[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

[Significant pathologic findings in 41 Atypical Glandular Cell pap smears]

The aim of this study was to evaluate the association between atypical glandular cell [AGC] on Pap smear and significant pathologic finding to tailor management protocols. Between 2002 and 2005, Among 26893 Pap smears 122 women with AGC Pap smears [prevalence=0.45%] were referred to our colposcopy clinic. Forty one women underwent colposcopy directed biopsy, endocervical curettage, endometrial sampling and cervical conization to determine the cytologic and histologic correlations of AGC on pap smears. A total of 122 women with AGC Pap smear were found. Only 41 women accepted to participate in the study and followed the workup procedures. The mean age of the patients was 46.92 +/- 11.48 years [range, 23-80 years]. Of these patients 13 patients [31.7%] were post menopause and 28 patients [68.2%] were in reproductive age. We found 13 [31.7%] significant pathologic findings including 4 [9.7%] high grade squamous intraepithelial lesion [HG-SIL], 3[7.3%] low grade squamous intraepithelial lesion [LG-SIL], 2[4.8%] Endometrial hyperplasia, 1[2.4%] Endometrial adenocarci-noma, 1[2.4%] adenocarcinoma of cervix, 1[2.4%] squamous cell carcinoma of cervix and 1[2.4%] papillary serous tumor of ovary. There was not any significant difference in the prevalence of significant pathologic findings and subtype of squamous or adenomatous lesions between pre and postmenopausal group. AGC on Pap smear was associated with a clinically significant diagnosis in approximately one third of our cases. The women with a diagnosis of AGC on cervicovaginal smear are needed to be evaluated at least with colposcopy, endocervical and endometrial curettage. Clinicians should be careful about the significance of AGC in pap smears

[Term delivery following successful treatment of choriocarcinoma with brain metastases a case report]

Cerebral metastases from choriocarcinoma are poor prognostic indicator of outcome in both the World Health Organization and FIGO classification systems. Although gestational trophoblastic neoplasia has become the most curable gynecological malignancy, failure rate among 'high-risk' patients is still high despite the use of aggressive multidrug regimens. A 27 year old woman [G4P2Ab1] presented with hemiplegia due to brain metastases of choriocarcinoma one year after spontaneous abortion. She underwent craniotomy and was treated with nine courses of multiple agent etoposide, methotrexate, actinomycin-etoposide and cisplatinum [EMA-EP] regimen combined with whole brain irradiation. She delivered a term healthy child two years after termination of treatment. Multiagent EMA-EP chemotherapy and whole brain irradiation with craniotomy in selected patients preserves fertility and may improve a patient overall prognosis

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

[Screening and vaccination in prevention of cervical cancer]

Cancer of cervix is the second most common cancer among women worldwide, with a frequency of more than 500000 cases every year. The mean age for cervical cancer is 51/4 years and the most common type is squamous cell carcinoma. HPV can be found in a growing proportion of patients with cervical cancer,approaching 100%. HPV 16 is the most prevalent in cervical cancer, followed by HPV 18 and 33. As half of cervical cancer cases are diagnosed as an advanced at the time of stage and with the techniques available, remain untreatable. During the past 20 years, vast research has been focused to unveil definite diagnostic techniques production of vaccines and new management modalities. Cultural status, habits and social behavior of women have an important bearing in the occurence and morbidity and mortality due to this disease. Minority class and woman with low income and women with low income undergo less screening. In America and Northern Europe, the Major cause for a reduction in the morbidity and mortality of cervical cancer has been the execution of screening at a large scale resulting in a 70% reduction in morbidity and mortality due to cervical cancer. On the other hand, in Iran according to the available statistics, the leading cause of a delayed diagnosis of cervical cancer has been the absence of the performance of Pap smear test. A high rate of false negative smears and atypical squamous cells [ASC] diagnoses have led to the development of new diagnostic techniques. More recently, the use of liquid-based technologies such as Thin Prep and AutoCyte Prep have gained popularity; It has been held till today that pap smear might increase the sensitivity of detecting cervical dysplasia. In reviewing the published literature about the efficacy of this technique and the endorsement of the results of screening, information is lacking HPVDNA typing can be used concurrently with pap smear in cases where pap smear is abnormal. A negative combination test [Pap smear HPVDA typing] in contrast three-repeated Pap smear tests shall provide more reliability as regards the absence of neoplasia in future. In the year 2003, FDA approved the use of Hybrid capture 2 Assay for HPVDVA typing along with Pap smear in women above 30 years of age, so that high risk in faction in these woman is subjected to screening

[Symptoms of ovarian cancer in young patients: a case control study in IRAN, 1998-2005]

Ovarian cancer is usually diagnosed after it has widely spread and is difficult to cure. Most of attempts to identify its early symptoms have either lacked a control group or have been based on interviews of patients with possible recall bias, and most studies have been performed on all age groups. To examine the early symptoms of ovarian cancer in young women aged between 15 and 35 compared with a matched control group. Hundred women with ovarian cancer were selected out of 565,611 women aging 15 to 35 years who were referred to Vali-Asr Gynecology Oncology Clinic of Imam Khomeini Hospital between 1998 and 2005. Symptoms of 100 cases were compared with those of 100 matched control women during one year before diagnosis. The proportion of cases who complained of at least one symptom up to one year before the diagnosis was significantly higher than controls, 95% versus 28%, respectively [p<0.05]. Most of these symptoms were abdominal in nature. Other symptoms included urinary problems, infertility and abnormal vaginal bleeding. The most common symptoms among cases were: unusual abdominal or lower back pain [52%], unusual bloating, fullness and pressure in the abdomen [37%], gastro-intestinal problems [36%], and unusual lack of energy [22%]. The proportion of controls reporting these symptoms were 11%, 3%, 12% and 7%, respectively, resulting in odds ratios [95% confidence intervals] of 8.765 [4.18-18.355], 18.989 [5.614-64.228], 4.125 [1.991-8.546], and 3.747 [1.520-9.237] for these symptoms, respectively. There were only minor differences between cases with early and late stage disease. Unusual abdominal or lower back pain, unusual bloating, fullness and pressure, gastro-intestinal problems, frequent urination, urgency or burning, and infertility should make women and physicians more aware of possible changes associated with ovarian cancer in young women

[A review of screening for gynecological cancers]

An early diagnosis of gynecological caner is a life saving measure in ensuring a woman's health. It is important that the current knowledge about screening and timely diagnosis of premalignant and malignant conditions are ensured for physicians, the necessity of widespread use of screening is due to its high sensitivity, specificity, low cost and its noninvasiveness. Cervical caner is one of the gynecological cancers where screening programs have resulted in a reduction in morbidity and mortality secondary to this disease, in endometrial cancer, as the patient usually reports during the initial phase of the disease; screening is only useful in the high risk group. Ovarian cancer is another gynecological caner in which considerable research is going on to find an appropriate screening Techniques. In this article we would discuss the varying screening techniques available for gynecological caners