Gynecology Oncology
Akram Ghahghaei-Nezamabadi; Afsaneh Tehranian; Setareh Akhavan; Elahe Rezayof; Nooshan Tajik
Articles in Press, Accepted Manuscript, Available Online from 11 May 2024
Abstract
Background & Objective: Immunosuppression, HPV persistence, and smoking are the main related risk factors of cervical intraepithelial neoplasia (CIN) recurrence. However, age as a basic factor may be a main factor related to CIN recurrence. Therefore, our study aimed to detect the potential role ...
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Background & Objective: Immunosuppression, HPV persistence, and smoking are the main related risk factors of cervical intraepithelial neoplasia (CIN) recurrence. However, age as a basic factor may be a main factor related to CIN recurrence. Therefore, our study aimed to detect the potential role of women's age in CIN recurrence.Materials & Methods: This cross-sectional study was conducted on 329 patients who underwent conization in the gynecology-oncology clinics of Arash and Imam Khomeini hospitals affiliated with Tehran University of Medical Sciences between February 2016 and February 2021.Results: Totally, 329 cases were enrolled in the study. Most women were in their thirties. CIN recurrence was about 10.0% (32 cases). The CIN recurrence rate was 8.9% in women younger than 30, 10.2% in 30-40, 11.3% in 40-50, and 5.6% in 50-60 decades. There was no significant (p-value=0.802) difference in recurrence rate among age groups. There was a significant (p-value=0.023) difference in the frequency of endocervical involvement regarding age category, women aged 40 to 50 had the most frequent marginal involvement with 26.8%, while there was no significant (p-value=0.802) difference in frequency of marginal involvement regards age category.Conclusion: CIN cases with age higher than 40 years need to have more caution and tight follow-up visit after conization.
Obstetrics and Gynecology
Mitra Modares Gilani; Azam Sadat Mousavi; Setareh Akhavan; Shahrzad Sheikhhasani
Volume 7, Issue 6 , September and October 2022, , Pages 530-535
Abstract
Background & Objective: Cervical cancer is one of the most common cancers in women. One of the most important indicators that deal with all aspects of the patients' health is the Health-related quality of life (QOL). In this study, the QOL of women with cervical cancer in Iran was investigated.Materials ...
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Background & Objective: Cervical cancer is one of the most common cancers in women. One of the most important indicators that deal with all aspects of the patients' health is the Health-related quality of life (QOL). In this study, the QOL of women with cervical cancer in Iran was investigated.Materials & Methods: The present cross-sectional study examined the QOL of 139 patients with cervical cancer referred to Imam Khomeini hospital, affiliated with the Tehran University of Medical Sciences. For this study, a specific questionnaire of QOL in patients with cervical cancer was used. To determine the predictors of cervical cancer patients, the QOL linear regression model was used.Results: Findings of this study showed that the total score of QOL of patients was 20.97±1.29. Moreover, in the regression model, a significant relationship was observed between the type of treatment and patients' QOL scores and those patients who had neoadjuvant therapy plus surgery (β=-17.45, P < /i>=0.02) and those who received brachytherapy (β=- 14.86 and P < /i>=0.09) had a significantly lower QOL score.Conclusion: Overall, the QOL of people with cervical cancer was moderate. Implementing educational programs for service providers and choosing the appropriate type of treatment according to the stage of the disease and the patient's age can help control this type of disease and its complications and improve the QOL of patients.
Gynecology Oncology
Azam-Sadat Mousavi; Setareh Akhavan; Fareideh Sabzi shahrbabaki; Narges Izadi-mood; Fariba Yarandi; Mehran Ghazimoghadam; Mohammad Pouryasin; Saina Nassiri; Mamak Shariat; Ali Pouryasin
Volume 7, Issue 3 , January and February 2022, , Pages 151-157
Abstract
Background & Objective: Recent advances in molecular testing for human papillomavirus (HPV) has increased the accuracy of cervical screening programs. This study intended to estimate the diagnostic value of high-risk (HR) HPV DNA- and E6/E7 mRNA-based methods for triage of Iranian women with ...
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Background & Objective: Recent advances in molecular testing for human papillomavirus (HPV) has increased the accuracy of cervical screening programs. This study intended to estimate the diagnostic value of high-risk (HR) HPV DNA- and E6/E7 mRNA-based methods for triage of Iranian women with abnormal cytological results regarding the histopathological cut-off.Materials & Methods: In this cross-sectional study, 360 non-pregnant women (≥ 21 years) who had faced abnormal cytological findings (ASC-US and LSIL) were enrolled and referred for further diagnostic tests. The INNO-LiPA® HPV Genotyping Extra-II and Aptima HPV assay kits were used in DNA- and E6/E7 mRNA-based methods for detection of HR-HPV. Regarding the CIN-2+ histopathological cut-off, the diagnostic value of each molecular-based assay was calculated.Results: Among the study participants, 260 cases had ASC-US, and 100 had LSIL. The overall positivity rate for DNA- and mRNA-based methods was 74.4% (268/360) and 64.2% (231/360), respectively. Fifty-nine (16.4%) individuals showed CIN-2+. The DNA-based test showed higher sensitivity (100%) than the mRNA-based method (93.2%), while the mRNA-based method revealed greater clinical specificity (41.5%) compared to the DNA-based test (30.6%).Conclusion: Our results revealed appropriate clinical sensitivity of the molecular-based methods for triage of Iranian women with abnormal cytological results; however, the mRNA-based method showed greater specificity for detection of CIN-2+.
