soheila aminimoghaddam

Synchronized endometrial and ovarian cancer (SEOC) is a condition in which there is both primary endometrial and primary ovarian cancer at the same time in a patient. These tumors have a better prognosis than metastatic ones. Most of them are diagnosed in the early stages and are low-grade tumors. So differentiation of this kind of rare tumor from others is essential. No adjuvant chemotherapy seems to be reasonable in cases with low-grade tumors both in endometrioid and non-endometrioid types. High-grades tumors have been described less, but, in some studies, genetic mutations were found in these tumors, which have been the basis of targeted therapy after surgery.

In this report, two rare non-endometrioid types of SEOC cases are discussed. The first case is a low-grade papillary serous carcinoma of the ovary and uterus endometrium. In contrast, the second case is a clear cell carcinoma of the ovary and endometrioid adenocarcinoma of the uterus. We also review the literature in this field.

We conclude that in these cases, chemotherapy with routine regimens does not seem to be helpful in early stages with low-grade tumors. Also, in high-grade tumors, targeted therapy may be more effective than adjuvant chemotherapy.

Cervical cancer stands out as one of the most prevalent gynecological cancers. Cervical cancer’s link to human papillomavirus (HPV) testing and recurrence is unclear despite previous studies. Investigating this relationship in Iranian patients is a pivotal aspect of this research.

This study encompassed all cervical cancer patients referred to Firoozgar Hospital, Tehran, Iran, between 2016 and 2018. Utilizing a census method, the patients’ data, including their demographics and treatment details, were extracted from records. Follow-up samples were collected after vaginal cuff or cervix treatment (surgical or radiotherapy). A total of 124 patients were included in the study and categorized into two groups: Patients with recurrence and those without. INNO-LiPA standard test was employed to detect HPV presence. Comparative analysis of various variables, such as age at diagnosis, smoking history, multiple partners, sexually transmitted diseases history, body mass index, abnormal cervix, vaginal fornix involvement, cervical parameters involvement, tumor size, The International Federation of Gynaecology and Obstetrics (FIGO) staging, MRI staging, pathology, and treatment, was conducted between the recurrence and non-recurrence groups.

A total of 124 patients were included in the study, with an average age of 45.95±7.45 years. Most patients had an 18-25 kg/m2 body mass index. Based on MRI findings, the most common stage of cervical cancer was stage III, IIB. Squamous cell carcinoma pathology was the most prevalent, observed in 47 patients (37.9%). The most frequently performed treatment modality was radical trachelectomy and adjuvant chemoradiotherapy, accounting for 20 cases (16.1%). There were no significant differences in terms of age at disease diagnosis, smoking history, body mass index, histological type, and treatment type between patients with recurrent disease and those without recurrence. However, a significant difference was observed in terms of lymph node involvement. In addition, the HPV test was positive in 3 cases (2.4%) with recurrence and 11(8.9%) without. These results suggest no relationship between hrHPV (high-risk human papillomavirus) status and disease recurrence (P=0.196).

The result of our study showed no correlation between positive HPV test and cervical cancer recurrence. Consequently, HPV testing is not suitable as a reliable predictor for the recurrence of cervical cancer.

Endometrial cancer represents the most prevalent malignant genital tract neoplasm in high-income countries and is the second most common cancer worldwide following cervical cancer. Endometriosis is a benign condition wherein endometrial glands and stroma are found outside the uterine cavity.

During a routine care and ultrasound examination of the uterus and adnexa of a 64-year-old woman, an increased endometrial thickness (22 mm) was noted. In 2023, according to ultrasound report, the patient underwent diagnostic curettage with immunohistochemistry, revealing a pathological diagnosis of endometrial cancer (endometrioid adenocarcinoma) with positive staining for p16, estrogen receptor (ER), and vimentin. Subsequently, after one week, she underwent complete surgical staging. Extensive superficial endometriosis disseminated in the pelvis and vulva was noted during surgery and preoperative examinations. Final pathology confirmed a well-differentiated typical endometrioid carcinoma (grade 1) with 40% myometrial invasion and positive lymphovascular invasion. The patient was considered to be at stage 1A.

