Docosahexaenoic Acid in the Inhibition of Tumor Cell Growth in Preclinical Models of Ovarian Cancer.

There is a strong rationale for investigating nutritional interventions with docosahexaenoic acid (DHA) in cancer prevention and therapy; however, the effects of DHA on ovarian cancer (OC) have not been well studied. Here, we investigated if DHA alone and in combination with carboplatin reduces OC cell growth in vitro. In vivo, we used a high-grade serous OC patient-derived xenograft (PDX) mouse model to investigate if DHA affects OC growth and enhances the anticancer actions of carboplatin. We showed synergistic cell killing by DHA and carboplatin in DHA-resistant Kuramochi and SKOV3 OC cells, which corresponded with increased DHA incorporation into whole-cell membrane phospholipids (P < 0.05). In vivo, feeding mice a diet supplemented with 3.9% (w/w of fat) DHA resulted in a significant reduction in PDX growth with and without carboplatin (P < 0.05). This reduction in tumor growth was accompanied by an increased tumor necrotic region (P < 0.05) and improved survival. Plasma membranes in tumors and livers excised from mice fed a DHA diet had ∼ twofold increase in DHA incorporation as compared with mice fed a control diet. Our findings indicate that DHA supplementation reduces cancer cell growth and enhances the efficacy of carboplatin in preclinical models of OC through increased apoptosis and necrosis.Supplemental data for this article is available online at https://doi.org/10.1080/01635581.2021.1952453.

Association between factor V Leiden mutation and recurrent pregnancy loss in the middle east countries: a Newcastle-Ottawa meta-analysis.

PURPOSE: Heritable thrombophilia is a category of genetic disorders of the coagulation cascade with the increasing risk of thrombus formation and recurrent pregnancy loss (RPL). Factor V Leiden (FVL) (R506Q) mutation is the most common genetic cause of deep venous thrombosis, but its association with RPL has been inconsistent in studies arising from non-Western countries. The present metanalysis was aimed to determine whether an association exists between FVL and RPL in the Middle East. METHODS: We searched PubMed, MEDLINE Web of Science, Scopus, and Embase, evaluating the association between the FVL and RPL. The Middle East countries (Bahrain, Cyprus, Egypt, Iran, Iraq, Israel, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, The State  of Palestine, Syria, Turkey, The United Arab Emirates, and Yemen) were evaluated in succession. Raw data were extracted, and 19 case-control studies were included in our final analysis. RESULTS: Overall, 2513 cases and 1836 controls in the Middle East showed a prevalence of FVL mutation as 12.6% and 4.9% in patients and controls, respectively. To evaluate the relationship between FVL mutation and RPL, we used Forest plot (random effect model) with the overall random OR of 2.37 (CI 95%: 1.50-3.75). FVL mutation was associated with a higher risk of RPL. In Iran, the OR was 1.90 (95% CI 1.04-3.45), and in Turkey, the OR was 3.01 (95% CI 1.10-8.23). CONCLUSION: The results of our study support an association between FVL mutation status and RPL in women of the Middle East countries. It is recommended that specific policies include comprehensive testing for FVL mutation as a standard of care in women of the Middle East region with unexplained RPL.

Qualitative and quantitative analysis of diffusion-weighted imaging of gestational trophoblastic disease: Can it predict progression of molar pregnancy to persistent form of disease?

PURPOSE: To describe the diffusion-weighted imaging (DWI) appearance of gestational trophoblastic disease (GTD) and to determine its apparent diffusion coefficient (ADC) values. To evaluate the feasibility of DWI to predict progression of hydatidiform mole (HM) to persistent disease. METHODS: During a period of 6 months, women with preliminary diagnosis of GTD, based on ultrasound and ßhCG levels, underwent 1.5T MRI (T2 high-resolution and DWI; b values 50, 400, 800; sagittal and perpendicular to the endometrium; and T1, T2 Turbo Spin Echo [TSE] axial images). Patients were followed for 6-12 months to monitor progression to persistent form of the disease. ADC values and image characteristics were compared between HM and persistent neoplasia and between GTD and non-molar pregnancy using Mann-Whitney U and Fisher's exact tests, respectively. RESULTS: Among the 23 studied patients, 19 (83%) were classified as molar and 4 (17%) as non-molar, based on pathology reports. After 6-12 months of follow-up, 5 (26%) cases progressed to persistent disease and 14 (74%) cases were benign HM. There was no significant difference between ADC values for HM (1.93±0.33×10-3mm2/s) and persistent neoplasia (2.03±0.28×10-3mm2/s) (P=0.69). The ADC of non-molar pregnancies was (0.96±0.46×10-3mm2/s), which was significantly different from GTD (1.96 ±0.32×10-3mm2/s) (P=0.001). Heterogeneous snowstorm appearance, focal intratumoral hemorrhage, myometrial contraction, and prominent myometrial vascularity were more common in GTD compared to non-molar pregnancy (P<0.05). CONCLUSION: Heterogeneous snowstorm appearance, focal intratumoral hemorrhage, myometrial contraction, and prominent myometrial vascularity are among the imaging characteristics of GTD. We cannot use ADC values to predict progression to persistent disease.

