فهرست مطالب mojgan akbarzadeh-jahromi

Human Papilloma Virus infection (HPV) high-risk genotypes are responsible for up to 70% of invasive cervical cancers. It was aimed to determine the national and provincial prevalence of the total HPV and its high-risk genotypes including HPV genotype 16 (HPV16) and HPV genotype 18 (HPV18), and HPV genotypes other than genotypes of 16 and 18 (HPV other genotypes) among Iranian healthy women.

Iran with 28 provinces locates at latitude and longitude of 32° 00' north and 53° 00' east. All Persian and English studies reporting HPV infection based on cervical specimens were selected through searching the PubMed, Magiran, Scopus, Irandoc databases, and Google Scholar research search engine. Sample size and event rates were used to compute the overall event rates and 95% confidence interval (95% C.I); Fixed or random effects model, heterogeneity indices including Q-statistics (p-value), and degree of heterogeneity (I2) were reported. The search was done up to February 29, 2022. Comprehensive Meta-analysis 2.2.064 and ArcGIS 10.8.2 software tools were used at a significance level of <0.05.

The meta-analysis included nineteen studies with 258839 participants. The national meta-analysis resulted in a total HPV prevalence of 0.025 (95% C.I 0.016, 0.039); those of HPV16, HPV18, and HPV other genotypes were 0.032 (95% C.I 0.019, 0.051), 0.028 (95% C.I 0.019, 0.040), and 0.048 (95% C.I 0.033, 0.069), respectively. The provincial meta-analysis showed that the total HPV prevalence was highest in Zanjn and Kerman (0.323 and 0.240, respectively); that of HPV16 was highest in Boushehr and Khozestan (0.298 and 0.253, respectively); that of HPV18 was highest in Tehran (0.089) and that of HPV other genotypes was highest in Khozestan (0.542).

The current results would help policymakers and health managers accentuate on further implementation of screening strategies and health services in needier areas such as Zanjan, Kerma, Khozestan, and Tehran.

The rate of cosmetic tattooing in Iran is increasing as in many other countries, with concomitant rises in tattoo-associated complications, including inflammatory (infectious and noninfectious) and neoplastic reactions. We reviewed clinical and pathology features of a series of 13 cases of adverse reactions to tattoo pigments. The participants included 11 women and 2 men aged between 22 and 58. The histopathologic reaction patterns were seven granulomatous (four sarcoid, with heavy tattoo pigments in the superficial dermis, and three tuberculoid, with scanty tattoo pigments in the superficial dermis), three cases of pseudoepitheliomatous hyperplasia, one cutaneous lupuserythematosus-like reaction, one pseudolymphomatous reaction, and one case of mild superficial perivascular inflammation. More than two-thirds of the reactions were to brown tattoos on the eyebrows. The lag in lesion development after tattooing varied from five days to two years.

Gestational trophoblastic disease (GTD) includes hydatiform mole, choriocarcinoma, placental site trophoblastic tumor, and epithelial trophoblastic tumor. Also, molar pregnancy can happen as an ectopic pregnancy. The coincidence of these complicated pregnancies seems to occur extremely rarely.

Here, we presented a 26-year-old woman, nulli gravida with the first presentation of intrauterine complete molar pregnancy; she underwent suction curettage but was prompted to Gestational Trophoblastic Neoplasm (GTN) and she received chemotherapy. During chemotherapy, she had severe abdominal pain and underwent laparotomy, and found an ectopicmolar pregnancy in the fallopian tube. Salpingectomy was done and followed up with serum human chorionic gonadotropin (hCG) level and again due to improper decrease of hCG levels, she was diagnosed as a heterotopic post-molar GTN and received methotrexate (MTX) in multiple doses, but she did not respond to MTX, so we started actionomycine-D (Act-D) for her. She was cured after receiving 5 courses of Act-D and now she is on her monthly follow-up with an hCG level.

