Metastatic gestational trophoblastic neoplasms and no gynecological symptoms: Report of five cases

Early recognition of Gestational Trophoblastic Neoplasm [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, gastrointestinal, pulmonary symptoms or radiographic evidence of metastatic tumor of unknown primary origin. We reported five cases of metastatic gestational trophoblastic neoplasms with bizarre pulmonary symptoms, acute abdomen, neurologic symptoms presenting without gynecological symptoms

[Fertility preservation in young women with endometrial carcinoma; report of three cases]

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. We reported 3 young patients with atypical; complex hyperplasia or early stage endometrial cancer that treated with conservative hormonal therapy. 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 and 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

Unusual presentation of gestational trophoblastic neoplasm: report of two cases

Gestational Trophoblastic Neoplasm [GTN] is among rare human tumors which can be observed with widespread metastasis. Two young patients with emergent neurologic symptoms with no gynecological problems are presented in this report. GTN was later diagnosed in both cases with brain metastasis.The first case: A 22 years old patient, admitted to the infectious disease ward, with probable diagnosis of Encephalitis. After brain CT scan and measurement of beta human chorionic gonadotropin [betahCG], GTN with brain metastasis was confirmed. The second case: A 33 years old patient who underwent craniotomy due to hemorrhagic brain tumor in neurosurgery department. Brain metastatic GTN was confirmed by histological examinations. Both cases received multiagent chemotherapy concurrent with whole brain irradiation of 3000 cGy in 10 fractions [F] within a period of 2 weeks, and chemotherapy was continued for additional course. The patients were both well after about 22 months. Diagnosis of GTN should be considered in any woman of reproductive age

[Pregnancy and gynecological malignancies]

Gynecological malignancies are very rarely associated with pregnancy. It is estimated that gynecological malignancies complicate approximately one in 1000 pregnancies. Cervical cancer and ovarian cancer are the most common malignancies diagnosed in pregnancy. Vulvar and endometrial carcinoma in pregnancy is very rarely. Cancer diagnosis in pregnancy may be delayed. The optimal therapy for diagnosis of cancer in pregnancy is a complicated problem and requires a collaborative and interdisciplinary approach between gynecologists, oncologists,obstetricians, preneatologists, neonatologists. Gynecological cancer associated with pregnancy are treated in the same manner as in nonpregnant patients.Surgery is the best treatment for different cancers. Prospective randomized studies regarding principles of treating these cancers do not exist are leaking. In the present review, recent carcinoma during pregnancy will be evaluated and discussed