فهرست مطالب mojgan hajisafari tafti

Ectopic molar pregnancy (EMP) is a rare form of gestational trophoblastic disease that occurs when a hydatidiform mole implants outside the uterus.

We describe a 35-yr-old woman with mild abdominal pain, delayed menstruation for 2 months, and high beta-human chorionic gonadotropin levels. Sonography revealed a heterogeneous hyperechoic mass in the left adnexa and fluid in the endometrial cavity, suggestive of a tubal EMP. She underwent endometrial curettage and left salpingectomy. Pathology confirmed the diagnosis of invasive hydatidiform mole/left tubal EMP. The case recovered well and had no complications.

This case highlights the need for early diagnosis and multidisciplinary treatment of EMP to avoid serious consequences from persistent trophoblastic tumors.

 Primary malignant melanomas (MM) of the female urogenital tract are extremely rare and aggressive neoplasms. The majority of these neoplasms occur in postmenopausal women, originate from the vulva and vagina, and involvement of the uterus, cervix, and ovary is exceedingly uncommon.

 We presented a patient with MM of the uterine cervix, first diagnosed with a punch biopsy of the lesion, which was distributed from the cervical mass to the vestibule and labia minor. She underwent anterior pelvic exenteration. Pathology evaluation revealed primary MM of uterine cervix in FIGO stage III. She received adjuvant treatment with radiation and immunotherapy. On her fallow up 1 year after her disease diagnosis, she is still alive without evidence of distant metastasis.

 When feasible, pelvic exenteration offers appropriate initial management in cervical MM.

Borderline ovarian tumor (BOT) is a tumor most prevalent in young woman with desire to fertility. There are some controversies on the patient characteristic besides to the factors affecting the recurrence rate among different races.

The aim of this study is to evaluate clinicopathologic features of the tumor to discover the controversies on the topic.

Medical data of the all referred patients to Motahari clinic from January 2010 till October 2020 were recorded. Patient clinicopathologic characteristics affecting on outcome were evaluated. By using SPSS software, data were tested by chi-square and fish exact test. Also, log rank test was used for survival analysis

Totally 145 patients were enrolled. 61.4% versus 38.6% of the patients underwent fertility sparing surgery and radical surgery respectively with common characteristics of mostly belong to stage 1A disease (61.8% vs. 66.1%), unilateral (93.3% vs. 89.3%), serous histology (51.7% vs. 66.1%). The characteristics were different in the aspects of age and tumor size. In the aspect of recurrence rate, higher FIGO stage, younger age, tumor size less than 10cm, performing laparoscopy and fertility sparing surgery were with higher rate of recurrence (P-value < 0.05) while histology type of the tumor, lateralization, micropapillary, microinvasion, noninvasive peritoneal implants, receiving adjuvant chemotherapy and performing lymphadenectomy were not statistically significant for recurrence (P-value > 0.05). Two patients had malignant transformation.

Fertility sparing surgery was with more recurrence rate in borderline ovarian tumor patients. However, micropapillary, microinvasion were not significantly with higher recurrence rate in our study but they are challenging issues in border line ovarian tumors among different studies. Due to most prevalence of border line ovarian tumors in young women and desire of fertility preservation, we should notice more to clinicopathologic and surgery types affecting on recurrence of BOTs.

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

Ectopic pregnancy (EP) is one of the major causes of maternal mortality during the first trimester of pregnancy.

Four treatment methods for EP including single-dose methotrexate (SD-MTX), double-dose methotrexate, expectant and surgical management were considered.

In this cross-sectional study, the clinical characteristics of 365 women aged 15-44 yr who had been diagnosed with EP were reviewed from March 2017 to March 2019 in hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. Receiver operating characteristics curves were plotted to determine the cut-off points for size of ectopic mass and beta-human chorionic gonadotropin (β-hCG) that suitably discriminated between double-dose methotrexate and surgery management.

The most common site of EP was adnexa. According to the receiver operating characteristics analysis, surgery was the best plan for the women with an ectopic mass > 34.50 mm in diameter or with an initial β-hCG level > 6419 mIU/ml. The β-hCG levels in the women successfully treated with SD-MTX were significantly lower than in those with failed treatment (p = 0.02). The SD-MTX group had a higher success rate and significantly shorter duration of hospitalization, and so this was a more effective medical treatment in comparison with the DD protocol.

Surgery is proposed as the best option for the cases with large ectopic mass or high β-hCG level. SD-MTX had a higher success rate and shorter hospital stay than the DD protocol, and so was found to be an efficient and safe alternative. Further randomized clinical trials with larger sample sizes are recommended to validate the current results.