AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2642-9756/186
1Pan-African Academy of Christian surgeons.
2Baptist Institute of Health Sciences.
3Mbingo Baptist Hospital.
*Corresponding Author: Blessing Ngoin Ngam, Pan-African Academy of Christian surgeons, Baptist Institute of Health Sciences, Mbingo Baptist Hospital.
Citation: Blessing N. Ngam., Laurie Elit., Richard L. Bardin, (2024), Diagnosis of Primary Ovarian Burkitt Lymphoma. A way to avert surgery, J. Women Health Care and Issues, 7(2); DOI:10.31579/2642-9756/186
Copyright: © 2024, Blessing Ngoin Ngam. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 09 January 2024 | Accepted: 25 January 2024 | Published: 02 February 2024
Keywords: elderly women; kegal and breathing exercise; obstetrical; urinary incontinence
Kegel's exercise is the cornerstone of noninvasive treatment for UI as it strengthens the muscular components of urethral supports by employs a small number of isometric repetitions at maximal exertion. Aim of the study: The study aimed to assess effect of Kegal and breathing exercise on obstetrical history of elderly women with urinary incontinence.
Design: A quasi-experimental study design was utilized in this study (one group pre and post-test).
Sample: A purposive sample was selected and this study was performed on 100 Menopausal women diagnosed with stress urinary incontinence. Setting: gynecological and urological outpatient clinics Beni-Suef university hospital. Tools: Data was collected using 1) a structure interviewing questionnaire schedule, 2) Pelvic floor muscles exercises checklist. Results: 70% of the studied sample got delivered more than three times while 56% of them aborted from 1-3 times. Regarding type of delivery, 66% of them delivered spontaneous vaginally, while 29% delivered by cesarean section. 33.3% of women who experienced 1-3 pregnancies reported that their frequency of urinary incontinence is once a week or less often compared to only 14.3% of women who had more than three pregnancies.
Conclusion:
It reveals a negative correlation between deep breathing and kegel exercises adherence and severity of stress urinary incontinence and a positive correlation between number of gravidity and parity and frequency of urinary incontinence with statistical significant association were found.
Recommendations: Health education about the correction of misconceptions about urinary incontinence, which can be an effective means of bringing incontinent women into contact with health care center for early appropriate intervention.
Burkitt lymphomas (BL) are a rare and aggressive subtype of B-cell non-Hodgkin lymphoma (NHL) arising from translocation of the myc gene on chromosome 8[1-3]. They are fast growing and have a doubling time of 24 hours[4,5]. The three types of BL include sporadic, endemic, and immunosuppression-related. The endemic subtype is prevalent in sub-Saharan Africa and Papua New Guinea and is said to be closely related to the higher incidence of plasmodium falciparum and Epstein-Barr virus (EBV) infections [6-11]. BL accounts for up to 50% of NHLs in this part of the world [12]. The incidence of BL in Africa is about 50 times higher than in the U.S.[9], estimated at 3-6 cases per 100,000 children per year[13]. It most commonly presents with jaw or facial bone masses but may also involve extranodal sites like bone marrow, peripheral blood, meninges, testes, ovary, kidney, and breast(14). Sporadic BL sometimes referred to as the non-African type, is rare, and occurs worldwide. It accounts for 1-2% of lymphomas[14] affecting 2-3 per a million persons per year in the U.S. and Europe[12,15,13]. Sporadic BL mostly presents with abdominal tumors and can also involve extranodal sites[14,17]. Immunosuppression-related BL is seen in HIV or post-transplant patients. It most commonly involves the lymph nodes but can involve the bone marrow or peripheral blood(14). Primary ovarian Burkitt is a rare manifestation of this disease and still poses a diagnostic challenge. Most often, the diagnosis is made following surgery[18,23]. Following a total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH/BSO) for a 23-year-old with primary ovarian Burkitt lymphoma at our centre, we resorted to an algorithm[22] which was used in the diagnosis of subsequent suspected cases.