Gynecology Oncology
Arvin Arian; Masume Giti; Azamosadat Moosavi; Setare Akhavan; Arash Azhideh; Mehran Arab-Ahmadi
Volume 5, Issue 1 , August 2020, , Pages 19-23
Abstract
Background & Objective: Endometrial cancer is the most frequent genitourinary tract malignancy in women. Women with endometrial cancer mostly refer at early stages of the disease which leads to good prognosis. Magnetic resonance imaging (MRI) has a crucial role in staging of the cancer. As there ...
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Background & Objective: Endometrial cancer is the most frequent genitourinary tract malignancy in women. Women with endometrial cancer mostly refer at early stages of the disease which leads to good prognosis. Magnetic resonance imaging (MRI) has a crucial role in staging of the cancer. As there are little studies regarding the correlation between histopathology and International Federation of Gynecology and Obstetrics (FIGO) staging in Iranian women with endometrial cancer, we designed this study to assess the relationship between histopathology and FIGO staging with MRI in Iranian women with endometrial cancer.Materials & Methods: This retrospective study was conducted in Imam Khomeini hospital complex between January 2015 and January 2018. All MRIs were performed on a 3T system. All imaging was done in Imam Hospital under observation of attending Radiologists with 10 and 20 years of work experience in women’s imaging who conducted this research. Obtained surgical specimens were assessed by an expert pathologist in the field of cancer and type of cancers were determined.Results: Thirty two women with proved endometrial cancer (D&C or endometrial biopsy) were enrolled. Mean age was 55.2±10.7 years and all women referred to our clinic with vaginal bleeding. The most common FIGO staging was IA (14, 43.75%) and the most frequent pathology was endometrioid type adenocarcinoma (30, 93.7%) (60% well differentiated, 13.3% moderately differentiated, and 26.6% poorly differentiated). Most cases with endometrioid type poorly differentiated referred with IIIC1 stage of cancer, most patients with endometrioid type well differentiated referred with stage IA, a patient with clear cell cancer referred with stage IIIB, and patients with sarcoma referred with stages IB, and IV.Conclusion: Patients with poor differentiated endometrial cancer referred with higher stages of the cancer.
Faramarz Karimian; Setareh Akhavan; Ali Marzoughi; Mohammad Reza Keramati; Mohammad Ashouri
Volume 4, Issue 4 , September and October 2019, , Pages 135-140
Abstract
Background & Objective: Cyclic mastalgia is clinically related to alterations in sex hormone levels during the menstrual cycle. A derangement in normal menstrual cycle leads to exacerbated mastalgia; which can also cause menstrual irregularities and abnormal uterine bleeding (AUB). A decrease in ...
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Background & Objective: Cyclic mastalgia is clinically related to alterations in sex hormone levels during the menstrual cycle. A derangement in normal menstrual cycle leads to exacerbated mastalgia; which can also cause menstrual irregularities and abnormal uterine bleeding (AUB). A decrease in severity of mastalgia is observed in patients with simultaneous cyclic mastalgia and menstrual irregularities/AUB, following correction of menstrual irregularity. This study was designed and conducted to investigate the possibility of whether correction of menstrual irregularities can diminish cyclic mastalgia.
Materials & Methods: This case-control study was carried out on women suffering from simultaneous mastalgia and menstrual irregularity. One-hundred and fifty patients were randomly distributed between case and control groups, each including 75 patients. Patients in both groups took 100 mg vitamin E oral tablet daily for 3 months. Patients in case group also received low-dose oral contraceptive pills (OCP-LD) to correct menstrual irregularity. Patients recorded the severity of mastalgia in Cardiff breast pain chart using Visual Analogue Scale (VAS).
Results: At the beginning of study, there was no significant difference in the number of days suffering from mild and severe mastalgia between two groups. However, at the end of the study, mild and severe mastalgia reduced significantly in the case group compared to the control group (P < /em>=0.003 and P < /em>=0.045, respectively).
Conclusion: In women with cyclic mastalgia, correction of menstrual irregularity leads to significant pain relief. Correcting menstrual irregularity is suggested as a first-line treatment in women with mastalgia.
Nadereh Behtash; Setareh Akhavan
Volume 4, Issue 3 , September and October 2019, , Pages 120-126
Abstract
Uterine sarcomas (US) are relatively rare malignant tumor of the uterine mesenchymal tumor. The present study evaluated the outcomes of patients with different types of uterine sarcoma in Iranian women during a 5-years survey. During 2014-2019, a case series of twenty-three patients of US (four cases ...
