mitra modarres gilani

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.

Invasive cervical cancer is one of the most fatal genital cancers of women which can be detected by having Pap smear in precancerous stage. Various approaches can be taken for treating or preventing the progress of these precancerous lesions. The aim of this study was to investigate the cytopathological and colposcopic response of precancerous lesions to multivitamin, mineral (multimineral), and coenzyme Q10 supplements.

The present randomized clinical trial was conducted on 120 participants with clinical complaints or abnormal Pap smear test results. The intervention and control groups received supplemental and placebo treatments, respectively, for 3 months after a primarily Pap smear test. The Pap smear test was also performed after the treatment and patients with abnormal results were screened by colposcopy. Data were analyzed by SPSS software and P-value less than 0.05 was considered significant.

The percentage of participants in the intervention and control groups were 40% and 28.3% in the age range of 20-29, 26.7% and 41.7% in the age range of 30–39, and finally 33.3% and 30% over 40 years of age, respectively (P=0.19). The percentage of normalization in Pap smear test result was 83.3% and 53.3% in the intervention and control groups, respectively (P<0.001).

It was found that short-term usage of multi-mineral and Q10 supplements may decrease the risk of cervical cancer in women with abnormal Pap smear. However, studies with larger population and longer trial period are needed for further investigation.

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.

Endometrial cancer usually occurs at postmenopause stage of life but its incidence in younger patients is increasing in the last decades. The objective of the study was to evaluate the ovarian preservation in the early stage of endometrial cancer.

In this cross-sectional study, 174 patients with endometrial cancer who underwent Total Abdominal Hysterectomy (TAH) and Bilateral Salpingo-oophorectomy in 5 years were included.

The results showed that 51.1% of the patients were at stage IA, 28.7% at stage IB, 6.9% at stage II, 11.5% at stage III and 1.7% at stage IV of endometrial cancer when they underwent surgery. One patient (1.12%) at stage IA of endometrial cancer, one patient (2%) at stage IB and one patient (8.3%) at stage II had micrometastasis in ovaries, and 8 patients (40%) at stage III and 2 patients (66.6%) at stage IV had micrometastasis and co-existing tumor.

In conclusion, findings revealed the high safety of ovarian preservation in endometrial cancer at earlier stages of the endometrial cancer with low risk of ovarian involvement.

The present study attempted to provide a clear view of gestational trophoblastic neoplasia (GTN) with the focus on resistance to treatment approaches in Iran.

This retrospective cohort study reviewed the medical records of 272 patients with the definitive diagnosis of GTN referring to Imam Khomeini hospital in Tehran during 2007-2017.

The mean age of participants was 29.19 ± 7.46 years. The abnormal uterine bleeding (AUB) was the most common clinical manifestation in 64.3% of patients. Regarding the risk scoring condition according to the World Health Organization criteria, 77.6%, 9.1%, and 13.3% were categorized as low-, intermediate-, and high-risk cases. Single therapy with methotrexate was used in 22.8% of patients and actinomycin-D was planned for 42.3% whereas 11.0% and 1.5% were considered for treatment with the EMA-CO (Etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) and EMA-EP (Etoposide methotrexate and actinomycin-D/ etoposide and cisplatin) regimens, respectively. Good response to methotrexate was 66.7% but it was 83.6% in the ACT group (P = 0.001). The resistance to single-agent chemotherapy in low- and intermediate-risk groups was 16% and 92%, respectively. In addition, 20.2% of patients in stage one had tumor invasion pattern in the uterus in pretreatment Doppler ultrasonography, but 52% and 30% had resistance to chemotherapy treatment in invasive and noninvasive groups, respectively (P = 0.008).

In general, due to the high resistance of the intermediate-risk subgroup to a single therapy, a combination therapy may be more useful to treat this disorder. The close association between tumor invasion pattern in the uterus in Doppler ultrasonography and drug resistance can be considered as a new criterion for tumor risk scoring

Choriocarcinoma and placental site trophoblastic tumor (PSTT) are rare varieties of gestational trophoblastic disease (GTD). PSTT alone constitutes about 1-2% of all trophoblastic tumors, which presents at early reproductive age and the serum beta-hCG level is much lower than choriocarcinoma. This tumor usually invades the myometrium and its depth of penetration is a prognostic factor. The first case report is regarding a 33-year-old woman with vaginal bleeding 3 months after abortion. The ultrasound exhibited heterogeneous and hypervascular mass related to previous cesarean scar. Serum beta-hCG level was 67 mIU/ml and chemotherapy was administered. However, due to severe vaginal bleeding and no regression in mass size, total abdominal hysterectomy was performed. Histopathological examination and IHC staining confirmed PSTT from previous cesarean section. The second case report is regarding a 33-year-old woman with cervicoisthmic choriocarcinoma, which was mistaken as cesarean scar pregnancy. The ultrasonography and elevated serum beta-hCG level suggested cesarean scar pregnancy. The patient was treated with methotrexate without any effect. Eventually, cervicoisthmic choriocarcinoma was detected after hysterectomy. A diagnostic error was made leading to possible uterus perforation along with incorrect chemotherapy that resulted in a life-threatening condition. It is concluded that PSTT and choriocarcinoma are the two important differential diagnoses of sustained elevated beta-hCG when imaging evidence is also suggestive. Although PSTT and cervicoisthmic choriocarcinoma are rare, they do exist and are on the rise.

The incidence of vulvar cancer is nearly 5% of all gynecologic malignancies and almost 95% of vulvar cancers are squamous cell carcinoma (SCC). Recurrence is possible in 4 ways: local, regional, pelvic, and distant. In a cohort of 391 patients with vulvar SCC, distant metastasis was reported 5% .The common sites of distant metastasis are pelvic nodes, lung, and liver. Both skin and bone metastasis are rare in vulvar SCC.