Despite some studies suggesting an unclear association between endometriosis and endometrioid or clear-cell ovarian cancers, the correlation between endometriosis and endometrial cancer and its prognosis remains ambiguous. Additionally, although infertility has been linked to both endometrial cancer and endometriosis in various studies, the presented case exhibited no signs of infertility. Extensive pelvic endometriosis with vulvar involvement was present, yet the patient did not exhibit any symptoms. This is in contrast to the typical initial manifestation of endometrial cancer, which is abnormal uterine bleeding. The patient's condition was incidentally detected through routine care due to an abnormal increase in endometrial thickness, prompting this presentation.

Women's cancers such as endometrium, ovary, cervix, and vulva are common and one of the most effective treatments is the use of surgical techniques. Today, the use of injectable anticoagulants (heparin and enoxaparin) before and after women's cancer surgeries is common in treatment protocols. The present study was performed with aim to compare the effect of oral (apixaban) and injectable (enoxaparin) anticoagulant drugs in patients undergoing gynecological oncological surgeries.

This clinical trial study was carried out from 2021 to 2022 on 80 women referred to the hospital of Iran University of Medical Sciences with the complication of women's cancer (ovary, uterus, cervix, vulva and vagina, etc.) whose disease was confirmed by diagnostic laboratory evaluations and specialist physician and were diagnosed for surgery. After discharge, all patients used two treatment protocols of oral anticoagulants or injectable drugs within 28 days. Demographic information and laboratory indices of patients were evaluated. Data analysis was done using SPSS statistical software (version 22) and Mann-Whitney test. P<0.05 was considered significant.

There was no significant difference between the groups receiving oral and injectable anticoagulants in terms of bleeding time and hospitalization duration (p>0.05). Also, the amount of hemoglobin and platelets in both groups decreased after surgery compared to before surgery, which was statistically significant (p<0.05).

The use of oral and injectable anticoagulants has no effect on the amount of bleeding after surgery in patients with gynecological cancers.

Hereditary non polyposis colorectal cancer (HNPCC) also known as Lynch syndrome (LS), is an autosomal dominant cancer syndrome. Besides colorectal cancers, it predisposes patients to extracolonic cancers. Despite several extracolonic cancers have been reported on LS, we found a new face of it. A 43-year-old G2L2 patient with chief complaint of abnormal uterine bleeding.  Her endometrium biopsy showed clear cell carcinoma, and the necessary work-ups have been done. But the patient's family history demonstrated HNPCC based on the Amsterdam 2 criteria. After some years, the patient presented to our hospital for fever, shivering and abdominal LUQ pain. Spiral CT scan showed a solid cyst with heterogeneous enhancement in the spleen, and hepatosplenomegaly. In this paper, another case with endometrial cancer as a sentinel cancer of LS is reported. This fact implicate that physicians should notice the family history of malignancies in patients with gynecologic cancers and consider LS.

Mature teratoma is a benign neoplasm, mostly composed of welldifferentiated derivations of almost two or three germ cell layers, while immature teratoma is a malignant neoplasm composed of immature neural and embryonic tissue. Immature teratoma in the context of ovarian endometrioma has not been reported yet.

A 34-year-old woman with primary infertility is reported in this study who suffered from immature teratoma associated with ovarian endometrioma. After several rounds of fertility treatment, the patient was referred for severe abdominal pain and underwent emergency surgery for the rupture of ovarian endometrioma. To preserve the ovary, the cyst was not resected in areas attached to the ovary. Some months later, the patient noticed a progressive abdominal enlargement. The sonographic evaluation revealed multiple solid-cystic lobulated masses on the abdominal wall and throughout the pelvic cavity. The histologic diagnosis was consistent with immature teratoma. The patient was treated with high-dose neoadjuvant chemotherapy and fertility-sparing surgery (FSS). The histologic evaluation of the extracted masses revealed teratoma maturation.

This study reveals the importance of complete removal of endometrioma and highlights the role of neoadjuvant chemotherapy in fertility-sparing surgery and potentiating teratoma maturation.

