Vitrification has detrimental effects on maturation, viability, and subcellular quality of oocytes post IVM in cancerous women: An experimental study

Background: In vitro maturation (IVM) of immature oocytes retrieved from ovarian tissue has been considered as a valuable approach for fertility preservation in cancerous patients.Objective: To evaluate the efficacy of vitrification on oocyte maturation, survival rates, as well as the subcellular oocyte quality post IVM.Materials and Methods: The ovarian cortexes from 19 women with cervix and uterine malignancy aged 21–39 yr were collected. Cumulus-oocyte complexes were aspirated from all visible antral follicles. 102 immature oocytes were collected, and 43 oocytes were detected appropriately for IVM (control group). Also, 59 immature oocytes were vitrified, then matured in vitro (IVM) in two groups: with Growth/differentiation factor9 (GDF9) (group 1) and without GDF9 (group 2) supplementation. Rates of oocytes viability, maturation, and survival along with meiotic spindle visualization and zona pellucida birefringence were assessed with Polyscope.Results: The rate of maturation was significantly higher in controls (55.8%) compared to the other groups. Maturation rate was 23.3% in oocytes cultured in IVM medium enriched with GDF9, and 27.6% in those cultured in IVM medium lacking GDF9 (p= 0.86). Also, the meiotic spindle was present in 74.4% of control oocytes whichwas significantly higher than the other groups. The proportion of high zona pellucida birefringence was higher in the controls when compared with group 1 (51.2% vs. 23.3%, respectively, p = 0.04).Conclusion: Vitrification had a detrimental effect on oocyte maturation, viability as well as the subcellular quality of the oocytes after IVM in cancerous women

Radical hysterectomy in the elderly

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A Collect of Recommendations and Guidelines for Management and Treatment of Underlying Malignancies During the COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic is the main challenges to public health systems worldwide now. Cancer patients are considered as a high risk group during the COVID-19 pandemic. Considering the evidence so far, cancer as underlying comorbidities might increase the risk of death in patients with COVID-19. Many cancer patients with increased risk of contracting COVID-19 than the general population regularly visit health facilities for treatment and disease surveillance. Thus, the COVID-19 pandemic has a profound impact on cancer care and treatment. Here, we attempted to summarize the current suggestions for handling of cancer patients during COVID-19 pandemic. We carried out a integrative literature review using several online bibliographies. A total of 113 papers were accessed for the time frame between October 05 2020 and October 10 2020. After screening of titles and full-texts, 10 publications were selected in this study. In this work some recommendations and guidelines that would help for management and treatment of cancer for the purpose of address the challenges during COVID-19 pandemic were collected. We hope that this collection recommendations and guidelines assist health care providers in management of individuals with underlying malignancy during the COVID-19 pandemic

Dysgerminoma in three patients with Swyer syndrome

<p>Abstract</p> <p>Background</p> <p>Dysgerminoma is the most common malignant germ cell tumor of the ovary. This malignancy can be associated with pure gonadal dysgenesis or Swyer syndrome, mixed gonadal dysgenesis and partial gonadal dysgenesis.</p> <p>Case presentation</p> <p>Dysgerminoma developed in 3 phenotypic female patients with 46 XY pure gonadal dysgenesis. All patients presented first with abdominopelvic mass. Laparatomy was done. 46 XY karyotype was made by lymphocyte culture. Then these patients underwent gonadectomy that histopathology results were streak ovaries without evidence for malignancy. Two patients received postoperative adjuvant therapy.</p> <p>Conclusion</p> <p>In Patients with Swyer syndrome the risk of dysgerminoma is high and gonadectomy is recommended. Also 5% of dysgerminomas are discovered in phenotypic female and 46 XY karyotype, thus in adolescent with dysgerminoimas and amenorrhea, karyotype should be done.</p

Ovarian carcinoma associated with pregnancy: A clinicopathologic analysis of 23 cases and review of the literature

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to analyze and describe cases of ovarian cancer in pregnant women treated at our center and to review the literature concerned, and to discuss the rationale for therapy.</p> <p>Methods</p> <p>Twenty-Three patients of ovarian malignancies during pregnancy were treated at Vali- Asr Hospital between 1991 and 2002. Data on treatment and follow-up were evaluated.</p> <p>Results</p> <p>The incidence of ovarian carcinoma associated with pregnancy in our series was 0.083/1000 deliveries. Eleven (47.8%) were found with ovarian malignant germ cell tumors, five (21.7%) with low malignant potential tumors, four (17.4%) with invasive epithelial tumors, and three (13%) with sex cord stromal tumors. Seventeen (73.9%) of the patients were diagnosed in stage I and had complete remission. Five of the six in advanced stage died. The mean follow-up was 36.3 months. The prognosis was significantly related with stage and histological type (<it>P </it>< 0.05). Sixteen healthy live babies were recorded in this group, and two premature newborn died of respiratory distress syndrome. Chemotherapy was administered to 44% of the patients, in two cases during pregnancy. Overall survival at 5 years was 61%. In most of case conservative surgical treatment could be performed with adequate staging and debulking.</p> <p>Conclusion</p> <p>Early finding of ascitis by ultrasound and persistent large ovarian mass during pregnancy may be related to malignancy and advanced stage. Pregnant women in advanced stage of ovarian cancer seem to have poor prognosis.</p

