Tehran University Medical Journal

Background: The aim of this study was to compare the outcome of treatment for ovarian cancer patients who have been treated by gynecologist oncologists and patients who have been treated by general gynecologists or general surgeons.

Methods: We enrolled in this cohort retrospective study all patients diagnosed with primary ovarian cancer in Vali-e-Asr Hospital, Tehran, Iran, between April 1999 and January 2005. A total 157 consecutive patients with ovarian cancer were available for analysis. Of these, 60 patients were treated by gynecologist oncologists and 95 by general gynecologists, and two patients were treated by general surgeons.

Results: The number of patients who underwent optimal cytoreductive surgery (residual tumor <1 cm) was higher in the gynecologist oncologist group, than in the general gynecologist group (P<0.001). Repeated surgeries were required for a majority of patients in the general gynecologist group, while only a few patients in the gynecologist oncologist group needed a second operation (P<0.0001). The interval between the initial surgery and the beginning of chemotherapy was significantly longer in the gynecologist oncologist group compared to that of the general oncologist group (P=0.001). Overall survival and disease-free survival was considerably greater in the gynecologist oncologist group. Optimal cytoreductive surgery and stage of disease are prognostic factors in patients with ovarian cancer. We can therefore conclude that patients with ovarian cancer who are treated by gynecologist oncologists have a better outcome.

Conclusions: We suggest that patients requiring cytoreductive surgery for ovarian cancer be referred to a gynecologist oncologist rather than having a less specialized physician care for such cases.

Background: Female genital tract sarcomas are rare but most aggressive tumors of mesodermal origin. Little is known about the pathogenesis, risk factors, optimal treatment and outcome of these diseases. Therefore, we aimed to evaluate the clinicopathologic characteristics of patients with genital sarcoma.

Methods: This is a retrospective, cross-sectional study. The medical records of 43 female patients with genital tract sarcoma, hospitalized during a 16-year period (from 1991-2007) were retrieved from the medical records office of Ghaem Hospital in Mashad, Iran. The demographic data extracted from the records.

Results: The mean age of the patients was 46.95 years (ranging from 3-77 years). The chief complaint of the patients was abnormal vaginal bleeding (69.8%). The mean interval between the onset of symptom to the pathological diagnosis of sarcoma was 8.53 months (ranging from 1-36 months). Histologically, the tumors included: leiomyosarcoma (79.1%), endometrial stromal sarcoma (18.6%) and embryonal rhabdomyosarcoma (2.3%). Three patients (7%) were in International Federation of Gynecology and Obstetrics (FIGO) stage I, 20(46.5%) in stage II, 6(14%) in stage III and 14(32.6%) in stage IV. 48.8% of the patients had undergone chemoradiotherapy.

Conclusions: In most cases, our patients were referred so late or the disease was recognized very late due to being rare. We should consider this disease for every patient with unusual vaginal bleeding especially in post menopause women who their sonography has reported uterine mass.

Background: Ovarian sex cord-stromal tumors (SCST) account for rare ovarian malignancy. These tumors are 5-8% of all ovarian neoplasms. The most common type of sex cord ovarian tumors is granulosa cell tumor (GCT). In this study our purpose was to have a look at some of clinicopathologic aspects and treatment results of these tumors. Methods: In a retrospective study, all documents of patients with SCST was referred to tumor clinics of Ghaem and Omid Hospitals, from 1998 to 2008. The data of patients were collected and analyzed. Results: In 39 (5.9) of the 398 cases, ovarian malignancies was present in SCST. Eight Patients omitted from the study because there were not enough data for them. The commonest pathology was adult granulosa cell tumor in 25 patients (80.6%). Two patients (8.33%) had juvenile granulosa cell tumor, they were 25 and 38 years old. At time of diagnosis, 27 cases (87.1%) were in early stages (stage I). Mean age of patients was 41 years (range 16-76 years) at time of diagnosis of disease. Surgical staging of cancer was performed in 14 patients (46.7%). We did fertility sparing surgery in 12 patients (40%). Two patients were pregnant after surgery. 17 patients (54.80%) did not receive chemotherapy. Three patients (9.7%) received radiotherapy. Overall survival rates were 95% at both 2 years and 5 years. Longer survival had correlation with early stages of disease (P= 0.002). Age, conservative surgery and chemotherapy had no correlations with survival. Conclusion: The prognosis of SCST is almost good. Most of the patients were diagnosed in early stage of disease. In sex cord ovarian tumor, the only factor that have a full effect on survival, is stage of the disease. If the patients desire to preserve fertility, we can do fertility sparing surgery with minimal effect on survival.