Background:Endometriosis has a major impact on women's quality of life. The two primary pathologies are chronic inflammation and altered apoptotic activity. Sulawesi propolis has been shown to have known anti-inflammatory and pro-apoptotic properties in other diseases. Objective:To investigate the effects of Sulawesi propolis in the rat endometriosis model. Methods:An autologous endometriosis model was created in 60 female Wistar rats by laparotomy. Rats were divided into four groups (n = 15 in each group): control group (CG), dienogest group (DG), propolis 50 mg/kg body weight (BW)/day (P50) group, and propolis 100 mg/kg BW/day (P100) group. Each treatment group was divided into three different treatment durations (n = 5 in each treatment group): 2, 4 and 6 weeks. After treatment, laparotomy was performed to determine endometriotic tissue growth, apoptosis [caspase-3 and Bcl-2-associated X/Bcl-2 (Bax/Bcl)] and inflammation [prostaglandin-E2 (PGE2) and interleukin-1B (IL-1B)]. Results:A significant difference was seen in endometriotic tissue growth between the P50 group and the CG, with the greatest reduction in the P50 6-week (P50-6) group, reaching 70.66% of the initial area. Highest Bax/Bcl-2 mRNA expression was shown in the P50-4 and P100-4 groups, highest caspase-3 expression was shown in the P50-2 and P50-4 groups, and lowest IL-1B expression was shown in the P50-4 group; all differed significantly from the CG. No significant difference in PGE2S mRNA was found between the groups. Conclusion:Sulawesi propolis extract suppressed endometriotic tissue growth in the rat model by increasing apoptotic activity. The effects were time-dependent, with 50 mg/kg BW as the optimal dose.

Objectives: To determine the anti-cancer effect of nanocurcumin on choriocarcinoma. Methods:This study observes the telomerase activity, NF-κB expression, and BrdU proliferation index in cultures of BeWo choriocarcinoma cell line (ATCC CCL-98) exposed to MTX and nanocurcumin in various doses.The sample used in this study consisted of 4 groups of BeWo cells that received a combination of MTX and nanocurcumin, and 2 other groups for positive and negative control.Results: There was a decrease in telomerase activity, NF-κB expression, and BrdU proliferation index in the 4 treatment groups compared to the negative and positive control group (p≤0.05). Conclusion:Nanocurcumin and MTX decrease telomerase expression, NF-κB expression, and the BrdU proliferation index in choriocarcinoma BeWo cell line culture faster than MTX alone.

Placenta previa often leads to antepartum hemorrhage, which warrants the patient for emergency room admission. The bleeding occurs mainly due to cervical dilation, which could be caused by cervical incompetence. Cervical cerclage has been considered as the primary treatment for cervical incompetence. However, evidence is lacking for its application in placenta previa. Here, we present a case of a 30-year-old pregnant woman diagnosed with complete placenta previa where a good obstetrical outcome could be achieved. The patient had antepartum hemorrhage during the 21st week of gestational age due to cervical dilation in a complete placenta previa case. An emergency cerclage using McDonald's technique was then performed, which prolonged the pregnancy to the 34th week of gestation. The patient had cesarean section and delivered a healthy baby girl weighing 2190 g. The mother and the baby had an uneventful recovery and were discharged after 2 days of hospitalization.

