سیما کدخدایان

From past time, breast cancer has been one of clinical and common problems among women. Given that chronic vitamin D deficiency is prevalent among most Iranian women, this study was performed with aim to examine the relationship between vitamin D serum level and 2 year survival without incidents such as metastasis and death among patients with breast cancer.  This cross-sectional retrospective study was performed on 360 patients with non-metastatic breast cancer in 2012-2017. Data collection tool was checklist. Serum levels of vitD were measured in early of breast cancer diagnosis before the start of non-surgical therapy (radio-oncology). The effects of vitD level on two year disease free survival was compared among patients with vitD deficiency and those with normal level of VitD. Data was analyzed by SPSS software (version 16) and Copplan and logRank tests and Chi-square test. 2year disease free survival was 91.3%. No significant difference was observed in 2year disease free survival between patients with vitD deficiency and those with normal level of VitD (p=0.313). However, survival time was higher in people with normal vitD serum levels, but this difference was not statistically significant (p>0.05). Although the results of current study did not show significant relationship between the effect of vitD level and disease free survival, but the number of good prognosis was more in patients with normal serum levels than those with low levels that indicates the clinical value.

Cancer of the endometrium is the most common gynecologic malignancy in western and industrial countries, and is the second most common in developing countries, therefore it is of special importance. Adenocarcinoma of the endometrium is the most common type of uterine cancer. The prevalence of endometrial cancer in young women under the age of 40 in western country is very low and about 5 percent. The aim of this study was to determine the prevalence of endometrial cancer at age ≤40 years in our center during 4 years.
In a cross-sectional study, all medical records of patients with endometrial cancer in Ghaem University Hospital, Mashhad, Iran was reviewed to identify women A total of 119 patients with endometrial cancer that was admitted in our genecology oncology center were evaluated. 19 patients (15.9%) were younger than 40 years old. 16 cases (84.2%) with endometrial adenocarcinoma and 3 (15.7%) had endometrial stromal sarcoma. The youngest patient was 27 years old and the oldest was 39 years. Seven patients (8/36%) had infertility and we don’t know about fertility condition in 3, because they were single. 12 cases (63%) were overweight (BMI≥35) and 6 cases (5/31%) had polycystic ovarian disease (PCOD). In 2 patients, there was concomitant ovarian and endometrial cancer. Histology report of both ovaries was endometrioid and both patients were overweight. Obesity, poly cystic ovary syndrome (PCOD) and Infertility were the most important risk factors for endometrial cancer in young patients.
The prevalence of endometrial cancer in young women under the age of 40 in our country is so higher than the statistics provided in industrial countries.

Breast cancer is the most common malignancy and the second leading cause of death due to cancer in women following lung cancer. Ample evidence has shown the antitumor activities of curcumin in breast cancer in preclinical and clinical trials. The anticancer effects of curcumin include the inhibition of cancer cell formation, angiogenesis, and tumor growth. Due to the low absorption of curcumin in the gastrointestinal tract, as well as its low water solubility, rapid metabolism, and high excretion, curcumin has low bioavailability. Therefore, using formulated curcumin could increase its bioavailability. The present study aimed to evaluate the effects of curcumin and its nano-formulated compositions in the prevention and treatment of breast cancer.
In this review, data were collected via searching in databases such as PubMed, Scopus, Google Scholar, and Magiran to identify the related English and Persian articles published until 2016 using keywords such as nano-forms, clinical study, cancer, breast, and curcumin. In total, 40 studies were identified and reviewed.
Using formulated curcumin could increase its absorption and bioavailability, while it also enhances its effects on cancer cells, including breast cancer cells. Therefore, nano-formulated curcumin was observed to be effective in the prevention and treatment of breast cancer.
Considering the higher bioavailability of the formulated compounds of curcumin compared to its free form and the low toxicity of this herbal medicine, curcumin could be used in combination with other anticancer medications in the treatment of breast cancer.

