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Purpose: The accuracy of intra-operative gross visual examination of myometrial invasion of uterine specimen has been evaluated in several studies with controversial results. The intra-operative frozen section (IFS) analysis is used to identify patients at high risk for pelvic and para-aortic nodal metastasis in order to avoid lymphadenectomy in low-risk patients. However, there is still some controversy concerning the efficiency of IFS. The aim of this study was to evaluate the accuracy and validity of frozen section diagnosis and gross examination of uterine specimen compared to the final histological results in patients with endometrial cancer., Methods: The study group comprised 31 patients with a pre-operative histopathological diagnosis of endometrial carcinoma. Comprehensive surgical staging was performed in all patients. Intra-operative gross examination of the uterine cavity and wall with frozen section analysis was performed. Lymphadenectomy was performed in all patients. After frozen section analysis, the uterus together with removed lymph nodes was stored and subjected to final pathologic diagnoses., Results: Gross examination accurately identified microscopic invasion of myometrium in 86.6% of the patients with 88.9% sensitivity, 85.7% specificity and negative and positive predictive values of 72.7 and 94.7%, respectively. The kappa was 0.70 (p < 0.0001) with a 95% CI 0.432-0.968. Frozen section in 90% of cases was correctly reporting final histopathological myometrial invasion with sensitivity 88.9%, specificity 90%, positive and negative predictive values 80 and 94.7%, respectively. The kappa was 0.76 (p < 0.0001) with a 95% CI 0.51-1.009., Conclusion: These data confirm the previous reports for the accuracy of gross examination and frozen section diagnosis in early stage and low-grade tumors.

Background and Goals: This study is designed to survey gestational trophoblastic neoplasia with vaginal metastases (GTN + VM) manifestations, prognosis and chemotherapy response in order to consider appropriate chemotherapy regimen for these patients. There have been just a few studies about treatment of GTN + VM., Materials and Methods: Patients with Stage III GTN with or without vaginal metastases who had referred to Vali-e-Asr Hospital during 1996-2006 have been selected to take part in this study and the size of metastases was measured. Then response and resistance to single and combination chemotherapy regimens have been compared in these two groups. The data were processed using SPSS system (release 10). Statistical analysis was done with Chi(2) to determine factors associated with complete clinical response. The level of significance was assigned at P< .05., Results: Forty-eight patients with stage III (with pulmonary metastases) GTN patients have been selected, 13 with vaginal metastases and 35 without vaginal metastases. Incidence of vaginal metastases in stage III was 26%. Metastases were mainly in distal part of vagina and suburethra. Chief complaint was severe hemorrhage in 25% of patients and was controlled by vaginal packing with just one exception. Group of vaginal metastases showed 66.6% resistance to first-line chemotherapy, compared to 28.6% in patients with no vaginal metastases (P-value=0.010). Median of chemotherapy courses in low-risk vaginal metastatic patients was 5 (mean=5.2), compared to three courses in the group without vaginal metastases. Resistance to single chemotherapy was significantly higher in GTN + VM versus GTN without VM patients and resistance was higher especially in patients with metastases with more than 3 cm (in diameter)., Conclusions: Vaginal metastasis with more than 3 cm in diameter is an important prognostic factor in GTN patients. There have higher risks for severe hemorrhage and resistance to single agent chemotherapy, so in these patients combination chemotherapy, with no regard to staging and scoring, would be a better choice.

