Shahrzad Sheikhhasani; Azamsadat Mousavi; Monireh Mirzai; Mitra Modares Gilani; Setareh Akhavan
Volume 3, Issue 2 , May and June 2018, , Pages 79-82
Abstract
Introduction: Timely diagnosis of gestational trophoblastic neoplasia (GTN) is essential for successful management of the condition and preservation of fertility. The aim of the present study was to describe a case of misdiagnosis GTN with brain and lungs metastasis.
Patient information: The present ...
Read More
Introduction: Timely diagnosis of gestational trophoblastic neoplasia (GTN) is essential for successful management of the condition and preservation of fertility. The aim of the present study was to describe a case of misdiagnosis GTN with brain and lungs metastasis.
Patient information: The present case study was conducted in Imam Khomeini hospital, Tehran, Iran, in 2017. A 35-year-old woman presented with acute headaches and left hemiplegia one month after the conclusion of her term pregnancy. The patient was previously diagnosed as a case of subarachnoid hemorrhage and inferior sagittal sinus thrombosis and was unsuccessfully treated with anticoagulant drugs leading to worsening signs and symptoms. Her initial β-hCG at admission to the hospital was 22,000,000IU/L, which lead to diagnosis of GTN with extensive metastatic lesions in the lungs and brain. Due to extensive intracranial hemorrhage, the patient was first treated with whole brain radiation therapy for 10 sessions daily (Total Dose=3000cGy). EMA-EP treatment was initially withheld due to concern for bleeding during concurrent radiation therapy. Following the brain radiation therapy, the chemotherapy was started for the patient. Upon completion of 3 cycles of EMAEP, the patient’s hCG was lowered to 5IU/L. The treatment was continued for 5 more cycles and resulted in hCG reading of under 2IU/L at her last visit.
Conclusion: This case highlights the variable presentation of GTN which might easily cause misdiagnosis and delayed treatment and shows excellent response to treatment despite late treatment and massive tumor burden with some modifications to plan of treatment
Azamsadat Mousavi; Mahshid Shooshtari; Setare Nassiri; Abas Ali Aipour; Setare Akhavan; Narges Zamani
Volume 2, Issue 4 , November and December 2017, , Pages 1-5
Abstract
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 ...
Read More
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.
Methods: In 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.
Results: There 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.
Conclusions: Although 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.
Setareh Akhavan; Azamsadat Mousavi; Mitra Modaresgilani; Abbas Alibakhshi; Maryam Rahmani; Nasrin Karimi
Volume 1, Issue 2 , September and October 2016
Abstract
Background: Gestational trophoblastic neoplasm (GTN) during pregnancy includes an associated heterogeneous group of lesions that originates from abnormal proliferation of placenta. It includes invasive mole, choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor.
Objectives: ...
Read More
Background: Gestational trophoblastic neoplasm (GTN) during pregnancy includes an associated heterogeneous group of lesions that originates from abnormal proliferation of placenta. It includes invasive mole, choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor.
Objectives: The aim of this study was to predict the risk of invasive mole in patients with a molar pregnancy in association with β-hCG level after the evacuation of molar pregnancy.
Methods: The current study was a prospective cross-sectional cohort research conducted as a diagnostic study on 110 patients with molar pregnancy referring to Department of Gynecology and Oncology of Vali-Asr, Imam Khomeini Hospital of Tehran between the years of 2015 and 2016. Patients with molar pregnancy, who were hospitalized with a diagnosis of hydatidiform mole by transvaginal ultrasonography, were examined in the study. The ability to perform ultrasonography before and after evacuation as well as the consent to participate in the study was among the inclusion criteria for patients. The patients were studied for invasive mole followed by two ultrasonography examinations, one 48 hours and the other 21 days after evacuation. β-hCG levels were also measured in successive periods of one week to six months. The association of sonography findings 48 hours and 21 days after evacuation with post-evacuation β-hCG levels was investigated using Chi-square test and multinomial regression.
Results: In the current study conducted on 110 patients with hydatidiform mole, the results showed that 46 patients (41.8%) suffered from invasive mole. In 23 patients (50%) with invasive mole, the results of both ultrasonography 48 hours and 21 days after evacuation were positive. There was a significant correlation between ultrasonography after evacuation (positive and negative results) and the progress of β-hCG after evacuation in women with invasive mole (P = 0.001); this means that in 73% of women with invasive mole, the positive β-hCG results corresponded with positive 21-day sonography after evacuation, and in 41% cases, ultrasound results on day 21 were reported positive before the results of β-hCG.
Conclusions: Positive results of sonography accompanied with positive results of β-hCG have a high efficiency in the diagnosis of invasive mole; therefore, more definitive studies with a larger sample size are suggested to confirm this hypothesis.
Setareh Akhavan; Azamsadat Mousavi; Abbas Alibakhshi
Volume 1, Issue 1 , May and June 2016
Abstract
Borderline ovarian tumors (BOT) consist of epithelial ovarian lesions that express cytological features of malignancy, but unlike malignant ovarian tumors, do not show obvious stromal invasion. The tumor incidence is between 1.8 and 4.8 per 100,000 females per year. The two major groups of BOT include ...
Read More
Borderline ovarian tumors (BOT) consist of epithelial ovarian lesions that express cytological features of malignancy, but unlike malignant ovarian tumors, do not show obvious stromal invasion. The tumor incidence is between 1.8 and 4.8 per 100,000 females per year. The two major groups of BOT include serous BOT (S-BOT) and mucinous BOT (M-BOT). S-BOTs are divided into two categories: tumors limited to ovary and tumors spreading outside the ovary. M-BOTs are divided into two categories. The more common type is intestinal that constitutes 85% of cases and the second type is endocervical or Mullerian. Mullerian M-BOTs is bilateral in 40% of cases, while it is accompanied by pelvic endometriosis in 20-30% of patients. Microscopic examination by intraoperative frozen section is necessary because macroscopic view of ovarian tumors alone is not reliable. It is better to perform conservative surgery until the final report is ready in patients who wish to preserve their fertility. It is hard to differentiate them based on clinical characteristics. Values of tumor markers including CA125, CA19-9 and CEA in diagnosis of BOT are confirmed. Standard treatment of BOT is surgery as is the case with invasive epithelial ovarian cancer. In the majority of patients referred for BOT, since there is no suspicion of malignancy, staging is not performed. In these cases, making decision to repeat surgery and staging depend on factors such as the type of histology, abdominal exploration results in the previous surgery and probability of the presence of residual tumor.
