conditions. There are no specific guidelines for the management of this disease. Surgical excision is the standard treatment but recurrences are common in spite of extensive surgery with negative margins. We report here a series of 7 cases of Paget's disease vulva treated by primary surgery. The series highlights some of the challenges in the diagnosis and management of Paget's disease vulva.

Endometrial cancer recurrences are usually either pelvic or distant metastases. Isolated scar recurrence is a rare entity, with approximately 43 cases being reported in the literature. The study highlights that most scar recurrences can be offered curative treatment with radical surgery. In our series, all the recurrences were in a previous Pfannenstiel incision scar. We report a series of four cases of isolated Pfannenstiel scar recurrences in patients with endometrial cancer who had undergone total abdominal hysterectomy and salpingo-oophorectomy. All four patients underwent curative radical surgery. Two patients had associated inguinal lymph node involvement, for which ilio-inguinal block dissection was done for one patient and en bloc resection of the node along with the recurrent disease was done for the other patient. We reviewed the previous literature to ascertain the possible aetiology of incisional recurrence, especially the isolated scar recurrences. In patients presumed to be having carcinoma endometrium, proper incision and surgical technique with good exposure, during the initial surgery, is important so as to minimise scar recurrence. Most of the isolated scar recurrences can be surgically resected with a curative intent.

The study aims at the prediction of optimal cytoreduction (OCR) in patients undergoing interval cytoreduction (ICR) in advanced epithelial ovarian cancer (AEOC) based on CT imaging and CA 125 values and assessing the survival pattern of these patients after ICR. This is a prospective observational study of patients with stage III C ovarian cancer who underwent ICR in our institution after neoadjuvant chemotherapy (NACT). All consecutive patients operated from April 2016 to October 2017 were included in the study. From their medical records, their demographic details and clinical variables were recorded. The CA 125 value and CT scan findings before and after chemotherapy were documented. A Bristow’s predictive score (BS) was calculated based on the radiological parameters. After ICR, the outcome of the surgery was documented. Optimal cytoreduction (OCR) was defined as no gross residual disease after surgery. The surgical outcome was correlated with the CA 125 difference pre and post chemotherapy and Bristow’s predictive score pre and post chemotherapy. The patients were followed up and their survival at 6 and 12 months was assessed. Univariate and multivariate analysis was done to identify factors predicting OCR. 51 patients were included in the study. Age group of the women ranged from 31 to 74 years with a mean of 52 years. Majority of the patients (70.6%) were postmenopausal. Of the 51 women, OCR could be achieved in 31 patients (60.8%). Post-chemotherapy, 36 patients had elevated CA125 above baseline of which 50% attained OCR. Forty six patients had CA 125 response post chemotherapy of which 67.4% attained OCR. Forty five patients had reduction in Bristow Score compared to the pre chemo values of which 64.4% attained OCR which was not found to be statistically significant. Overall survival was 100% survival at 6 months and 92.8% at 12 months in those who achieved OCR. Those with residual disease 0.1–1 cm had survival of 74.1% at 6 and 12 months. Those with residual disease > 1 cm had a survival of 50% at 6 and 12 months. CA125 response has a significant role in predicting OCR while CT evaluation using the BS was not useful in predicting OCR during ICR for AEOC.

Rhabdomyosarcomas are malignant skeletal muscle tumours. They are rare in adults, but account for about 50% of soft tissue sarcomas in children. Most frequent sites include head and neck (35%), followed by the genitourinary tract (25%), extremities and trunk, and cervix is one of the least common sites in the genitourinary tract. We report the case of a 13-year-old girl who was evaluated for excessive discharge per vaginum and was symptomatically treated and later diagnosed as a case of cervical RMS. She developed excess bleeding per vaginum associated with prolapse of the mass for which an emergency excision had to be done. Then, she completed her chemotherapy and is disease free till date. We report this case due to its unusual presentation. She was initially treated as a case of vaginitis and diagnosis was missed. Once she was diagnosed as having cervical RMS and on chemotherapy, she developed prolapse of the mass with bleeding, which is also an unusual presentation. So cases of excessive discharge per vaginum not responding to treatment should have a detailed pelvic examination to rule out any mass lesions.