setare akhavan
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International Journal of Women’s Health and Reproduction Sciences, Volume:10 Issue: 2, Apr 2022, PP 86 -90Objectives
The present study aimed to assess the significance of human epididymis protein 4 (HE4) and cancer antigen 125 (CA 125) in the overall survival (OS) and the recurrence survival of endometrial cancer.
Materials and MethodsThe study was conducted on 99 patients with a mean age of 53±64. The patients were all cases with a definitive diagnosis of endometrial cancer. With regard to the histology and the surface measurement, the HE4 and CA 125 were both confirmed within 1 to 2 week(s) prior to hysterectomy by implementing the standard-procedure treatment of extra facial total hysterectomy and bilateral salpingo-oophorectomy with selective pelvic and para-aortic node dissection. Then, risk-assessment for possible recurrence (Mayo criteria) was carried out as well. Patients with the variables of HE4 and CA 125 in the upper third (66th) percentiles were grouped as high-risk. Finally, the data were analyzed using SPPS 23, and P <0.05 was considered statistically significant.
ResultsThe mean (SE) of OS among patients with the serum CA 125 of ≤22 kU/L and higher 22 kU/L was 47.97 (±2.58) and 41.78 (3.75) months (P = 0.466). In addition, the mean (SE) of OS in patients with the serum HE4 level of ≤ 98 ρmol/L and >98 ρmol/L was 50.14 (2.06) and 38.54 (3.74), respectively. The log-rank test revealed a substantial difference between low- and high-risk groups by HE4 ( χ2=4.98, P = 0.025). Accordingly, there is no significant difference between recurrence-free survival (RFS) with CA 125 (P = 0.264) and HE4 ( P = 0.114), respectively.
ConclusionsIn general, the serum HE4 level is a significant independent prognostic factor for OS in endometrial cancer and is useful in survival studies.
Keywords: Endometrial carcinoma, CA 125 antigen, HE4 protein, Overall survival, Recurrence-free survival -
International Journal of Women’s Health and Reproduction Sciences, Volume:9 Issue: 4, Oct 2021, PP 280 -283Objectives
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.
Materials and MethodsThe 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.
ResultsThe 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).
ConclusionsIt 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.
Keywords: Precancerous, Dietary supplement, Q10, Cervix, Colposcopy -
International Journal of Women’s Health and Reproduction Sciences, Volume:8 Issue: 1, Jan 2020, PP 95 -100Objectives
Uterine endometrial cancer (EC) is the most common female reproductive system malignancy. There are various comments on pelvic and para-aortic lymphadenectomy during the surgical staging of EC. Several oncologists believe that total lymphadenectomy, in some cases, may lead to operative morbidity without any considerable advantage over more surveillance, especially in patients with comorbidities. The purpose of the current study was to examine the correlation between serum tumor marker levels and stage, grade, histological type, myometrial invasion, and lymph node involvement in EC.
Materials and MethodsA total of 131 patients with EC participated in the present cross-sectional study. Preoperative serum CA125 and HE4 levels were evaluated 1 week before surgery. Then, the stage, grade, and lymph node involvement were recorded according to the pathological findings. After Data analysis through SPSS software, P value<0.05 was considered to be significant.
ResultsOne hundred thirty-one patients with EC (70, 31, 15, and 15 patients in sequence with stages IA, IB, II, and III) were analyzed. The serum CA125 and HE4 levels were significantly higher in more advanced stages (over IA), (P = 0.016 and P = 0.004, respectively). Levels of both tumor markers were significantly higher in patients with lymph node involvement, and cervical and myometrial invasions. In logistic regression analysis, a significant correlation was found between HE4 level (odds ratio [OR] = 1.005, P = 0.035) and grade of disease (OR = 2.137, P = 0.005).
ConclusionsHE4 and CA125 are useful for predicting high-risk patients. Sensitivity of 64% and specificity of 60% were indicated at cut-off value of 70 pmol/L for HE4 in stage IA in comparison with stages over IA. Although the ideal cut-off which is defined as higher than 80% was not obtained, such a cut-off (60%) can also be considered for preoperative evaluation of surgical staging of EC.
Keywords: Endometrial cancer, Human epididymis 4, Cancer antigen 125 -
Background & Objective
Endometrial cancer is the most frequent genitourinary tract malignancy in women. Women with endometrial cancer mostly refer at early stages of the disease which leads to good prognosis. Magnetic resonance imaging (MRI) has a crucial role in staging of the cancer. As there are little studies regarding the correlation between histopathology and International Federation of Gynecology and Obstetrics (FIGO) staging in Iranian women with endometrial cancer, we designed this study to assess the relationship between histopathology and FIGO staging with MRI in Iranian women with endometrial cancer.