Transitional cell carcinoma (TCC) is a rare type of ovarian epithelial cancer. This type of ovarian cancer accounts for only 1% of superficial epithelial carcinomas. Ovarian cancer is a major clinical challenge in obstetrics and gynecology. The reason of this is the lack of specific symptoms for ovarian cancer before the recurrence and progression of the tumor, so many cases are not diagnosed until the onset of metastatic disease. Overall, ovarian cancer accounts for 4% of all diagnosed cancers and 5% of all mortality due to cancer. Malignant ovarian tumors are divided into several categories, including epithelial, germ cell tumors, and sex stromal cord tumors. Early diagnose of small ovarian-limited tumors is an important prognostic factor. Ovarian cancer has no specific symptoms and does not show itself in the early stages. The most common early manifestations are bloating, pain, frequent urination and constipation. Therefore, patients do not pay attention to the symptoms. The clinical manifestations of transitional cell carcinoma of the ovary are indistinguishable from other types of ovarian cancer. However, early detection of this type of tumor is important because of the favorable response to chemotherapy compared to other ovarian epithelial cancers.

Case report: 

The patient is a 43-year-old woman (G2P2L2) who referred to a hospital in Tehran with vaginal bleeding and abdominal pain. The results of sonography showed the presence of a suspected mass of uterine leiomyoma with dimensions of 90 * 58 mm and two cysts with a diameter of 43 and 39 mm in the right ovary. The patient is a candidate for myomectomy due to bleeding. In October 2019, during surgery, the surgeon discovered that the mass was not a leiomyoma and the mass was of ovarian origin.so she underwent curettage and the right ovarian mass were removed and sent for pathology, the diagnosis of “High grade serous carcinoma of the right ovary” is reported. Due to the malignancy, the pathology result, patient was referred to Firoozgar Medical Center in Tehran, In the review of the pathology report in this center by the gynecologist pathologist, primary ovarian transitional cell carcinoma was reported without need to do IHC (ImmunoHistoChemistry) because of the net diagnosis and the new ultrasound showed a hypoechoic, homogeneous, well defined and oval mass without clear vascularity with dimensions of 28 * 36 * 47 mm anterior to inferior vena cava (IVC) and proximal location of aortic artery bifurcation to common iliac and the effect of compression on IVC and Its displacement was seen. In spiral CT scan, a circular solid mass with dimensions of 42 * 33 * 51 mm corresponding to the location of the aortocaval with compressive effect on IVC and multiple mesenteric metastatic lymphadenopathy with a maximum SAD = 10 mm was seen. No free fluid was seen in the abdomen. The uterus had normal dimensions. Neurogenic masses such as paraganglioma and metastatic lymphadenopathy were presented in the differential diagnosis. Other normal abdominal areas were reported. Endoscopy and colonoscopy were also reported to be normal.
The patient did not have complete surgery, hence it was decided that in addition to the uterus and ovaries, the tumor between the duodenum and IVC would be removed in the reoperation. Therefore, on December 20, 2019, a complete laparotomy and debulking of the ovarian tumor, including a complete hysterectomy, removal of bilateral fallopian tubes and ovaries and remnants of the right ovarian tumor were performed. Appendectomy and omentectomy were performed also The tumor was removed on IVC. In the pathology report from the second surgery, primary  Transitional Cell carcinoma of the ovary with metastasis and involvement of right and left ovaries, parameter, lesion removed from the rectum, sigmoid mesentery, posterior cul-de-sac, seeding into the adipose tissue of the peritoneal lymph nodes of the right and left pelvis were reported.
One month after reoperation, the patient underwent 6 courses of chemotherapy every 3 weeks with paclitaxel 300 mg and carboplatin 480 mg with AUC-6 according to the advice given to the patient in the tumor board. Now that 2 years have passed since the patient's reoperation, the patient is in good general condition and no trace of the tumor or its recurrence, has been observed in regular follow-ups. In addition, the CA-125 patient before her reoperation is 450U / ml, and one month after surgery, who also received one course of chemotherapy, its rate decreased to 25U / ml, and after 6 courses of chemotherapy, its rate was 15U / ml. At present, the CA-125 level of patient is 10U / ml.