BACKGROUND: Cervical cancer is the second-most common cancer in Indonesian women. While the cervical cancer screening has been integrated in Indonesian primary health-care facilities, the HPV vaccination has not yet become a national program. AIM: The objective of this research was to measure the knowledge, attitude, and behavior of medical students in Jakarta toward cervical cancer and its prevention. The result of this study could be implemented to develop a more comprehensive national educational program and public health policy. METHODS: We conducted a cross-sectional study on medical students at 10 different universities in Jakarta, Indonesia. Student’s knowledge, attitude, and behavior were collected through a self-administered online questionnaire consist of a total of 27 questions concerning cervical cancer epidemiology, pathogenesis, screening, diagnosis, and prevention. RESULTS: A total of 2159 medical students participated in this study. More than half (55%) of the students obtained satisfactory knowledge score. The students’ knowledge regarding HPV vaccination was low. However, 87.2% of them agreed to get the HPV vaccination. Only 7.0% had participated in cervical cancer screening program and only 16.8% had received HPV vaccination. Female gender, second or third year of study, and three universities had better odds to have good practice score. CONCLUSION: The knowledge and attitude score did not reflect on student’s practice on cervical cancer and its prevention. Effort to increase the awareness toward cervical cancer should be endorsed through university curriculum and public health policy.

Abstract Objective: To evaluate the impact of pathogenic BRCA1/2 tumor mutation on advanced stage-high grade serous epithelial ovarian cancer (HGSOC) survival outcome. Methods: A total of 68 from 144 patients were diagnosed with FIGO 2014 stage IIB-IV HGSOC between January 1st 2015, until March 31st 2021, at Dr. Cipto Mangunkusumo National Central Referral Hospital, Persahabatan Central Referral Hospital, and MRCCC Central Referral Hospital Siloam Jakarta, underwent NGS tumor BRCA1/2 gene testing and were included in this cohort historical study. We compared patient’s overall survival outcomes to pathogenic BRCA1/2 tumor mutational status. The patient’s clinicopathological characteristic factors that might affect patient’s survival outcomes were also investigated. Results: In the group with pathogenic BRCA1/2 tumor mutation, the likelihood of dying was 86% ​​lower (adjusted RR 0.149; 95%CI 0.046-0.475; p-value=0.001), and the median survival was better (median 46 months; 95%CI 34.009-57.991; p value=0.001) than the group without pathogenic BRCA1/2 tumor mutations (median 23 months; 95%CI 15.657-30.343; p value=0.001). The multivariate analyses identified pathogenic BRCA1/2 tumor mutation as an independent favorable prognostic factor for survival outcome (adjusted RR 0.149; 95%CI 0.046-0.475; p-value=0.001).Conclusions: In advanced stage-HGSOC patients, the pathogenic BRCA1/2 tumor mutations group have a better prognosis with longer survival outcomes than those without pathogenic BRCA1/2 tumor mutations.

Background: Ovarian cancer is one of the leading cancers in women. Seventy percent were founded in the advanced stage, with a 5-year survival rate of only 46%. The current treatment modality is cytoreduction with platinum-based adjuvant chemotherapy as the first line. The effectiveness of chemotherapy is only 60% in the advanced stage, later developing into recurrent. Therefore, additional types of therapy are required based on agents that work specifically in cancer cells and synergize with current standard treatments. This study aimed to know the anti-proliferation effect and apoptosis effect of combination cisplatin with nanocurcumin on SKOV3 cells. Methods: This experimental study was conducted in vitro using the biological cell line SKOV3 to determine the anti-proliferation effect (expression Ki67) and the apoptosis effect (caspase 3 and 8) of combination cisplatin with combination with cisplatin nanocurcumin on the cell. The data were analyzed with unpaired T when regular distribution / Mann Whitney test when the distribution is abnormal and using Graph Pad Prism. Results: Based on this result, 50cc of nanocurcumin is 67 μm, and 50cc of cisplatin is 54 μm, using the MTT Assay method. The viability of the cells in this study decreased according to the dose-dependent, whereas the combined dose of 134 μm nanocurcumin with 108 μm cisplatin found the lowest life cell, 24.3% (p <0.001). Ki67 expression was low in the SKOV3 cells post-exposure to cisplatin, but increased post-exposure to nanocurcumin, suspected nanocurcumin at certain doses of pro-oxidant properties that triggered proliferation. Caspase 3 and 8 cannot be detected in this cell by the ELISA method. Conclusions: Nanocurcumin has a potential effect on chemosensitive cells. However, our study shows no healing effect in chemoresistance cells, particularly SKOV3.

