فهرست مطالب azamsadat mousavi

Cervical cancer is prevalent cancer among women that correct diagnosis has very important role in its treatment.

The aim of this study was to evaluate the accuracy of magnetic resonance imaging (MRI) in comparison with surgical staging. Also, we compared the accuracy of physical examination with surgical pathology.

This retrospective cross-sectional study was performed on women who had cervical cancer from the start of 2017 to the end of 2021. Age, tumor pathology report (squamous cell carcinoma, clear cell carcinoma, adenocarcinoma, and small cell carcinoma), stage of the tumor, involvement of vagina, uterine, and parametrium, cervical stroma invasion, mass size, pelvic and abductor lymph node metastasis were extracted from the patient’s data and all were evaluated. The pathology report was considered as the gold standard.

Eighty women with cervical cancer were evaluated and the mean age was 47.3 years. There was a statistically significant difference between the different prevalence of disease stages (P-value = 0.035) and also stage diagnosis between the three methods (P-value = 0.0004). The diagnostic accuracy of physical examination and MRI in terms of vaginal involvement, parametrium involvement, and uterine involvement were 97.5% and 98.7%; 98.7% and 96.2%; 94.9% and 93.6%; respectively.

Magnetic resonance imaging is a good method for the assessment of the clinical staging of cervical cancer and its accuracy is more than 94% in the diagnosis of different parts of cervical cancer involvement.

Methotrexate (MTX) and actinomycin D (ActD) have been used as first-line chemotherapy agents in the treatment of low-risk gestational trophoblastic neoplasia (GTN). Although low-risk GTN is considered a curable disease, its reported primary remission rates of 49 to 93% reflect the difficulties of treatment and different factors influencing it. Hence, this study aimed to determine the remission rates and related factors of single-agent chemotherapy resistance in low-risk GTN patients.

This retrospective study included patients with diagnosed low-risk GTN who received either MTX once a week (IM, 30mg/m2) or ActD once every two weeks (pulsed IV, 1.25mg/m2). Then, the patients were followed-up until complete remission or single-agent treatment failure to assess resistance rate and related factors.  

Eighty-four patients were included in the study (18 patients were receiving MTX and 66 patients were receiving ActD). 85.7% of all participants achieved complete remission after first-line chemotherapy (72.2% in MTX vs 89.4% in ActD). There was a significant association for higher tumor size (P=0.046), the occurrence of metastasis (P=0.019), and pretreatment β-HCG levels (P=0.005) with resistance to treatment.

This study demonstrated higher tumor size, the occurrence of metastasis, and pretreatment β-HCG levels have been associated with increased resistance to first-line chemotherapy agents.

More than 75% of epithelial ovarian cancer (EOC) cases are diagnosed in advanced stages, which is associated with tumor recurrence and chemotherapy resistance. So far, to the best of our knowledge, a similar study has not been conducted in Iran to investigate the clinical characteristics and survival rate of these patients treated with neoadjuvant chemotherapy (NACT).

This study aimed to evaluate the clinical characteristics and survival of patients treated with NACT followed by cytoreductive surgery and the factors affecting survival.

This retrospective cohort study was conducted on 147 advanced ovarian cancer cases who were treated with NACT referring to the Gynecology Oncology Department of Imam Khomeini Hospital in Tehran, Iran, between 2011 and 2021 and met the inclusion criteria for this study. The survival curve and Cox regression method were used to analyze the data.

The results revealed that 8.9% of advancedEOC (147/1,650) were treated with NACT and the average number of NACT courses was 4.12 periods. The survival rates of 1, 3, 5, and 8 years were 85.31%, 44.05%, 18.35%, and 13.77%, respectively. The mean and median of survival time were 47.7 and 36 months,respectively. Nearly 80% of the patients had stages 3C and 4A before receiving NACT. Based on the results of the adjusted Cox regression model, tumor marker level showed a significant relationship with survivalrate (P=0.008), and also peritoneum involvement had a clinically significant impact on survival with a hazard ratio of 2.88.

