Evaluation of ovarian function after hysterectomy with or without salpingectomy: A feasible study

Background: Prophylactic salpingectomy for the prevention of ovarian cancer has been recommended strongly. The aim of this study was to compare ovarian function in patients who undergo hysterectomy for benign reasons with or without bilateral salpingectomy. Materials and Methods: This was a clinical-trial study on patients undergone hysterectomy with/without bilateral salpingectomy in Al-Zahra Hospital, in 2015–2016. Demographic information (age, height, and weight) were recorded. Follicle stimulating hormone (FSH) and luteinizing hormone (LH) were measured in 2–5 days of menstrual cycle before operation. Patients were asked to refer in 6 months for follow-up, including FSH and LH re-measurement and also menopausal status examination. Patients were divided into age groups of 39–45, 46–50, and ≥51 and also groups of body mass index including 18.5–24.9, 25–29.9, and 30–34.9. Results: A total of 37 patients divided into two groups, including 22 patients undergone hysterectomy without salpingectomy (H) and 15 undergone hysterectomy with bilateral salpingectomy (H-bS). The mean age (standard deviation) of Group H was 47.77 (3.03) and Group H-bS was 48.47 (2.03) (P > 0.05). Furthermore, the mean level of FSH and LH before surgery was not significantly different (P > 0.05). The mean level of FSH and LH changes was not significant between H and H-bS groups (P = 0.17), (P = 0.16). Conclusion: Bilateral salpingectomy during hysterectomy did not increase the risk of ovarian dysfunction after 6 months follow-up

Sentinel lymph node mapping using methylene blue and Technetium-99 in early endometrial cancer

Background: Endometrial cancer (EC) is the most prevalent genital related cancer of females. One of the controversial points about endometrial cancer surgery is preserving or dissection of sentinel lymph nodes (SLNs). Lymphatic mapping and sentinel nodes sample has been used widely for diverse solid tumors in order of finding metastasis in lymph nodes. The aim of current study was to evaluate diagnostic value of technetium-99 and methylene blue in diagnosis of sentinel lymph node involvement in low-risk endometrial cancer. Methods: This cross-sectional study was conducted through 2016 on 14 patients with low-grade endometrial cancer referred to Al-Zahra and Shahid Beheshti Hospitals (affiliated to Isfahan University of Medical Sciences), Iran, in 2016-17. Eighteen and twenty-four hours before operation, patients underwent technetium-99 (Tc-99) injection to uterine cervix. Twenty-four hours prior to surgery, patients were referred to resident of gynecology and filled demographic checklist. In next day during operation, Tc-99 was detected by gamma probe. Methylene blue was injected in operation room and blue nodes were detected by naked eye. All patients underwent total hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy. Dissected lymph nodes were sent for frozen section and assessment of positive/negative metastasis. Then data were analyzed with SPSS software, version 20 (SPSS Inc., Chicago, IL, USA). Results: Mean age of our patients was 60.64±9.18 years. Total number of 80 SLNs was dissected. 18.8% of nodes were detected using methylene blue, 12.5% using tecnethium-99 and 6.3% were in common with both methods. Number of two nodes was metastatic and was detected by blue dye and Tc-99. Sensitivity, negative predictive value and detection rate of Tc-99 alone, methylene blue alone and their combination was 100% and false negativity of all above was 100%. Conclusion: Due to findings of our study, as sensitivity, detection rate, negative predictive value and false negativity of methods lonely and in combination were similar thus based on higher probability of blue dye adverse effects, use of Tc-99 lonely may be adequate. &nbsp

