Leiomyosarcoma with Unusual Macroscopic Features: A Case Report

Uterine sarcoma is a rare tumor of mesodermal origin, accounting for 2-6% of uterine malignancies. Leiomyosarcoma (LMS) has been reported in only 1% of all uterine malignancies and is regarded as the most common primary uterine sarcoma. Herein, we present a case of LMS with unusual macroscopic features. The patient was a 61-year-old woman with LMS, which consisted of a large cystic mass (88×136 mm), containing six liters of brownish fluid on the right side of the pelvis and abdomen. The fundus of the uterus was ruptured by the solid part of the tumor. For treatment, total hysterectomy, salpingo-oophorectomy and the optimal resection of tumoral parts were carried out. Overall, the distinctive biological behavior and poor overall survival of uterine sarcoma challenge the post-operative management of this tumor. According to the one-year follow-up, the patient was disease-free. Unfortunately, no further information is at hand beyond this period

Prognostic Value of KI6 Biomarker in Predict Short Time Prognosis of Low Grade Cervical Intraepithelial Neoplasia in HPV Negative and Positive Patients

Screening of cervical cancer is the most common gynecologic cancer in developing countries. Despite being preventable, but we have still some problems with the screening of this cancer. Recently, many studies have been done on immunohistochemistry to improve screening of cervical intraepithelial neoplasia (CIN) as a precancerous lesion. But, the majority of the studies are based on cytological samples. The objective of this study was to analyze the correlation KI-67 biomarker and HPV infection in predict short time prognosis in CIN as an alternative or auxiliary method to the current screening method in a different geographic population. This descriptive cohort prospective study included 40 patients with a diagnosis of CIN based on cervical punch biopsy samples after colposcopy examination. They were referred to the department of gynecology and oncology of an academic hospital, Mashhad University of   2016 to 2017. All samples were investigated for HR- HPV DNA with Cobas test and immunostaining for KI-67 biomarker. Finally, after one year follows up, the prognosis for all patients was evaluated. Data were analyzed by SPSS software program version 23.0 and Mann-Whitney U test and Fisher's exact test. P<0.05 was considered significant. Significant difference was found between HR-HPV positive and negative tests in KI-67 expression (P<0.001), but no significant difference was observed in reactivity level (P=0.5), also no significant difference was found in KI-67 expression in the metaplastic and non-metaplastic epithelium (P=0.88). KI-67 biomarker is recommended as complementary screening tests not alternative for differentiating in high risks patients with CIN1. The patients with low KI-67 / HR-HPV positive test could be offered for a less aggressive follow-up protocol

Prognostic Value of KI6 Biomarker to Predict Short Term Prognosis of Low Grade Cervical Intraepithelial Neoplasia in Human Papilloma Virus Negative and Positive Patients

Background: Cervical cancer is the most common gynecologic cancer in developing countries. Although this malignancy is preventable, problems exist with screening this cancer. Numerous studies have researched immunohistochemistry methods, such as the KI-67 biomarker as a proliferation marker, to improve screening for cervical intraepithelial neoplasia as the precancerous phase of cervical cancer. These studies mostly screened cytological samples. In the current study, we sought to analyze the correlation between the KI-67 proliferative biomarker and HPV infection in order to predict short-time prognosis in cervical intraepithelial neoplasia as an alternative or ancillary method to current screening methods. Our assessment was based on histologic samples from a different geographic population. Methods: This descriptive cohort prospective study included 40 patients diagnosed with low grade cervical intraepithelial neoplasia based on cervical punch biopsy samples after colposcopy examination. We enrolled patients who referred to the Department of Gynecology- Oncology of an academic hospital of Mashhad University of Medical Sciences from 2016 to 2017. All low grade cervical intraepithelial neoplasia samples were investigated for HR-HPV DNA with the Cobas test and immunostaining for the KI-67 biomarker. After a one-year follow-up, we evaluated the prognosis for all patients based on liquid based cytology and HRHPV test. Data were analyzed by SPSS version 23.0 and the Mann-Whitney U and Fisher's exact tests. A P-value < 0.05 was considered significant. Results:We observed a significant difference between HR-HPV positive and negative tests in KI-67 expression (P<0.001), but there were no significant differences in reactivity level of cervical epithelium (P=0.5) and in KI-67 expressions in metaplastic and non-metaplastic epithelium (P=0.88). After one year, most low grade cervical intraepithelial neoplasia cases in group A that had a low staining KI-67 biomarker had evidence of regression. On the contrary, all cases with high grade KI-67 expression didn’t persist or progressed necessarily. Conclusion: The KI-67 biomarker is recommended as a complementary screening test, but not an alternative for triage of high-risk patients with low grade cervical intraepithelial neoplasia. Patients with low grade cervical intraepithelial neoplasia/HR-HPV positive cervical samples and low staining KI-67 antigen could be offered a less aggressive follow-up protocol