Background: Early detection and treatment of cervical intraepithelial neoplasia (CIN) through a "see and treat" approach is a pillar of cervical cancer prevention programs in developing countries such as Indonesia. One of the major challenges faced is the limited N2O or CO2 gas supply for cryotherapy. Thus, an alternative therapeutic method such as trichloroacetic acid (TCA) topical application is needed as an alternative solution. The effectiveness of this therapy will depend on its destructive effect on eliminating the whole lesion in CIN. Objective: To estimate the extent of damage in the normal cervical tissue after a single topical application of 85% TCA solution. Design and Methods: This research was an intervention study carried out by applying ±5 ml of 85% TCA solution into the cervix of 40 patients scheduled for total hysterectomy for indications other than cervical pathology 24 h before surgery. The extent of tissue destruction was determined microscopically using histopathological specimens. The study protocol is registered at www.clinicaltrial.gov (ID NCT04911075). Results: In the final analysis, 39 subjects were included. The necrotic area was detected at the superficial layer, accompanied by the full epithelial erosion thickness. In addition, there were also fibrotic areas resembling burned tissue in the stroma. The mean depth of destruction was 1.16 ± 0.01 mm in the anterior lip and 1.01 ± 0.06 mm in the posterior lip. There was no significant depth difference between the anterior and posterior lips (p ≥0.05). Moreover, the 85% TCA topical application was tolerable, as represented by the fact that the vast majority (82.1%) of participants experienced pain with a visual analog scale score of <4. Conclusion: Single dose of TCA 85% in topical solution was able to destroy the normal cervical tissue with a deeper mean depth than the mean depth of CIN III in squamous epithelium.

Background The borderline ovarian mucinous cystic tumor may appear with mural nodules. However, its entity may remain rare. Malignant mural nodules mainly occur in old patients and have poor clinical outcomes. Accurate diagnosis of mural nodules is vital to choose the proper treatment, although it is complicated to manage. Case Presentation A 24-years-old nulliparous woman was examined due to abdominal pain and enlargement. She had been performed salpingo-oophorectomy due to ovarian tumor suspicion in the previous hospital. We did the surgical staging and found severe adhesion, but no cancer cell was found. During the follow-up, the symptoms got worsened. The CT-Scan results said massive ascites, CA 125 levels raise to 174 U/mL, and CA 19-9 920 U/mL. Exploratory laparotomy was performed, histology examination concluded malignant mural nodules mixed type on an ovarian borderline mucinous tumor. Carboplatin 750mg, paclitaxel 300mg, and bevacizumab 800mg was prescribed. In the beginning, the response was great, CA 125 and CA 19-9 levels decreased. But after four cycles, the CA 19-9 levels raise significantly. On the other hand, the CA 125 remains normal. We concluded that it was a chemotherapy resistance – malignant mural nodules and new chemotherapy regiment was prescribed but also resistance. Currently, the patient refused to continue the treatment. Conclusion Although it is rare, malignant mural nodules should be considered when we find a mucinous borderline ovarian tumor at a younger age. The angiosarcoma-type mural nodule is very difficult to manage due to the high probability of chemotherapy resistance.

BACKGROUND:Although epithelial ovarian cancer (EOC) spreads through peritoneal circulation, all patients with clinical early-stage ovarian cancer (OC) benefit from routine surgical staging is still unclear.METHODS:This cross-sectional study used data from medical records of patients with clinical early-stage EOC who received complete surgical staging from 2006 to 2016 at our hospital. We excluded patients with non-epithelial OC or with stage IV disease.RESULTS:Among 50 patients with clinical early-stage EOC who underwent surgical staging, biopsies showed EOC cells in peritoneal fluid for 12 patients (24%), in peritoneal tissue for ten patients (20%), and omental tissue for eight patients (16%). Of those 50 patients, 40 patients had undergone peritoneal biopsies, and the other five patients also had omental biopsies. The results showed that only one (2.5%) from 40 patients with peritoneal biopsy and three (6.7%) from 45 patients with omental biopsy had no visible nodules. From cytology examination, 3 out of 26 patients (11.5%) showed positive cytology from peritoneal washing.CONCLUSIONS:Routine peritoneal biopsies do not seem advantageous for patients with clinical early-stage EOC as negative visible nodules with positive biopsy results were only 1 in 40 cases. However, further study with a larger cohort is needed to obtain more information on peritoneal fluid metastasis patterns.