Objective: The overall risk of malignancy in ovarian neoplasm is 13% in premenopausal women and 45% in postmenopausal women. Differentiating benign and malignant disease with frozen section is possible during operation; however, information on patients' history, physical examination, paraclinical criteria (tumour markers, imaging) and gross examination of tumour can also be helpful in planing the surgery., Methods: This study was conducted on 150 women who underwent laparotomy due to adnexal mass between April 2003 and October 2005 at Vali-e-Asr Hospital, Tehran, Iran. Sensitivity and specificity of clinical assessment (history, tumour marker and imaging), gross examination and frozen section were calculated., Results: Based on our findings frozen section had the highest sensitivity for diagnosing malignant tumour comparing with other methods of diagnosis (88.9%). Sensitivity was 71.3% for preoperative clinical examination, 83% for ultrasonography, 89.8% for CT scan, 70% for CA125 and 84.1% for gross examination, likewise the highest specificity was seen for frozen section (93.5%)., Conclusion: This data confirm that frozen section diagnosis is a reliable method for the surgical management of patients with an ovarian mass, but history of disease, Para clinical criteria and gross examination can help to surgeon to perform on appropriate operation in the areas where frozen section is not possible.

Background: Vulvar lymphangioma circumscriptum (LC) is a developmental defect of lymphatics in deep dermal and subcutaneous layers. The entity may be acquired that induced by surgical intervention and radiation therapy for malignancy or congenital. Lymphangiomas of the vulva are rare. Thirteen cases of the congenital and 24 cases of acquired form have been reported in the literature presently., Objective: To evaluate major labiaectomy as surgical management of vulval lymphangioma, we report our experiences on surgical treatment of three cases of this rare disease from Gynecologic Oncology Department of Vali-E-Asr Hospital., Methods: Three female patients, aged 18, 17 and 63 years, presented with persistent edema, papules, and vesicles of the labia major, among which two first cases had congenital LC and another case had developed 9 years after radical hysterectomy, lymph node dissection, and adjuvant radiotherapy of cervical cancer., Result: Overall there was a clear improvement in the symptoms and signs associated with these conditions in all patients. In particular, all patients reported an improvement in the amount of edema following surgery., Conclusion: In particular, major labiaectomy seems to be more successful than methods such as lymphovenous anastomoses and lymph angioplasties. A single operation may prove beneficial; also, this approach has the potential to allow patients to rehabilitate to normal life and activity.

Objective: Rhabdomyosarcoma (RMS) of the lower genital tract is a rare tumor. It tends to occur in childhood in the vagina and in rare cases, RMS can originate in the uterine cervix, with a peak incidence in the 2nd decade., Methods: A hospital-based tumor registry was searched to find all patients with female genital tract RMS, which were treated between 1999 and 2004. The medical records of all patients were reviewed. A single pathologist reviewed all pathologic specimens., Results: Among the 1,528 patients with genital tract malignancies, six RMS were found: three vaginas, three cervixes. All patients presented with vaginal bleeding. Mean age of patients was 16(13-30). The lesions in vagina were clinically staged as stage I (2), stage II (1) and in cervix were stage I (2) and stage III(1). All of the patients were treated with surgery and adjuvant chemotherapy. One patient with cervical RMS was treated with adjuvant chemo radiation. Two patients with cervical RMS died from the large size and extent of the disease 9 and 11 months after diagnosis, but all patients with vaginal RMS remain alive after a mean follow-up of 38 months., Conclusion: Most patients present with vaginal bleeding and a palpable cervical or vaginal mass. While the optimal management of these tumors is uncertain, primary therapy with wide local excision and chemotherapy can result in prolonged survival and cure in patients with early stage RMS. Vaginal lesions have a better prognosis than cervical lesions. In patients with un-embrional RMS, large size of lesion, cervical origin and extent of disease, survival rates was decreased.

Early recognition of gestational trophoblastic neoplasms (GTN) will maximize the chances of cure with chemotherapy but some patients present with many different symptoms months or even years after the causative pregnancy making diagnosis difficult. Clinicians should be aware of the possibility of GTN in any reproductive age woman with bizarre central nervous system symptoms, gastrointestinal symptoms or radiographic evidence of metastatic tumor of unknown primary origin. We reported two cases of metastatic gestational trophoblastic neoplasms with bizarre pulmonary symptoms, one patient with small bowel metastasis, and two patients with brain metastasis presenting with unusual manifestations.

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.