The results suggested that8.9% of ovarian cancer cases were treated with NACT. It was also revealed that the average number of NACT courses was 4.12 periods and the 8-year survival rate was 13.77%. CA125 tumor marker level showed a significant relationship with survival rate, and peritoneum involvement had a clinically significant impact on survival.

Cervical cancer is one of the most common cancers in women. One of the most important indicators that deal with all aspects of the patients' health is the Health-related quality of life (QOL). In this study, the QOL of women with cervical cancer in Iran was investigated.

The present cross-sectional study examined the QOL of 139 patients with cervical cancer referred to Imam Khomeini hospital, affiliated with the Tehran University of Medical Sciences. For this study, a specific questionnaire of QOL in patients with cervical cancer was used. To determine the predictors of cervical cancer patients, the QOL linear regression model was used.

 Findings of this study showed that the total score of QOL of patients was 20.97±1.29. Moreover, in the regression model, a significant relationship was observed between the type of treatment and patients' QOL scores and those patients who had neoadjuvant therapy plus surgery (β=-17.45, P=0.02) and those who received brachytherapy (β=- 14.86 and P=0.09) had a significantly lower QOL score.

Overall, the QOL of people with cervical cancer was moderate. Implementing educational programs for service providers and choosing the appropriate type of treatment according to the stage of the disease and the patient's age can help control this type of disease and its complications and improve the QOL of patients.

Persistent infection with some types of Human papillomavirus (HPV), which are high-risk genotypes, can lead the patients toward cervical cancer and, finally, death. Recent studies showed HPV co-infection with non-HPV sexually transmitted infections (non-HPV STIs) could increase the persistency rate of HPV infections. This study aimed to estimate the prevalence of STIs and assess the association of HPV/non-HPV STIs co-infection on cervical cell changes based on cytological findings.

In this cross-sectional study, in addition to the routine cervical screening, including HPV testing and cytological assessment, non-HPV STI testing was performed on 1065 Iranian women. To assess the HPV and non-HPV STIs, commercial kits were used.

964 (90.5%) women had normal cytology (NILM) results. The overall prevalence of HPV and non-HPV STIs were 39.1% and 68.5%, respectively. HPV-53 (6.5%), -16 (6.1%) and -31 (5.5%) were found as the most prevalent genotypes. Ureaplasma Parvum (UP) (42.7%), Group B Streptococcus (GBS) (23.7%), Candida Species (CS) (23.6%), Ureaplasma Urealyticum (UU) (9.6%), and Mycoplasma Hominis (MH) (7.1%) were found as the most prevalent non-HPV STIs. The co-infection of HPV with GBS played an important role in developing the cervical lesion (P<0.05).

In the present study, the STIs, including HPV, UP, GBS, CS, UU, and MH, were prevalent among the study participant, and it was found that the HPV/GBS co-infection played a significant role in the development of LSIL or worse cytological grades. To clarify this issue, further studies will be conducted.

 The present study aimed to assess the significance of human epididymis protein 4 (HE4) and cancer antigen 125 (CA 125) in the overall survival (OS) and the recurrence survival of endometrial cancer.

The study was conducted on 99 patients with a mean age of 53±64. The patients were all cases with a definitive diagnosis of endometrial cancer. With regard to the histology and the surface measurement, the HE4 and CA 125 were both confirmed within 1 to 2 week(s) prior to hysterectomy by implementing the standard-procedure treatment of extra facial total hysterectomy and bilateral salpingo-oophorectomy with selective pelvic and para-aortic node dissection. Then, risk-assessment for possible recurrence (Mayo criteria) was carried out as well. Patients with the variables of HE4 and CA 125 in the upper third (66th) percentiles were grouped as high-risk. Finally, the data were analyzed using SPPS 23, and P <0.05 was considered statistically significant.

The mean (SE) of OS among patients with the serum CA 125 of ≤22 kU/L and higher 22 kU/L was 47.97 (±2.58) and 41.78 (3.75) months (P = 0.466). In addition, the mean (SE) of OS in patients with the serum HE4 level of ≤ 98 ρmol/L and >98 ρmol/L was 50.14 (2.06) and 38.54 (3.74), respectively. The log-rank test revealed a substantial difference between low- and high-risk groups by HE4 ( χ2=4.98, P = 0.025). Accordingly, there is no significant difference between recurrence-free survival (RFS) with CA 125 (P = 0.264) and HE4 ( P = 0.114), respectively.