INTRODUCTION:Endometriosis is a disease that impacts around 10% of all women in reproductive age, with pelvic pain and infertility as its main clinical features. Current medical treatment targeting lowering estrogen activity has not shown sufficient result due its side effects and reproductive function suppression. Propolis has been widely studied, showing anti inflammation and pro-apoptosis property, that could potentially be used in the treatment of endometriosis. This study investigates the interaction between Sulawesi Propolis' active components and receptors and protein related to endometriosis pathogenesis. METHODS:Active components of Sulawesi Propolis were initially identified with their targeted protein receptors. Lipinski rules were used to screen potential components. The ligands and proteins were tested using Autodock program to predict the most active compound and possible binding sites between propolis and some target proteins associated with inflammatory and apoptotic activity in endometriosis models. Receptor modelling is then performed using Swiss-Model. RESULTS:These active components of Sulawesi Propolis showed a strong binding potential towards TNF- α, NF-kb, Estrogen-α, Estrogen-β, progesterone B, PGE2 EP2 and EP3 subtype respectively: Sanggenon C, Sanggenon H, Epicryptoacetalide, Chrysin-7-O-β-D-glucopyranodside, Irilone, Polydatin and Epicryptoacetalide. Compared to its negative ligand, Sulawesi Propolis displayed a stronger binding capacity to TNF-α, Estrogen-α, and Progesterone B receptors. CONCLUSION:Sulawesi Propolis has the ability to interact with receptors related to reproductive function, apoptotic reactions and inflammatory processes, a significant factor associated with the pathogenesis of endometriosis.

BACKGROUND Placenta accreta is an abnormal invasive placenta that can be life-threatening because of the risk of hemorrhage. Its incidence has increased due to high cesarean delivery rates. Early gestational age placenta accreta is difficult to diagnose and misdiagnosis can lead to inappropriate treatment. CASE REPORT Patient 1, a 34-year-old woman (para 2 abortus 1) with 2 previous cesarean deliveries, was referred to our department for vaginal bleeding and abdominal pain. She received 2 curettages for blighted ovum; then, ultrasound examination found uterus perforation and fluid in the Douglas cavity. Exploratory laparotomy confirmed uterine perforation, and a hysterectomy was performed. Histopathological examination revealed placenta accreta. Patient 2, a 35-year-old woman (para 3) with 3 previous cesarean deliveries, was treated at a previous hospital for vaginal bleeding and stomach enlargement. She received serial chemotherapy for gestational trophoblastic neoplasia. Ultrasound examination showed a nonhomogeneous opacity in the lower uterine corpus with color score 4. Total abdominal hysterectomy was performed, and histopathological examination revealed placenta accreta. Patient 3, a 32-year-old woman (para 2) with 2 previous cesarean deliveries, had irregular vaginal bleeding suspected as gestational trophoblastic neoplasia due to ultrasound examination and positive beta-human chorionic gonadotropin. Ultrasound and MRI examination showed enlargement with nonhomogeneous opacity, color score 4, and bridging vessels. Due to our previous experience, we suspected it was a placenta accreta and performed a hysterectomy. The histopathology result indicated placenta accreta. CONCLUSIONS The key point in diagnosing placenta accreta properly is to evaluate the morphometric changes based on the structure using imaging like ultrasound. Collection and analysis of these data enables precise diagnosis in early gestational age placenta accreta.

