Aggressive angiomyxoma (AA) is an extremely rare locally invasive mesenchymal tumor with a high risk of recurrence. Till date, only about 350 cases reported worldwide. Because of the rarity it should be considered as differential diagnosis whenever patient present with vulvovaginal growth. The diagnosis is clinched on histopathology. These are hormone-dependent and have estrogen and progesterone receptors. Hence sometimes GnRH agonists are used for ovarian estrogen secretion suppression but long-term use is not advocated due to side effects. A 45-year-old P4 L4 perimenopausal female presented to the GOPD with a 4×4×3 cms pedunculated painless globular mass on right labia majora. On palpation, the globular mass was firm, non-tender and with a smooth surface. Mass was excised and on gross histopathology, cut sections showed white myxoid areas. On microscopy epidermal lined tissue with stellate and spindle-shaped mesenchymal cells was found, embedded in a loose myxoid stroma with few collagen fibers. The cells were small and bland and lacked nuclear atypia. Small to medium-sized blood vessels were present with the thickened wall. Entrapped nerves and adipocytes were also present. No necrosis or mitosis was identified. All these features were suggestive of an aggressive angiomyxoma. Immunohistochemistry markers ER, PR, CD34, desmin, SMA were all positive. Imaging was done to rule out metastatic lesions and wide local excision was done around the stump with laparoscopic bilateral oophorectomy. Aggressive angiomyxoma is a rare disease. In women with asymptomatic growth in the vulvovaginal region, perineum or pelvis, aggressive angiomyxoma should be considered as a differential diagnosis. Ideal treatment is a wide local excision to prevent local recurrences, which are common and a hypoestrogenic milieu is created by either GnRH Agonists or by bilateral oophorectomy due to their hormone-sensitive nature.
Iron aluminide alloys containing both ferrous as well as non-ferrous (aluminum) components form unique materials from machining theory and practice point of view. While the cutting tool materials specifically required for their machining are not available, the mechanism of machining of such materials containing ferrous and non-ferrous components has not been adequately investigated. This paper deals with fundamental aspects of chip formation and tool-life in machining of an iron aluminide, Fe 3 Al alloy. Microstructural analysis of chips shows that the interaction of chip and tool in the secondary deformation zone, dependent upon the cutting speed mainly determines the mechanism of chip formation. Results of tool-life testing indicate that thermal softening of tool point combined with abrasion is the predominant tool failure mechanism.
Introduction: In India, cervical cancer stands as the 2nd most common female cancer and it is the 2nd most leading cause of deaths in women aged 15 to 44 years. The first visit to the gynecologist for most of the women in India is during pregnancy, thereby making it a fair opportunity for the screening of premalignant and malignant cervical disease. Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynaecology, AIIMS, Rishikesh, Uttarakhand, India from January 2018 to January 2019. The Pap smear testing of 237 spontaneously conceived antenatal women, aging between 20 to 35 years was performed. The same women were followed up for postnatal testing after 6 weeks of delivery. Results: Out of 237, 8 women were reported positive for pre malignant lesions of cervix in the antenatal testing, 5 cases of ASCUS, 1 case of AGC, 1 case of ASC-H & 1 case of HSIL. In the postnatal Pap smear testing, 37 women were lost to follow-up including 1 case of ASCUS. Postnatal Pap smear testing of the remaining 200 women showed that 193 women who were reported NILM in the antenatal period remained unchanged in the postnatal screening too. Out of the 7 women who tested positive, 4 cases of ASCUS, 1 case of AGC and 1 case of ASC-H showed regression, giving result as NILM in the postnatal screening test. Out of the 7 positive antenatal tests, 1 case which was reported as HSIL in the antenatal screening, remained unchanged in the postnatal period.Conclusion: The study concluded that there is significant regression (p<0.01) of Positive Pap smear findings from antenatal to postnatal period. Hence, it is imperative to repeat Pap smear test in postnatal period.
Objective: To establish the comparability of two step approach of See and treat with the conventional three step approach In management of Precancerous lesions of the cervix. Methods: A Randomised controlled Trial was conducted in AIIMS Rishikesh over a period of one year (2020-2021). All women presenting to OPD in age group 25-60 years were screened with PAP smear and per speculum examination, and women with Abnormal PAP smear or clinically unhealthy cervix were subjected to colposcopy. Reid and Swede scores were calculated and colposcopy guided biopsy taken. Women with CIN2/3 on either of the colposcopy scores were randomized to two or three step approach. Women falling into two step approach (group A) underwent LEEP in the same sitting while the latter group (group B) was told to follow up with histopathology reports for further management.The final histopathological diagnosis and LEEP results were compared. Results: Overtreatment rates were 22% in see and treat approach, distributed as 3.6% in HSIL + ASC_H group and 33 % in LSIL patients. None were lost to treatment in this group. 39 out of 50 women in Group B needed definitive treatment after their biopsy results and 48% of them were lost to follow up. 72% were adequately treated in group A while only 22 % could be adequately treated in Group B. Conclusion: It can thus be safely concluded that despite the risk of overtreatment, a two step approach should be considered for preventive management, especially considering the rate of loss to follow up in three step approach. This study thus advocates the use of See and Treat protocol, especially in the high-grade cytology lesions. IN low risk cases too, the study proposes that see and treat protocol can be used, albeit with good clinical judgement. Offering opportunities to reduce suffering associated with the eminently preventable cervical cancer is an ethical imperative and the SEE and TREAT approach is an attempt in that early preventive direction.
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