فهرست مطالب لعیا شیرین زاده

Didelphys uterus is one of the rare cases of mullerian anomalies that in most cases, remains asymptomatic until pregnancy and delivery. In women with mullerian anomalies, pregnancy and delivery are associated with more complications such as preterm labor that requires more attention to such pregnancies. Most cases of pregnancies in Didelphys uterus are reported in the left cavity. Ultrasound and MRI can be used to diagnose it.

The patient was a 21 year old female with history of dyspareunia and one spontaneous abortion at 38 weeks of pregnancy who referred to the maternity complaining of amniotic fluid leakage and labor pain. Longitudinal vaginal septum was diagnosed during the vaginal examination. The patient underwent a cesarean section due to thick meconium-stained amniotic fluid far from delivery and a healthy term baby was born. Didelphys uterus was seen and the fetus was in the right cavity.

Despite the high incidence of pregnancy complications in pregnancies with mullerian anomalies, sometimes these pregnancies continue without complications until term.

preeclampsia is one of the rare symptoms of molar pregnancy and is more prevalent in pregnancies with large volumes of abnormal trophoblastic tissue. Preeclampsia is associated with hypertension and proteinuria and rarely occurs in patients with Hydatidiform mole. Since in most cases, molar pregnancy is diagnosed by sonography at first trimester of pregnancy, the possibility of gestational trophoblastic disease should be considered in all patients with preeclampsia in first trimester of pregnancy. The aim of this report is to introduce a case of hydatidiform molar pregnancy with preeclampsia in 6th weeks of pregnancy.
Case report: A 15-year-old primigravid female with 6 weeks of menstrual retardation and diagnosis of molar pregnancy with increase of β-HCG titers, proteinuria and upper extremity edema was referred to emergency of maternity ward of an academic hospital, Mashhad University of Medical Sciences in 2017. Preeclampsia was confirmed. After curettage, hydatidiform mole was diagnosed. Preeclampsia associated with molar pregnancy was diagnosed. After mole curettage, blood pressure reached to normal and edema and other symptoms were gradually improved. Preeclampsia is one of the rare symptoms in molar pregnancy. Considering that in most cases molar pregnancy is diagnosed with ultrasound in the first trimester of pregnancy, it is recommended that hydatidiform mole should be considered in all patients with preeclampsia in early pregnancy

Ovarian superovulation and increased follicle-stimulating hormone concentration for infertility treatment may be the risk factors of developed granulosa-cell tumor. The aim of this report is to introduce a case of granulosa-cell tumor which was discovered after ovarian stimulation.

A 31-yr-old woman with clinical presentation of massive abdominal distention was referred to the gynecology and oncology department of an academic hospital, Mashhad University of Medical Sciences in Aug 2017. She had the history of secondary infertility and was undergoing In Vitro Fertilization protocol and ovarian stimulation, but, the cycle was canceled. The patient suffered from gradual abdominal distention one month after the end of IVF procedure despite pregnancy failure. 2-3 months after management of the ovarian hyperstimulation syndrome, investigation revealed large ovarian mass and increased tumor marker inhibin. Exploratory laparotomy was performed and revealed stage III ovarian cancer. The final pathology report indicated juvenile granulosa cell tumor. So, optimal surgical staging and cytoreductive surgery without fertility preserving were perfumed. Chemotherapy was recommended due to the advanced stage of ovarian cancer. Unfortunately, she experienced metastatic diseases in pelvic and abdomen in less than six months; and currently is receiving the second and third line chemotherapy.

Persistent ovarian enlargement or ascites during or after infertility treatment should be carefully considered and managed.

Ovarian cancer is a common malignancy in women, the major presentations of which are gastrointestinal symptoms. The intra-abdominal metastasis of ovarian cancer often occurs in the peritoneal cavity, while cervical metastasis has rarely been reported. This study aimed to present the case of a metastatic epithelial ovarian cancer to the cervix.
Case Report: A 58-year-old woman (gravida 3) was admitted with a history of postcoital bleeding in the oncology clinic of a teaching hospital affiliated to Mashhad University of Medical Sciences in 2016. Colposcopic examination was performed due to the abnormal appearance of the cervix, and pathology results confirmed squamous cervical cancer. Considering the early stage (II A) of the disease, the patient underwent a radical surgery. In laparotomy, due to the extent of the intra-abdominal metastasis similar to that of ovarian cancer, only omental biopsy was possible. The pathology report of the specimen showed the metastasis of the serous papillary adenocarcinoma of the ovary to the omentum. Furthermore, repeated review of the pathology of the cervical specimen was indicative of ovarian metastasis to the cervix. Due to the advanced stage of ovarian cancer, chemotherapy (taxol-carboplatin) was recommended, followed by standard optimal surgical cytoreduction. Afterwards, the patient was followed-up for ovarian cancer. After less than six months, she experienced pelvic and abdominal metastasis and is currently receiving palliative chemotherapy.
Cervical metastasis is an unusual occurrence at presentation and during the progression of epithelial ovarian cancer. As an initial symptom of ovarian cancer, postcoital bleeding is rare and should be considered in the patients with cervical cancer who are at the risk of metastatic lesions from the adjacent tissues.