Transitional cell carcinoma is a rare type of ovarian epithelial cancer that is in the latest WHO classification, Introduced as” high grade serous tumor with transitional cell differentiation”. Primary ovarian TCC is differentiated from benign, metaplastic, or proliferative Brenner and has two subtypes; 1. Papillary 2. Malignant pseudo-Brenner. This tumor was first defined by Austin and Norris in 1987. They reported a group of patients with ovarian tumors that had tissue characteristics similar to malignant Brenner tumors, while these patients lacked benign Brenner tumor characteristics and no prominent stromal calcification. According to the World Health Organization (WHO), depending on the histological pattern, Transitional cell tumors are classified as benign, borderline or malignant tumors Brenner and TCC that accounts for 2% of all ovarian tumors.
Primary ovarian TCC is similar to bladder and urinary TCC but is differentiated in immunochemistry and pathology. Ovarian TCC is negative for CK20 but is usually positive for vimentin, ca125, wilms tumor1 and also strongly estrogen receptor (ER). Also, transitional carcinoma of the ovary is much more invasive than malignant Brenner tumor (MBT) and must be isolated. Silva et al observed TCC in 88 of 934 ovarian cancers (9%). Young et al in their study, stated that TCC tumor cell nuclei were longitudinal or round, often with nuclei with longitudinal grooves. The cytoplasm was often pale and granular, rarely clear or eosinophilic.
Common clinical signs of ovarian TCC include abdominal pain, ascites, bloating, and weight loss. Occasionally, there may be signs of uterine bleeding, back pain, urinary or abdominal symptoms. The clinical manifestations of this cancer are indistinguishable from other types of ovarian cancers. Our patient also referred to the hospital with symptoms of uterine bleeding and pain in the abdomen. Due to the absence of abdominal ascites and the generality of the symptoms, the tumor was not diagnosed in time. According to the sonography and symptoms, the first surgeon suspects leiomyoma and operates on the patient, but during the surgery, he notices that the mass is malignant.
In the study by Ihan et al, age of women with ovarian TCC ranged from 46 to 87 years, with an average age of approximately 59 years. Most patients had menopause. But in our study, the patient's age (43 years) is lower than the average age of previous studies.
Most studies show that surgery with chemotherapy (cisplatin) increases the life expectancy of patients. In the study of Silva et al, 5-year survival after surgery was reported to be 37% for 88 patients, while in the group with chemotherapy, it was 41%. The standard chemotherapy regimen recently used for patients with ovarian epithelial cancers includes paclitaxel and carboplatin on a six-period basis, our patient has also undergone chemotherapy with the same drugs.

A woman with a suspected ovarian mass should be examined and treated by a gynecologist oncologist. Histopathological examination of these tumors is necessary to distinguish them from other ovarian cancers. Immunohistochemistry features are useful in its diagnosis. Para-clinical methods can be used to evaluate metastasis. Surgery is the main method of treatment followed by standard chemotherapy.
This case is important because the patient had this tumor before menopause at the age of 43, who underwent surgery and chemotherapy with paclitaxel and carboplatin for 6 periods due to extensive metastasis to other abdominal organs. A noteworthy point in the above patient and similar patients is that, due to the non-specificity of ovarian cancer symptoms, whenever there is a suspected adnexal mass, referral to a gynecologist oncologist is recommended for beginning of appropriate treatment plan and surgery or chemotherapy to increase Survival and improvement of patient's quality of life.

Tuberculosis is relatively common in reproductive age and thereby can be observed in pregnancy. Some of the clinical presentations of tuberculosis overlap with nonspecific symptoms that are found in normal pregnancy. Therefore, delay in diagnosis is understandable. The aim of our study is to indicate that tuberculosis is related to sanitary inadequacy and crowding and should be considered in every patient with such circumstances.

This case report is about a pregnant woman who referred to us with low-grade fever and ascites and then disseminated intravascular coagulation was observable. Accordingly, several differential diagnoses were considered, and eventually, visceral tuberculosis was detectable.

It is recommended that tuberculosis be considered in every patient even without any response to the usual treatments. Extrapulmonary tuberculosis, which is more common in pregnancy, poses a tremendous challenge on the diagnosis and treatment of tuberculosis.

Endometrial cancer is one of the common diseases among women, which causes the death of many women in the world every year. The survival of patients and their response to treatment is determined based on clinical conditions and the stage of the disease. It has been determined that patients who are in the advanced stage (stage III and IV) have a shorter survival. The present study was conducted with aim to evaluate the survival of patients based on OS and PFS (overall survival and progression-free survival).