In general, the serum HE4 level is a significant independent prognostic factor for OS in endometrial cancer and is useful in survival studies.

 Recent advances in molecular testing for human papillomavirus (HPV) has increased the accuracy of cervical screening programs. This study intended to estimate the diagnostic value of high-risk (HR) HPV DNA- and E6/E7 mRNA-based methods for triage of Iranian women with abnormal cytological results regarding the histopathological cut-off.

In this cross-sectional study, 360 non-pregnant women (≥ 21 years) who had faced abnormal cytological findings (ASC-US and LSIL) were enrolled and referred for further diagnostic tests. The INNO-LiPA® HPV Genotyping Extra-II and Aptima HPV assay kits were used in DNA- and E6/E7 mRNA-based methods for detection of HR-HPV. Regarding the CIN-2+ histopathological cut-off, the diagnostic value of each molecular-based assay was calculated.

Among the study participants, 260 cases had ASC-US, and 100 had LSIL. The overall positivity rate for DNA- and mRNA-based methods was 74.4% (268/360) and 64.2% (231/360), respectively. Fifty-nine (16.4%) individuals showed CIN-2+. The DNA-based test showed higher sensitivity (100%) than the mRNA-based method (93.2%), while the mRNA-based method revealed greater clinical specificity (41.5%) compared to the DNA-based test (30.6%).

Our results revealed appropriate clinical sensitivity of the molecular-based methods for triage of Iranian women with abnormal cytological results; however, the mRNA-based method showed greater specificity for detection of CIN-2+.

We aimed to evaluate treatment responses and recurrence rate of atypical endometrial hyperplasia (AEH) and endometrial endometrioid adenocarcinoma (EA) with Stage IA Grade 1 to megestrol in Iranian patients who are candidates for medical treatments.

In a retrospective cohort study that was conducted on 50 patients with AEH and 22 patients with EA who were referred to the oncology clinic of Imam Khomeini Hospital, Tehran, Iran, during 2006–2016, we recruited all patients with AEH or EA of Stage IA Grade 1 and their disease was diagnosed during endometrial curettage with or without hysteroscopy. Patients were initially treated with 160 mg of megestrol daily, along with aspirin up to 3 months, and then after 3–4 weeks of discharge of the drugs, patients underwent curettage with hysteroscopy.

The patients with AEH had 31 complete responses and five progressive diseases, and the patients with EA had seven complete responses and seven progressive diseases. After treatment, 25 cases with AEH and 5 cases with EA had an intention to get pregnant, whereas eight patients with AEH and 1 case with endometrial cancer became pregnant. Recurrence occurred in the 2 cases with AEH and 2 cases with endometrial cancer which the time of recurrence in the patients with AEH was longer than in patients with endometrial cancer (P = 0.011).

Megestrol is an effective therapeutic agent in endometrial hyperplasia or low-grade endometrial cancer patients who are willing to conserve their childbearing.

In recent years, before radical hysterectomy, neoadjuvant chemotherapy (NACT) has been administered to patients with locally advanced cervical cancer to shrink large tumors. It has been reported that this treatment significantly reduces the need for radiotherapy after surgery. The current study aimed to assess the outcome (survival, recurrence, and the need for adjuvant radiotherapy) of locally advanced cervical cancer in patients treated with NACT followed by radical hysterectomy and primary surgery.

In a retrospective cohort study, the records of 258 patients with cervical cancer (stage IB2, IIA, or IIB), who referred to Imam Khomeini Hospital (Tehran, Iran) from 2007 to 2017 were evaluated. The patients were assigned into two groups; group A (n=58) included patients, who underwent radical hysterectomy and group B (n=44) included those, who underwent a radical hysterectomy after NACT. The outcome measures were the recurrence rate, five-year survival rate, and the need for adjuvant radiotherapy.