It is important to notice the likelihood of ectopic molar pregnancy or a heterotopic molar pregnancy in the case of managing molar pregnancy, especially when we encounter a case’s poor response to medical or surgical therapy

Papillary Serous Cervical Carcinoma (PSCC) is a very rare type of primary adenocarcinoma of the cervix. Herein, we report such a case of PSCC and describe its presentation and treatment.Our patient was a 65-year-old woman presented with vaginal spotting 14 years after menopause. Vaginal examination was not remarkable; however, transvaginal ultrasound showed cervical irregularity. A Pap smear was done for her that revealed atypical cells. The patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Pathologic examination and Immunohistochemical study disclosed PSCC. Metastatic evaluations including abdomen and pelvic MRI and chest CT scan were negative. Therefore, pathologic stage was IB1. Due to inadequate lymph node dissection, the patient received adjuvant external beam radiotherapy (45 Gy in 25 fractions). Subsequently, adjuvant endocavitary brachytherapy (3 fractions of 4 Gy) was delivered; however, she refused to receive any adjuvant chemotherapy. After 12 months she is well and is doing her regular daily life. PSCC is a rare case and although Radiotherapy is usually done for patients, its treatment is not well known.

Uterine leiomyosarcoma is a rare gynecological disease. Myxoid leiomyosarcoma (mLMS) is an aggressive and very uncommon type of leiomyosarcoma, with few cases reported in English literature. Stromal metaplasia is rare in leiomyosarcoma. Here we present huge uterine myxoid leiomyosarcoma with stromal chondroid metaplasia.

A 48–year–old single woman with lower abdominal pain and increased abdominal circumference. The detected mass on imaging was diagnosed as uterine mLMS with stromal chondroid metaplasia in the histopathological examination after surgery.

Myxoid leiomyosarcoma should be considered in uterine mass with extensive myxoid change, infiltrative border, low mitotic count, and mild atypia. Stromal chondroid metaplasia can be seen in the myxoid leiomyosarcoma.

We conducted the present study to analyze the clinicopathologic features of patients with malignant ovarian germ cell tumor (MOGCT) with recurrence after 2 and 5 years.
In this retrospective and analytical-descriptive study, the obtained data included: age, tumor size, histopathological type, tumor stage, lymph node involvement, laterality of tumor, tumor necrosis, and mitosis. We also evaluated the Cox Regression analysis between these variables with recurrence after 2 and 5 years.
According to our exclusion criteria, we eliminated 81 cases. These cases consisted of the subjects with dysgerminoma (48.1%), immature teratoma (22.2%), yolk sac (16%), mix germ cell (11.1%), non-gestational choriocarcinoma (1.2%), and embryonal carcinoma (1.2%). We did not observe pure polyembryoma or polyembryoma in combination with mixed germ cell. All the patients received the treatment. The patients’ mean age was 23.3±8.4 years. MOGCT reoccurred in 10 patients after 2 years and in 13 patients after 5 years (10 cases in the first 2 years, and 3 new cases in the next 3 years). Most of the cases (64.2%) were diagnosed to be at stage 1. The Cox regression analysis between positive lymph node and the recurrence of MOGCT after 2 years and between stage IV of disease and the recurrence after 2 years were significant. The Cox regression analysis between laterality, mitosis and necrosis in pathologic slides of the recurrence after 2 and 5 years was not significant.
Stages and involvement of lymph nodes are two major factors concerning the recurrence of MOGCT. Most recurrences occur in the first 2 years. Pathologic features (mitosis and necrosis) of MOGCt in the time of diagnosis not correlated with the recurrence of the disease.

Single umbilical artery (SUA) is found in 0.5-6% of all pregnancies, worldwide. Although the association of SUA with some of congenital malformations is mainly accepted, its effect on pregnancy/neonatal outcomes is still controversial.

This is the first study aimed to approximate the SUA prevalence in southern part of Iran. SUA epidemiologic features accompanied by some of its effects on pregnancy/neonatal outcomes are investigated as well.

