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"n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 st1":*{behavior:url(#ieooui) } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Ovarian cancer is the leading cause of death among all gynecologic cancers in developed countries. The standard treatment for advanced ovarian cancer consists of cytoreductive surgery associated with a platinum/paclitaxel-based chemotherapy. Over than 50% of patients with advanced ovarian cancer will develop recurrent disease. For those patients who have recurrence of disease at least six months after initial therapy, the paclitaxel- platinum combination has been shown to be a superior treatment to platinum monotherapy. However, many patients develop clinically relevant neurotoxicity, frequently resulting in treatment discontinuation. The efficacy and safety of an alternative regimen that dose not show significant neurotoxicity were evaluated by comparing gemcitabin- carboplatin with carboplatin in platinum sensitive recurrent ovarian cancer patients in a Gynecologic Cancer InterGroup trial in Canada and European Organization for research and treatment of Cancer Gynecological Cancer Group. But this study was not done in Iran."n"n Methods: We performed a study with escalating doses of gemcitabin combined with carboplatin in 21 patients. All patients who were treated in Vali-Asr hospital between 2003- 2005 evaluated. Gemcitabin with dose of 800mg/m2 was given on days 1, 8 and 15 followed by one week rest period for a 28 day cycle. Combine with carboplatin with AUC 4 given on day 2. All patients with surgically resected, histologically confirmed epithelial ovarian cancer and who had failed first- line platinum chemotherapy were allocated to this study."n"n Results: Median age was 49 years (range 23-78 years). Median follow-up was six months (range 4-22). Total of 87 cycles of chemotherapy were administered with median number of four (range 2-6 cycles). Thrombocytopenia (grade I) and leucopenia (grade I) were seen in 4.75% and 9.52% of patients."n"n Conclusion: Gemcitabin and carboplatin Combination was tolerated in patients with recurrence of ovarian cancer. "nKeywords: Ovarian cancer, recurrence, gemcitabin, carboplatin, survival.

Background: The aim of this study was to compare the outcome of treatment for ovarian cancer patients who have been treated by gynecologist oncologists and patients who have been treated by general gynecologists or general surgeons. Methods: We enrolled in this cohort retrospective study all patients diagnosed with primary ovarian cancer in Vali-e-Asr Hospital, Tehran, Iran, between April 1999 and January 2005. A total 157 consecutive patients with ovarian cancer were available for analysis. Of these, 60 patients were treated by gynecologist oncologists and 95 by general gynecologists, and two patients were treated by general surgeons. Results: The number of patients who underwent optimal cytoreductive surgery (residual tumor

Background: Although endometrial cancer is primarily a disease of the postmenopausal female, 25% of patients are premenopausal, with 3-5% in women 40 years old or younger. The younger group of women with endometrial carcinoma are frequently nulligravid with a history of infertility, and a strong desire to preserve fertility. This may pose a therapeutic dilemma for both patients and treating physician. Case report: We reported 3 young patients with atypical; complex hyperplasia or early stage endometrial cancer that treated with conservative hormonal therapy. Conclusion: Medical treatment of young patients with endometrial carcinoma and complex atypical hyperplasia who wish to preserve fertility is a reasonable and appealing option. A comprehensive evaluation prior to counseling the patient should include A complete history and physical examination. A formal D&C with review of history with an experienced gyn-onc pathologist. Evaluation of the pelvic and abdomen preferably with contrast-enhanced MRI or transvaginal ultrasound. In patients found to have a clinical stage I grade I tumor and who want to preserve fertility , thorough counseling include risks and benefits, and explanation that the data is partial and incomplete due to the lack of appropriate controlled studies is mandatory. In patients considered for medical treatment, a high dose progestin regimen should be started with endometrial sampling every 3 months until complete regression of the tumor is documented. Although most responses are long standing, there is a small risk of progression during or after cessation of progestin therapy.

Background: Access to a safe and efficient chemotherapy regimen for improving the survival and live quality is a goal in ovarian carcinoma. Despite surgery is the base treatment of ovarian cancer, but in most patients chemotherapy is used due to progression of their disease. This study designed to compare two important chemotherapy regimens. Methods: This historical cohort study compared two chemotherapy regimen; cisplatin (75mg/m2)+ cyclophosphamide (750mg/m2), versus taxol (175mg/m2)+ carboplatinium (GFR+25)AUC; between 1998-2005 in valiasr hospital. In this study toxicities of two regimes were compared. The survival function in these two groups were analysed with Kaplan-Meire curve. Results: Gastrointestinal and mucosal toxicity were significantly higher in CP group compared TC group (p=0.02). Also there were no significant relation between decrease of serum CA125 and patient remission length in CP group but in other group with decrease of CA125 in lower than three cycle we had an increase in patient remission period. (P=0.02). Disease free interval in cisplatin group was longer versus taxol group (p