Methods :

In this retrospective cohort study, all patients with advanced endometrial cancer who were treated in Firouzgar and Rasoul Akram hospitals during the last 8 years from 2010 to 2018 were compared in two groups with different treatment methods (first neoadjuvant therapy and then surgery compared to first surgery and then adjuvant therapy). Data were analyzed by Stata software (version 14.1). The survival rate of patients was evaluated using the Kaplan-Meier approach. Factors affecting the survival rate were also analyzed using a Cox regression model. The investigation of factors affecting the response to treatment was also done in a multiple logistic regression model. P< 0.05 was considered statistically significant.

There was no significant difference in terms of mean survival in patients who were treated with chemotherapy surgery and surgical chemotherapy (p>0.05). Total survival rate was higher in patients treated with standard method compared to patients who received chemotherapy first and then surgery.

There was no significant difference in the survival of patients in terms of treatment with chemotherapy surgery and surgical chemotherapy. However, the variable of surgery had the highest correlation in the recurrence of the disease and also the survival of the patients.

Perivascular Epithelioid Cell Tumors (PEComas) are rare mesen- chymal tumors originating from perivascular epithelioid cells. The second common affected organ is uterine. Most of PEComas are benign and patients have good prognosis. At the present time, surgery is the main treatment and adjuvant chemo- therapy is used in malignant cases, although the best diagnostic and management method is yet to be discovered considering the rarity of this neoplasm.

The patient was a 53 year old lady with a history of two vaginal deliveries and no previous surgery. She had severe pelvic pain and underwent MRI with the primary impression of sarcoma. In MRI, she had a 7 cm mass in lower segment of uterus. The patient underwent laparoscopic hysterectomy, bilateral oophorectomy, lymphadenectomy, and omental biopsy in Jam Hospital. Pathologic report of the patient revealed malignant PEComa without lymph node and omentum involvement.

Diagnosis of PEComa before surgery is difficult and its differential diagnoses form uterine leiomyoma or leiomyosarcoma. Final diagnosis can be made after surgical biopsy and immunohistochemistry evaluation. Surgery is still the main treatment and adjuvant therapy is used in high risk 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.

Uterine cancer affects more than 1.28 million people worldwide; considering current world trends in obesity and aging, a +52.7% growth by 2040 is foreseen. Around 5% of endometrial cancer patients are less than 40 years old, meaning that conventional oncologic approaches would result in fertility loss; thus, it is essential to consult patients regarding their fertility and family planning. Owing to developments of oncofertility, patients are now able to preserve their fertility and complete their childbearing, drafting from the standard of care in endometrial cancer. Strict criteria should be applied to make sure of selecting patients who benefit most from the fertility preservation approach. Furthermore, careful selection of patients increases the possibility of successful treatment. Most candidates for fertility preservation have risk factors in common with infertility, including polycystic ovarian syndrome, obesity, increasing of age and irregular menses; therefore, Advanced Reproductive Technology (ART) can improve their chances for pregnancy. Current applied knowledge towards the fertility preservation approach in patients with endometrial cancer is reviewed in this article.

Response to the editor letter Dear Professor Behtash, I am writing this letter to respond to the letter written by Professor Reda Hemida from Mansoura University, Egypt, regarding a publication of mine titled “The Association of Gestational Trophoblastic Neoplasia and Misoprostol Administered Before Suction Curettage of Molar Pregnancy,” published in 2019 in your journal. I want to first thank Professor Hemida for reading my paper carefully and sharing his comments. I highly believe that sharing comments and raising scientific questions could benefit our society. I hope that the responses that the co-authors have provided be helpful and to the point. As he suggested, I am willing to let the journal publish the responses in the next issue.

Boswellia serrata is an important medicinal plant with strong antioxidant activity. The present study was designed to evaluate the effects of Boswellia vaginal gel on apoptosis and oxidative damage in vaginal mucosal cells of women with vaginal candidiasis.

Ninety-five women with vaginal candidiasis were enrolled in the clinical trial and received the gel for seven consecutive nights. The clinical symptoms of the disease including vaginal secretion, pain, itching, unpleasant odor, and dyspareunia were recorded. Vaginal discharges were collected before and after treatment for the assessment of malondialdehyde (MDA) and total antioxidant capacity (TAC) using TBAR and FRAP methods, respectively. Expression of Bax, Bcl2, and Caspases-3 genes was surveyed by RT-PCR.