The median for overall survival time in group A and B was 113.65 and 112.88 months, respectively (P=0.970). There was no recurrence among patients with stage IB2 cervical cancer in group B, while the recurrence rate in group A was 19.5% with a median recurrence time of 59.13 months. Lymph node involvement was the only factor that affected patients’ survival. The need for postoperative adjuvant radiotherapy in group B was lower than in group A (P=0.002).

NACT before the hysterectomy was found to reduce the need for postoperative radiotherapy in patients with locally advanced cervical cancer according to disease stages. As a direct result, adverse side effects and the recurrence rate were reduced, and the overall survival rate of patients with stage IIB cervical cancer was increased.

Human papillomavirus (HPV) has been found as the most considerable causes of cervical cancer. Recently, several molecular methods have been introduced to increase the accuracy of the screening programs and decrease the mortality rate. Among these methods, mRNA-based methods have more advantages as they assess the expression level of HPV E6 and E7 oncogenic mRNAs. This study aimed to evaluate the results of HPV RNA- and DNA-based methods among Iranian women population with normal cytology results.

Overall, 4640 women were enrolled referred to the Gynecology Oncology Ward of Vali-e-Asr Hospital, private and academic clinics, Tehran, Iran from Jan 2016 to Apr 2018. To assess the HPV-DNA infection INNO-LiPA® HPV Genotyping Extra-II kit was used. For HPV-RNA assessment, Aptima HPV Assay and in house HPV-RNA genotyping methods were applied.

The positivity rates of HPV infection according to DNA- and RNA-based methods were 18.0% and 11.2%, respectively (P<0.001). The positive predictive value, negative predictive value, specificity and sensitivity of DNA-based method in contrast with RNA-based method were 59.2% (56.6-61.6), 99.4% (99.0-99.6), 91.7% (90.8-92.6) and 95.2% (93.0-96.9) respectively.

At the present study for prognosis of cervical cancer, RNA-based method seemed to be more specific in contrast to DNA-based method. Patient follow up and further studies will be conducted in order to clarify the clinical sensitivity and specificity of the two methods.

Cytology testing has been successful in reducing the incidence of cervical cancer and mortality. Molecular testing like HPV typing and Aptima test can improve screening effectiveness. We compared the diagnostic value of cytology testing, High-risk (HR) HPV DNA typing, and APTIMA tests based on the results of the cervical biopsy in the diagnosis of cervical cancer and neoplasia in patients referred to Imam Khomeini Hospital.

One hundred fifty women between 21 and 56 years old who referred to having clinical symptoms or conducting screening tests enrolled in the study. Sensitivity, specificity, positive and negative predictive values, and accuracy for cervical involvement were calculated for cytology, High-risk HPV testing, and APTIMA tests separately.

The most abundant genotype found was HPV 16. cytology testing had a sensitivity of 59% for CIN 2+ and a specificity of 61% for CIN 2+. For CIN I, the sensitivity and specificity of cytology testing were higher (63% and 71%, respectively). High-risk HPV typing had the highest sensitivity (76%) for CIN 2+, but its specificity was low (66%). Its sensitivity was 51% for CIN I with a specificity of 74%. APTIMA tests had a sensitivity of 53.7% and a specificity of 87.5% for CIN2 +, which was less sensitive to High-risk HPV typing but was more specific. The APTIMA test sensitivity for CIN I was very low (22.2%), but its specificity was high (87.5%).

High-risk HPV typing showed the highest sensitivity (75.9%) and APTIMA tests had the highest specificity (87.5%) in predicting CIN 2+.

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.

Uterine endometrial cancer (EC) is the most common female reproductive system malignancy. There are various comments on pelvic and para-aortic lymphadenectomy during the surgical staging of EC. Several oncologists believe that total lymphadenectomy, in some cases, may lead to operative morbidity without any considerable advantage over more surveillance, especially in patients with comorbidities. The purpose of the current study was to examine the correlation between serum tumor marker levels and stage, grade, histological type, myometrial invasion, and lymph node involvement in EC.

