Granulosa-cell tumor after ovarian stimulation

Background: 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

Case: 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

Conclusion: Persistent ovarian enlargement or ascites during or after infertility treatment should be carefully considered and managed

Uterine arteriovenous malformation after molar pregnancy: a case report and review of literature

Introduction: Uterine arteriovenous malformation [AVM] following molar pregnancy is a rare condition. The present study aimed at reporting a case of uterine arteriovenous malformation after molar pregnancy

Case Presentation: A 38-year-old woman with repeated heavy vaginal bleeding was referred to oncology department of Ghaem hospital affiliated to Mashhad University of Medical Sciences in 2016. She had history of evacuation curettage of molar pregnancy in the previous month. Examinations revealed AVM in fundus of uterus; and the patients was asymptomatic after embolization of the AVM and she is now under serial follow-up

Conclusions: The diagnosis of AVM should be considered when an unexplained massive hemorrhage occurs after gestational trophoblastic disease. In the case of correct diagnosis, unnecessary surgery is avoided

Leiomyosarcoma with unusual macroscopic features: a case report

Uterine sarcoma is a rare tumor of mesodermal origin, accounting for 2-6% of uterine malignancies. Leiomyosarcoma [LMS] has been reported in only 1% of all uterine malignancies and is regarded as the most common primary uterine sarcoma. Herein, we present a case of LMS with unusual macroscopic features. The patient was a 61- years-old woman with LMS, which consisted of a large cystic mass [88×136 mm], containing six liters of brownish fluid on the right side of the pelvis and abdomen. The fundus of the uterus was ruptured by the solid part of the tumor. For treatment, total hysterectomy, salpingo-oophorectomy and the optimal resection of tumor were carried out. Overall, the distinctive biological behavior and poor overall survival of uterine sarcoma challenge the post-operative management of this tumor. According to the one-year follow-up, the patient was disease-free. Unfortunately, no further data is available beyond this period

Sentinel node mapping in vulvar cancers: report of two cases and literature review

Vulvar cancer is a rare gynecological malignancy with mainly lymphatic spread. Sentinel node mapping plays an important role in the management of this gynecological malignancy. In the current study, we reported our experience in sentinel node mapping of vulvar cancer and review the literature accordingly. Since the introduction of sentinel node mapping to the surgical oncology community of our university in 2004, we had two operable vulvar cancer patients who were candidate for sentinel node mapping for inguinal lymph node staging. In the current study, we reported these two cases in details and a brief review of literature on sentinel node mapping in vulvar cancer was done. We specifically discussed the overall accuracy, importance of blue dye injection, learning curve effect, frozen section, excisional biopsy and location of the tumors. Overall sentinel node mapping is a safe and effective method for inguinal lymph node staging in vulvar cancers. In order to perform sentinel node mapping efficiently, paying attention to the details is of utmost importance

value of lateral lymphoscintigraphy images of the pelvis for gynecological cancers: are they necessary?

In the current study we evaluated the incremental value of lateral pelvic lymphoscintigraphy imaging of endometrial or cervical cancer patients who underwent sentinel node mapping. Operable endometrial and cervical cancer patients without clinical or paraclinical evidence of lymph node involvement were included in the study. The day before surgery the patients were sent to the nuclear medicine department for injection of the radiotracer. All patients received two intra-cervical injection of 1 mCi/0.2 cc radiotracer in the 6 and 12 hour locations. 18-24 hours after the radiotracer, lymphoscintigraphy imaging in anterior/posterior and lateral views was done. After induction of anesthesia, 2 mL Methylene blue in two aliquots was injected intra-cervically in the same location as the radiotracers. During operation, any hot and/or blue node was harvested as sentinel nodes. Overall 40 patients were included in the study [30 endometrial and 10 cervical cancers]. Sentinel node visualization was achieved in 30 patients. These sentinel nodes were all visualized on the ANT/POST views. Only in 7 patients sentinel nodes could be visualized on the lateral views. Intra-operative sentinel node detection rate was 38 out of 40 [95%]. Radiotracer detection rate was 37/40 [92.5%] and blue dye detection rate was 17/40 [42.5%]. Anterior/Posterior pelvic lymphoscintigraphy imaging is sufficient for imaging in cervical and endometrial cancer patients undergoing sentinel node mapping. Lateral views can be omitted due to limited valued of these projections