Abstract Objective: To investigate the effectiveness of referral system, in regard to pregnant women with indication of C-section, and to learn the patients’ profile and their baby’s perinatal outcome. Methods: The research uses a retrospective descriptive method utilizing patient medical records with history of C-section at RSCM from January 2016 to December 2019. The target population is all pregnant women who were referred and performed cesarean section to at the hospital. Results: The most indications of C-section were premature membrane ruptures (16.1%), fetal distress (14.5%) and previous C-section (14.1%). There were 1585 cases (41.9%) coming without referral, 779 cases (20.6%) were bookcase, and 806 (21.3%) non-bookcase without referral. The main reasons for referral were absence of NICU facilities (27.31%), premature membranes rupture (20.81%), and eclampsia/preeclampsia/HELLP syndrome (15.40%). Most babies are born with normal weight (2500-3999 grams) as many as 45.1% and 54.9% are groups of babies with abnormal weight. Most babies have an APGAR score 5 minute of 7-10 (83.6%). As many as 47.8% rooming in and infants requiring perinatological care in both SCN and NICU are 52.1%. Conclusion: The study found that the effectiveness of RSCM tiered referral system still has much room for improvements. The study also found gap between number of referred cases and the cases eventually underwent for C-section with the same indication. The screening can be done better for an indication of the origin of the reference whether it is appropriate to do the reference or not. Keywords: caesarean section, perinatal outcome, pregnant women, referral system. Abstrak Tujuan: Untuk mengetahui efektivitas sistem rujukan pada ibu hamil dengan indikasi seksio sesarea, serta mengetahui profil pasien dan hasil perinatal bayinya. Metode: Studi ini menggunakan metode deskriptif retrospektif dengan memanfaatkan rekam medis pasien riwayat seksio sesarea di RSCM dari Januari 2016 sampai Desember 2019. Populasi sasaran adalah semua ibu hamil yang dirujuk dan dilakukan seksio sesarea di RSCM. Hasil: Indikasi seksio sesarea terbanyak adalah ketuban pecah dini (16,1%), gawat janin (14,5%), dan riwayat seksio sesarea sebelumnya (14,1%). Ada 1.585 kasus (41,9%) yang datang tanpa rujukan, 779 (20,6%) bookcase, dan 806 (21,3%) non-bookcase tanpa rujukan. Alasan utama rujukan adalah tidak adanya fasilitas NICU (27,31%), ketuban pecah dini (20,81%), dan eklampsia/preeklamsia/sindrom HELLP (15,40%). Sebagian besar bayi lahir dengan berat badan normal (2500-3999 gram) sebanyak 45,1% dan 54,9% merupakan kelompok bayi dengan berat badan tidak normal. Sebagian besar bayi memiliki skor APGAR 5 menit 7-10 (83,6%). Sebanyak 47,8% rawat inap dan bayi yang membutuhkan perawatan perinatologi baik di SCN maupun NICU sebanyak 52,1%. Kesimpulan: Studi ini menemukan bahwa efektivitas sistem rujukan berjenjang RSCM masih memiliki banyak ruang untuk perbaikan. Studi ini juga menemukan kesenjangan antara jumlah kasus yang dirujuk dan kasus yang akhirnya menjalani seksio sesarea dengan indikasi yang sama. Penapisan dapat dilakukan lebih baik untuk indikasi asal rujukan apakah layak dilakukan rujukan atau tidak. Kata kunci: ibu hamil, luaran perinatal, seksio sesarea, sistem rujukan