This study was designed to assess the role of first-line chemotherapy with 5-FU and platinum in the treatment of advanced or recurrent cervical cancer, ten patients with advanced or recurrent cancer of the cervix, with no prior chemotherapy were entered in phase II trial, from Oct. 2000 to Nov. 2001. Eight patients were treated with cis-platinum (50 mg/m2 over 60 minutes in first day) followed by 5-FU (1 g/m2 over 24 hours for 4 days) and two patients with impaired renal function were treated with carboplatin (300 mg/m2 over 15 minutes in first day) followed by 5-FU (1 g/m2 over 24 hours for 4 days) every three weeks, until progression of disease or prohibitive toxicity had been observed. Median age was 52 years (range: 28-70 years). Ten patients received a total of 42 cycles of chemotherapy. The mean number of chemotherapy cycles was 4.2 (median 4, range: 3-7). Three patients had partial response (30%, CI, 1.7%-58.5%). Mean response duration was 198 days (range: 122-273 days). Four patients required red blood cell transfusions; three of them had grade II and one of them grade III nausea and vomiting Two had fever and neutropenia (one developed acute renal insufficiency), and there wee no treatment related mortalities. First-line chemotherapy with platinum and 5-FU for advanced recurrent cervical cancer is promising and deserves consideration for large phase III trials.

To evaluate the effectiveness of conjugated estrogen (Premarin) and progesterone in twenty-one postmenopausal women who had been menopause one year, we tested during a 6-month period the serum lipoprotein levels in subjects who offered by premarin in dosage of 0.625 milligram for days 1 to 25 and oral medroxy progestrone acetste for days 15 to 25 of a 30-day cycle. Twenty-one subjects completed at least 6-month follow-up serum total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, very low density lipoprotein (VLDL) cholesterol and triglycerid (TG) measurements by calorimetric method. The results, six months after treatment, is compared to before treatment. The median change in biochemical studies showed significant decrease in serum total cholesterol (248.85 compared with 229.4, P

It this prospective cross sectional study out-patient endometrial biopsy by PIPELLE was compared with diagnostic curretage (D&C) in patients suffering of Abnormal Uterine bleeding (AUB). Diagnostic accuracy, sufficient tissue sampling, intensity of pain and effective factors in biopsy results were the evaluated parameters in this study. In 70 patients with complaint of AUB (20 of them were post-menoupsal age admitted in hospital for D&C) endometrial biopsy was conducted by PIPELLE before operation and the results were compared. 96% of total patients (67) and 91% of patients with post menopause age had tolerance of undergoing out-patient PIPELLE biopsy of endometrium. 79% of these individuals complained of mild pain and 21% of moderate pain. Endometrium biopsy by PIPELLE in 77% of patients had similar accurate diagnostic results as compared to D&C. PIPELLE in 34% of patients (24) could not be conducted with the same accuracy of D&C patients, although in 14 (20%) of them, notissue samples could be collected by D&C. In none of these methods endometrial hyperplasia or endometrial cancer were detected. This study showed that in 77% of the total patients, the extra cost and general anesthetical risk of D&C could have been eliminated, by utilization of out-patient biopsy with PIPELLE

The article presents a study which determines whether optimum versus suboptimal cytoreductive surgery predicts cancer antigen 125 (CA125) levels two weeks after surgery. It states that cytoreductive surgery is a crucial component of primary treatment in patients with ovarian epithelial cancer (OEC). It notes that postoperative CA125 significantly decreased in two weeks after tumor cytoreduction in patients with OEC, but its regression did not differ to optimal or suboptimal groups.

The article presents a retrospective study on the effect of ovarian cancer surgery performed by general gynecologists (GGs) and gynecologist-oncologists (GOs) on the overall survival of cancer patients. The study involves patients who were diagnosed with primary ovarian cancer in Tehran, Iran. The results of the study suggest that patients can have greater disease-free survival chances if they will be referred to the gynecologist-oncologists for optimal treatment.

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OBJECTIVE: To determine the strength of correlation between colposcopic impression using Reid index and biopsy histology. METHODS: In a colposcopy referral clinic in Tehran University, Iran. Colposcopy was carried out using Reid colposcopic index (RCI) scoring system and directed biopsy on 344 women between March 2004 and October 2005 by fellows supervised by a board-certified gynecologic oncologist. Results were retrospectively compared with a previous study carried out on 353 women by the same physicians. In this previous study, the colposcopy findings did not use RCI index; the significance of association between these 2 studies was assessed by chi(2) and kappa statistics. RESULT: The association between colposcopic impression and biopsy histology was highly significant (p < .001), both in RCI colposcopy group and general colposcopy group. However, the strength of the correlation between colposcopy impression and biopsy histology in RCI colposcopy group was more than the general colposcopy group (0.74 vs 0.45). The positive predictive value of any colposcopic abnormality for any histologic abnormalities in the RCI group was 92%. The negative predictive value of a benign colposcopic impression was 70.5%. The sensitivity was 74%, and the specificity was 90.7%. CONCLUSIONS: The good correlation between colposcopic impression and histological diagnosis by using Reid index in colposcopy would produce higher agreement and strength of the correlation. Therefore, the Reid index can be used as a reproducible technique which is easy to learn in colposcopic clinic. [ABSTRACT FROM AUTHOR]