Choriocarcinoma is one of the rare diseases of gestational trophoblastic tumor with various and sometimes misleading clinical presentations. Clinical suggestion of the disease and timely diagnosis can be useful. The aim of this study is to report a case of diagnostic medical error in postpartum choriocarcinoma.
Case report: A 25-year-old woman with prolonged postpartum hemorrhage referred to the hospital in one of the cities around Mashhad. Despite frequent referring of the patient due to bleeding, and not considering laboratory signs and sonography and increased levels of βhCG, gestational trophoblastic tumor was not diagnosed. It led to uterus rupture. Then, with emergency situation due to uterus rupture, multiple lung and brain metastases, she was referred to the gynecologic oncology ward in 2017. Currently, she is under chemotherapy without need to surgery.
The possibility of choriocarcinoma should be considered in every woman of reproductive age with postpartum abnormal uterine bleeding and also bleeding from other organs or diagnosis of metastasis with unknown etiology.

Severe vaginal bleeding after postpartum is an emergency in obstetrics and if not treated appropriately associated with high mortality. Uterine artery embolization is a minimally invasive procedure and effective method in addition to control bleeding, moreover may also preserve fertility. However, this method is also associated with complications such as ischemia and uterine rupture. The aim of this article is to report of a case of necrosis and rupture of the uterus following uterine artery embolization.
Case report: A 23-year-old woman with clinical presentation of massive postpartum hemorrhage was referred. She had history of twice Cesarean section and suffered severe vaginal bleeding after last surgery. Uterine artery embolization was performed and following it, because of repeated and uncontrolled vaginal bleeding, inevitably explorative laparotomy was performed. During surgery due to rupture of the myometrium and the impossibility of its restoration, she underwent hysterectomy. Pathology report confirmed the diagnosis.
Despite the effective beneficial outcomes of uterine artery embolization, due to its complications, proper indication and careful attention should be considered.

Pyoderma gangrenosum (PG) (ulcerating neutrophilic dermatosis) is a rare disease that about of half of these patients have a systemic disorder, particularly Crohn's and ulcerative colitis. In addition, inflammatory lesions play key role in its pathogenesis. In early diagnosis of disease, we will further prevent of serious consequences of the disease. In this report, a case of PG after the vaginal surgery with history of ulcerative colitis was introduced.
A 37-years old woman was admitted in an University Hospital of Mashhad University of Medical Sciences, Iran, in 2016 two weeks after genital surgery. The chief complaints were fever, painful tenderness, ulcerative lesion and inflammatory papule on surgical site and thigh. She suffered of fever despite received oral and then wide spectrum intravenous antibiotic therapy. Blood cultures and wound culture were negative. In addition to two deferent intravenous antibiotics, topical wound debridement was performed. Despite this course of treatment which did not improve the lesion, biopsy was performed. Histopathology features of biopsy specimen indicated prominent neutrophils mixed inflammation and lymphocytic vasculitis indicated as pyoderma gangrenous. The patient's medical history included associated ulcerative colitis from 18 years ago and she was under irregular oral receiving of Asacol (mesalamine). Intravenous corticosteroid therapy was administered which led to response of skin of right thigh and surgical site inflammation. After 6-months follow-up, the patient is still in good condition.
Based on major variable clinical manifestations and no diagnostic serologic test of pyoderma gangrenosum, diagnosis of this disease is difficult. Increased awareness about PG and exclusion of other etiologies such as inflammatory and immunologic disease will aid in prompting of pyoderma gangrenosum diagnosis and proper management of the disease.

The most common symptom of patients with gestational trophoblastic neoplasia is abnormal vaginal bleeding. Despite repeated visits of patients with postpartum choriocarcinoma and abnormal postpartum hemorrhage, delayed diagnosis leads to advanced disease with widespread metastasis. Therefore, occurrence of choriocarcinoma with variable patterns in different diagnosis of late onset postpartum hemorrhage should be considered. Early diagnosis of choriocarcinoma after term pregnancy is important that resulted in decrease of maternal morbidity. Therefor late onset postpartum hemorrhage should have an awareness. The aim of this study was to report a case of choriocarcinoma after caesarian section.
A 33-years-old woman one month after antecedent caesarian section in her second pregnancy admitted with abnormal vaginal bleeding. Based on raised titer concentration of β-hCG was 187000 u, with clinical suspicious of choriocarcinoma she was referred to oncology department of Ghaem Hospital, Mashhad University of Medical Sciences, Iran, in 2016. Vaginal exam revealed an enlarged uterus about 10 weeks of pregnancy. Transvaginal sonography showed an intracavitary heterogeneous mass with irregular surface in fundus without myometrium invasion. Extra pelvic metastasis excluded via vaginal exam, pulmonary X-ray and, ultrasonography and computed tomography scan. Due to early stage of gestational trophoblastic neoplasia and diagnosis of this condition, single agent chemotherapy (methotrexate) was recommended, but because of unresponsive disease, subsequently, she was treated with combination chemotherapy (etoposide, methotrexate, and actinomycin, followed by cyclophosphamide and vincristine) that led to remarkable response. After three courses of therapy, normal level of β-hCG was observed and now the patient is free of disease and under-serial follow-up visit for choriocarcinoma.
Diagnosis of choriocarcinoma should be considered in any postpartum woman with abnormal vaginal bleeding.

Vulvar cancer, primary or metastatic, is a rare tumor constituting Case report: A 56 years old woman with history of renal cell carcinoma with ulcerative vulvar mass referred. Biopsy of vulva reported metastasis of renal cell carcinoma. Patient underwent local resection of lesion and chemotherapy.
The high clinical suspicion for vulvar metastasis should be considered in women with history of cancer who refer with vulvar lesion. Early diagnosis and appropriate treatment can affect the prognosis of these patients.