Extragonadal sclerosing stromal tumor: a rare case report.

Sclerosing stromal tumor is a rare, benign, sex cord stromal tumor of the ovary. We report a case of extragonadal sclerosing stromal tumor in a 45-year-old woman who presented with menstrual irregularity and vague pelvic pain. Imaging studies showed a well-defined mass between the posterior wall of the bladder and uterus, suspected of being a pedunculated leiomyoma. The histopathological and immunohistochemical study was consistent with sclerosing stromal tumor. No ovarian tissue was found on representative sectioning. This is the first case of sclerosing stromal tumor in an extragonadal location.

Postpartum Spontaneous Rupture of Spleen in a Woman with Severe Preeclampsia: Case Report and Review of the Literature.

Splenic rupture during pregnancy is considered a catastrophic condition associated with high maternal and fetal mortality and morbidity. Herein, we report a case of severe preeclampsia that underwent cesarean delivery with subsequent spontaneous splenic rupture. A 21-year-old primigravid woman was transferred to our center due to severe preeclampsia that underwent cesarean delivery because of uncontrolled blood pressure and low platelet count. She developed coffee ground vomiting postoperatively and clinical evidence of free fluid was present. Emergency laparotomy was performed and revealed an approximately 2.5-3 cm defect in splenic capsule with active bleeding from the ruptured site. The site of splenic laceration was packed with gauze. Postoperative period was uneventful and she was discharged on day 15 after admission. As spontaneous splenic rupture is associated with severe complications, its differential diagnosis should be kept in mind in pregnant women with severe preeclampsia.

The Effect of Extrafascial Hysterectomy After Completion of External Beam Radiotherapy for Treatment of Locally Advanced Stages (IIB-III) of Cervical Cancer.

BACKGROUND: Worldwide, cervical cancer is one of the most challenging gynecologic cancers in treatment. OBJECTIVES: This study was designed with the aim of comparing patients treated with External Beam Radiotherapy (EBRT) and Interactivity Brachytherapy (ICBT) with EBRT and extrafascial hysterectomy in locally advanced stages of cervical cancer (IIB-III). PATIENTS AND METHODS: The present study was designed as a case-control which was performed on the patients with cervical cancer in locally advanced stages (IIB-III) admitted to Namazi and Faghihi hospitals (university hospitals in Shiraz) between 2008-2011. 51 patients were included in two distinct groups: 25 patients were treated with EBRT and Interactivity Brachytherapy (group A). 26 patients were treated with EBRT and extrafascial hysterectomy group B. RESULTS: In group A, the number of patients with FIGO stage IIb and III were 16 and 9, respectively, and 17 and 9 in group B. The median duration of follow-up was 24 months. There were no significant differences between two groups in metastasis and recurrence rate (P > 0.05). 5-years overall survival rate was 54.8% [95% CI: 39-70.9] in group A and in group B was 50.9% [95% CI: 41.5-60] and The LOG-rank test which controls the effect of treatment modalities on overall survival rate, did not show any significant difference between two groups (P = 0.407). CONCLUSION: The results of our study showed that the trend of treatment using EBRT along with intracavity brachytherapy may have the same outcome as the method of using EBRT and extrafascial hysterectomy. Overall, it seems that external beam radiation followed by extrafascial hysterectomy could be a proper substitute for brachytherapy.

