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Granulosa Cell Tumour -
A Clinical Review of Three Cases
Dr Nalini (Senior Resident)
Neerja Goel (Professor)
Kishor C. Singh (Associate Professor)
Sarla Aggarwal (Professor)
Shalini Rajaram (Associate Professor)
Department of Obstectrics & Gynaecology,
University College of Medical Sciences (UCMS) &
Guru Teg Bahadur (GTB) Hospital,
Delhi-110095, India.
Summary
- Granulosa cell tumours account for less than 2% of all ovarian malignancies.
- The tumours are characterised by a low malignant potential and propensity for late recurrence (in 15 to 20% of cases).
- Three cases of granulosa cell tumour encountered at UCMS & GTB Hospital are described in this paper.
Editor's Comment
Granulosa cell tumours of the ovary are low-grade malignancies where surgery forms the cornerstone of treatment. Three cases of granulosa cell tumour are discussed in this report by UCMS and GTB Hospital gynaecologists. The role of adjuvant chemotherapy and/or radiotherapy is yet to be clearly defined in these tumours.
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Foetal Loss Rate in Treated and Untreated Pregnancies of Women with Antiphosphoplipid Antibodies
Dr Deepika Deka (Additional Professor)
Dr Renu Saxena (Additional Professor)
Dr Kamal Buckshee (Ret'd Professor & Head)
Department of Obstetrics and Gynaecology & Haemotology,
All India Institute of Medical Sciences (AIIMS),
New Delhi, India.
Summary
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Foetal loss rate and pregnancy outcome among 9 women with the antiphospholipid antibody, lupus anticoagulant (LAC) were compared in untreated (n = 29) and treated (n = 10) pregnancies.
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Specific treatment consisted of: low-dose aspirin; high-dose prednisolone and low-dose aspirin; low-dose prednisolone; or intravenous immunoglobulin.
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Foetal loss occurred in 93% of untreated pregnancies compared with 40% in the treated group. Treatment carried 90% of pregnancies to the third trimester, but was associated with preterm labour, premature rupture of membranes, foetal growth retardation, pregnancy-induced hypertension and foetal distress.
- LAC is associated with high foetal loss rate, especially in untreated pregnancies, although pharmacological prophylaxis improves pregnancy outcome.
Editor's Comment
The "antiphospholipid antibody syndrome" is now a well recognised medical disorder with disastrous effect on pregnancy; the presence of lupus anticoagulant in maternal serum is a very powerful risk factor causing foetal loss in more than 90% of pregnancies. Current therapy with immunosuppressive drugs and aspirin has resulted in better foetal survival, but the search for the optimal treatment protocol is still on.
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Medical Disorders of Pregnancy
K C B Tan
A W C Kung
C Y Li
J E Sanderson
W K To
R T F Cheung
Department of Medicine and Obstectrics and Gynaecology,
The University of Hong Kong
Queen Mary Hospital,
Hong Kong.
Department of Obstetrics and Gynaecology and Medicine
Prince of Wales Hospital
Th Chinese University of Hong Kong
Hong Kong
Summary
- Gestational diabetes is associated with excess risk for adverse maternal, foetal and neonatal outcomes, including long-term hazards. As gestational diabetes is often asymptomatic, a high index of clinical suspicion and timely intervention are needed for prevention of its potentially serious sequelae.
- Pregnancy has important implications for the thyroid gland iodine insufficiency, goitre development, and abnormal thyroid function are common during pregnancy. In patients with Graves' disease, thyrotoxicosis must be controlled with the lowest effective dose of antithyroid drug therapy.
- Around 0.5% of all pregnancies may be complicated by epilepsy. Uncontrolled seizures during pregnancy are potentially harmful to both the mother and the foetus. The need to balance this risk against the possible teratogenicity of antiepileptic medications is an exacting clinical task.
Editor's Comment
In a pregnant woman, there are two patients the mother and the foetus. The physician and obstetrician have to balance the risks and benefits to both when deciding on the best course of management. Although often highly challenging, this situation nevertheless provides the opportunity to dramatically improve the clinical course of the mother and child.
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