فهرست مطالب laya shirinzadeh

Choriocarcinoma is a rare and malignant tumor, which may present during or following any type of pregnancy. This tumor often demonstrates rapid hematogenous spread to multiple organs and is associated with high levels of human chorionic gonadotropin (HCG) and a good response to chemotherapy. Herein, we introduced a case of metastatic choriocarcinoma who failed to response to conventional therapies.

A 22-year-old woman referred with vaginal bleeding. The evaluations revealed that she had a metastatic choriocarcinoma that failed to response to conventional therapies. Continuation of chemotherapy was not possible due to the development of neutropenia. Interestingly, the patient achieved a complete remission spontaneously without receiving further treatment. During the follow-up period, when the patient should not become pregnant, she became pregnant and had no problems during the pregnancy.

Gestational trophoblastic neoplasia is a rare disease. The majority of women suffering from this disease can be cured and their reproductive function could be preserved through the utilization of sensitive quantitation assay for human chorionic gonadotropin (β-hCG) and highly effective chemotherapy.

The aim of this study was to estimate the overall survival (OS) and relapse free survival (RFS) of the non-epithelial ovarian tumors (NEOTs) of ovarian germ cell tumors (OGCT) and ovarian sex cord tumors (OSCT) in Iranian women; we also evaluated the relative prognostic factors.

In this retrospective study, we screened the documents of all the women diagnosed with OGCTs and OSCTs from 2012 to 2019. We further assessed the OS, RFS, and different prognostic factors.

A statistically significant association existed between RFS and stage of the disease at diagnosis in OSCTs group by univariate analysis and multivariate analysis (HR: 0.25 (95% CI (0.08-0.78), P=0.01) and multivariate analysis (HR: 0.27 (95% CI (0.08-0.97), P=0.04), respectively. The kaplan-meier analysis and the Log Rrank (Mantel-Cox) showed a statistically significant relationship between the stage at diagnosis and RFS in OGCT group (P=0.042). RFS was 96% for OGCT patients, and 92.7% for OSCT patients. During the follow-up, only one patient passed away in the dysgerminoma group; the OS rate was 98% for OGCT patients, and 100% for OSCT patients.

The OS and RFS obtained in this study confirmed that the ovarian germ cell and sex cord malignancies were among the highly treatable solid tumors. Stage can be proposed as the main prognostic factor; also, larger series of studies are needed for detecting the prognostic significance of serum markers.

Cesarean scar pregnancy is an ectopic pregnancy implanted in the myometrium at the site of a previous cesarean section scar and is the rarest kind of ectopic pregnancy. The present study present a case of choriocarcinoma (CC) in the cesarean scar. The clinical course, findings, and treatment plan are discussed.

Case report:

 A 41-years old multi-gravid woman with a history of one previous cesarean section and three subsequent abortions was admitted to the hospital. She suffered from an unknown abnormal vaginal bleeding for two months. Β-HCG titer was 1,000 IU/L and the report of sonography showed no gestational sac. Accordingly, the patient was diagnosed with ectopic pregnancy in the cesarean scar site and, therefore, weekly usage of methotrexate was prescribed for her. Since she did not respond to the treatment, she was referred to our department in the Faculty of Medicine. The evaluation showed mass invasion through the entire uterine wall. The uterus preservation was not possible, therefore, total hysterectomy was performed. The pathology report confirmed CC in the cesarean scar.

Based on previous studies, as the number of cesarean sections increases, the possibility of complications rises, as well.  Cesarean scars implantation of CC is one of the rare complications of caesarean section. The probability of a gestational trophoblastic disease should be considered in any woman during her pregnancy. Early detection and proper management of the complications can result in a decrease in morbidity and mortality.

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.

The presence of a normal fetus with normal karyotype accompanied by molar changes in the placenta is a rare condition, which carries a significant risk to the mother and fetus. There is a controversy regarding the proper management of this condition. Here, we present the case of a singleton pregnancy that showed molar changes in the pathological study of the placenta, but ended up with a normal viable neonate.

Case Report:

 A 23-year-old primigravida woman, with a 3-year history of infertility, presented with vaginal bleeding and spotting. Her ß-human chorionic gonadotropin (HCG) at 13th week was 36500 mIU/ml. Serial sonography assessments were suggestive for molar changes and a normal fetus with growth retardation but normal Doppler assessment. The patient underwent elective Cesarean section at 37 weeks gestation and a healthy female neonate with an Apgar score of 9-10, weighing 2270 g was born. Pathological assessment of the placenta confirmed the diagnosis of incomplete hydatidiform mole. After two months, the mother had no complications, her ß-HCG level was untraceable, and the infant was in good condition.

Despite being a rare condition, partial moles can be accompanied by delivery of a normal fetus. The management of this condition still remains challenging and should be done under close monitoring with extreme caution.

Cervical ectopic pregnancy is a rare condition with an incidence of less than 0.1% in all ectopic pregnancies. This life-threatening condition is associated with a high morbidity and mortality rates. Recently, the recommended protocol for the treatment of cervical ectopic pregnancy is fertility preservation rather than invasive surgery and hysterectomy. The aim of this report was to introduce a case of successful management of cervical ectopic pregnancy.