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Uterine sarcomas (US) are relatively rare malignant tumor of the uterine mesenchymal tumor. The present study evaluated the outcomes of patients with different types of uterine sarcoma in Iranian women during a 5-years survey. During 2014-2019, a case series of twenty-three patients of US (four cases of leiomyosarcoma (LMS), nine cases of endometrial stromal sarcoma (ESS), seven cases of carcinosarcoma (CS), and three cases of adenosarcoma (AS)) were studied. One case of AS needed adjuvant radiotherapy and a recurrence was occurred in this case four years later. Two cases of CS have died during study period. All of ESS cases were alive by the study duration. One case who did not receive radio/chemotherapy experienced a bronchial recurrence after 8-years of ESS diagnosis Immunohistochemistry test on tumoral cells of three patients for vimentin+Ki67, BCL2+CD64+Ki67, ER+PR+WT1+Ki67 expressions were 30%, 30%, 15% respectively. Two cases of CS died during the study period. Even with multimodalities of treatment, the prognosis of uterine sarcoma is still poor and early diagnosis seems to improve the prognosis of the patients.
Setareh Akhavan; Jila Agah; Abbas Alipour
Volume 3, Issue 2 , May and June 2018, , Pages 59-63
Abstract
Aims: Ovarian cancer is the 4th cause of women’s mortality occurring due to cancer. Malignant germ cell tumors (GCTs) account for 5% of malignant ovarian tumors and 70% of ovarian tumors in women between the ages of 10-30 years old. The aim of the present study was to detect the frequency of malignant ...
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Aims: Ovarian cancer is the 4th cause of women’s mortality occurring due to cancer. Malignant germ cell tumors (GCTs) account for 5% of malignant ovarian tumors and 70% of ovarian tumors in women between the ages of 10-30 years old. The aim of the present study was to detect the frequency of malignant ovarian germ cell tumor and distribution of demographic features in the most crowded gynecology oncology clinic.
Materials and Methods: This cohort descriptive-analytical study was conducted on cases with malignant ovarian tumor managed in Vali-Asr hospital, Tehran, Iran, from 2001 to 2018 (n=1540). The malignant germ cell tumors cases were extracted (n=128) and evaluated in point of epidemiologic and demographic data via the software SPSS 24.
Findings: 128 patients (8.3%) had GCTs. The average age was 23.88±7.85 years. 79.7% lived in the city, 76.6% had medium economic status and 53.6% had normal body mass index. Premature puberty was revealed in one person. Karyotype XY was detected in 5 persons. About 70.3% of the patients had no parity. In parous women, the highest percentage was related to a childbirth (55.0%). A history of infertility was detected at 6.1%. In 10 patients, the tumor was detected during pregnancy.
Conclusion: The highest frequency is related to the early young women with no considerable association with socioeconomic and weight status. It is possible that parity would be a protective factor for this tumor. In the case of adnexal mass during pregnancy, Malignant Germ cell tumors should be rolled out.
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 ...
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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
Mahboobeh Shirazi; Fatemeh Shahbazi; Setareh Akhavan; Mohadeseh Sharifi Taskooh; Fatemah Azadi
Volume 1, Issue 3 , November and December 2016
Abstract
Backgroung: Given the importance of natural childbirth and emphasis on the normal vaginal delivery, and since important causes of having a C-section are lack of response to induction of labor with Syntocinon® injection and the fact that the cervix is unfavorable for labor.
Objective: The present ...
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Backgroung: Given the importance of natural childbirth and emphasis on the normal vaginal delivery, and since important causes of having a C-section are lack of response to induction of labor with Syntocinon® injection and the fact that the cervix is unfavorable for labor.
Objective: The present study aims at achieving the best method of cervical ripening for pregnancy termination to reduce the C-section rate, labor duration, economic burden, and labor pain.
Methods: In this regard, the current study examined the effect of hyoscine-N-butylbromide (HBB) on the progression of cervical ripening in normal vaginal delivery. In the current prospective double-blind controlled clinical trial, 60 pregnant females referred to Valiasr hospital (with the mean age of 27.2 years) were randomly divided into 2 groups of experimental and control; HBB and normal saline (placebo) were intravenously administered in the active phase of labor.
Results: The pain reduction in the patients, the duration of drug action until the cervical dilatation, the number of drug use for the full cervical dilatation, the time of the onset of the first, second, and third stages of labor, the length of hospitalization until the delivery, the drug effect on the fetus and mother, and the delivery method were evaluated in both groups. HBB significantly reduced the duration of the first stage of labor; however, it did not affect the second and third stages. Moreover, no negative effects were observed on the mother and fetus health.
Conclusion: According to the obtained results, it can be concluded that the intravenous injection of HBB can be applied as an effective drug for labor progress; however, further clinical studies with larger sample sizes are required to confirm these findings.
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: ...
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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.