Recently the concept of delayed diagnosis has become as an important issue in the cancer prevention and

To report a case of FIGO stage III papillary serous carcinoma of ovary, diagnosed during pregnancy at 20 weeks of gestation and treated with unilateral salpingo-oophorectomy and surgical staging, then initial combination chemotherapy while preserving the pregnancy. The patient underwent cesarean section at 35 weeks after four courses of taxol plus carboplatin. She delivered a healthy baby. After that total hysterectomy, omentectomy, pelvic and para-aortic lymphadenectomies were carried out. The surgical resection was complete and no macroscopic residual diseases were seen. During histologic examination, traces of resistant disease were found. The patient underwent three postoperative courses of chemotherapy (carboplatin plus paclitaxel regimen). After 6 months follow-up, the patient remained in complete remission and the child's development was normal. Combination chemotherapy during pregnancy with preservation of the fetus could be considered, and should be discussed with caution in case of epithelial ovarian cancer diagnosed during the second trimester of the pregnancy.

As far as transection and damage of obturator nerve cause thigh claudication, paresthesia and cosmetic problems due to atrophy of related group of muscles, we recommend precise anastomosis of this nerve and grafting whenever achieving a tension-free anastomosis is not possible.

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Background: This study was designed to evaluate the comparison of insertion of levonorgestrel (LNG)-releasing intrauterine system versus oral medroxyprogesterone acetate on endometrial hyperplasia in a randomized controlled trial. Materials and Methods: A total of 60 women with the initial histopathological diagnosis of endometrial hyperplasia in two groups received LNG or medroxyprogesterone (10 mg/d orally) for 12 days a month for 3 months). Endometrial biopsy was obtained for all patients after 3 months of treatment. Response to treatment was defined based on the histopathology of the post treatment pipelle endometrial specimens in three categories of resolution, persistence and progression. Results: Treatment response rate in patients in the LNG group was 89.3% (25 of 28 patients), versus 70.4% (19 of 27 patients) in patients in the medroxyprogesterone group. The rate of persistence was 10.7% (3 of 28 patients) and 22.2% (6 of 27 patients) in LNG and medroxyprogesterone groups respectively. No progression of endometrial hyperplasia observed in any of the patients in LNG group, but progression of endometrial hyperplasia was observed in 7.4% (2 of 27 patients) in the medroxyprogesterone group. There was no statistically significant difference between groups regarding the response to treatment ( P = 0.15). Side effects such as bloating, weight gain, fatigue and hair loss were comparable between the groups ( P > 0.05). Hirsutism was significantly more in the medroxyprogesterone group than LNG group ( P = 0.013). Conclusion: Results showed that the use of LNG for treating endometrial hyperplasia for 3 months was associated with high-treatment response rate and the low proportion of patients with progression compared to the use of medroxyprogesterone.