Surgical staging is the standard treatment of ovarian cancer. Pelvic and para-aortic lymphadenectomy is the important part of the surgery. The aim of this study was to evaluate the effect of para aortic lymph node dissection in early stage of patients with ovarian cancer.
This descriptive cross-sectional cohort study was performed on all stage I of ovarian cancer patients admitted in department of gynecology oncology of Ghaem Hospital, Mashhad University of Medical Sciences in November 2012 to March 2014. Every patient with clinical early stage of ovarian cancer candidate to surgical treatment selected. All cases underwent surgical staging surgery with concurrent systematic pelvic and para-aortic lymphadenectomy. In laparotomy after identification of left and right iliac artery, all lymph nodes have been properly exposed and dissected as a part of a staging laparotomy. The dissection was continued up to the nodal tissues surrounding the aorta, and inferior vena cava, until inferior mesenteric artery lymphadenectomy level. The procedure performed only by gynecologist oncologist. In addition, we assessed other parameters such as operation time, estimated blood loss, associated mortality and morbidity and vascular injuries. Finally, the effect of para aortic lymph node dissection in early stage of ovarian cancer evaluated.
Among a total of 57 ovarian cancer patients, 27 of them apparent stage I disease cases were selected. Surgical staging surgery with concurrent systematic pelvic and para-aortic lymphadenectomy was carried for all of them. Positive para-aortic lymph node was found only in one case. The average number removed para-aortic lymph nodes in the pelvis was 9 and in para aortic was 7, respectively. In addition, 20 minutes increase in total length of operation time was observed duo to para-aortic lymphadenectomy. Also the rate increase in intra-abdominal hemorrhage rate was estimated 60 ml.
Lymph node dissection will produce a significant benefit in accurate and complete surgical staging. Staging surgery in addition to systematic pelvic and para aortic lymph adenoctomy in early stage ovarian cancer is preferred in gynecologic oncology centers.

Swyer syndrome is a type of hypogonadism with 46,XY karyotype. This syndrome was named by Gerald Swyer, an endocrinologist. It leads to a female with normal internal genitalia (uterus, fallopian tubes, cervix, vagina), but instead of ovaries, they have non functional ovary (streak gonads). Also, they have absence of puberty because of gonadal digenesis. The current practice is to proceed gonadectomy once the diagnosis is made due to the fact that the risk of malignant transformation is high in dysgenetic gonad. In addition, hormonal replacement therapy after surgery is acceptable.
We present a case of gonadoblastom in right ovary in a Swyer syndrome who referred to the department of Gynecology Oncology at Ghaem Hospital, Mashhad University, Iran in 2015 for evaluation of abdomino-pelvic distention. She was a 18-year-old female with 46, XY karyotype and poor secondary sexual character and normal external genitalia. She suffered of abdominal pain. In palpation of the abdomen, an irregular mobile mass was detected in left lower quadrant. The ultrasound revealed uterine size approximate dimensions 3×2 cm (infantile) and a 19 cm pelvic mass heterogeneous and multi-loculated in left side of the pelvic cavity with possible origin of the left ovary. In addition, in right pelvic fossa, a mass about 6 cm was detected. CT-Scan showed a pelvic mass with overall dimensions of 10 cm with vicinity to the left iliac vessels, modest amounts of ascities along with evidence of peritoneal dissemination (seeding). In laparotomy we observed massive ascities and a 20 cm solid mass in left ovary and a small mass in right ovary and involvement para aortic lymph node. Pathological report indicated as stage III of dysgerminoma in left ovary and gonadoblastom in right ovary.
This case is presented because it could have excellent prognosis if not missed opportunities of early recognizing and furthermore adequate treatment with gonadectomy.

The majority of adnexal tumors in pregnancy are benign. It is important to distinguish between benign and malignant ovarian tumors. Due to the sensitivity of pregnancy، especially malignant adnexal masses in pregnancy and the lack of accurate information from the prevalence of this malignancy، this study was performed with aim to evaluate the prevalence of adnexal masses in pregnancy.

This cohort study was performed on 53 pregnant women with adnexal mass who needed to surgery referred to gynecology oncology department of Mashhad Ghaem Hospital during 2010-2014. Evaluating variables included maternal age، gestational age، sonographic characteristics of tumor، clinical symptoms of patient، type of surgery، pathology status of tumor، performed chemotherapy and prognosis of mother and fetus. Data collection tool was a questionnaire. Data was analyzed by SPSS statistical software (version 16)، and Mann-Whitney and Kruskal-Wallis tests.

the prevalence of malignancy was 21% (11patients). The most frequent malignancy in adnexal masses and pregnancy was germ cell tumors. 55% of these tumors were in stage 3 and 4. Borderline tumors included 18% of malignant tumors. In this study، maternal mortality rate of 5. 6% and maternal mortality rate of 3. 8% was reported.