A total of 131 patients with EC participated in the present cross-sectional study. Preoperative serum CA125 and HE4 levels were evaluated 1 week before surgery. Then, the stage, grade, and lymph node involvement were recorded according to the pathological findings. After Data analysis through SPSS software, P value<0.05 was considered to be significant.

One hundred thirty-one patients with EC (70, 31, 15, and 15 patients in sequence with stages IA, IB, II, and III) were analyzed. The serum CA125 and HE4 levels were significantly higher in more advanced stages (over IA), (P = 0.016 and P = 0.004, respectively). Levels of both tumor markers were significantly higher in patients with lymph node involvement, and cervical and myometrial invasions. In logistic regression analysis, a significant correlation was found between HE4 level (odds ratio [OR] = 1.005, P = 0.035) and grade of disease (OR = 2.137, P = 0.005).

HE4 and CA125 are useful for predicting high-risk patients. Sensitivity of 64% and specificity of 60% were indicated at cut-off value of 70 pmol/L for HE4 in stage IA in comparison with stages over IA. Although the ideal cut-off which is defined as higher than 80% was not obtained, such a cut-off (60%) can also be considered for preoperative evaluation of surgical staging of EC.

The aim of this study was to determine the 3-year overall survival among the epithelial ovarian cancer patients based on the histology, age, and the stage of the disease in Iran during 2011-2017.

This study was a cross-sectional retrospective study that was conducted on 179 newly diagnosed patients with epithelial ovarian cancer, who had referred to the gynecologic cancers clinic in a referral training hospital in Tehran during 2011-2017. The patients’ data including the demographic characteristics of the patients, the stage of the disease, and the treatment type were analyzed based on the pathologic responses.

Among 220 newly diagnosed patients with epithelial ovarian cancer, 179 of them were suitable for the follow-up. There were 93 death and 85 living cases among these patients and the mean age of the patients was 50.5 ± 11.3. In addition, most of the patients were in stage 3 (60.9%) and 6.7% of them were in stage 4. The most common pathology was serous adenocarcinoma (70.9%). In this study, the overall survival rate had no connection with the type of tumor histology but it was related to the stage of the disease (P=0.05). Finally, there was no mortality in stage one and among the mucinous adenocarcinoma cases.

The survival in the epithelial ovarian cancer was related to the stage of the disease and among all the pathologies, mucinous adenocarcinoma and clear cell carcinoma had the best survival rate.

Context: Pelvic masses are a prevalent cause for referral to gynecologic oncology departments to evaluate the possibility of benign or malignant conditions. Pelvic mass often was found in pelvic examinations among females with ovarian. Tumor markers are advantageous biomarker in tumor diagnosis. Evidence Acquisition: We performed a computerized search in Medline/PubMed databases and Google Scholar with key words: “Cancer antigen 125 (CA125), Human epididymis protein 4 (HE4), risk of ovarian malignancy algorithm (ROMA), Risk of malignancy index (RMI), and Pelvic mass”. The usage of tumor marker CA125 alone is associated with serious limitations like low sensitivity for early or stage I disease and lack of specificity especially in pre-menopausal women. Serum HE4 is a good biomarker for discriminating ovarian cancer from benign pelvic disease, but could be affected by several factors including pregnancy, age, and smoking. ROMA has a high sensitivity, specificity, and negative predictive value to predict the presence of ovarian cancer in women with a pelvic mass. RMI could differentiate between benign and malignant pelvic masses, but RMI expression was higher in women with 55 years or more. According to the results of this study, combination of these biomarkers or at least 2 or 3 biomarkers are suggested for early stage diagnosis of pelvic mass with high sensitivity and specificity.