Gel therapy significantly decreased the frequency of pain, burning, itching, dyspareunia and secretion compared to the baseline (p<0.001). Boswellia vaginal gel treatment significantly improved TAC values (from 1.27 ± 0.41 μM/mL to 4.69 ± 0.53 μM/mL; p<0.001) and decreased MDA values (from 31.47 ± 6.69 nM/L to 13.85 ± 3.72 nM/L; p<0.001). The therapy caused a significant decrease in Bax and Casp3 expression, as well as Bax/Bcl2 ratio by 2.34-fold (p=0.018), 2.86-fold (p=0.002), and 12.72-fold (p<0.001), respectively. In contrast, BVG treatment significantly enhanced the expression of Bcl2 expression by 5.42- fold (p<0.001). 

Vaginal candidiasis is remarkably linked to oxidative stress, reduction of the antioxidants and vaginal mucosal cells apoptosis. Boswellia vaginal gel has potential role to improve vaginitis symptoms by elevating antioxidants capacity, mitigating oxidative stress, as well as down-regulating of apoptotic factors.

SARS-CoV-2 is a newly identified virus that causes COVID 19, spreading very fast in the world. Uncontrolled diabetes in pregnancy can increase the risk of pregnancy outcomes. Pregnant women are at high risk of developing a viral infection, like SARS-COV and on the other hand, diabetes ketoacidosis (DKA) which is coupled with COVID-19, can increase maternal mortality. The patient was a 27-years-old female G3P1L1Ab1 with a history of a previous cesarean section. On 26 March 2020, a fetal ultrasound revealed intra-uterine fetal death (IUFD) and also diagnosis of DKA and COVID-19 in the patient that she was expired eventually due to the uncontrolled DKA. In this case report, a pregnant woman with a diagnosis of IUFD, DKA, and COVID-19 simultaneously is described. To the best of the authors of this paperchr('39')s knowledge, no previous work has been reported for the comorbidity of diabetes and COVID-19 in pregnancy, but it seems that the coincidence of the above-mentioned diseases can delay the recovery period and also can increases maternal and fetal mortality. When DKA and COVID-19 appear in the patient simultaneously, we cannot control DKA by the routine protocol treatments of DKA which were used formerly.

Endometrial cancer is the fourth most widespread cancer among females, with a growing prevalence in recent years. Management by combined therapies along with surgery, radiotherapy, and chemotherapy have improved patients’ prognoses. Besides, the development of new therapies helps preserve fertility and prognosis in aggressive tumors.The purpose of this research was to identify the efficacy of metformin on the H19 long non-coding RNA expression in endometrial cancer to provide further insight into the pathogenesis and treatment of the disease.

A total of 23 patients with endometrial cancer, diagnosed by biopsy or diagnostic curettage, were recruited and divided into three groups, before and after metformin treatment and placebo. Real-time PCR was used to evaluate the H19 expression in cancer tissue in all patients.

It has been observed that in endometrial tissue of the “after-metformin” treatment group, the H19 expression level was significantly reduced, compared with the “before-metformin” treatment group, but not in comparison with the placebo. These findings indicate that metformin reduced the H19 expression in endometrial cancer.

Anti-diabetic drugs, such as metformin, may be beneficial by reducing the H19 expression in endometrial cancer due to the H19 relation to cancer progression.

Endometrial carcinoma is the most common malignancy of the female genital tract, which most often affects postmenopausal women. The ovaries may be active when a patient has endometrial cancer, so removing an ovary can worsen a patientchr('39')s quality of life. On the other hand, a complete surgical staging in endometrial cancer includes oophorectomy since 1988. There has been some research to assess whether an oophorectomy should be performed and in which cases, ovaries can be preserved.

 Aim of this study was to evaluate the coexistence of ovarian involvement in endometrioid endometrial carcinoma. In this study, we evaluated 180 patients with endometrioid endometrial cancer patients who were surgically staged at Imam Hossein Hospital between 2004 and 2017.