A 31-year-old woman was presented with her third pregnancy with a history of one cesarean section and spontaneous abortion. She was admitted to an academic hospital with vaginal bleeding following 10 weeks of amenorrhea. Based on transvaginal ultrasound, a live fetus of about nine weeks was reported, located in the cervical canal. The β-subunit of human chorionic gonadotropin (βhCG) titer was reported as 108000 mIU/m. Cervical pregnancy diagnosis was consistent. In order to preserve fertility based on the patient’s hemodynamic status, medical treatment and surgical intervention, including methotrexate and then intravaginal ligation of cervical branches of uterine arteries, and subsequently cervical tampon was successfully performed.

The early detection and accurate diagnosis of cervical ectopic pregnancy using ultrasound and serial βhCG titer can be a valuable approach. Appropriate and conservative management has decreased the morbidity rate and preserved the ongoing fertility in the affected patients.

Cervical ectopic pregnancy is a rare condition with an incidence of less than 0.1% in all ectopic pregnancies. This life-threatening condition is associated with a high morbidity and mortality rates. Recently, the recommended protocol for the treatment of cervical ectopic pregnancy is fertility preservation rather than invasive surgery and hysterectomy. The aim of this report was to introduce a case of successful management of cervical ectopic pregnancy.

 Case report:

A 31-year-old woman was presented with her third pregnancy with a history of one cesarean section and spontaneous abortion. She was admitted to an academic hospital with vaginal bleeding following 10 weeks of amenorrhea. Based on transvaginal ultrasound, a live fetus of about nine weeks was reported, located in the cervical canal. The β-subunit of human chorionic gonadotropin (βhCG) titer was reported as 108000 mIU/m. Cervical pregnancy diagnosis was consistent. In order to preserve fertility based on the patient’s hemodynamic status, medical treatment and surgical intervention, including methotrexate and then intravaginal ligation of cervical branches of uterine arteries, and subsequently cervical tampon was successfully performed.

The early detection and accurate diagnosis of cervical ectopic pregnancy using ultrasound and serial βhCG titer can be a valuable approach. Appropriate and conservative management has decreased the morbidity rate and preserved the ongoing fertility in the affected patients.

Uterine rupture often occurs in the third trimester of pregnancy or during labor. Its occurrence in early pregnancy and in the absence of any predisposing factors is very rare. Untimely diagnosis and a low index of suspicion could be life-threatening. Here we report the case of a 29-year-old woman with a history of two previous cesarean sections. An ultrasound report revealed a dead fetus in the abdominal cavity at 14 weeks into the abdominal cavity due to a rupture at the site of the previous cesarean scar. Awareness of probable diagnosis of uterine rupture in a pregnant woman with abdominal pain could be important for timely diagnosis and proper management.

Squamous cell carcinoma is one of the common malignancies among women, especially in the third and fourth decades of life. Human papillomavirus is the most important cause of squamous cell carcinoma among women worldwide. Early diagnosis and treatment of this carcinoma can prevent disease progression. Herein, we present the case of a pregnant woman with squamous cell carcinoma. A 35-year-old pregnant woman referred to our clinic for cervical cerclage. During the procedure, the gynecological surgeon observed a suspicious lesion. Accordingly, cervical conization was performed and a squamous cell carcinoma lesion was confirmed by the pathology reports. Neoadjuvant chemotherapy was initiated for the patient during pregnancy. Radical hysterectomy and bilateral lymphadenectomy were conducted toward caesarean section. As the patient was a young fertile woman, the ovaries were saved. Although chemotherapy is not a standard treatment for cervical cancer in pregnancy, but neoadjuvant chemotherapy followed by radical hysterectomy and bilateral pelvic lymphadenectomy during cesarean section was a successful treatment in our patient.

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.

Isolated metastasis of cervical carcinoma to iliopsoas region might be infrequent and its occurrence is a diagnostic challenge. The aim of this study was to report a case of iliopsoas muscle metastasis from cervical carcinoma.
A 52-year-old multiparous females complaining about post menopause bleeding was referred to the researcher’s oncology department. Gynecological examination revealed cervical mass with involved parameters and biopsy confirming squamous cell carcinoma. In addition, the patient had a large cystic mass on the lateral side of pelvic area and abdomen. Investigations detected solid ovarian mass associated with a rise of tumor marker CA-125 and CEA levels. Magnetic resonance imaging (MRI) and CT scan reports suggested possible hematoma in iliopsoas muscle. Imaging-guided biopsy detected metastatic squamous cell carcinoma in iliopsoas muscle mass. Based on diagnosis of advance stage cervical cancer, the patient received chemotherapy following adjuvant radiation therapy.
Metastasis of squamous cell carcinoma of the cervix to iliopsoas muscle is considered as a rare event. It is recommended to keep this unusual manifestation in mind.

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.

In patients with female genital tract cancers, during treatment, differentiating between a tumor recurrence and a benign phenomenon is of great importance. This study aimed to report a case of retroperitoneal lymphocele in a patient with primary ovarian cancer.

A 49-year-old woman diagnosed with papillary serous ovarian carcinoma was referred to the oncology clinic in 2017. She was treated with an optimal surgical staging and underwent adjuvant chemotherapy. After 3 courses of chemotherapy, she complained of a large abdominal mass in the umbilical area. Evaluating the mass confirmed retroperitoneal lymphocele, which was treated with a non-surgical therapy.

Pelvic mass in patients with previous ovarian cancer is not necessarily due to the recurrence of the tumor and the possibility of lymphocele diagnosis should be considered. Since preventing the causes of lymphocele is very difficult, it is only necessary to carefully follow-up and provide essential consultations for highrisk patients.

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.