In this study we aimed to evaluate diagnostic accuracy of magnetic resonance imaging (MRI) and transvaginal sonography (TVS) in identifying the depth of myometrial invasion and cervical involvement and also their relationship with the uterine arteries resistance index (RI) and pulsatility index (PI) in endometrial carcinoma.
We performed a prospective study on 45 women with histologically confirmed diagnosis of endometrial carcinoma. The study was performed from October 2009 to December 2012. All the patients were evaluated by 3T MRI and TVS and transvaginal color Doppler sonography of uterine arteries. All the patients underwent hysterectomy and the result of imaging and pathologic studies were compared.
Mean age was 54.5 ± 10.8 years (33 to 77 years), mean gravid was 3.93 ± 2.8 and the mean parity was 3.9 ± 2.5. The pathology results indicated 29 patients (64.4%) in stage IA and 16 patients (35.6%) in stage IB. Mean endometrial thickness in stage IA patients was 18.4±14.4 mm and in stage IB patients was 38.5±11.5 mm. TVS also showed positive predictive value (PPV) of 76.5%, negative predictive value (NPV) of 88.9%, sensitivity of 81.3%, specificity of 85.7%, and accuracy of 84.1% for assessment of the depth of myometrial invasion in endometrial carcinoma. We found PPV of 86.7%, NPV of 92.3%, sensitivity of 86.7%, specificity of 92.3%, and accuracy of 90.2% for MRI study.
TVS can evaluate the depth of myometrial invasion with an acceptable accuracy when MRI is not available or cost-effective, or when MRI is contraindicated. Both preoperative MRI and TVS can predict low risk patients (less than 50% of myometrial invasion) accurately; thereby avoiding lymphadenectomy in these patients.

The present study sought to examine the effectiveness of evaluation of teachers' competency in EFL classrooms on Iranian learners' motivation. The study was conducted at Alzahra technical school in Qazvin, Iran. 300 female EFL students at intermediate level of proficiency comprised the participants of this study. The researchers selected the participants based on convenience sampling and divided them into two equal groups; each group was randomly assigned to one of the treatment conditions. In the experimental group, the principal observed the classes and constantly reminded the teacher that all the positive and negative points would be taken into account. After eight observation sessions, the principal evaluated the teacher. Throughout all these eight sessions, the teacher was expected to provide a supportive environment in the classroom, and a friendly relationship was expected between the teacher and the students. In the control group, the teacher was not evaluated by the principal. Before and after the experimental period, a motivation questionnaire was administered to both groups of participants to compare the two conditions. An ANCOVA procedure was used to analyze the data. The findings revealed that the evaluation of teachers' competency in EFL classrooms has a statistically significant relationship with Iranian learners' motivation. These findings may have pedagogical implications for language teachers and learners.

Introduction:

 Timely diagnosis of gestational trophoblastic neoplasia (GTN) is essential for successful management of the condition and preservation of fertility. The aim of the present study was to describe a case of misdiagnosis GTN with brain and lungs metastasis.

Patient information :

the present case study was conducted in Imam Khomeini hospital, Tehran, Iran, in 2017. A 35-year-old woman presented with acute headaches and left hemiplegia one month after the conclusion of her term pregnancy. The patient was previously diagnosed as a case of subarachnoid hemorrhage and inferior sagittal sinus thrombosis and was unsuccessfully treated with anticoagulant drugs leading to worsening signs and symptoms. Her initial β-hCG at admission to the hospital was 22,000,000IU/L, which lead to diagnosis of GTN with extensive metastatic lesions in the lungs and brain. Due to extensive intracranial hemorrhage, the patient was first treated with whole brain radiation therapy for 10 sessions daily (Total Dose=3000cGy). EMA-EP treatment was initially withheld due to concern for bleeding during concurrent radiation therapy. Following the brain radiation therapy, the chemotherapy was started for the patient. Upon completion of 3 cycles of EMAEP, the patient’s hCG was lowered to 5IU/L. The treatment was continued for 5 more cycles and resulted in hCG reading of under 2IU/L at her last visit.