Materials & MethodsThis retrospective study was conducted in Imam Khomeini hospital complex between January 2015 and January 2018. All MRIs were performed on a 3T system. All imaging was done in Imam Hospital under observation of attending Radiologists with 10 and 20 years of work experience in women’s imaging who conducted this research. Obtained surgical specimens were assessed by an expert pathologist in the field of cancer and type of cancers were determined.
ResultsThirty two women with proved endometrial cancer (D&C or endometrial biopsy) were enrolled. Mean age was 55.2±10.7 years and all women referred to our clinic with vaginal bleeding. The most common FIGO staging was IA (14, 43.75%) and the most frequent pathology was endometrioid type adenocarcinoma (30, 93.7%) (60% well differentiated, 13.3% moderately differentiated, and 26.6% poorly differentiated). Most cases with endometrioid type poorly differentiated referred with IIIC1 stage of cancer, most patients with endometrioid type well differentiated referred with stage IA, a patient with clear cell cancer referred with stage IIIB, and patients with sarcoma referred with stages IB, and IV.
ConclusionPatients with poor differentiated endometrial cancer referred with higher stages of the cancer.
Keywords: Endometrial cancer, Magnetic resonance imaging, Staging -
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.Keywords: Trophoblastic neoplasms, Cesarean scar, pregnancy, Trophoblastic tumor, Placental site
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Background
Currently, the prevalence of borderline ovarian tumors (BOT) is increasing, and given the higher diagnosis in the third and fourth decades of life, fertility sparing procedures are widely used. There are important consequences in females with borderline ovarian tumors and number of effective factors on recurrence and fertility rate.
MethodsIn this cohort study, the required information was collected from a file of 43 patients with final pathologic diagnosis of borderline ovarian tumor, who had undertaken fertility sparing surgery at Imam Khomeini Hospital, Tehran University of Medical Sciences, and recurrence rate, fertility rate, and the effect of different variables were studied.
ResultsThere were significant correlations between oral contraceptive pill (OCP) consumption, serous pathology, micro invasion in pathology, advanced stages, and recurrence rate of BOT, while this relationship was not found between parity, surgical methods (laparotomy and laparoscopy), surgical techniques (cystectomy and USO), papillary projection, and recurrence rate.
ConclusionsAlthough the recurrence rate was higher in the current research when compared to other previous studies, yet only in one patient, the pattern of recurrence was invasive epithelial carcinoma, thus in the current study the overall survival did not seem to change. The results of this study on fertility rate are comparable to other studies on this issue. Therefore, these methods are recommended for young patients and emphasis should be place on follow-up.
Keywords: Borderline Ovarian Tumor, Fertility Preservation, Recurrence -
Introduction
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.
Case PresentationThe 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.
ConclusionsIt 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.
Keywords: Squamous Cell Carcinoma, Vulvar Cancer, Cutaneous Metastasis -
BackgroundCervical cancer is the second most common type of cancer among women. Effective screening programs can help cancer detection in early phases and reduce death. Metastasis to lymph nodes is one of the most prognostic factors in patients who underwent surgery. Also, a positive result from pathology report alert oncologist as a cause of death. Sentinel lymph node biopsy has been widely studied and clinically used for many types of cancer.
MethodsTwo techniques exist for detecting sentinel node in cervical cancer, which are Blue dye and gamma probe with radioactive isotope (99mTc). Moreover, lymphoscintigraphy has many advantages over the stain method. Detecting the sentinel node is performed via laparoscopy or laparotomy; former method is better and more accurate.ResultsVarious researchers have focused on this method and its positive results; its superiority against full lymphadenectomy has been declared in previous studies. Moreover, the role of sentinel lymph nodes biopsy in cervical cancer is still being extensively studied. Sentinel lymph nodes (SLN) method has a higher accuracy level to detect metastasis.