Mean age of subjects of the study was 56.78 ±10.59. Forty-six of patients (25.6 %) were less than 50 years old and 74.4 % (134) were older than 50. Twenty out of 180 (11.1 %) of them had ovarian involvement (one of them had simultaneous ovarian tumor) and 11 (55%) of these cases were less than 50 years old. In 55 % (11) patients, the involved ovaries were less than 5 cm with grossly normal appearance, lymph nodes metastases were detected in 3 out of 20 (15 %) of them although their ovarian size were 4, 4.5 and 6.5 cm. In 10 (50 %) of them, deep myometrial invasion was detected.

 In endometrial cancer staging, ovarian preservation could be a challenging decision and a real controversy which needs more researches.

 Fertility-sparing strategies are suggested for selected patients with cervical cancer, who wish to preserve their fertility, which includes neoadjuvant chemotherapy, conization, and trachelectomy. Radical trachelectomy is suggested as a safe method with favorable outcomes. However, the controversy about the success rate, fertility rate, and risk of recurrence of radical trachelectomy questions its applicability.

 Here, we presented a 39-year-old woman with high-grade invasive cervical cancer, squamous cell carcinoma (SCC) which was successfully managed by laparoscopic lymphadenectomy and radical trachelectomy and leading to normal pregnancy in the following years.

 This case report suggests that this procedure should be considered in selected patients, especially those who wish to have a child in the future. Besides, it is recommended that obstetricians pay greater attention to post-trachelectomy pregnancies to reduce the complication rates.

Carcinoma of the uterine cervix is the most common gynecological malignancies in developing countries. Human papilloma virus is known as the main etiology. In addition, the spread of uterine cervical cancer often occurs through direct local extension and the lymphatics although the hematogenous spread is uncommon. Further, the scalp metastasis of cervical cancer is extremely rare.

In this regard, a 50-year-old woman with scalp metastasis of previous cervical cancer was discussed in the present study. She was suffering from a fast-growing and painful nodule, located on the frontal part of the scalp as a sole site of metastasis. A multidisciplinary approach was considered for her, which consisted of radical excision, followed by radiotherapy and chemotherapy. Given the lack of abundant evidence for the efficacy of this treatment, our patient has fortunately survived for more than two years.

During the follow-up period after the completion of treatment, it is not sensible to only focus on the primary site of the tumor and thus entire examination is mandatory in this regard.

This study investigates the possibility of predicting preterm labor by utilizing serum Magnesium level, BMI, and muscular cramp.

In this case-control study, 75 preterm and 75 term labor women are included. Different factors such as serum magnesium level, mother’s age, infant’s sex, mother’s Body Mass Index (BMI), infant’s weight, gravid, and muscular cramp experience are measured. Preterm labor is predicted by developing a linear discriminant model using Matlab, and the prediction accuracy is also computed.

The results show that each of the studied variables has a significant correlation with preterm labor. The p-value between BMI and preterm labor is 0.005, and by including the muscular cramp, it becomes less than 0.001. The correlation between serum magnesium level and the preterm labor is less than 0.0001. Using these three significant variables, a linear discriminant function is developed, which improves the accuracy of predicting preterm labor.

The prediction error of preterm labor decreases from 31% (using only serum magnesium level) to 24% using the new proposed discriminant function. Based on this, it is suggested to use the optimized linear discriminant function to enhance the prediction of preterm labor, since the serum magnesium level cannot predict the preterm labor accurately.

Acute myeloid leukemia (AML) is a malignant hematological disorder which has numerous manifestations at the initial step such as infections and hemorrhagic signs. This is the first report in which the diagnosis of AML was made after managing of Bartholin gland site swelling and pain as the chief complaint of a patient.

Herein, we present a young girl who was referred to us in our tertiary level hospital, Firoozgar Hospital, Tehran, Iran, in october, 2017 just with pain and swelling of the left Bartholin gland. At first, it was suspected to be a cyst or abscess of Bartholin gland, she did not have any history or symptoms of infection on comprehensive physical examinations such as pneumonia, meningitis, Nevertheless, the ultimate diagnosis of AML was made after generalized and precise systemic examination and laboratory findings were done. According to the guidelines for the treatment of AML, systemic chemotherapy with multiple drugs was given immediately but unfortunately, she died due to severe septicemia which was resistant to broad-spectrum antibiotics and disseminated intravascular coagulation.