Adnexal masses in pregnancy should be evaluated with more care and sensitivity and in cases of suspected or stable tumors، it is better to perform surgery in gynecologic oncology centers.

P53 is mutated in more than 50% of solid tumors and has been changed in 30-40% of endometrial cancer which is the most common malignancy of the genital tract of women and this change is associated with papillary serous cell type and advanced stage and poor prognosis. In addition، the overexpression of BCL2 and tumor angiogenesis is important in the prognosis of patient. Therefore، this study was performed with aim to evaluate the expression of BCL2 and P53 and angiogenesis in endometrial cancer and its relationship with clinicopathological characteristics and the factors affecting the prognosis of disease.

In this retrospective longitudinal study which was performed during 2005-2014، 30 files of patients with endometrial cancer in three different hospitals (Imam Reza، Ghaem، Omid) were collected. The pathology samples were immunohistochemical staining in terms of Bcl2 and P53 markers and angiogenesis and the association of these markers with factors affecting the prognosis and recurrence of disease were investigated. Log rank، t-test and Chi-square tests were used to analyze the data and P.

P53 expression was positive in 9 cases of 10 patients (90%) with non-endometrial cancer and all patients (100%) were negative in terms of Bcl2 and angiogenesis was severe in 8 cases of 10 patients (80%) with non-endometrial cancer and in 6 cases of 20 patients (30%) with endometrial cancer. There was significant relation between tumor histology and tumor grade and stage of the disease and survival (P = 0. 002).

Since there is relationship between genetic markers with stage and grade of disease and also survival of the patients، it is better that the related block be evaluated in terms of these markers at the time of pathological diagnosis of endometrial cancer.

Gynecologic cancers can have profound effects on function of women''s life. In women with ovarian cancer، treatment leads to changes in the anatomy and function of the vagina. This study was performed with aim to evaluate sexual dysfunction in women with ovarian cancer.

This cross-sectional study was performed on 210 women with ovarian cancer admitted to Mashhad Ghaem and Omid hospitals and 130 healthy women who were matched with our patients in terms of age from 2009 to 2013. The subjects completed the form of sexual function questionnaire (FSFI) through an independent inquiry. Data was analyzed by SPSS software (version 16. 5).

31. 9% of patients were within 5 decades of life and had mean age of 48. 15 years. According to Pearson test، the prevalence of sexual dysfunction was 85. 7% in patients with ovarian cancer and 52. 9% in healthy women that the difference was significant (P< 0. 001).

Sexual dysfunction is more prevalent in patients with cancer compared to healthy subjects. Disorders were highly prevalent in the excitement and libido، vaginal moisture، orgasm and pain during intercourse.

Cervix is a rare and dangerous site for ectopic pregnancy. When the placenta is implanted lower than internal cervical os, it is called “cervical pregnancy”. Known risk factors for cervical pregnancy are previous cesarean section, cigarette smoking, premature transfer of fertilized ovum before having suitable endometrium and pelvic inflammatory disease. In the past, hysterectomy was the usual treatment. Nowadays, with the newer diagnostic and therapeutic managements, cases of cervical pregnancy treated by fertility sparing methods have been reported. Conservative treatments include using methotrexate and KCl, hyperosmolar glucose, and prostaglandins. Also, surgical methods with fertility sparing have been reported. The purpose of this study is introducing two cases of cervical pregnancies treated by fertility sparing. The first patient had six weeks pregnancy with live fetus and detectable fetal heart beat. There was six weeks menstrual retard and βhCG titer was 10.000 UI/ml. Two doses of methotrexate were prescribed and pregnancy terminated successfully. The other patient had eight weeks pregnancy with fetal heart beat. There was eight weeks retardation and βhCG titer was 70379 UI/ml with no gestational sac in sonography in both patients. After prescribing two doses of methotrexate and doing curettage three days after the last dose of methotrexate, pregnancy terminated. The known risk factors for our patients were history of endometrial curettage in one and history of cesarean section in both of them. Conservative method may be considered for the treatment of cervical pregnancy in patients who desire to preserve their fertility. The treatment is associated with high success rates. Methotrexate (MTX) is the most common medicine for resolving ectopic cervical pregnancy, other medications such as KCl, hyperosmolar glucose, RU486 and prostaglandins have also been used with different success rate. Methotrexate may be administered systemic (intramuscular or intravenous) or local (intra-amniotic transfusion or intrauterine).