ConclusionHence, it can be considered as a more appropriate alternative for pelvic lymph node dissection (PLND), which is a standard technique. Altering the method to a standard clinical method needs in-depth researches and studies.Keywords: Biopsy, Sentinel lymph nodes, Cervical cancer, Blue dye -
BackgroundPeritoneal cytology has been reported to be an independent risk factor for poor survival, but it is not included in the current international federation of gynecology and obstetrics (FIGO) staging system for risk stratification.ObjectivesWe aimed to investigate the prognostic significance of positive peritoneal cytology (PPC) in patients with early stage endometrioid adenocarcinoma.MethodsMedical profiles of patients with uterine carcinoma referring to Imam Khomeini hospital and Mirza Koochak Khan hospital between September, 2005 and December, 2011 have been reviewed. Patients had a complete staging procedure and peritoneal cytology evaluation.ResultsAmong 220 patients with mean age of 56.3 ± 9.1 years, 204 were Negative for peritoneal cytology (NPC) and 16 showed PPC. In the group of patients with endometrioid adenocarcinoma, 125 were in stage I and 32 were in stage II. Univariate analysis on patients with endometrioid adenocacinoma revealed that stage II (OR = 7.12, 95% CI = 2.95-22.10, P valueConclusionsOur study demonstrated that positive peritoneal cytology is an independent prognostic factor in patients with early stage endometrioid adenocarcinoma. We propound that peritoneal cytology adds back into the future FIGO staging criteria revision. Until then, peritoneal washings should still be considered as an important part for accurate risk-stratification.Keywords: Early Stage, Endometrioid Adenocarcinoma, Peritoneal Cytology, Survival
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Introduction
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.
Case PresentationOur 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.
ConclusionsIn conclusion, we believe that vascular endothelial growth factor (VEGF) production of tumor is responsible for massive bleeding.
Keywords: Sclerosing, Stromal, Ovarian Mass -
Introduction
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.
Case PresentationHere, 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.
ConclusionsBecause 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.
Keywords: Mesonephric, Adenocarcinoma, Cervix -
Introduction
Embryonal (Botryoid) Rhabdomyosarcoma (RMS) is an aggressive malignancy that arises from embryonal rhabdomyoblasts. It is commonly seen in the genital tract of female infants and young children. The primary site of these tumors is closely related to the age of the patient. Embryonal Rhabdomyosarcoma has a marked tendency for local recurrence after excision. Due to young age of affected patients who desire fertility, the management of this rapidly growing malignancy is very critical and poses challenges.
Case PresentationWe report on two cases embryonal rhabdomyosarcoma of uterine cervix, who were referred to Imam Khomeini hospital during year 2014. Both of them were young virgin females. The presenting symptom for both was vaginal bleeding and protrusion of polypoid mass from the hymen. After neoadjuvant chemotherapy, radical hysterectomy was offered to them. One of them refused, thus local excision was done. Both patients received adjuvant chemotherapy yet in the patient with local excision, the tumor recurred with multiple metastases.
ConclusionsThere are several methods of surgical approach and variation in adjuvant therapy in the management of embryonal rhabdomyosarcoma. If we choose a conservative approach for surgery of early stage, surgical margin should be negative and in other cases doing radical surgery is the best.
Keywords: Embryonal Rhabdomyosarcoma, Cervix, Surgery -
مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران، سال هفتاد و یکم شماره 2 (پیاپی 146، اردیبهشت 1392)، صص 128 -132زمینهتومورهای موسینی بینابینی (بوردرلاین) تخمدان به دو گروه مورفولوژیک تقسیم می شوند: نوع شبه اندوسرویکال و نوع روده ای. اغلب آدنوکارسینوم های اندوسرویکال تمایز موسینی و یا شبه اندومتری از خود نشان می دهند. این تومورها به ندرت به تخمدان ها متاستاز می دهند اما گاها علایم تومورهای تخمدانی را دارند. در بیماران مبتلا به آدنوکارسینوم موسینی در حفره شکم، در تفسیر این که منشا احتمالی تومور بر پایه پروفایل های ایمونوهیستوشیمی کدام نقطه است، باید با احتیاط عمل کرد، به علاوه بررسی DNA ی ویروس پاپیلومای انسانی در شناسایی تومور اولیه از موارد متاستاتیک ارزش دارد. در این مطالعه یک خانم 36 ساله با دو نئوپلاسم هم زمان ژنیتال معرفی می شود.
معرفی مورد: بیمار خانم 36 ساله ای بود که با خون ریزی غیرطبیعی رحمی و درد قسمت تحتانی شکم مراجعه نمود. در شرح حال سابقه ای از پولیپ دهانه رحم داشت. سونوگرافی لگنی توده ای در آدنکس راست نشان داد و اندازه سرویکس بزرگ تر از حد طبیعی بود. تشخیص بافت شناسی نمونه برداری سرویکس، آدنوکارسینوم دهانه رحم را نشان داد. بیمار تحت هیسترکتومی رادیکال تیپ III همراه با سالپنگواووفورکتومی قرار گرفت. آزمایش DNAی ویروس HPV در بافت تومورال منفی بود. یافته اخیر نشان داد که این تومور یک آدنوکارسینوم اندوسرویکال متاستاتیک نیست.نتیجه گیریبه نظر می رسد در مواردی که تومور دو عضو مختلف را درگیر کرده باید بررسی های تشخیصی دقیق جهت افتراق نوع اولیه از ثانویه انجام شود چرا که شاید عوامل ایجاد کننده ی رشد غیرطبیعی سلولی روی سلول های مشابه اثر هم زمان داشته باشند.