A comparison of the effect of short-term aromatase inhibitor (letrozole) and GnRH agonist (triptorelin) versus case control on pregnancy rate and symptom and sign recurrence after laparoscopic treatment of endometriosis.

PURPOSE: To compare the role of an aromatase inhibitor (letrozole) with a GnRH agonist (triptorelin) versus case control on the pregnancy rate and recurrence of symptoms and signs in patients with endometriosis. METHODS: In a prospective randomized clinical trial, after treatment of 144 infertile women in their reproductive age by laparoscopy (whose endometriosis was confirmed by prior laparoscopy), they were divided into 3 groups: group 1 (47 cases) who received letrozole for 2 months, group 2 (40 patients) who were prescribed triptorelin for 2 months and group 3 who were 57 patients in the control group and did not receive any medication. We followed up each group at least for 12 months after their restoration of regular cycle. RESULTS: Pregnancy rate was 23.4% in group 1, 27.5% in group 2, and 28.1% in group 3. The results did not show significant differences among the 3 groups. Recurrence rate of endometriosis was 6.4% in group 1, 5% group 2 and 5.3% in group 3, which was not statistically significantly different as well. CONCLUSION: Pregnancy rate and endometriosis recurrence rate are comparable among the 3 groups.

Term delivery following successful treatment of choriocarcinoma with brain metastases, a case report and review of literature.

BACKGROUND: Cerebral metastases from choriocarcinoma are a poor prognostic indicator of outcome in both the World Health Organization and FIGO classification systems. Although gestational trophoblastic neoplasia has become the most curable of gynecological malignancies, failure rate among "high-risk" patients is still high despite of the use of aggressive multidrug regimens. CASE: A 27-year-old woman (G(4)P(2)Ab(1)) presented with hemiplegia due to brain metastases of choriocarcinoma 1 year after spontaneous abortion. She underwent craniotomy and was treated with nine courses of multiple agent etoposide, methotrexate, actinomycin- etoposide, and cisplatinum (EMA-EP) regimen combined with whole brain irradiation. She delivered a term healthy child 2 years after termination of treatment. CONCLUSION: Multiagent EMA-EP chemotherapy and whole brain irradiation with craniotomy in selected patients preserves fertility and may improve a patient overall prognosis.

The value of frozen sectioning for the evaluation of resection margins in cases of conization.

OBJECTIVES: To determine the role of frozen section examination (FSE) of the cone specimen in the evaluation of the resection margin status and to rule out invasion in patients with high-grade cervical intraepithelial neoplasia. METHODS: Thirty patients with cervical intraepithelial neoplasia underwent conization followed by FSE and planned hysterectomy. The results of the definitive paraffin exam were compared with FSE. RESULTS: In evaluation of the margins by FSE, 4 patients (13%) had positive cone margines and 26 (87%) had negative margins. The definitive of paraffin examination of margin status was concordant in all the cases. Intraoperative diagnosis of invasion was made in three cases such that all of them were invasive squamous cell carcinoma. Among the remaining 27 cases, we detected five CIN1, two CIN2 and three CIN3, so the diagnosis of the FSE was concordant with paraffin section in 26 out of 30 cases (87%). Also we detected four additional CIN (one CIN 1, two CIN2 and one CIN3) after paraffin study, whose frozen specimens were reported normal. CONCLUSION: Frozen section examination can provide immediate and precise evaluation of the cone margin status in high-grade cervical intraepithelial neoplasia. It can identify frank invasion and permit adequate treatment in a one-stage procedure and reliably detect clear resection margins.

High levels of CA125 (over 1,000 IU/ml) in patients with gynecologic disease and no malignant conditions: three cases and literature review.

OBJECTIVE: To report the very high serum levels of CA125 in patients with benign gynecologic disease which manifests as pelvic mass. METHODS: Clinical data of three cases with high levels of CA125 over 1,000 IU/ml and benign gynecologic conditions were gathered. in Vali-Asr hospital. RESULTS: Three patients were scheduled for laparatomy as ovarian cancer and leiomyosarcoma. Histologic results after laparatomy showed uterine myoma in two patients and endometrioma in a third patient. CONCLUSION: High levels of CA125 over 1,000 IU/ml, may be showed in other gynecologic conditions with no malignancy. So, other clinical and imaging data could be helpful for differential diagnosis of these patients.