Introduction and importancePeritoneal Tuberculosis is one of extrapulmonary tuberculosis that occurs in 1-2% of patients, its incidence is higher in developing countries. It is very difficult to diagnosed and can mimic advanced ovarian cases. Making an accurate diagnosis is vital, laparoscopy is a great modality for this purpose.Case presentationA 36 years-old woman got referred with abdominal distention and weight loss from an internist and digestive surgeon. The abdominal computed tomography said thickening of the stomach wall with ascites. Ultrasound concluded the uterus, ovary, and endometrium within normal. The CA 125 levels elevated to 1200 U/mL and the complete blood count was normal. We were making diagnosis of peritoneal tuberculosis, peritoneal carcinomatosis, and advanced ovarian cancer. We did the diagnostic laparoscopic and taking a biopsy sample, ascites with peritoneal carcinomatosis and omental cake were found, the peritoneal cavity was covered by miliary nodules. Histopathology results concluded peritoneal tuberculosis without malignancy signs. The patient was treated with tuberculosis drugs. The follow-up evaluations show significant clinical improvement.Clinical discussionWhen facing patients with massive ascites and elevated CA 125 without any ovary enlargement, a gynecologist should think that it may be a peritoneal TB case with peritoneal carcinomatosis and advance ovarian cancer possibility as differential diagnosis especially in developing countries. An exact diagnosis can be made using laparoscopy and histopathology examination.ConclusionLaparoscopy is the best modality to differentiate between peritoneal tuberculosis, peritoneal carcinomatosis, and advance ovarian cancer. The benefits are direct visualization and could take a biopsy for histology examination.

Ovarian cancer o ten presents itself in advanced stages and can be accompanied by various comorbidities.Treatment options are primary debulking surgery (PDS) followed by adjuvant chemotherapy, or alternatively, neoadjuvant chemotherapy followed by interval debulking surgery (IDS).The option taken is based on several considerations.If the patient can be treated with PDS, the absence of macroscopic residual disease becomes an independent prognostic factor.However, achieving this outcome is a challenge for the gynaecologic oncologist since advanced stage ovarian cancer generally metastasizes into the peritoneum and the upper abdominal organs.Optimal outcomes are that surgery will be safe for the patient, no macroscopic residual disease is achieved, minimal postoperative complications are encountered, and a good survival rate is obtained.Developed countries, especially Europe, have well-recognized standards of care which are followed by developing countries; however, challenges with insurance coverage and inter-departmental cooperation are recognized hurdles in developing countries.Competency improvement along with good inter-departmental communication and collaboration are keys to optimal outcomes for PDS.

Introduction and importance: Caesarean scar endometriosis (CSE) is a rare form of endometriosis due to previous surgical scars from obstetrical and gynecological procedures. The incidence of CSE was 0.08% and quite difficult to diagnose. Case presentation: A 37-year-old multiparous woman came with intermittent pain in her lower left abdominal region and lump with a bluish color and solid consistency on the left side of the caesarean scar. Ultrasounds findings show a solid mass, measured 45 x 40 x 39 mm with neovascularization color score: 4. In April 2021, we performed mass resection, intraoperatively we found solid mass with no adhesion and infiltration found. Histological examination results confirm external endometriosis from the mass and the fascia was free from endometriosis. The symptoms reported relief after the procedure. Clinical discussion: Scar endometriosis is largely related to previous abdominal surgery like caesarean section, the mass increase in size during menses and becomes symptomatic. CSE develop ranging 12 months to 21 years and could mimic other hernias or tumor, that's why careful and precise examination is needed. The imaging modality we use in this case was ultrasonography which is the best and most accessible, reliable and cost-effective to diagnose. We performed large surgical excision of the lesion with reconstruction of damaged tissue to prevent recurrence and conversion to malignancy. Conclusion: Caesarean scar endometriosis should be considered in women of reproductive age with lower abdominal pain and/or mass at the caesarean scar from previous delivery or following obstetric-gynecologic surgery.