In this cross-sectional study, data from two referral centers in Southern Iran were analyzed. In total, 1,469 pregnancies, fetus, and neonates were examined for epidemiological features associated with SUA. SUA was confirmed by pathological examination, while congenital anomalies were diagnosed by clinical, ultrasound, and echocardiographical examinations. Data on pregnancy outcome were recorded based on the patients’ medical records.

The prevalence of SUA was 3.47% (95% CI: 2.6-4.6%). Fetal anomalies including renal, cardiac, and other congenital anomalies, intrauterine fetal death, early neonatal death, low birth weight, low placental weight, and preterm birth were significantly higher in the SUA group (OR = 68.02, 31.04, 16.03, 3.85, 11.31, 3.22, 2.70, and 2.47, respectively). However, the maternal multiparity was lower in the SUA group (OR = 0.65; 95% CI: 0.44-0.98).

A significant association was observed between SUA and increased risk of intrauterine fetal death and early neonatal death, as well as low birth weight and preterm birth. Obstetrical history of the mother like parity was identified as an important predictor of SUA. Further investigations are suggested on risk stratification of neonates in this regard.

Several studies reported that endometriosis is associated with an increased risk of ovarian cancer. Atypical endometriosis is common in patients with endometriosis-associated ovarian, which might be considered as a precancerous lesion.

This study aimed to assess ki67 and PTEN expression in endometriosis associated ovarian cancer (EAOC), atypical endometriosis, and typical endometriosis.

In this study, all H & E slides of 260 ovarian endometriosis cases were reviewed. And 25 cases were diagnosed with atypical endometriosis. Forty-one typical endometrioses and 24 ovarian cancers with endometriosis were included. We assessed PTEN and Ki67 immunoexpression in epithelial and stromal cells.

The prevalence of atypical endometriosis was about 9%. PTEN loss was found in 12 (out of 24 or 50%) of EAOC, 2 (out of 25; 8%) of atypical endometriosis, and none of the typical endometriosis. In all 12 PTEN loss cases, the PTEN loss pattern in endometriosis adjacent to ovarian cancer was similar to that of ovarian cancer. A total of 7.3% of typical endometriosis and 8% atypical endometriosis and 33.3% of EAOC had Ki67 staining in more than 50% of the epithelial component. Both typical and atypical endometriosis showed similar PTEN loss and Ki 67 staining (in more than 50% of the epithelial component) (P value > 0.05), and both of them were different from EAOC (P value < 0.05).

The PTEN loss pattern in endometriosis adjacent to ovarian cancer was similar to that of ovarian cancer. The result indicated that PTEN loss could be an early event in the tumor development pathway from endometriosis to ovarian cancer.

Cervical conization is a standard diagnostic method for precancerous lesions. However, its results could be negative despite an initially positive punch biopsy. The present study aimed to re-evaluate pathological biopsies with Ki-67 and p16 immunostaining to assess the diagnostic accuracy of punch biopsies.

This retrospective study performed in Motahhari Clinic and Shahid Faghihi Hospital, (Shiraz, Iran). 88 punch and cone biopsy slides from 2007-2016 were re-evaluated by two pathologists, and the results were compared with the original diagnoses. Agreement between the initial diagnoses and re-evaluations and between our pathologists were assessed with the kappa coefficient. Twenty-two negative conization results after positive punch biopsy were re-sectioned and evaluated with Ki-67 and p16 immunostaining.

The overall agreement (kappa) between the primary punch diagnoses by the original pathologists and those made in the present study (by the first and second pathologists) before immunohistochemical (IHC) staining was 0.33 and 0.43, respectively. The kappa coefficient between punch biopsy diagnoses by the first and second pathologists before IHC staining was 0.73, while it increased to one after IHC staining with Ki-67 and p16. Out of the 22 specimens with the positive punch and negative cone biopsies on initial diagnosis, cervical intraepithelial neoplasia (CIN) was not confirmed in 11 specimens by our pathologists after IHC staining with Ki-67 and p16. These cases were reclassified as transitional metaplasia or acute/chronic cervicitis.