The current report presented a 58-year-old female with the diagnosis of vulvar SCC. She was the 11th cutaneous metastasis, 13th bone metastasis, and the 1st case with simultaneous bone and skin metastasis reported in the last 60 years.

It is necessary to consider any lesion on the vulve, especially inmenopause females, and it should be the low threshold for biopsy to avoid delay in detection. After completion of selective treatment, the exact follow-up should be considered to discover metastases.

One of the rare ovarian neoplasms is sclerosing stromal tumor (SST). The most common age at presentation of sclerosing stromal tumor is the second and third decades of life. Usually this tumor presents with menstrual irregularity and pelvic pain as reported previously. Surgery is mandatory for diagnosis because there is not any distinctive feature to diagnose by imaging techniques.

Our case in this report is a 26-year-old woman presented with pelvic pain. We conducted routine laboratory tests and checked ovarian mass tumor markers preoperatively. Due to her normal hormonal status in physical examination, we did not request more hormonal laboratory tests. However on imaging, we did not suspect benign tumor. Doppler sonography showed low resistance flow in peripheral and center of the mass. Right ovarian mass was resected and diagnosed as ovarian stromal tumor compatible with sclerosing stromal tumor. Unexpectedly at operation, we encountered severe hemorrhage from peritoneal surface so that conservativemanagement such as packing and suturing or cauterization was not helpful. Finally, argon coagulation stopped bleeding. All coagulation laboratory tests requested by a hematologist were normal.

In conclusion, we believe that vascular endothelial growth factor (VEGF) production of tumor is responsible for massive bleeding.

Mesonephric adenocarcinoma of uterine cervix is a rare variant of primary endocervical adenocarcinoma and a few cases have been reported previously. In fact in non-metastatic adenocarcinoma of the cervix, less than 5% possess mesonephric type. Because of the low incidence of mesonephric adenocarcinoma, various methods have been proposed for treatment of mesonephric adenocarcinoma. Nevertheless, there is no unity in treatment approaches.

Here, we present a 45-year woman who had bloody discharge for 6 months period. Hormonal profile such as thyroid stimulating hormon (TSH) and prolactin was normal and all imaging studies showed a cervical fibroma as a mass. Abdominal hysterectomy -bilateral salpingectomy was performed. After pathologic report as a mesonephric adenocarcinoma, she received radiation and then she was candidate for bilateral oophorectomy.

Because of the diversity and an unusual appearance of mesonephric adenocarcinoma with aproblematic case of cervical mass, it is very important to consider mesonephric adenocarcinoma as a type of diagnosis. Numerous differential diagnoses should be considered for management of this type of carcinoma. In order to make a diagnosis, deep biopsy of infiltrative mass of uterine cervix, is mandatory.

The relationship between Human T cell leukemialymphoma virus type1 (HTLV1) and adult T cell leukemia and tropical spastic myelopathy was documented but there are controversies about the role of HTLV1 and the other diseases especially cervical cancer. Since this virus is endemic in north east of Iran (Khorasan) and cervical cancer is the common genital tract cancer in Iran, this study was designed to evaluate probable association between HTLV1 and cervical cancer. This case – control study was done in 49 new cervical cancer patients and 100 healthy women who referred to the Ghaem and Omid Hospitals in two years. Presence of HTLV1 virus examined with Bio rad kit by Eliza method and the positive samples rechecked by Western blot test. Both groups were matched based on age and reproductive factors. 6.1% of cases and 2% of control group had positive tests for presence HTLV1. There was no significant difference between these 2 groups (P=0.362). HTLV1 is not a risk factor in cervical carcinoma in north east Iran (Khorasan).

Inhibin is a dimeric glycoprotein that has a depressive effect on the anterior hypophys secretion. The level of this tumor marker is undetectable in menopause women. In patients with gynecological cancer, especially granulosa and epidermal-type (mucinous), ovarian cancers considerable increase in the serum level of inhibin has been reported. The increased level of inhibin has been reported in patients with recurrent ovarian cancer. We measured total serum inhibin and CA125 tumor marker level in 38 postmenopausal women with pathologically confirmed ovarian cancer before and after surgery out of 51 suspected women

Recent studies have showed conservative management in selective patients with borderline and malignant ovarian tumors is safe; therefore this management is considered in patients with ovarian tumor who desire to preserve fertility.

This study has been performed to evaluate the clinical outcome and fertility in patients with ovarian tumors who were treated conservatively.

All patients who were treated conservatively (preservation of uterus and at least one ovary) or were on follow-up and had recurrence were evaluated in Vali-e-Asr Hospital during 2000-2004.

Among 410 patients with ovarian tumors, 60 were treated conservatively. Age range was 13-34 years. Twenty-six of patients (43.3%) were desired pregnancy and 34 (56%) patients did not. Three (5%) patients had history of infertility. Histological types of tumors were as follows; 15(25%) borderline tumors, 10(16.7%) epithelial tumors, 26(43.3%) germ cell tumors, and 9(15%) sex cord tumors. Range of follow-up time was 12-48 months. Seven term pregnancies in 6 patients had been occurred, 1 in epithelial group, 2 in germ cell group, 1 in sex cord group and 3 in borderline group. Nine patients had recurrence and 2 patients expired, including one patient with serous cyst carcinoma (Stage IIIC).This patient had refused radical surgery and referred to our center with recurrence. Another patient had immature teratoma (Stage IIIC).

Conservative surgical management in young patients with stage I (grade 1, 2) of epithelial ovarian tumor and sex cord-stromal tumor and in patients with borderline and germ cell ovarian tumors could be performed in order to preserve fertility.