The ovarian hyperstimulation syndrome is usually iatrogenic and occurs as a complication of ovulation induction. It may be associated with multiple pregnancy، molar pregnancy، hypothyroidism and rarely following hydrops fetalis. We report a case of ovarian hyperstimulation syndrome following hydrops fetalis. Case Report: The patient was a 35 years old woman with history of vaginal delivery with immune hydrops fetalis. She had abdominal pain، nausea، decrease of appetite. She was hospitalized with diagnosis of hyperstimulation syndrome. Clinical and laboratory signs of ovarian hyperstimulation syndrome appeared during hospitalization. The patient was discharged with good condition after two weeks of treatment.

The ovarian hyperstimulation syndrome following hydrops fetalis is a very rare complication. Other causes of abdominal pain and distention should be study.

Both fibrocystic change and phyllodes tumor are classified as fibroepithelial tumors of breast which are composed of epithelial and stromal components. Although as the most common benign breast lump fibrocystic lesions are known by symptom such as pain، nipple discharge، heaviness، usually in women’s third decade of life، mammographic and sonographic features often render them almost indistinguishable from phyllodes tumor. In view of the essential differences in terms of therapeutic planning which exist between these two tumors، their early and precise distinction is crucial to avoid problem such as patients’ anxiety and unwarranted tumors operation. In this article a case of fibrocystic change in a 24 year old woman is reviewed in which clinical signs and symptoms and mammographic changes are indication of phyllodes tumor.

Vulvar melanoma is a very rare tumor with the rate of 0.1-0.19/100000. It mostly occurs during post menopausal period. In this case report, our patient was a 43 years old woman, her symptom was a small pruritic lesion noticed two months earlier when she was referred to the clinic. This lesion was a 5mm diameter dark brown and flat on her left labialis minor. Malignant melanoma with 3-5mm thickness was diagnosted following biopsy. Wide local excision with more than 2cm free margin and inguino femoral lymphadenectomy at the site of the lesion was done. The recurrence of tumor was not abserved during four months follow-up.

Prophylaxis of Rh immunization has a critical role in the Rh negative pregnant women for prevention of fetal erythroblastosis. The aim of this study was to evaluate the fetomaternal hemorrhage (FMH) in relation to the delivery mode.

In this case- control study. 170 pregnant women (85 terminated by normal vaginal delivery and equal number by cesarean section) were studied in 2005 in Ghaem hospital affiliated to Mashhad university of medical sciences.The data was collected by a questionnaire, Klei hauver and Betke test was done, and the correlation between measured variables and FMH was studied. The results were analyzed by SPSS software (SPSS, Inc. Chicago, IL) version 11.5 by using The Students’t and Man-Whitney U tests.

The extent of fetomaternal hemorrhage was significantly different according to the gestational hypertension, twin pregnancy, still birth, abruptio placenta, placenta previa, gestational age and sex of the fetus; but there was no significant difference according to the mode of delivery, maternal blood group and Rh, maternal age, gravidity and the extent of fetomaternal hemorrhage.

In this study, there was no difference in the extent of FMH according to the mode of delivery and so the needed doses of anti-D.

Up to seventh week of gestation, progesterone secreted from the ovary is necessary to preserve the pregnancy. In the ART cycles GnRH-a is prescribed and oocytes and granulosa cells or retrieved, both causes corpus luteum insufficiency, so corpus luteum should be supported the best way is progesterone prescription. In this research we compare intramuscular and intravaginal suppositoar forms of progesterone for preserve the pregnancy. A prospective cross sectional evaluation on 193 patients was designed. All of them were on IVF or ICSI cycles. The patients were randomly divided into two groups. Intramuscular progesterone was prescribed in 138 and intravaginal progesterone (supp cyclogest) in 54 patients. The outcome of pregnancy was analyzed using statistical trials including t-test and chi-squre. The two groups were similar duo to age – the ethiology causes of infertility – the doses of proscribed HMG ampule – FSH titrago – the number and grade of transferred embryos. The day after HCG presciption until the end the seventh week in the first group (138 patients) intramuscular progestrone (50 mg /bid) and in the secound group (54 Patients) supp of cyclogest (400 mg / bid) was prescnbed. The rate of positive pregnancy test, abortion, successful poegnancy in this two groups were similar. Intramuscular or intravaginal progesterone for supporting corpus luteum in IVF or ICSI cycles has the same effect but the intramuscular route is cheaper.