Abstract: Aim: The aim of this study was evaluation of the efficacy of neoadjuvant chemotherapy (NACT) and radical hysterectomy on long-term survival in stage IB–IIA locally advanced cervical cancer as compared with radical surgery alone. Methods: We reviewed all patients with cervical cancer stage IB–IIA who were treated with two treatment modalities, i.e. NACT followed by radical hysterectomy and lymphadenectomy, and radical hysterectomy alone between March 1996 and March 2004. There were 22 patients in the NACT group (group 1) and 160 patients in the immediate radical surgery group (group 2). All patients in group 1 were followed for more than 108months, and long-term survival and factors affecting recurrence were evaluated. Results: Nineteen patients in the NACT arm underwent radical surgery. Pelvic lymph node metastasis was found in 8 patients in this group and in 36 in the radical surgery group. Eighteen patients in the NACT group and 96 patients in the radical surgery group were scheduled for adjuvant postoperative chemoradiation. During the 9-year follow-up, recurrence rate was 47.1% and 30.2% in NACT and control groups, respectively. In the NACT group lymph node metastasis was a significant independent risk factor for recurrence. Overall survival in the NACT arm was not statistically significantly lower than the control arm (p =0.06). Conclusion: NACT did not improve long-term overall survival of bulky early-stage cervical cancer patients compared to primary radical surgery. [Copyright &y& Elsevier]

Background. Malignant melanoma of the uterine cervix is a rare neoplasm with poor prognosis. Diagnosis is confirmed by immunohistochemical methods and by exclusion of other primary sites of melanoma.Case. In this paper, we are reporting a case of a 38-year-old patient with a malignant melanoma of the uterine cervix. Diagnosis was made by histological and immunohistochemical method. The tumor was stage IB1 of the International Federation of Gynecology and Obstetrics classification. Chest x-ray and abdominopelvic computed tomography scanning were normal. A radical hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy was performed. After performing combined radical surgery and irradiation, complete remission of the tumor was achieved. The patient has been followed for 24 months. She is well without any symptoms or signs of recurrence.Conclusions. Malignant melanoma is usually misdiagnosed specially in the chronic form. The immunohistochemical study is useful for definite diagnosis. Treatment is not well established, and the disease histogenesis has been controversial for a long time. [ABSTRACT FROM AUTHOR]

Ghaemmaghami F, Hasanzadeh M. Good fetal outcome of pregnancies with gynecologic cancer conditions: cases and literature review. Int J Gynecol Cancer 2006; 16(Suppl. 1):225–230. Gynecologic malignancies frequently occur in women of reproductive age and are estimated to complicate 1 in 1000 pregnancies. Cancer diagnosis may be delayed because of difficulties in distinguishing symptoms from physiologic changes in pregnancy. Another problem is applying the standard workup in pregnant women. These reports describe the good fetal outcome of pregnancies in patients with vulvar and ovarian carcinoma. Patients underwent multimodality treatment, and their infants were developmentally normal. Vulvar and ovarian cancer is a rare finding in pregnancy. Early diagnosis and appropriate treatment offer the best prognosis. Aggressive postoperative chemotherapy also continues to better the outcome. [ABSTRACT FROM AUTHOR]

Focuses on the successful treatment of a patient with gestational trophoblastic neoplasm metastatic to the colon. Application of surgical intervention to control hemorrhage; Observation of invasive gestational trophoblastic neoplasm by histological examination; Consideration of selective angiographic embolization techniques as therapy option.

Presents a case report of vulval lymphangioma circumscriptum. Discovery of bilateral swelling of labia majora with erythema; Presence of an inflammatory infiltrate in the papillary dermis; Congenital nature of the lesion.

Abstract Introduction Prediction of optimal cytoreduction in patients with advanced epithelial ovarian caner preoperatively. Methods Patients with advanced epithelial ovarian cancer who underwent surgery for the first time from Jan. to June 2008 at gynecologic oncology ward of TUMS (Tehran University of Medical Sciences) were eligible for this study. The possibility of predicting primary optimal cytoreduction considering multiple variables was evaluated. Variables were peritoneal carcinomatosis, serum CA125, ascites, pleural effusion, physical status and imaging findings. Univariate comparisons of patients underwent suboptimal cytoreduction carried out using Fisher's exact test for each of the potential predictors. The wilcoxon rank sum test was used to compare variables between patients with optimal versus suboptimal cytoreduction. Results 41 patients met study inclusion criteria. Statistically significant association was noted between peritoneal carcinomatosis and suboptimal cytoreduction. There were no statistically significant differences between physical status, pleural effusion, imaging findings, serum CA125 and ascites of individuals with optimal cytoreduction compared to those with suboptimal cytoreduction. Conclusions Because of small populations in our study the results are not reproducible in alternate populations. Only the patient who is most unlikely to undergo optimal cytoreduction should be offered neoadjuvant chemotherapy, unless her medical condition renders her unsuitable for primary surgery.