کلید واژگان: آدنوکارسینوم سرویکس، موسینوس تومور، تومور تخمدانBackgroundOvarian mucinous borderline tumors are divided into two morphologic groups: endocervical-like and intestinal type. Most endocervical adenocarcinomas exhibit mucinous and/or endometrioid differentiation، they infrequently metastasize to the ovaries but may simulate primary ovarian tumors (both atypical proliferative or borderline and carcinoma). In patients with mucinous adenocarcinoma in the abdominal cavity، caution should be exercised in interpreting the possible primary site of the tumor on the basis of the immunohistochemical profiles. The presence of human papillomavirus (HPV) DNA is assessed to determine whether the ovarian neoplasms were metastases or primary independent neoplasm. Approximately 90% of endocervical adenocarcinomas are related to high-risk human papillomavirus (hr-HPV) with the remainder being unrelated to HPV. Both types metastasize to the ovaries very infrequently. Ovarian endocervical-type (mullerian) mucinous tumors and tumors composed of a mixture of endocervical-type mucinous، serous endometrioid، squamous، and indifferent cells with abundant eosinophilic cytoplasm reported to date have been primarily limited to borderline and micro invasive types. We report a-36-yr old woman with adenocarcinomas of uterine cervix who also had ovarian mucinous borderline tumor.Case PresentationThe patient presented with abnormal uterine bleeding and lower abdominal pain. She had a history of uterine cervix polyps. Pelvic ultrasound showed a right adnexal mass and a large cervical size. Histological diagnosis in uterine cervix biopsy revealed adenocarcinoma of cervix. Radical hysterectomy type III with bilateral salpingo-oophorectomy was performed. Histological finding in adnexal mass revealed borderline mucinous tissue of ovarian tumor. Testing for HPV DNA in the tumoral tissue was negative. This confirms that the ovarian tumor is not metastatic from endocervical adenocarcinoma.ConclusionWe conclude that in a patient with tumors that involve two organs، complete diagnostic investigation should be done to distinguish the primary origin. The factors that affect cell proliferation، can probably have synchronous effects on the two similar cells. -
آدنوکارسینوم سلول شفاف دهانه رحمClear Cell Adenocarcinoma of Cervix یک بیماری نادر است که فقط در 2% تا 7% از تمام موارد آدنوکارسینوم دهانه رحم دیده می شود. عوامل خطر عمده برای سرطان دهانه رحم عبارتند از: شروع زود هنگام فعالیت جنسی، شرکای جنسی متعدد و داشتن شریک جنسی پرخطر. این عوامل احتمال وجود نقش عفونت ویروس پاپیلومای انسانی Human Papiloma Virus را مطرح می کنند و عفونت HPV قویا با گسترش سرطان گردن رحم همراه است. آدنوکارسینوم اولیه سلول شفاف دهانه رحم عمدتا در زنان جوانی رخ می دهد که در دوران جنینی در معرض دی اتیل استیل بسترول که قبلا برای جلوگیری از سقط استفاده می شد، قرار گرفته اند. مورد 1: بیمار نوجوان 14 ساله بود که در شرح حال از خونریزی واژینال شکایت داشت. او به علت خونریزی بدون درد واژینال تحت معاینه ژنیکولوژیک قرار گرفت در تست پاپ اسمیر سلول های آتی پیک گزارش شد.
The first case was a 14-year-old women with complaint of painless vaginal bleeding. There was atypical cells in Pap Smear and a bleeding tumor with 1.5 cm in diameter was found in vagina. She was admitted with a diagnosis of CCAC of the uterine cervix stage Ib2 according to FIGO classification. The second case was a 23-year-old patient with complaint of painless vaginal bleeding. The results of cervical cytology was normal. Evaluation of the punch biopsy sample revealed CCAC. Her clinical exam showed stage IIb according to FIGO classification. Both patients had no history of exposure to DES during embryonic period. The first patient treated with radical abdominal hysterectomy and systematic pelvic
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