The importance of re-examination with deep biopsies in diagnosing cervical malignancies despite multiple negative pathology reports: A case report

Introduction: Clinical symptoms of female genital tract lymphoma are often non-specific, and mimic other more common gynecological malignancies. Diagnosis can only be confirmed by histology. Case presentation: We report the case of a 48-year-old multiparous woman who underwent subtotal hysterectomy because of enlarged myomatous uterus and persistent heavy vaginal bleeding. “2 months later”, postoperative pelvic and abdominal CT scan performed because of flank pain, revealed bilateral hydronephrosis. Pelvic and colposcopic exam and cervical biopsy under anesthesia showed benign histology, as reported by two pathologists. Referral to a third pathologist and immunohistochemical (IHC) exam revealed malignant lymphoproliferative disorder. Conclusion: Despite multiple negative pathology reports of the cervical biopsies, bimanual pelvic exam with deep biopsies by a gynecologist, allowed accurate final diagnosis of this unusual case

Primary histiocytic sarcoma of the uterine cervix: an extremely rare entity

Objective. Histiocytic sarcoma (HS) is an extraordinary rare tumor and it has an offensive clinical course. HS of the uterine cervix is a far uncommon tumor with just a few cases described so far. Here we presented a case of primary HS of the uterine cervix in a 62-year-old female initially misdiagnosed as large cell non-keratinizing squamous cell carcinoma. To the best of our knowledge, this is the first reported case of HS of the uterine cervix from Iran

Barriers of child adoption in infertile couples: Iranian's views

Background: There are many reasons why some couples do not become parents. Some are infertile, some do not want kids, children can be in a social context unacceptable and for others different life goals are more important. Objective: This study was designed to determine barriers of child adoption in infertile couples in Iran. Materials and Methods: This cross-sectional study was carried out at Iran from April 2010 to June 2011. The research program was comprised consecutively in 240 infertile couples. Experts in Guidance and Counseling vetted the instrument and set that it has content validity. Test re-test reliability was conducted by the investigators using a sample of 20 couples who have filled questionnaire. Results: Although 230 (96%) of the respondents heard of child adoption, only 89 (37.3%) of couples knew correct meaning of child adoption. Fifty four women (24%) knew how to adopt a baby while the rest did not; 196 (82%) respondents expressed their unwillingness to adopt a baby. Hoping of childbearing (78%) was the main barrier to adopt a child. Conclusion: The barriers mentioned were cultural practices, stigmatization, financial implications, and technical problems. Most of the infertile Iranian couples prefer to stay even so without children or think about new treatment

Developmental competence of immature oocytes aspirated from antral follicles in patients with gynecological diseases

Background: In vitro maturation (IVM) of immature oocytes collected from ovary has been proposed for fertility preservation. In addition, quality of oocytes post IVM is one of the factors determining its developmental competence. By using the non-invasive Polscope system, both meiotic spindle (MS) and zona pellucida (ZP) can be assessed in living oocytes. Objective: The aim was to investigate the developmental potential of immature oocytes retrieved from ovarian tissue after IVM, as a method for fertility preservation, in patients with gynecological diseases. Materials and Methods: The ovarian cortex from 26 patients with malignant and benign diseases (21-45 years old), were obtained directly from collaborating hospitals, and transported to the IVF center on ice. In total 61 immature oocytes were aspirated, of which 18 (29.5%) were degenerated and discarded. The remaining 43 (70.5%) healthy oocytes were cultured in IVM culture media for 48 hr. The rate of maturity was assessed, and the ZP birefringence and MS were imaged with Polscope technology. Results: Overall 43 immature oocytes underwent IVM technology, of which 30.2% reached viable metaphase II (MII) oocytes. The ovarian tissues of 9 (34.6%) women were lacking oocytes at any stage. During polarized light microscopy examination, MS could be visualized only in one of the MII oocytes, but high ZP birefringence’s were observed in the majority of the oocytes post IVM (61.5%). Conclusion: Oocytes maturation post IVM from unstimulated ovaries showed a good developmental competence in gynecologic patients. Further studies should be performed to advance the oocyte maturation program, such as co-culture system, for fertility preservation