Abstract Background The considerable increase in life expectancy on one hand and an increase in cervical cancer among Iranian patients on the other, brings out the importance of investigating whether radical surgery can be performed safely and effectively on patients above 60 years of age. Methods In a study of historical cohort, all 22 patients 60 years and above who have undergone a Wertheim radical hysterectomy for cervical cancer from 1999 to 2005 were compared with 128 matched cases under 60 years of age who had undergone a Wertheim hysterectomy during the same calendar year. All patients were analyzed for preexisting medical comorbidities, length of postoperative stay, morbidity, and postoperative mortality. Results There was no operative mortality in either group, morbidity (minor, p = 0.91; major, p = 0.89) were statistically not different in the two groups despite the patient's above 60 years having significantly higher comorbidity prior to surgery than the younger cohort (minor, P < 0.05; major, P < 0.05). The mean postoperative hospital stay was significantly longer in the older patients (5 days vs. 3 days, P < 0.001). Conclusion Wertheim Radical hysterectomy is a safe surgical procedure in the selected population of patients 60 years and over. No differences in operative mortality or morbidity were found when compared to a cohort of patient's aged 60 years or younger.

Abstract Background The aim of this study was to analyze and describe cases of ovarian cancer in pregnant women treated at our center and to review the literature concerned, and to discuss the rationale for therapy. Methods Twenty-Three patients of ovarian malignancies during pregnancy were treated at Vali- Asr Hospital between 1991 and 2002. Data on treatment and follow-up were evaluated. Results The incidence of ovarian carcinoma associated with pregnancy in our series was 0.083/1000 deliveries. Eleven (47.8%) were found with ovarian malignant germ cell tumors, five (21.7%) with low malignant potential tumors, four (17.4%) with invasive epithelial tumors, and three (13%) with sex cord stromal tumors. Seventeen (73.9%) of the patients were diagnosed in stage I and had complete remission. Five of the six in advanced stage died. The mean follow-up was 36.3 months. The prognosis was significantly related with stage and histological type (P < 0.05). Sixteen healthy live babies were recorded in this group, and two premature newborn died of respiratory distress syndrome. Chemotherapy was administered to 44% of the patients, in two cases during pregnancy. Overall survival at 5 years was 61%. In most of case conservative surgical treatment could be performed with adequate staging and debulking. Conclusion Early finding of ascitis by ultrasound and persistent large ovarian mass during pregnancy may be related to malignancy and advanced stage. Pregnant women in advanced stage of ovarian cancer seem to have poor prognosis.

Abstract Background Placental site trophoblastic tumor (PSTT) is a rare and unique form of gestational trophoblastic disease (GTD). This tumor represents a neoplastic transformation of intermediate trophoblastic cells. We document a case of long term remission in a patient with metastatic PSTT. Case presentaion A 27-year-old patient with metastatic PSTT was treated with combination therapy (chemotherapy and surgery). Patient is alive after 10 years without any evidence of recurrence. Literature on PSTT was searched using Medline and cross references, and pertinent articles were reviewed. Conclusion With surgery and chemotherapy it is possible to achieve long-term remission in metastatic PSTT. Only a handful of previously reported cases with prolonged remission had been treated with the described combined chemotherapy and surgical approach. We suggest that this approach may be recommended for metastatic PSTT.

Abstract Background This study has evaluated urinary tract injuries and dysfunction after Radical Hysterectomy (RH) performed in patients with cervical cancer and has compared the cystometric parameters and urinary complications occurring in these patients with those occurring in patients who had undergone Simple Hysterectomy (SH). Patients and methods A prospective case-control study was conducted to evaluate urinary tract injuries (intra-operative and post-operative) and dysfunction in 50 patients undergoing RH for cervical cancer and to compare them with the same parameters in 50 patients who underwent SH for benign disease. Results Mean age in the RH group was 46.3 years and in the SH group was 50.1 (p = 0.63). There were no bladder and urethral injuries in either group of patients. There was one intra-operative ureteral injury in the RH patients but none in those who underwent SH. (p < 0.05). In the two weeks after surgery, 15% of RH patients and 11% of SH patients had experienced a urinary tract infection urinary tract infection (p = 0.61). Two week after surgery 62% of RH patients had no urinary symptoms, compared to 84% in the SH group who did (p < 0.02). Urinary residual volume, first urinary sensation and maximal bladder capacity were higher in the RH group, but this was not statistically significant. The only case of a urinary fistula appeared in a patient who received 5000 cGy radiation therapy pre-operatively, but this spontaneously healed after 3 weeks of catheterization. Conclusions Intra-operative and post-operative urinary tract complications are comparable in patients undergoing RH and SH and an expert gynaecological oncologist might be able to further decrease complications. However, radiation therapy before surgery may increase the risk of complications.

