بهروز دواچی

Non-Hodgkin's lymphoma in the genital system is uncommon and ovary is one of the most common sites of involvement. Ovarian involvement in non-hodgkin's lymphoma is often secondary and is a part of the systemic involvement. Primary and localized ovarian involvement is uncommon and occurs in less than 10% of cases. In this study, a rare case of primary ovarian non-Hodgkin's lymphoma is presented.

The patient was a 64-year-old woman with a history of hysterectomy and postmenopausal bleeding that referred to the academic hospital of Mashhad University of Medical Sciences. On ultrasound and CT scans, solid cystic foci were found between the bladder and rectum, consistent with the location of the cervix and uterus. Subsequent evaluations confirmed histological and immunohistochemical diagnosis of ovarian non-Hodgkin's lymphoma.

Ovarian lymphoma is one of the differential diagnoses that should be considered in the pelvic masses.

Endometrial cancer is the most common gynecologic malignancy in the world. The most important factor in managing of this malignancy is early detection of the disease and the proper management either by surgery or radiation therapy. This study was performed with aim to evaluate the epidemiology and risk factors of patients with endometrial cancer.  In this cross-sectional study, 53 endometrial cancer patients (endometrioed typing) referred to the gynecology oncology clinic of an academic hospital in Mashhad University of Medical Sciences within 18 months from 2017-2018 were assessed. The standard questionnaire of risk factors for endometrial cancer was completed for all the patients. Data were analyzed by SPSS software (version 25) and kapa test. P In family history of most patients (92.45%), there were no endometrial-related cancers. Blood pressure was the most commonly associated illness in this study. There was no significant difference between mean endometrial thickness in postmenopausal and non-menopausal women (p= 0.134). In terms of risk factors, menopause, weight gain and increased number of pregnancies, there was more increase in these patients. Emphasizing on preventive measures which are available for endometrial cancer and minimizing the risk factors associated with this malignancy are effective in reducing the mortality resulting from this cancer.

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.

Surgical staging is the standard treatment of ovarian cancer. Pelvic and para-aortic lymphadenectomy is the important part of the surgery. The aim of this study was to evaluate the effect of para aortic lymph node dissection in early stage of patients with ovarian cancer.
This descriptive cross-sectional cohort study was performed on all stage I of ovarian cancer patients admitted in department of gynecology oncology of Ghaem Hospital, Mashhad University of Medical Sciences in November 2012 to March 2014. Every patient with clinical early stage of ovarian cancer candidate to surgical treatment selected. All cases underwent surgical staging surgery with concurrent systematic pelvic and para-aortic lymphadenectomy. In laparotomy after identification of left and right iliac artery, all lymph nodes have been properly exposed and dissected as a part of a staging laparotomy. The dissection was continued up to the nodal tissues surrounding the aorta, and inferior vena cava, until inferior mesenteric artery lymphadenectomy level. The procedure performed only by gynecologist oncologist. In addition, we assessed other parameters such as operation time, estimated blood loss, associated mortality and morbidity and vascular injuries. Finally, the effect of para aortic lymph node dissection in early stage of ovarian cancer evaluated.
Among a total of 57 ovarian cancer patients, 27 of them apparent stage I disease cases were selected. Surgical staging surgery with concurrent systematic pelvic and para-aortic lymphadenectomy was carried for all of them. Positive para-aortic lymph node was found only in one case. The average number removed para-aortic lymph nodes in the pelvis was 9 and in para aortic was 7, respectively. In addition, 20 minutes increase in total length of operation time was observed duo to para-aortic lymphadenectomy. Also the rate increase in intra-abdominal hemorrhage rate was estimated 60 ml.
Lymph node dissection will produce a significant benefit in accurate and complete surgical staging. Staging surgery in addition to systematic pelvic and para aortic lymph adenoctomy in early stage ovarian cancer is preferred in gynecologic oncology centers.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in females of reproductive age. Insulin resistance is a frequent metabolic disturbance in PCOS. Vitamin D deficiency is a common problem. Accumulating evidence suggests that vitamin D has a role on insulin sensitivity so may contribute to reduction of hyperandrogenemia. The aim was to determine the effects of vitamin D treatment in metabolic components and ovulation evidence in PCOS. Fifty one untreated PCOS patients were randomly divided into three groups and treated with calcitriol, metformin, or placebo. Before and 3 months after treatment, ovulation evidence was assessed by ovarian trans abdominal sonography. Plasma fasting glucose, insulin, homeostasis model assessment insulin resistance (HOMA-IR), 25-hydroxyvitamin D, parathyroid hormone and androgen levels were measured before and after treatment. A 75gr glucose test was performed before and after treatment and two set of results was compared. Three patients did not continue this study. Only 11 patient (22.9%) had sufficient vitamin D levels (>30 ng/ml). Metformin caused a significant decrease in weight (p=0.027), insulin level (p=0.043), and insulin resistance (p=0.048). Systolic blood pressure and PTH significantly improved after calcitriol (p=0.029, p=0.009 respectively). An improvement in ovulation was detected after calcitriol and seven patients, without evidence of ovulation before treatment, illustrated ovulation after 3 months. Difference with calcitriol in ovulation was significant versus other two methods (p=0.02). Calcitriol treatment in PCOS may be prior to metformin in ovulation induction.

Prevalence of polycystic ovarian syndrome (PCOS) in reproductive age women is about 10 %. There is a lot of morbidity due to this syndrome. Vitamin D deficiency is a common problem in the world and especially in Iran. Because of probable role of activated vitamin D on induction of insulin secretion and reduction in insulin resistance and the effect of hyperinsulinemia on elevation of free androgens; we designed to evaluate the effect of active form of vitamin D on control of PCOS clinical and metabolic complications. This clinical trial study was carried out in Ghaem hospital. 51 untreated PCOS patients randomly were divided into three groups. Treatment with calcitriol (0. 5mg)، metformin (1000 mg) and placebo were started for each group for three month. After three month assessment for improvement in clinical (improvement of ovulation) and metabolic status (fasting blood glucose، glucose tolerance test، insulin resistance and androgen levels) were performed. Only 22. 9% of patients had sufficient vitamin D levels (>30 ng/ml). Treatment with metformin significantly decreased weight (p=0. 027)، insulin level (p=0. 043)، insulin resistance (p=0. 048) and BMI (p=0. 019). Systolic blood pressure and PTH significantly decreased after calcitriol therapy (p=0. 029، 0. 009 respectively). An improvement in ovulation was detected after calcitriol treatment and 7 patients without ovulation demonstrated ovulation features after treatment with calcitriol. Resumption of ovulation was observed in treatment with metformin and placebo but this changes were significantly more evident in calcitriol group (p=0. 02). It seems that treatment with calcitriol may be effective in management of PCOS and it may be better in ovulation induction than metformin therapy.