Presentation of Placental Site Trophoblastic Tumor with Amenorrhea

Placental site throphoblastic tumor (PSTT) is a rare manifestation of gestational trophoblastic neoplasia that may complicate any type of pregnancy. The disease is unique from other type, and is defined by slow growth, low human chorionic gonadotropin (hCG) serum levels, the late-onset metastatic potential, and most significantly, insensitivity to chemotherapy. We describe a case of a 31-year-old woman with prolonged amenorrhea and slightly elevated serum beta hCG (βhCG) level, referred for termination of abnormal pregnancy. During curettage, necrotic tissue was removed and severs vaginal bleeding was controlled with medical therapy. Histology examination showed neoplastic intermediate trophoblastic cells with invasion to the vessel wall compatible with PSTT. After that, hysterectomy was down and serum βhCG declined to undetectable level 2 weeks after surgery and was followed for 2 years without complication

Accuracy of Human Papillomavirus (HPV) Test for Triage of Women with Atypical Squamous Cells of Undetermined Significance (ASCUS)

Background: In recent years, human papillomavirus (HPV) test has been approved in triage of women with Atypical Squamous Cells of Undetermined Significance (ASCUS). However, due to the low prevalence of cervical cancer, high costs and limited access to test, the effectiveness of this test in our country is ambiguous. Methods: In a diagnostic accuracy study, 245 women who were diagnosed as ASCUS in cervical cytology based on Bethesda 2001 criteria, were then assessed with colposcopy. Cervical biopsy was taken when needed. They were classified according to the results to high risk [Cervical Intraepithelial Neoplasia (CIN) > 2] or normal. Cobas® HPV Test was conducted for participants. Considering the colposcopy-biopsy as the golden standard, the performance of the HPV test was determined for detecting precancerous lesions. Findings: 24 patients had CIN1, 10 patients CIN of 2, and 4 patients had CIN ≥ 3. The sensitivity and specificity of the HPV test was 80% and 77%, respectively. Positive predictive value (PPV) and negative predictive value (NPV) was 12.9% and 98.9%, respectively. Conclusion: Considering the low prevalence of high-risk lesions in this series of women with ASCUS cytology, and the high NPV of the HPV test, it seems that its application can be helpful in the initial triage of patients with this pathology. In other words, the negative result of this test provides sufficient assurance that there are no precancerous or cancerous lesions

Sentinel lymph node mapping in early stage of endometrial and cervical cancers

Background: The sentinel lymph node (SLN) is defined as the first chain node in the lymphatic basin that receives primary lymphatic flow. If the SLN is negative for metastatic disease, then other nodes are expected to be disease-free. SLN techniques have been extensively applied in the staging and treatment of many tumors, including melanoma, breast and vulvar cancers. This study aims to evaluate our technique in SLN mapping in early stage endometrial and cervical cancers. Materials and Methods: We scheduled a cross-sectional pilot study for patients undergoing staging surgery for endometrial and cervical cancer from November 2012 to February 2014 in Beheshti and Sadoughi Hospitals. Our SLN mapping technique included 1 h preoperative or intraoperative injection of 4 ml of 1% methylene blue dye in the tumor site. At the time of surgery, blue lymph nodes were removed and labeled as SLNs. Then systematic lymph node dissection was completed, and all of the nodes were sent for pathologic examination concerning metastatic involvement. All of the sentinel nodes were first stained with hematoxylin and eosin and examined. Those negative in this study were then stained with immunohistochemistry using anti-keratin antibody. Descriptive statistics, sensitivity, negative predictive values (NPV), false negative (FN) and detection rates were calculated. Results: Twenty-three patients including 62% endometrial and 38% cervical cancers enrolled in the study. Median of SLN count in the endometrial and cervical cancers was 3 and 2, respectively. Among endometrial and cervical cancers, detection rate of metastatic disease was 80% and 87.5%, respectively. The FN rate for this technique was 0 and the sensitivity and NPV are 100% for both endometrial and cervical cancers. Conclusion: Considering the lower risk of metastases in early stage of both endometrial and cervical cancers, SLN technique allows for confident and accurate staging of cancer

The WHO score predicts treatment outcome in low risk gestational trophoblastic neoplasia patients treated with weekly intramuscular methotrexate

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 40mg/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 eigtheen 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