Based on our searching, this is the first case. Because we expected other more common symptoms of acute lukemia, systematic and precise generalized examination must be performed gently in all of the patients even in women just with genital symptoms as their chief compliant for instance, pain and swelling of Bartholin gland. Finally, not focusing just on the perineal site and detailed examination for all parts of the body may reveal an accurate diagnosis of the main underlying disease.

Abnormal placental invasion in pregnancy is one of the most important dilemmas in gynecology and obstetrics medicine and because of the high potential risk of life-threatening massive bleeding, it has been considered as one of the most important causes of maternal morbidity and even mortality. According to the fact that previous cesarean section is the most highlighted and well-known risk factors for developing these types of abnormal placental invasion, and despite comprehensive recommendations for decreeing of this kind of surgery, the rate of caesarian delivery is raising worldwide, detecting the safer methods of management for optimizing the outcome is mandatory.

In this report, we are discussing a patient in Firoozgar Hospital, Tehran, Iran, with twin pregnancy accompanying with placenta previa with abnormal invasion, which has got the best possible outcome after performing a multidisciplinary approach without any need to blood transfusion or general anesthesia during cesarean hysterectomy as the standard management of placenta increate. In this case, we have performed magnetic resonance imaging (MRI) before surgery. We found out that we can use the exact site of placental margin and the distance between placental margin and uterovesical junction. So we have done the uterine incision horizontally without damaging to the placenta. Generally, Doppler ultrasonography has enough accuracy for detecting all kinds of placenta creates.

By selecting a safe uterine incision, we can prevent such a sudden and massive bleeding during the operation and also avoid occurring end-organ damage due to hemorrhage for instance, acute tubular necrosis, disseminated intravascular coagulation resulted in maternal morbidity and mortality. In this report, we also discuss the points needed for management and treatment of abnormal placental invasion by reviewing the recent literatures.

Gestational trophoblastic neoplasia contains a group of abnormal trophoblastic tumors including hydatidiform moles (partial and complete) and non-molar trophoblastic neoplasms (invasive mole, choriocarcinoma, placental site trophoblastic tumor). The incidence is 1-2 per 1000 deliveries both in the United States and Europe. The aim of this study was to prove the noninferiuority and safety of misoprostol use in cervical ripening in patient with molar pregnancy.

This retrospective cohort study was performed on 150 women with molar pregnancy referred to Firuzgar and Mirza-koochack-khan hospitals in Tehran, between 2006 and 2013. We defined group 1 as 100 patients without Misoprostol pretreatment and group 2 as 50 patients with Misoprostol pretreatment. There was no significant difference in the number of complete or partial mole between the two groups. They were followed by serum ß-hCG level and if it became plateaued in 4 measurements or rose more than 10% in 3 measurements in a period of three weeks, would be defined as persistent.

We found no significant difference of maternal age, fundal height, gestational age, gravity, parity, number of previous abortions and prevalence of complete and partial moles between the two groups. A total of 27 (27%) patients in non-Misoprostol group and 5 (10%) patients in Misoprostol group developed Persistent GTN (P<0.05). We observed no case of trophoblastic embolism in the misoprostol group.

 Misoprostol cervical ripening resulted in lower Persistent GTN incidence. Also, trophoblastic embolism following misoprostol administration is so rare that we observed no case.

Upper genital tract infection causes inflammation in multiple organs such as endometrium, fallopian tubes, ovaries, and pelvic peritoneum. This type of disease is caused due to infection with cervical pathogens, such as neisseria gonorrhea, chlamydia trachomatis, mycoplasma genitalium, bacterial vaginosis pathogens, and respiratory pathogens. The pathogens which involve the respiratory system and cervix are streptococci type A and enteric pathogens.  The primary goal of this study is reviewing reasons for having cervicitis and upper genital tract infection by discussing the appropriate treatments.
Significant Pelvic Inflammatory Disease  is one of the major topics of this field which needs a review since it engenders multiple disorders such as chronic pelvic pain, infertility, and ectopic pregnancy. Moreover, even by performing a treatment, there is a good chance of seeing sequela and scar in the fallopian tube in such patients. It should be noted that although recent progress in detecting/treatment of the infection during the early stages, infertility caused by PID is a major concern for health system. Additionally, subclinical PID remains poorly controlled, which needs more attention. In developing country Prevention programs, such as chlamydia screening or vaccination, should be developed to mitigate the infection problems.