Introduction: Metastases in cervical cancer could be spread through direct local invasion, lymphatic dissemination, or hematogenous dissemination. The most common sites of distant metastases are lungs, bone, and liver. Skin metastases from cervical cancer are categorized as a rare occurrence of metastases. This rarity of the cases has led us to report it. Case description: A 66-year-old multiparous woman diagnosed with stage IIA cervical cancer seven years ago, then she came into our outpatient clinic complained about a brownish white color mass on the left side of the neck that keeps getting bigger over time came from a skin lesion. The lesion was first treated with topical steroid but there was no improvement. Biopsy was done and the result showed a carcinoma metastasis that led to adenosquamous carcinoma or cervical adenocarcinoma. The patient went through chemoradiation with biosensitizer paclitaxel 120 mg/m(2) for six cycles, which began in August 2019 until October 2019. The treatment progress showed a promising result. We observed the patient during treatment until two months after finishing the treatment. At the last visit, the patient came to our outpatient clinic, the mass size decreased significantly, and the skin showed an excellent regeneration sign. Conclusion: The physicians should always consider the patient's history and pay more attention to skin lesions in patients with a history of cervical cancer. The physicians should also perform a thorough physical examination and biopsy to confirm the diagnosis.

Background: Cervical cancer is the fourth most common cancer among women worldwide. In Indonesia, cervical cancer is the second most frequent disease related to cancer. Based on staging system criteria, clinical findings are the main criteria to determine cervical cancer stage. In the revised version of the Federation of Gynecology and Obstetrics staging system criteria for cervical cancer, radiological examination for pretreatment evaluation in gynecological malignancies has been used in routine modalities. Magnetic resonance imaging (MRI) and ultrasonography (USG) are commonly used in the presurgery determination of tumor size and the follow-up of cervical cancer patients. Tumor size determines cancer stage which influences the treatment and the survival. The equality of diagnostic accuracy was compared for MRI and ultrasound in this study for tumor size evaluation of cervical cancer patients. Methods: This was a prospective study including 195 patients with cervical cancer Stage IIIB in Dr. Cipto Mangunkusumo Hospital from 2016 to 2018. The tumor sizes and stages of cervical cancer were assessed on MRI and ultrasound. This study evaluated diagnostic accuracy between MRI and US. The sensitivity and specificity were compared by using McNemar test. Results: The result of the study showed that from 195 patients, 76 patients fulfilled the study inclusion criteria. There is a significant difference in assessing tumor size in cervical cancer patients between ultrasound and MRI (mean, 1.72 cm; P < 0.0001). US had 82% sensitivity, 88% specificity, and 82% diagnostic accuracy (P = 0.003, McNemar test). Conclusion: Ultrasound examination showed a comparable accuracy to MRI for assessing tumor size in cervical cancer. US is an affordable and feasible diagnostic staging tool with accuracy comparable to MRI.

Metastatic cervical cancers to the oral cavity are uncommon. These metastases most commonly present as lesions of the jaw bones and the mandible. A 57-year-old female patient complained of mass lesion in her oral cavity after definitive treatment for squamous cell carcinoma of the cervix stage IIIB. On examination a swelling of 3cm in size was found on the left side of buccal vestibule adjacent to the lower canine tooth. Wide local excision was performed, and histopathology results showed a squamous cell carcinoma of moderate differentiation. She was continued with segmental mandibulectomy, supraomohyoid neck dissection and plate-screw reconstruction. Radiotherapy was given as an adjuvant therapy.

Ovarian fibrosarcoma is an extremely rare tumour with no universally accepted guidelines for treatment. We present a 46-year-old nulliparous woman with ovarian fibrosarcoma who mainly presented with a painful abdominal enlargement. Optimal debulking surgery was performed, and a specimen of the tumour was examined. A frozen section examined during surgery revealed spindle cell morphology, raising the suspicion of ovarian fibrosarcoma, which was later confirmed by immunohistochemistry staining. Our patient refused to undergo chemotherapy and died 3 months after surgery due to tumour recurrence. Although no clear consensus exists for administering chemotherapy for fibrosarcoma, some published case reports have shown a lower chance of recurrence and better prognosis in patients who undergo chemotherapy compared with our patient.