Conclusion :

This case highlights the variable presentation of GTN which might easily cause misdiagnosis and delayed treatment and shows excellent response to treatment despite late treatment and massive tumor burden with some modifications to plan of treatment

Cervical cancer is the third most common cancer in women, and its annual incidence is more than 500,000 cases in the world and is the most common cause of death due to gynecologic cancer in America in 2011. The pursuit of abnormal Pap smear with the help of high-sensitivity diagnostic methods requires to evaluate the diagnostic value of Pap smear compared with colposcopy in diagnosing the abnormal cases and timely treatment and reduce the mortality from cervical cancer. Therefore, this study was performed with aim to evaluate the diagnostic value of Pap smear compared with colposcopy in diagnosing the abnormal cases of cervix.
This cross-sectional descriptive study was performed on 172 women with abnormal Pap smear who referred to the gynecology clinic of Yasouj and had undergone colposcopy in 2015. Data collection tools included a checklist (demographic and midwifery characteristics, Pap-smear report and colposcopic examination), and data collection method was through examination and observation. Data were analyzed by SPSS software (version 19) and Chi-square test. P In this study, 55 patients (31%) had abnormal colposcopy and 22.1% of abnormal cases were aceto withe. 117 cases (68.0%) of abnormal pap smears were diagnosed by normal colposcopy, which indicated the compliance of pap smear and colposcopy with an agreement coefficient of 30% (p = 0.032). The most compliance of pap smear and colposcopy was obtained in a high-grade lesion (CIN3), and the least complication was reported in cases which pap smear showed a mild-grade lesions (CIN1, CIN2). The diagnostic sensitivity of colposcopy was obtained 93%, so the diagnostic accuracy of colposcopy (54.3%) was higher than pap smear (41.26%).
Colposcopy compared with Pap smear has higher efficacy and diagnostic accuracy in finding the early stages of cervical cancer. The most compliance of pap smear and colposcopy was obtained in a high-grade lesion (CIN3).

Currently, the prevalence of borderline ovarian tumors (BOT) is increasing, and given the higher diagnosis in the third and fourth decades of life, fertility sparing procedures are widely used. There are important consequences in females with borderline ovarian tumors and number of effective factors on recurrence and fertility rate.

In this cohort study, the required information was collected from a file of 43 patients with final pathologic diagnosis of borderline ovarian tumor, who had undertaken fertility sparing surgery at Imam Khomeini Hospital, Tehran University of Medical Sciences, and recurrence rate, fertility rate, and the effect of different variables were studied.

There were significant correlations between oral contraceptive pill (OCP) consumption, serous pathology, micro invasion in pathology, advanced stages, and recurrence rate of BOT, while this relationship was not found between parity, surgical methods (laparotomy and laparoscopy), surgical techniques (cystectomy and USO), papillary projection, and recurrence rate.

Although the recurrence rate was higher in the current research when compared to other previous studies, yet only in one patient, the pattern of recurrence was invasive epithelial carcinoma, thus in the current study the overall survival did not seem to change. The results of this study on fertility rate are comparable to other studies on this issue. Therefore, these methods are recommended for young patients and emphasis should be place on follow-up.

Epithelial ovarian cancer (EOC) is the fifth leading cause of cancer death in women. Primary surgery, followed by adjuvant chemotherapy is the basis of treatment for this disease. A standard treatment includes primary surgery and if possible optimal debulking surgery (tumor residue of <; 1 cm), followed by a chemotherapy; paclitaxel-carboplatin is the standard regimen in ovarian cancer. Given that the main method of spreading this disease is in the peritoneal cavity, the systemic chemotherapy brings about numerous complications; moreover, as the method of prescribing a drug inside the peritoneum causes a high drug concentration in the peritoneal cavity, conducting an intraperitoneal chemotherapy has been examined clinically. In cases of ovarian cancer recurrence, performing a secondary cytoreductive surgery, in addition to hyperthermic intraperitoneal chemotherapy (HIPEC), has led to a good survival among patients. Currently, studies are ongoing to better explain the effects of this treatment method compared to previous methods.