Background: The aim of this study was to analyze and describe cases of ovarian cancer in pregnant women treated at our center and to review the literature concerned, and to discuss the rationale for therapy.Methods: Twenty-Three patients of ovarian malignancies during pregnancy were treated at Vali- Asr Hospital between 1991 and 2002. Data on treatment and follow-up were evaluated.Results: The incidence of ovarian carcinoma associated with pregnancy in our series was 0.083/1000 deliveries. Eleven (47.8%) were found with ovarian malignant germ cell tumors, five (21.7%) with low malignant potential tumors, four (17.4%) with invasive epithelial tumors, and three (13%) with sex cord stromal tumors. Seventeen (73.9%) of the patients were diagnosed in stage I and had complete remission. Five of the six in advanced stage died. The mean follow-up was 36.3 months. The prognosis was significantly related with stage and histological type (P < 0.05). Sixteen healthy live babies were recorded in this group, and two premature newborn died of respiratory distress syndrome. Chemotherapy was administered to 44% of the patients, in two cases during pregnancy. Overall survival at 5 years was 61%. In most of case conservative surgical treatment could be performed with adequate staging and debulking.Conclusion: Early finding of ascitis by ultrasound and persistent large ovarian mass during pregnancy may be related to malignancy and advanced stage. Pregnant women in advanced stage of ovarian cancer seem to have poor prognosis. [ABSTRACT FROM AUTHOR]

Abstract: The ability of silver ions to form reversible π-bond complexation with unsaturated hydrocarbons can be utilized to separate olefins from paraffins using a solution of AgNO3 dissolved in an ionic liquid (IL). The process is suggested because of zero vapor pressure of the solvent, which results in higher purity of the separated product in comparison to when an aqueous AgNO3 solution is applied. In the present study, 1-butyl-3-methylimidazolium nitrate ([Bmim]NO3), an IL that can dissolve AgNO3, is applied as the solvent. The absorption of ethylene from a gaseous mixture of ethylene/ethane with constant flowrate in the silver nitrate dissolved media is investigated in silver nitrate concentrations of 1, 2 and 5M, and temperatures within the range of 5–35°C. The absolute absorptivity of ethylene is increased from 1.12 to 5.68gl−1 at 25°C when the concentration of AgNO3 is increased from 1 to 5M. Maximum absorption of ethylene is found at near ambient temperatures (15°C). The absorption selectivity of ethylene to ethane increases with increase of AgNO3 concentration and decrease with increasing temperature. The capacity of ethylene absorption in the reactive media at 25°C and 5M concentration of AgNO3 is about 0.43 of that for the aqueous AgNO3 solution. The results of an applied theoretical model for prediction of total ethylene absorption can be verified by the experimental results. [Copyright &y& Elsevier]

Background: Gestational trophoblastic neoplasia (GTN) includes a spectrum of disease ranging from hydatidifrom mole to choriocarcinoma. Low risk GTN is defined as persistent molar pregnancy with a WHO score lower than seven. The optimal chemotherapeutic regimen still remains controversial., Aim: The objectives of this study was to determine efficacy and safety of weekly intramuscular methotrexte in the treatment of low risk gestational trophoblastic neoplasia.(LRGTN) and also identify prognostic factors associated with treatment failure, necessitating second line chemotherapy., Materials and Methods: Sixty-six women with LRGTN from 2001 to 2009 were treated with weekly intramuscular methotrexate at 40 mg/m 2 as first line therapy.Monitoring of treatment was done with weekly checking of βhCG level. Three consecutive negative βhCG measurements showed complete response. After first negative βhCG measurement, one additional dose was administered for consolidation., Results: Of 66 patients, who started the treatment five continued their treatment in other medical centres and were excluded from final analysis for treatment evaluation, and seven discontinued first line therapy because of hepatotoxicity. Of the remaining 54, complete remission occurred in 43 (79.6%) and eleven were resistant to first line therapy. Mean WHO score prior to starting chemotherapy was significantly different between two groups of response and resistance according to our data. Change of treatment to second line Actinomycin-D was necessary in eighteen cases because of resistance to first line in eleven and liver enzyme elevation in seven patients. Sixteen of these 18 responded to Actinomycin-D as second line and one needed hysterectomy for complete response. One patient received multiagent chemotherapy for complete remission., Conclusion: We recommend this effective and safe method of chemotherapy for women with LRGTN. According to our data, lower mean WHO score predicts a better outcome for this regimen.