We prospectively reviewed the medical records of 4 patients diagnosed with ovarian BL at our hospital within 15 months, to identify similarities in clinical and paraclinical presentation.
| Patient | Patient 1 | Patient 2 | Patient 3 | Patient 4 |
| Age (yrs.) | 23 | 12 | 23 | 26 |
| Gravid formula | G1P1001 | G0 | G0 | G3P3003 |
| Presenting Symptoms and duration | 2weeks of painful abdominal distension | 3 weeks history of abdominal distension | 3 weeks history of painful abdominal distension | 2weeks of abdominal distension |
| Other signs and symptoms | Early satiety | Nausea, vomiting, weight loss, early satiety and frequency | fever | Fever, anemia, early satiety |
| Involved ovary | Bilateral | Left | Right ovary | Right ovary |
| Other organ system involvement (via CT, USS, cytology of CSF or bone marrow) | none | none | none | Hepatic nodule on CT |
| Ascites | Present | Present | Present | Present |
| Appearance of ascitic fluid | Bloody | Bloody | Bloody | Bloody |
| Cytology on ascitic fluid | Lymphocyte predominance | Lymphocyte predominance | Lymphocyte predominance, with diffuse chromatin patterns, scant blue-gray cytoplasm, and numerous clear cytoplasmic vacuoles. | Lymphocyte predominance. Medium-sized lymphoid cells with a high NC ratio, blue cytoplasm, and small round clear cytoplasmic vacuoles |
| Ovarian mass Fine needle aspiration(cytology) | No | No | discohesive, monomorphic population of atypical small to medium-sized lymphoid cells with round nuclei evenly dispersed chromatin, and scant dark blue cytoplasm. Numerous small round clear cytoplasmic vacuoles are evident. Macrophages with ingested nuclear material are present. Blue cytoplasmic fragments are evident in the background. AHNL favor BL. | discohesive, monomorphic population of atypical small to medium-sized lymphoid cells with round nuclei evenly dispersed chromatin, and scant dark blue cytoplasm. Numerous small round clear cytoplasmic vacuoles are evident. Macrophages with ingested nuclear material are present. Blue cytoplasmic fragments are evident in the background. AHNL favor BL. |
| Core biopsy; Touch imprints | None | monomorphic round cell neoplasm with scattered tangible-body macrophages. Tumor cells are medium-sized with high NC ratio, round nuclei, nucleoli, and blue cytoplasm with numerous small clear cytoplasmic vacuoles. Cytoplasmic fragments are present in the background with numerous vacuoles. AHNL consistent with BL. | None | None |
| Histopathology | ovarian tissue was replaced by a monomorphic, discohesive, small round cell neoplasm with numerous tingible body macrophages giving a "starry sky" appearance at low power. The tumor cells had indiscernible cytoplasm, an immature chromatin pattern, and one or more nucleoli. The peritoneal implants were composed of the same tumor. ANHL favor BL | Consistent with touch imprints (fig 4) | None | None |
| TB test (gene xpert) | Neg | Neg | Neg | Neg |
| HIV status | Neg | Neg | Neg | Neg |
| AFP (0-20ng/ml or <5> | 0.5IU/ml | 2.96IU/ml | 7.9ng/ml | 5.60IU/ml |
| βHCG (<5IU> | 0.100miu/ml | Negative pregnancy test | < 2IU> | <2miu> |
| CA125 (<35U> | 6.13U/ml | Not done | Not done | 1499 |
| LDH | Not done | Not done | Not done | Not done |
| Uric acid (2.4-5.7mg/dl) | Not done | 8.21 | 8.3 | 25.5 |
| Ultrasound scan | Left adnexal mass; 13.9cm x 7.9cm x 10.8cm and 10.1cm x 11.0cm x 12.4cm on the right, mild splenomegaly | Huge intrabdominal complex mass | Huge hypoechoic right adnexal mass 14.14x12.17x15.46cm | Solid hypoechoic right ovarian mass 8.9x 7.5x8.2cm |
| CT scan | Not done | solid abdominopelvic mass arising from left ovary, measuring 16x12x24cm with necrotic components and mild enhancement | Huge pelvic mass and ascites | Pelvic mass with signs of peritoneal carcinomatosis and a hepatic nodule |
| Surgery before diagnosis | TAH/BSO | None | None | None |
Within the 15 months, between the first and the last case,129 cases of lymphoma were diagnosed at our hospital pathology lab. 80.6%(n=104) were based on cytology while 19.4% (n=25) where based on histology. 46.5% (n=60) of these cases were Burkitt lymphoma, which is similar to the 50
We do not have a large enough sample size to make any firm conclusions. However, faced with high ascitic fluid lymphocyte counts with predominately solid ovarian mass in a young woman living in a malaria endemic region, the use of FNA of the mass may be an alternative to ovarian biopsy or removal after a wider scale study.
Considering the cost to the patient, time to onset of treatment, and patient quality of life, cytology might offer enormous benefits in the diagnosis of primary ovarian BL.
None
Informed consent was obtained from all patients for the publication of this case series and any accompanying images. IRB approval was gotten from CBCHSIRB
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