Peritoneal cytology has been reported to be an independent risk factor for poor survival, but it is not included in the current international federation of gynecology and obstetrics (FIGO) staging system for risk stratification.
We aimed to investigate the prognostic significance of positive peritoneal cytology (PPC) in patients with early stage endometrioid adenocarcinoma.
Medical profiles of patients with uterine carcinoma referring to Imam Khomeini hospital and Mirza Koochak Khan hospital between September, 2005 and December, 2011 have been reviewed. Patients had a complete staging procedure and peritoneal cytology evaluation.
Among 220 patients with mean age of 56.3 ± 9.1 years, 204 were Negative for peritoneal cytology (NPC) and 16 showed PPC. In the group of patients with endometrioid adenocarcinoma, 125 were in stage I and 32 were in stage II. Univariate analysis on patients with endometrioid adenocacinoma revealed that stage II (OR = 7.12, 95% CI = 2.95-22.10, P value Our study demonstrated that positive peritoneal cytology is an independent prognostic factor in patients with early stage endometrioid adenocarcinoma. We propound that peritoneal cytology adds back into the future FIGO staging criteria revision. Until then, peritoneal washings should still be considered as an important part for accurate risk-stratification.

Background:

 Gestational trophoblastic neoplasm (GTN) during pregnancy includes an associated heterogeneous group of lesions that originates from abnormal proliferation of placenta. It includes invasive mole, choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor.

Objectives:

 The aim of this study was to predict the risk of invasive mole in patients with a molar pregnancy in association with β-hCG level after the evacuation of molar pregnancy. Methods: The current study was a prospective cross-sectional cohort research conducted as a diagnostic study on 110 patients with molar pregnancy referring to Department of Gynecology and Oncology of Vali-Asr, Imam Khomeini Hospital of Tehran between the years of 2015 and 2016. Patients with molar pregnancy, who were hospitalized with a diagnosis of hydatidiform mole by transvaginal ultrasonography, were examined in the study. The ability to perform ultrasonography before and after evacuation as well as the consent to participate in the study was among the inclusion criteria for patients. The patients were studied for invasive mole followed by two ultrasonography examinations, one 48 hours and the other 21 days after evacuation. β-hCG levels were also measured in successive periods of one week to six months. The association of sonography findings 48 hours and 21 days after evacuation with post-evacuation β-hCG levels was investigated using Chi-square test and multinomial regression.

Results:

 In the current study conducted on 110 patients with hydatidiform mole, the results showed that 46 patients (41.8%) suffered from invasivemole. In 23 patients (50%) with invasivemole, the results of both ultrasonography 48 hours and 21 days after evacuation were positive. There was a significant correlation between ultrasonography after evacuation (positive and negative results) and the progress of β-hCG after evacuation in women with invasive mole (P = 0.001); this means that in 73% of women with invasive mole, the positive β-hCG results corresponded with positive 21-day sonography after evacuation, and in 41% cases, ultrasound results on day 21 were reported positive before the results of β-hCG.

Conclusions:

 Positive results of sonography accompanied with positive results of β-hCG have a high efficiency in the diagnosis of invasive mole; therefore, more definitive studies with a larger sample size are suggested to confirm this hypothesis.

Borderline ovarian tumors (BOT) consist of epithelial ovarian lesions that express cytological features of malignancy, but unlike malignant ovarian tumors, do not show obvious stromal invasion. The tumor incidence is between 1.8 and 4.8 per 100,000 females per year. The two major groups of BOT include serous BOT (S-BOT) and mucinous BOT (M-BOT). S-BOTs are divided into two categories: tumors limited to ovary and tumors spreading outside the ovary. M-BOTs are divided into two categories. The more common type is intestinal that constitutes 85% of cases and the second type is endocervical or Mullerian. Mullerian M-BOTs is bilateral in 40% of cases, while it is accompanied by pelvic endometriosis in 20-30% of patients. Microscopic examination by intraoperative frozen section is necessary because macroscopic view of ovarian tumors alone is not reliable. It is better to perform conservative surgery until the final report is ready in patients who wish to preserve their fertility. It is hard to differentiate them based on clinical characteristics. Values of tumor markers including CA125, CA19-9 and CEA in diagnosis of BOT are confirmed. Standard treatment of BOT is surgery as is the case with invasive epithelial ovarian cancer. In the majority of patients referred for BOT, since there is no suspicion of malignancy, staging is not performed. In these cases, making decision to repeat surgery and staging depend on factors such as the type of histology, abdominal exploration results in the previous surgery and probability of the presence of residual tumor.