Objectives: Recurrence of cervical cancer is one of the important and plausible discussions in oncology especially in patients with advanced stages. The purpose of this study was to introduce probability invasive cervical carcinoma recurrence as well as determining characteristics and the prognostic factors of this entity., Methods: A retrospective study was designed to identify risk factors and pattern of uterine cervical carcinoma recurrence evaluating the outcome of 36 registered patients. Recurrence was defined based on clinical or para-clinical documentation over at least 6 months after complete remission following surgery or radiotherapy. Treatment consisted of a radiosurgical combination and exclusive radiotherapy., Results: Mean age in selected patients is 54.8 ± 12.0 years. The pathological reports of primary diagnosis are squamous cell carcinoma in 94.44 % and adenocarcinoma in remaining patients. Mean duration of recurrence among patients is 2.75 ± 1.5 years after the initial treatment. Metrorrhagia is mostly revealing symptom which patients present in recurrent episode. Usually, the recurrence of cervical cancer is presented in pelvic cavity locally. Marginal involvement is documented in 50 % of cases and lymph node in 33.3 % of patients with recurrent episode being involved. Most important prognostic factors are improper treatment (16.66 % of cases) after initial diagnosis., Conclusions: Prognostic factors such as selection of appropriate method for treatment are an important point for reducing the rate of recurrence. Moreover, warning patients about symptoms and frequent episodes of follow up is necessary for early diagnosis of recurrence.

Objective: This study aim was to evaluate indications and outcomes of surgical interventions performed in patients with gestational trophoblastic neoplasm., Methods: During January 1995 to December 2005, 110 patients with a diagnosis of persistent gestational trophoblastic neoplasm were treated in our Gynecologic Oncologic Department. Risk score calculation was carried out based on the revised FIGO 2000 scoring system for gestational trophoblastic neoplasm. Data from the patients' records and pathologic reports were analyzed by the chi-square and Fisher's exact tests and logistic regression. The Kaplan-Meier method including the log rank test was used to compare survival and recurrence., Results: Eight patients did not complete their treatment and were excluded from the study. We evaluated treatment responses and outcomes in 102 patients. Seventy-nine patients (77.5%) responded fully to chemotherapy while 23 patients (22.5%) required surgery. Among 23 patients who underwent surgery, 10 cases (43.5%) had bleeding, and 13 cases (56.5%) had drug resistance. Several factors were found to be significantly different between the groups who responded to chemotherapy and those who needed surgery, including age (p=0.001), antecedent non-molar pregnancy (0.028), tumor stage (p=0.009), and pre-treatment risk scores (p=0.008). But, the total courses of chemotherapy (p=0.521), need to salvage chemotherapy (p=0.074), survival rates (p=0.714), and disease free survival rates (p=0.206) were not significantly different., Conclusion: The data suggest that age, antecedent non-molar pregnancy, tumor stage and the prognostic score are clinical predictors of need for surgery. But, it dose not seem that surgery have any effect on the total course of chemotherapy, need for salvage chemotherapy, and patient prognosis.

Endometrial stromal sarcomas (ESS) are the second most common uterine sarcomas. Endometrial stromal sarcomas account for 0.25% of all uterine malignancies. Uterine sarcomas most often affect postmenopausal women. The aim of this retrospective study was to review the experience in the treatment and clinical outcome of low grade malignant endometrial stromal sarcoma. Seventeen patients with histologically proven low grade ESS in department of Gynecologic Oncology of the Vali-e-Asr Hospital, Tehran-Iran, between 1999 and 2008 were included in the analysis. Demographics, pathology, treatment, time to recurrence, salvage therapy and survival information was collected. The median age of our patients was 45.35 ± 6.8 (range 36-61). The median parity of the patients was 5 (range 0-8). Most patients were diagnosed at FIGO stage I. The mean survival for patients with stage I and II was 73.5 ± 35.09 and 57.6 ± 5.37 months, respectively, with mortality rate of 5.9% through a median follow-up time of 68.82 ± 30 months. Of 17 patients, seven cases (35.29%) were disease free at 6 years after hysterectomy. Radiotherapy was administered to four patients (23.53%). Only one patient recurred at 10th month after surgery. Surgeries not preserving ovarian function were helpful to decrease the risk of recurrence compared with those sparing ovarian function.