Steroidal Hormone Receptor Expression in Male Breast Cancer

Introduction: The etiology of male breast cancer is unclear, but hormonal levels may play a role in development of this disease. It seems that the risk of male breast cancer related to increased lifelong exposure to estrogen or reduced androgen. The aim of this study was to investigate the expression of the steroid hormone receptors including estrogen receptor (ER) and progesterone receptor (PR) in Iranian cases with male breast cancer. Methods: This is a prospective review of 18 cases of male breast cancer in in Omid Hospital, Mashhad, North East of Iran, between October 2001 and October 2006. ER and PR were measured by immunohistochemistry. Clinicopathologic features and family history were obtained by interview. Data were analyzed with SPSS 13 using descriptive statistics.  Results: The median age was 63.2 year. All the cases were infiltrating ductal carcinoma. A high rate of expression of ER (88.8%) and PR (66.6%) was found in the studied cases. Conclusion: Cancers of the male breast are significantly more likely than cancers of the female breast to express hormonal receptors

Gestational throphoblastic diseases in North East of Iran: 10 years (2001-2010) prospective epidemiological and clinicopathological study

Background: Many aspects of epidemiological and clinicopathological features of gestational trophoblastic disease (GTD), one of the important subject in gynecology oncology, needs to be defined so as to recommend the best approach and management toward it. In the present study, we evaluated 10-years incidence of throphoblastic diseases in north east of Iran in prospective epidemiological and clinicopathological study. Materials and Methods:We reviewed the registered histopathology database archive (120 records) related to throphoblastic diseases of the Ghaem Hospital, Mashhad University of Medical Sciences from 2001 to 2010. Results:Evaluation of the pathological reports revealed 5 (4.2%) choriocarcinom and 115 (95.8%) of hydatidiform mole (HM), with complete and partial HM diagnosis in 29 (25.2%) and 86 (74.8%) patients, respectively. The pregnancy rate of HM patients (2.72 ± 1.86) and choriocarcinoma patients (3.56 ± 2.8) was not significantly different ( P = 0.61). There was no statistical significant difference between the number of pregnancies in HM (2.90 ± 3.13) and choriocarcinoma (3.84 ± 3.80) patients ( P = 0.46). The ratio of complete to partial mole increased with age, although this correlation was not significant. Most patients in both the groups had no history of abortion. O positive was the predominant blood group among the studied patients. Conclusion:Throphoblastic diseases occur during the fertility age mostly, and there is an increased risk with more previous pregnancies; ultrasound sonography is a useful method for primary diagnosis of this disease. Further pathological studies are needed to define the mole type

Primary Small Cell Carcinoma of the Esophagus (PSCEC) Associated with Paraneoplastic Sweating Syndrome: A Case Report and Literature Review

Introduction: Primary small cell carcinoma of theesophagus (PSCEC) associated with paraneoplastic sweating syndrome is a rare disease characterized with rapid growth rate, metastasis at the time of diagnosis, and poor prognosis. The lung is the most common site for small cell carcinoma but this malignancy includes 0.1% to 1% of all gastrointestinal and 0.8% to 2.7% of esophageal malignancies. So far more than 200 cases of PSCEC have been reported in literature.   Case Report: The patient is a 54-year-old female from the Golestan province who presented with dysphagia, 19 kg-weight loss (from 105 kgs to 86 kgs), and excessive sweating. She was admitted in the thoracic surgery ward, at Ghaem Hospital, in the Mashhad University of Medical Sciences, with a pathological diagnosis of small cell carcinoma. She underwent transhiatal total esophagectomy. Excessive sweating was eradicated after surgery and she was discharged after 13 days without any complication. She received chemotherapy and at her 5-year follow up, she showed no recurrence or metastasis.   Conclusion: PSCEC usually requires chemotherapy with or without surgery. A favorable outcome, with total resection of the lesion combined with chemotherapy, was obtained. However, due to the rarity of the disease there is no definitive choice of treatment