Ahmet Özfuttu

Routine histopathologic analysis of product of conception following first-trimester spontaneous miscarriages

Aim: To evaluate the histopathologic findings relating to tissue samples collected at surgical uterine evacuation in first‐trimester spontaneous miscarriages.

Comparison of advanced stage mucinous epithelial ovarian cancer and serous epithelial ovarian cancer with regard to chemosensitivity and survival outcome: a matched case-control study

Objective The aim of this study was to compare clinicopathologic characteristics, surgery outcomes and survival outcomes of patients with stage III and IV mucinous epithelial ovarian cancer (mEOC) and serous epithelial ovarian carcinoma (sEOC). Methods Patients who had surgery for advanced stage (III or IV) mEOC were evaluated retrospectively and defined as the study group. Women with sEOC who were matched for age and stage of disease were randomly chosen from the database and defined as the control group. The baseline disease characteristics of patients and platinum-based chemotherapy efficacy (response rate, progression-free survival and overall survival [OS]) were compared. Results A total of 138 women were included in the study: 50 women in the mEOC group and 88 in the sEOC group. Patients in the mEOC group had significantly less grade 3 tumors and CA-125 levels and higher rate of para-aortic and pelvic lymph node metastasis. Patients in the mEOC group had significantly less platinum sensitive disease (57.9% vs. 70.8%; p=0.03) and had significantly poorer OS outcome when compared to the sEOC group (p=0.001). The risk of death for mEOC patients was significantly higher than for sEOC patients (hazard ratio, 2.14; 95% confidence interval, 1.34 to 3.42). Conclusion Advanced stage mEOC patients have more platinum resistance disease and poorer survival outcome when compared to advanced stage sEOC. Therefore, novel chemotherapy strategies are warranted to improve survival outcome in patients with mEOC.

Krukenberg tumor mimicking pregnancy luteoma

Background. Pregnancy-associated Krukenberg tumor is very rare, and the diagnosis in pregnancy is even more difficult. Usually symptoms are attributed to pregnancy luteomas, which are hormone-active benign neoplasms. Case. A 22-year-old female presented at the 28th week of gestation with rapid onset of hirsutism and acne since the 20th week of gestation. Physical and ultrasonographic examinations revealed bilateral ovarian solid masses which were considered as pregnancy luteomas. The patient underwent exploratory laparotomy due to the onset of ascites and elevated tumor markers four months after delivery. Histopathologic examination revealed adenocarcinoma with signet-ring-type cells. Conclusion. Krukenberg tumors should be considered in the differential diagnosis of pregnancy luteomas. Otherwise, early diagnosis of the tumor can be delayed.

An old patient with growing teratoma syndrome of the ovary

Abstract Growing teratoma syndrome (GTS) is a rare complication of malignant ovarian germ cell tumors. A 52-year old woman was admitted to our Gynecological Oncology Department with metastatic multiple abdominal masses. Her initial gynecological history presented an immature teratoma of the ovary 3 years previously, and she underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic-paraaortic lymphadenectomy and omentectomy. She received three cycles of bleomycin, etoposide and cisplatin (BEP) regimen after surgery. Although the tumor markers were within normal limits, multiple metastatic lesions were detected in the 3rd month of follow-up. The patient was referred to our gynecological oncology department, optimal debulking including resection of the tumoral lesions localized on the liver, diaphragm, peritoneum, sigmoid colon, omentum and retroperitoneum was performed. Histopathology of all samples revealed mature teratoma. This syndrome should be remembered when a tumor is refractory to chemotherapy and growth of the tumor still continues after resection of the initial tumor.

Analysis of non-squamous vulvar cancer cases: A 21-year experience in a single center

Objective: To evaluate the patients with non-squamous cell type of vulvar cancer who were treated in our clinic within 21 years. Materials and Methods: We assessed the data of 14 patients who were treated for non-squamous cancer of the vulva between January 1992 and August 2013. The age of patients, histopathological diagnosis of the tumor, tumor size, tumor location, medical or surgical treatment, response to the treatment, recurrence, and survival rates were analyzed. Results: The mean age of the patients was 53 years. The main complaint was vulvar pruritus (71%). Mean tumor size was 2.4 cm (range: 0.5-6 cm). In 65% of cases, the tumor was localized in the labia majora. The histopathologic diagnosis of the patients was as follows: malignant melanoma in 5 patients, basal cell carcinoma in 5 patients, mucinous type adenocarcinoma in 2 patients, apocrine gland carcinoma in one patients, and malign peripheral nerve sheath tumor in 1 patient. For 11 patients, surgery was the primary treatment. Radical vulvectomy and bilateral inguinofemoral lymphadenectomy were performed in 8 patients. Local excision alone without lymphadenectomy was performed in other 3 patients. Five of eight patients (62.5%), who undergone radical surgery, had lymph node metastases. Of these 5 patients, two had bilateral lymph node metastasis. Mean follow-up time was 49.2 months (range 12 to 72 months). Eight (57.1%) patients had suffered first recurrence. In those patients, the mean time to recurrence was 19.5 months (range, 6-48 months). Conclusion: Non-squamous cell vulvar cancer is a rare disease and comprises a heterogeneous group of tumors. Malignant melanoma is the most aggressive one. Multicenter prospective studies are necessary in order to standardize the treatment of these rare tumors.

The effect of cell type on surgico-pathologic risk factors in endometrial cancer.

OBJECTIVE In this study the effect of histologic subtype as a surgicopathologic risk factor in endometrial cancer is evaluated. MATERIAL AND METHODS We evaluated 182 patients who underwent systematic lymphadenectomy up to the level of the renal vessels and at least 15 lymph nodes were dissected from the pelvic area and 10 lymph nodes from the para-aortic area. investigation of whether endometrioid and aggressive cell types (serous papillary cell and clear cell) affect the distribution of surgicopathologic risk factors among endometrial cancer cases was carried out. RESULTS Patients in the aggressive cell type group were older and the tumor size was significantly smaller. There was no difference between the two groups for the total number of dissected lymph nodes except for the external iliac area. Although the difference is not statistically significant, the total number of lymph nodes dissected in the aggressive group was less (54.3 vs 62.9, p=0.067) than that of the endometrioid cell type group. While the incidence of pelvic lymph node metastasis in the aggressive group was 59.1% the incidence was 15.6% in the endometrioid cell type group (p>0.001). The possibility of lymph node metastasis for aggressive cell type endometrial carcinoma in the para-aortic area was twice the endometrioid cell type group. It was found that the presence and type (stromal/glandular) of cervical invasion, depth of myometrial invasion and presence of lymphovascular space invasion were not affected by cell type. CONCLUSION Aggressive cell types significantly increase the adnexial and lymph node metastasis in endometrial cancer.