With increase in the marriage age some women experience gynecological cancers before giving birth. Thus fertility sparing in these patients is an important point and much work has been done on conservative management. We here report our experience on fertility sparing with cervical, endometrial and ovarian cancers and include a review of the literature. With cervical cancer, radical trachelectomy with para-aortic and pelvic lymphadenectomy can be performed in patients with early stage IA1-IB cancers, because they have low recurrence rates. The complications are fewer than with radical hysterectomy. For endometrial cancer, the accepted treatment is total abdominal hysterectomy+bilateral salpango-oopherectomy (TAH+BSO), but in young patients with early stage 1 lesions, we can suggest use of hormonal therapy in place of radical surgery if we evaluate with MRI and the result is early stage disease without the other site involvement and the grade of tumor is well differentiated. GNRH analog, oral medroxyprogestrone acetate (MPA), 100-800 mg/day, megestrol acetate 40-160 mg/day and combination of tamoxifen and a progestin have been applied, but we must remember, they should underwent repeated curettage for investigating medical outcome after 3 months. With normal pathology we follow medical therapy for 3 months and can evaluate for infertility treatment. The best option for patients who treated by medical therapy is TAH+BSO after normal term pregnancy. With ovarian cancer, there is much experience on fertility sparing surgery and in Iran conservative surgical management in young patients with stage I (grade 1,2) of epithelial ovarian tumor and sex cord-stromal tumor and patients with borderline and germ cell ovarian tumors is being successfully performed.

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.

Introduction: Prediction of optimal cytoreduction in patients with advanced epithelial ovarian caner preoperatively., Methods: Patients with advanced epithelial ovarian cancer who underwent surgery for the first time from Jan. to June 2008 at gynecologic oncology ward of TUMS (Tehran University of Medical Sciences) were eligible for this study. The possibility of predicting primary optimal cytoreduction considering multiple variables was evaluated. Variables were peritoneal carcinomatosis, serum CA125, ascites, pleural effusion, physical status and imaging findings.Univariate comparisons of patients underwent suboptimal cytoreduction carried out using Fisher's exact test for each of the potential predictors. The wilcoxon rank sum test was used to compare variables between patients with optimal versus suboptimal cytoreduction., Results: 41 patients met study inclusion criteria. Statistically significant association was noted between peritoneal carcinomatosis and suboptimal cytoreduction. There were no statistically significant differences between physical status, pleural effusion, imaging findings, serum CA125 and ascites of individuals with optimal cytoreduction compared to those with suboptimal cytoreduction., Conclusions: Because of small populations in our study the results are not reproducible in alternate populations. Only the patient who is most unlikely to undergo optimal cytoreduction should be offered neoadjuvant chemotherapy, unless her medical condition renders her unsuitable for primary surgery.

Background: Surveys have shown that fertility sparing in patients with ovarian tumors has proven to be effective. Thus this approach in ovarian tumor cases has been carried out. The purpose of this study was to evaluate the clinical outcome and pregnancies in women who suffered from ovarian tumor and underwent conservative treatment., Materials and Methods: All cases who received conservative treatment and those who had recurrence of the disease during the follow-up period were evaluated at Vali-Asr Hospital from 2000-2004., Results: 60 of 410 patients with ovarian tumor (age range: 13-34) were treated conservatively. Three patients (5%) were infertile. Histology of tumors showed: 26 (43.3%) germ cell tumors, 15 (25%) borderline tumors, ten (16.7%) epithelial tumors and nine (15%) sex cord tumors. The cases were followed for 12-48 months. Seven term pregnancies occurred in six patients. Three in the borderline group, two in the germ cell group, one in the epithelial group and one in the sex-cord group. Nine recurrences were reported among our cases. Two of the patients (serous carcinoma and immature teratoma, both Stage IIIc) died during follow-up due to refusal to undergo radical surgery., Conclusion: Fertility preserving surgery in young women with epithelial ovarian tumors, borderline and sex-cord tumors Stage I, grade 1 and 2 is recommended.

Ovarian cancer rarely complicates pregnancy. Usually these malignancies consist of germ cell tumors. Preserving maternal safety along with favorable neonatal outcome is a subject of debate in the management of ovarian cancer during pregnancy. In this report, the authors describe a 25-year-old primigravid woman who was diagnosed to with an ovarian immature teratoma which was diagnosed at 13th weeks of pregnancy during a routine sonography. She underwent oophorectomy at week 21 of her gestation. Then she received three cycles of BEP regimen (bleomycin, etoposide, and cisplatin) during her pregnancy until week 37 of gestation. At 36 weeks she delivered a male baby with mild glandular hypospadia who was otherwise normal. Management of immature teratoma after the first trimester of pregnancy is similar to non-pregnant patients and is safe for both the mother and the fetus.

Background: Intraoperative injury of obturator nerve has rarely been reported in patients with gynecological malignancies who undergo extensive radical surgeries. Irreversible damage of this nerve causes thigh paresthesia and claudication. Intraoperative repair may be done by end to end anastomosis or grafting when achieving tension-free anastomosis is not possible., Case History: A 46-year-old woman with stage IIA cervical cancer underwent radical hysterectomy and bilateral pelvic lymphadenectomy. Left obturator nerve was damaged intraoperatively during pelvic dissection. Immediate microsurgical grafting of the sural nerve was successful and there was no functional deficit in the left thigh for 6 months postoperatively., Conclusion: As far as transection and damage of obturator nerve cause thigh claudication, paresthesia and cosmetic problems due to atrophy of related group of muscles, we recommend precise anastomosis of this nerve and grafting whenever achieving a tension-free anastomosis is not possible.