Punch biopsy can be misdiagnosed as CIN positive, leading to unnecessary conization. The use of Ki-67 and p16 markers as appropriate ancillary tests are recommended.

Oxidative stress and GSH-dependent antioxidant system plays a key role in the pathogenesis of polycystic ovary syndrome (PCOS).

We compared glutathione peroxidase (GPx) and glutathione reductase activities and reduced glutathione (GSH) levels in serum and follicular fluid (FF) of the first-retrieved follicle and their impact on quality of oocyte and embryo in PCOS women undergoing IVF.

This cross sectional study was conducted on 80 pairs of blood samples and FF of the first-retrieved follicle from PCOS women, at the Infertility center of Ghadir Mother and Child Hospital. The mean activity of GPx and GR, also GSH levels in the serum and FF were compared to the quality of the first follicle and resultant embryo.   

Retrieved oocytes included 53 (66.25%) MII, 17 (21.25%) MI, and 10 (12.5%) germinal vesicles; after IVF 42 (52.50%) embryos with grade I and 11 (13.75%) with grade II were produced. The mean values for all three antioxidants were higher in the FF compared to serum (p < 0.001). Also all of the mean measured levels were significantly higher in the FF of the MII oocytes compared to that of oocytes with lower grades (p = 0.012, 0.006 and 0.012, respectively). The mean GPX activity and GSH levels were significantly higher in the serum (p = 0.016 and 0.012, respectively) and FF (p = 0.001 for both) of the high-quality grade I embryos.

GSH-dependent antioxidant system functions more efficiently in the FF of oocytes and embryos with higher quality.

Infertility is a critical condition in women with polycystic ovary syndrome (PCOS), caused not only by anovulation but also by endometrial abnormality.

This study aimed to evaluate and compare the hysteroscopic and histological findings of endometrial biopsies in infertile women with PCOS and normal endometrial thickness and women with unexplained infertility (UI).

This cross-sectional study compared the initial hysteroscopy and endometrial histological findings of 70 infertile women with PCOS and normal endometrial thickness with those of 35 women with UI. The relationship between endometrial histology and clinical parameters such as including luteinizing hormone, follicle-stimulating hormone, thyroid-stimulating hormone, testosterone, prolactin, fasting blood sugar, body mass index (BMI), and infertility duration was analyzed.

The mean age of women with PCOS was significantly lower than that of women with UI (27.5 ± 4.1 vs. 30 ± 4.5 years, respectively) (p < 0.001). The mean BMI was higher in women with PCOS than in women with UI (28.7 ± 4.4 vs. 25.1 ± 3 kg/m2) (p < 0.001). The hysteroscopic findings of all women with PCOS were normal, whereas 91.4% of women with UI had normal hysteroscopic findings, 2.9% had a polyp, and 5.7% had endometrial thickening. The histological findings of women with PCOS revealed proliferative endometrium in 54.3%, disordered proliferative endometrium in 17.1%, secretory endometrium in 8.6%, and endometrial polyp in 17.1%, whereas these percentages in women with UI were 28.6%, 0%, 54.3%, and 20%, respectively.

The hysteroscopic evaluation alone of infertile women might not detect all probable endometrial pathologies in women with PCOS.

Primary carcinoma of the fallopian tube is very rare among primary genital tract malignancies. Transitional cell carcinoma is among the rarest tumor subtypes that can involve the fallopian tube.
Here, we reported a 42-year-old premenopausal lady presenting with spotting, dysmenorrhea, and abdominal pain. She was found to have a pelvic mass in the right posterior cul-de-sac suspicious to be an eccentrically located leiomyoma. Histopathology examination of the resected mass revealed transitional cell carcinoma arising from the fallopian tube.
Primary fallopian tube tumors could be considered in differential diagnosis of pelvic mass and intraoperative frozen consultation is useful for correct diagnosis.