Peripheral primitive neuroectodermal tumor of the pelvis

The primitive neuroectodermal tumor [PNET] belongs to a group of highly malignant tumors and is composed of small round cells of a neuroectodermal origin. Categorized in the same tumor family as Ewing sarcoma, the PNET is most likely to occur in bones and soft tissues. However, a small number of PNET cases arising in the pelvis have been reported as well. We present three cases of pelvic PNET: two cases in the ovary and one case in the broad ligament. The PNET often exhibits aggressive clinical behavior with worse outcomes than other small round cell tumors. The significant prognostic factors of the PNET include site of tumor, volume of neoplasm, and presence of metastasis. The treatment protocol is multimodal and includes local surgical treatment followed by chemotherapy. We herein describe three PNET cases as a rare entity in the pelvis. Pelvic PNETs should be included in the differential diagnosis of pelvic masses

Inappropriate intracervical injection of radiotracer for sentinel lymph node mapping in a uterine cervix cancer patient: importance of lymphoscintigraphy and blue dye injection

Herein, we report a case of sentinel lymph node mapping in a uterine cervix cancer patient, referring to the nuclear medicine department of our institute. Lymphoscintigraphy images showed inappropriate intra-cervical injection of radiotracer. Blue dye technique was applied for sentinel lymph node mapping, using intra-cervical injection of methylene blue. Two blue/cold sentinel lymph nodes, with no pathological involvement, were intra-operatively identified, and the patient was spared pelvic lymph node dissection. The present case underscores the importance of lymphoscintigraphy imaging in sentinel lymph node mapping and demonstrates the added value of blue dye injection in selected patients. It is suggested that preoperative lymphoscintigraphy imaging be considered as an integral part of sentinel lymph node mapping in surgical oncology. Detailed results of lymphoscintigraphy images should be provided for surgeons prior to surgery, and in case the sentinel lymph nodes are not visualized, use of blue dye for sentinel node mapping should be encouraged

Metastatic choriocarcinoma in the small bowel: a case report

Choriocarcinoma is a highly malignant form of gestational trophoblastic disease. It is characterized by metastatic potential, rapid growth and deeply invasion into blood vessel and then widespread dissemination metastasis. However, the most common sites of metastatic choriocarcinoma are lung, vagina, liver, and brain. But, metastatic choriocarcinomas rarely is extended to gastrointestinal system. It is important to keep in mind that despite extensive metastasis, choriocarcinoma is very curable disease. Due to high responsibility of this disease, early diagnosis of choriocarcinoma and treatment with chemotherapy can prevent mortality and morbidity of these patients. In this case report, we present a rare case of metastatic choriocarcinoma in the small bowel after normal term pregnancy. A 34-years-old woman G4, P4, L4 presented with abnormal postpartum vaginal bleeding [45 days] and unresponsive to usual medical and surgical therapy [oxytocine, methergine, antibiotic, and double curettage]. The patient was admitted in the Ghaem Hospital, Mashhad University of Medical Sciences in April 2013. She suffered from rectal hemorrhage and severe weakness. Because of unsuitable condition and shock, laparotomy was performed and small bowel involvement was observed. Segmental resection of small bowel detected metastatic choriocarcinoma of the lesion. We couldn't rescue our patient due to unresponsive to combination chemotherapy [actino-mycine, methotrexate, cyclophosfamide, vincrystine, etoposide]. In abnormal postpartum hemorrhage, we should consider the possibility of choriocarcinoma. Although, it is important to note rare manifestations of metastatic choriocarcinoma of small bowel in massive gastrointestinal hemorrhage