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 aim of this study is to evaluate the results of neoadjuvant chemotherapy (NACT) and the impact of interval debulking surgery (IDS) on clinical outcomes of patients with advanced-stage ovarian cancer., Methods: We performed a retrospective analysis on 92 patients with advanced ovarian cancer admitted to Vali-Asr Gynecologic oncology departments during 1996-2002. Comparison was made with results of neoadjuvant chemotherapy of 24 patients with unresectable advanced epithelial ovarian cancer treated with platinum- based NACT followed by IDS and clinical outcomes of 68 consecutive stage III and IV ovarian cancer patients treated with primary cytoreduction followed by platinum-based adjuvant chemotherapy., Results: Primary cytoreductive surgery caused longer survival compared to neoadjuvant chemotherapy. Patients who underwent optimal interval debulking surgery (IDS) had a better progression free survival (PFS) (p=0.002) and overall survival (p=0.03) than those who did not. There were not significant differences between the two groups in complications of surgery., Conclusion: NACT followed by successful IDS can lead to high survival percentage in patients with chemoresponsive advanced ovarian cancer; although the result is more effective in those with optimal primary cytoreduction, we still got the same results with those with suboptimal primary cytoreduction.

Objective: The aim of this study is to assess the response of patients with nondysgerminomatous ovarian germ-cell tumors (NDOGCT) to platinum-based chemotherapy and to determine association of prognostic factors to relapse of disease., Methods: We retrospectively reviewed 21 patients who had surgical resection of nondysgerminomatous ovarian germ-cell tumors (NDOGCT) and received adjuvant chemotherapy in Vali-e-Asr Hospital, Tehran, Iran during 1997-2004. The median age at presentation was 18 years and the median follow-up was 20 months. Histological type of tumors included the following: immature teratoma (n=7), mixed germ-cell tumor (n=7), yolk sac tumors (n=4), and embryonal carcinoma (n=3). Distribution by stage at the time of surgery was as follows; stage I (n=10), stage III (n=6), and stage IV (n=5)., Results: Sixteen patients underwent unilateral salpingo-oophorectomy and 5 patients underwent cystectomy. After the initial surgery, 13 patients immediately received chemotherapy and the other 8 patients received chemotherapy at a median time of 5.5 months (range, 1-40 months). Postoperative chemotherapy included the following: bleomycin, etoposide, and cisplatin (n=17); vincristine, actinomycin-D, and cyclophosphamide (n=2); methotrexate, etoposide, and cisplatin (n=l); and cisplatin (n=l). Thirty-one percent of the patients suffered a relapse after platinum-based combination chemotherapy. The median disease-free survival was 40 months and the median overall survival was 50 months. The 5-year survival rate was 39%., Conclusions: This study showed that stage at the initial surgery, residual disease and the interval from initial diagnosis to the start of chemotherapy were possible prognostic factors for relapse. Also, our study indicates that there may be a role for aggressive cytoreductive surgery in advance NDOGCT, and a need for second-line combination chemotherapy.

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: Uterine sarcomas are rare and heterogeneous tumors with histopathological diversity characterized by rapid clinical progression and a poor prognosis. The aim of this study was to investigate clinical and histopathological characteristics together with treatment and outcome of Iranian patients with uterine sarcomas., Materials and Methods: Records of 57 patients with histologically verified uterine sarcoma treated at the Vali-e-Asr Hospital were reviewed (1999-2004)., Results: The lesions were 19 leomyosarcoma (LMSs), 17 malignant mixed Mullerian tumors (MMMT), 16 endometrial stromal sarcomas (ESSs), 3 unspecified sarcomas, 2 rabdomyosarcomas. Median age at diagnosis was 50 (17-81) years. Clinical stages (based on FIGO) were 30 with stage I disease, 9 with stage II, 12 with stage III and 6 with stage IV. Only one patient did not undergo surgery and most cases with LMS and ESS were treated with simple total hysterectomy (STH). Forty patients (out of 57) received adjuvant radiotherapy. The median follow-up period was 19 (2-96) months and median disease free period was 16 (1-86) months. The overall survival rates after 1, 2, and 5 years were 71%, 58% and 52%, respectively. Survival was related to histological type of ESS (p=0.0018), grade I (p=0.0032) and early stage (p=0.045) significantly, but was not linked to postoperative irradiation. However, local recurrence rate was significantly improved after adjuvant radiotherapy. Twenty-one patients had relapse, 16 in the pelvic and 5 in extrapelvic sites., Conclusion: Based on the findings in this series, prognosis is dependent on histopathological subtype, grade and tumor stage. Adjuvant radiotherapy decreases local recurrence rate, but without significant impact on survival.