An invasive mole is a rare form of gestational trophoblastic disease in which the molar tissue invades into the deep myometrium, cervical stroma, blood vessels or extrauterine sites. This report is of an invasive mole of spleen that has originated from an ectopic pregnancy, which was primarily though to be a choriocarcinoma.

Pathophysiology of preeclampsia has remained unknown. Excessive maternal systemic inflammatory response to pregnancy along with systemic oxidative stress is one of the underlying theories. Extracellular HSP70 produced from stressed and damaged cells may be involved in the elaboration of maternal systemic inflammatory response.. In this regard, we investigated the circulating levels of 70-kiloDalton heat shock protein (Hsp70) in patients with preeclampsia, as well as healthy pregnant women..Patients and The study performed during a 6-month-period in Zeinabieh Hospital of Shiraz University of Medical Sciences. We recruited 31 patients with preeclampsia and 31 healthy normotensive pregnant controls (age and ethnicity matched). The serum levels of Hsp70 were measured in all patients and controls and the values were compared between groups. We also compared Hsp70 levels between severe and mild preeclampsia cases.. The mean age of the patients was 27.5 ± 6.3 (range 21 - 42) years, which was comparable to control group 27.7 ± 7.2 (range 19 - 45) years (P = 0.925). The mean systolic and diastolic blood pressure was significantly higher in those with preeclampsia compared to healthy controls (P < 0.001). There was no significant difference between the two study groups regarding the circulating levels of Hsp70 (P = 0.310). We found that the systolic blood pressure was positively associated with gestational age in those with preeclampsia (r = 0.397, P = 0.027). However, there was no correlation between circulating levels of Hsp70 and baseline characteristics as well as blood pressure parameters.. Circulating levels of Hsp70 are not associated with preeclampsia and increased blood pressure in pregnancy. Further studies on the role of heat shock proteins in the pathogenesis of preeclampsia and gestational hypertension is recommended..

Adenoid cystic carcinoma of Bartholin’s gland is a rare malignant tumor of female genital tract. We report a case of a 42-year-old woman, presenting a palpable painful mass and burning sensation on the left side of vulva during the preceding two months. Based on examination, a solid fixed painful nodule with intact mucosa was palpated on the left side of the vagina. Histological features were compatible with adenoid cystic carcinoma. Often, such lesion is clinically misdiagnosed as a cyst or inflammation. The present case was carried out with an impression of endometriosis. The possibility of cancer should be considered in any female older than 40 years of age with a lesion near the Bartholin’s glands.

Tumors which originate from the Bartholin’s glands (BGs) are very rare. Many solid masses that arise from the BGs are carcinoma, though these benign solid lesions are rare. To the best of the reporter’s knowledge, about 35 cases have been reported in the English literature so far, most of which accompanied with signs or symptoms of Bartholin’s duct cyst. In this paper we report a 43-year-old woman with bilateral solid masses in the BGs, incidentally detected during anterior-posterior colpoperineoplasty. The masses were then excised. The histopathological examination showed increased number of acini with preserved duct-acinar connection, consistent with nodular hyperplasia. The patient had used oral contraceptive pill for four years.

To verify the myofibroblastic origin of spindle cells by immunohistochemistry in idiopathic inflammatory pseudotumor (IPT) of the orbit. We reviewed a series of 32 orbital IPTs for expression smooth muscle actin (SMA), Vimentin, Desmin and anaplastic lymphokinase (ALK). The study was performed on histologic samples of 33 patients with a diagnosis of orbital IPT. The lesions expressed SMA in 51.7%, Vimentin in 72.0% and Desmin in 17.2%. All lesions were negative for ALK. Reactivity for SMA in spindle cells may indicate their myofibroblastic origin. The absence of ALK expression in all cases strongly suggests that these lesions, although histologically similar, are biologically distinct from their soft tissue counterparts. IPTs which are negative for ALK may be characterized by one or more chromosomal aberration involving regions other than 2p23