فهرست مطالب صدیقه قاسمیان دیزج مهر

Epithelioid trophoblastic tumor (ETT) is a kind of trophoblastic tumors that is arising from placenta. Since it is extremely rare, estimation of its prevalence is difficult. Involvement of lower uterine segment and cervix in this tumor is unique when compared with other types of trophoblastic tumors. ETT is similar to placental site trophoblastic tumors (PSTTs), in terms of growing slowly, producing low levels of HCG and resistance to chemotherapy. Optimal surgery is always the first and the best approach. In this article, an extremely rare case of metastatic ETTs in the lymph nodes is reported.

A 49 year old women G3L3 presented with menorrhagia in recent 4 months and being severe, she underwent emergency curettage. Pathology report was pregnancy products. Because of exaggerated vaginal bleeding and plateaued hcg levels (40MIU/MIL), hysterectomy was performed. Pathology report was ETT.

Abnormal vaginal bleeding can be the signs of normal or abnormal pregnancy and it is necessary to check hcg level. ETT is usually associated with misdiagnosis or delay in diagnosis which leads to mismanagement of the disease and reducing its survival. Therefore, in diagnosis of molar diseases, regarding to resistance to chemotherapy, the best surgical approach should be performed for the patient.

Spleen is an immunologic organ and has critical role in prevention of capsulated microorganism infection. Accessory spleen after splenectomy is important due to this immunologic effect. On the other hand, accessory spleens should be considered in differential diagnosis of abdomino-pelvic masses. In this report, we present a rare case of pelvic mass with final diagnosis of autoimplantationof accessory spleen on the mesentery of the rectum.

The patient was a 32-year-old nulligravidarum woman with history of primary infertility and previous splenectomy due to spleen trauma in childhood without the history of hospitalization due to infection. The imaging results showed solid and hypervascular pelvic mass following IVF assessment.
The patient was admitted in Gynecology Oncology Surgery Section in Emam Khomeini hospital, Tehran University of Medical Sciences. She underwent laparotomy, and the result due to the frozen section pathology, was reported as accessory spleen.

Abdominopelvic masses with normal serum tumor marker, especially in patient with previous trauma and splenectomy, should be considered in differential diagnosis of accessory spleens, and should be confirmed with exact assessment by nuclear scan or laparoscopy, so that by accidental resection of these kind of masses the immunological safety of patients wouldn't be at risk.

Fibroma is a sex cord-stromal tumor of ovary, a benign tumor and due to the source of stromal, it cannot produce CA125. CA125 is produced from epithelial cells of the peritoneum, Pleural, pericardium, endocervix, endometrium and fallopian tubes. In this article, a rare case of fibroma with increased CA125 levels is reported.

The patient was a 48-year-old nulligravida woman with regular menstrual cycles, with a history of infertility that had undergoing IVF; during an ultrasound, a left ovarian mass was detected. The mass was solid with size of 160×100×90 mm in the left ovary and due to its association with high ascites, pleural effusion, and high CA125; she was admitted to the Imam Khomeini Hospital of Tehran.

Increased CA125 levels and its association with adnexa masses, ascites and pleural effusion are the manifestations of malignant ovarian masses. Increased CA125 is not necessarily associated with malignancy, however, it should be considered as a differential diagnosis of Meigs' syndrome which is associated with benign ovarian fibroma masses. Evaluating the cytology of ascites and sending the mass to the pathology of frozen section during surgery should be used to prevent extensive surgeries and loss of fertility. In this patient, fibrothecoma was diagnosed based on Frozen and fibroma was a definitive diagnosis based on pathology.

Sclerosing stromal tumor (SST) is a rare tumor of sex cord stromal tumor. Regarding to specific clinical, historical and hormonal feature, it has been differentiated from sex cord stromal tumor. In this study, a rare case of ovary sclerosing stromal tumor is reported.

A 37-years-old woman with history of one pregnancy, one normal delivery and 3 months amenorrhea referred to physician and was evaluated. Sonography showed a solid cystic mass in right adnexa, intraperitoneal free fluid and normal tumor marker, and was admitted in Emam khomeini hospital, Tehran university of medical sciences with possible diagnosis of malignancy and underwent open surgery. The mass was released from the tissue around the ovary and was sent to frozen section pathology. She underwent right salpingo oophorectomy according to the possibility of stromal sclerosing tumor.

Solid masses with intraperitoneal free fluid are considered as the cases of differential diagnosis of ovary malignant tumor, but some benign tumors such as SST could present with malignant feature in sonographic pattern, it is suggested to do limited surgery with preserving ovary before excessive surgery and sending the sample to frozen section and pathology confirming of benign tumor based on ovary sclerosing stromal tumor.