Surgeon's errors in the managment of patients with Cervical Cancer

Generally, in patients with cervical cancer, careful preliminary evaluation is necessary for avoiding improper surgical procedures and making effective clinical decisions for treatment. The aim of this study was to determine surgeon errors, which necessitate a combination of surgery and radiotherapy for cervical cancer patients. In this retrospective study, medical records of all cervical cancer patients, undergoing hysterectomy at tumor clinics of Ghaem and Omid Hospitals, were collected from 1988 to 2008. In total, the medical records of 93 subjects with postoperative radiotherapy were examined. All records were assessed in terms of surgeons' errors, patients' follow-up after radiotherapy, rate of disease recurrence, and mortality rate. In addition, survival factors were recordedandassessed, and cumulative 3- and 5-year disease-free survival [DFS] rates as well as overall survival [OS] rate were determined by Kaplan-Meiertest. The overall rate of surgeons' errors was 41%. The most common surgical error was improper surgical care due to surgeon's lack of knowledge about the cervical cancer treatment. The 3-year DFS rates were 86% and 64% in cases without surgeon's error and those affected by surgeon's error, respectively. In addition, the 5-year DFS rate was 53% in the non-affected group and 47% in cases affected by surgeon's error [P=0.05]. Pre-treatment evaluation as well as proper treatment is necessary for the prevention of adverse effects, caused by inappropriate surgical interventions. It is suggested that more time and attention be allocated to the improvement of surgical outcomes

Neoadjuvant chemotherapy and radical surgery in locally advanced cervical cancer during pregnancy: case report and review of literature

For pregnant patients with cervical cancer, treatment recommendations are individualized and dependent on the stage of the disease, gestational age at the time of diagnosis, and the patient's desire as to the cosntinuation of the pregnancy. The aim of this study is to describe the outcome of neoadjuvant chemotherapy with radical surgery and pelvic lymphadenectomy in a woman with cervical cancer who wished to maintain her pregnancy This is a report of a 26-week pregnant woman with locally advanced cervical cancer stage I. [FIGO] who was successfully treated with neoadjuvant chemotherapy Paclitaxel plus platinum, followed by C/S and radical surgery. Her neonate was healthy and had no abnormalities. This case was the first cervical cancer during pregnancy that was treated using this method at the tumor clinic, Mashhad University of Medical Sciences/ Iran. Neoadjuvant chemotherapy is an effort to allow time for the fetal to reach viability by preventing the progression of the disease

Comparing serum follicle-stimulating hormone [FSH] level with vaginal PH in women with menopausal symptoms

Despite the important implication for women's health and reproduction, very few studies have focused on vaginal PH for menopausal diagnosis. Recent studies have suggested vaginal PH as a simple, noninvasive and inexpensive method for this purpose. The aim of this study is to compare serum FSH level with vaginal PH in menopause. This is a cross-sectional, descriptive study, conducted on 103 women [aged 31-95 yrs] with menopausal symptoms who were referred to the Menopausal Clinic at Ghaem Hospital during 2006. Vaginal pH was measured using pH meter strips and serum FSH levels were measured using immunoassay methods. The data was analyzed using SPSS software [version 11.5] and results were evaluated statistically by the Chi-square and Kappa tests. P 4.5, and serum FSH as >/= 20 mIU/ml, then the sensitivity of vaginal pH for menopausal diagnosis was 97%. The mean of FSH levels in this population was 80.79mIU/ml. Vaginal pH is a simple, accurate, and cost effective tool that can be suggested as a suitable alternative to serum FSH measurement for the diagnosis of menopause

Assessment of correlation between unprotected coitus and preeclampsia

Preeclampsia is a common complication of pregnancy often leading to significant maternal and fetal complications Preeclampsia occurs more frequently in primigravidae and in multigravidae who have a change in paternity. Length of sperm exposure has been proposed to influence the risk of preeclampsia. The aim of this study was to assess the relationship between unprotected coitus and preeclampsia. A case-control design was used to compare 91 women with preeclampsia [cases] with 91 matched ones in control group. The age range was from 20 to 35 years. Subjects were selected from mothers referred to Mahdieh and Akbar-Abadi hospitals. Data were gathered by interview method and were analyzed by independent t-test, Mann-Whitney, chi-square, and logistic regression using SPSS software. Women with a short period of co-habitation [<4 months] or the ones who used barrier methods for contraception had a substantially higher risk for development of preeclampsia compared with women with more than 4 months of cohabitation before conception [P = 0.0001]. Oral contraceptive users had a lower preeclampsia rate than women who used no oral contraceptive [P = 0.003]. No relationship was observed between coital rate before and during pregnancy and the risk of preeclampsia. This study suggests that the risk of developing preeclampsia in primigravidae is inversely proportional to the duration of sexual co-habitation