Anil Onan

The role of frozen section evaluation in the diagnosis of adnexal mass

The purpose of this study was to evaluate the accuracy of frozen section diagnosis in patients who were subjected to the exploratory laparotomy for pelvic mass. Overall, 207 patients were included in this study and the mean age of the patients was 50.9 ± 14.9 years (range, 18–84 years). Of these patients, 98 (47%) had benign, 16 (8%) had borderline, and 93 (45%) had malignant histologies at permanent section. The diagnosis at frozen section was deferred for three patients (1.4%) and these patients were excluded from the further analyses. The overall discordance rate was 5.3%. To calculate the sensitivity and specificity values, 2 × 2 contingency tables were constructed in two ways. In the first calculation, borderline histology was considered malignant, and the sensitivity and specificity rates were 97% and 92%, respectively. In the second analysis, it was accepted as benign, and these values were 100% and 98%, respectively. To determine the possible factors related with discordant diagnoses, age, menopausal status, tumoral size, laterality of tumors, and histologic diagnoses were analyzed. Significant association was noted for size and borderline and mucinous histologies. In patients with borderline histology, the discordance rate was 40%. This value for the remaining patients was 3.2% (P< 0.001). The rate of misdiagnosis was 17.4% for mucinous tumors, whereas it was 4.8% for the remaining epithelial tumors (P= 0.03). Frozen section evaluation revealed high sensitivity and specificity values in this study. To increase the accuracy of diagnosis, further diagnostic markers are needed especially for patients with large lesions, borderline tumors, and mucinous histologies.

HPV Types in Turkey: Multicenter Hospital Based Evaluation of 6388 Patients in Turkish Gynecologic Oncology Group Centers Türkiye'deki HPV Tipleri: Türk Jinekolojik Onkoloji Grubuna Üye Merkezlere Başvuran 6388 Hastanin Retrospektif Analizi

Abstract Objective: To evaluate the prevalence of HPV DNA and cervical cytological abnormalities, to compare cervical cytology results and HPV DNA and to define HPV types distribution in a large series of Turkish women who have undergone HPV analysis in hospitals that are members of the Turkish Gynecological Oncology Group. Material and Method: Between 2006 and 2010, a total of 6388 patients’ data was retrospectively evaluated at 12 healthcare centers in Turkey. Demographic characteristics, cervical cytology results, HPV status and types were compared. Results: The mean age of the patients was 38.9±10.2. Overall, 25% of the women were found to be HPV positive. Presence of HPV-DNA among patients with abnormal and normal cytology was 52% and 27%, respectively. There was significant difference with respect to decades of life and HPV positivity (p < 0.05). HPV was positive in (within the HPV (+) patients) 37%, 9%, 27%, 20%, 22%, and 41% of the ASCUS, ASC-H, LSIL HSIL, glandular cell abnormalities, and SCC cases respectively The most common HPV types in our study were as follows; HPV 16 (32%), HPV 6 (17%), HPV 11 (9%), HPV 18 (8%), HPV 31 (6%), HPV 51 (5%), HPV 33 (3%). Conclusion: In this hospital based retrospective analysis, HPV genotypes in Turkish women with normal and abnormal cytology are similar to those reported from western countries. Further population based prospective multicenter studies are necessary to determine non-hospital based HPV prevalence in Turkish women Öz Amaç: Türkiyedeki HPV tiplerinin geniş bir seri ile ortaya konması amacı ile Türk Jinekolojik Onkoloji grubuna üye hastanelerde HPV analizi yapılan hastaların sonuçlarının retrospektif olarak değerlendirilmesi ve sitolojik anormalliklerdeki HPV tiplerinin belirlenmesi. Gereç ve Yöntem: 2006 ve 2010 yılları arasında 12 ayrı merkeze başvuran smear ve HPV analizi yapılan toplam 6388 hasta retrospektif olarak incelenmiştir. Hastaların demografik bilgileri, smear sonuçları, HPV tipleri online olarak toplanıp analiz edilmiştir. Bulgular:Ortalama hasta yaşı 38.9±10.2 idi. Tüm grup değerlendirildiğinde, %25 hastada HPV pozitif olarak saptandı. Anormal sitolojisi olanlarda HPV pozitifliği %57 iken normal pap testi olanlarda HPV pozitifliği %27 oranında tespit edildi. Hastaların yaşam dekadları ile HPV pozitifliği arasında anlamlı bir ilişki bulundu (p<0,05) HPV pozitifliği ASCUS, ASC-H, LSIL, HSIL, glandüler anormallikler ve skuamöz hücreli karsinom için sırasıyla %37, %9, %27, %20, %22, %41 idi. En sık görülen HPV tipleri sırasıyla HPV 16 (%32), HPV 6 (%17), HPV 11 (%9), HPV 18 (%8), HPV 31 (%6), HPV 51 (%5), HPV 33 (%3) idi. Sonuç:Bu hastane temelli retrospektif analizde HPV tipleri gelişmiş batı ülkelerinde rapor edilen tiplerle benzer olarak tespit edildi. Ülkemizdeki gerçek popülasyon temelli HPV prevalansı ve tiplerinin belirlenmesi için hastane temelli olmayan çok merkezli geniş sayıda hasta içeren serilere ihtiyaç vardır

Urogenital symptoms of postmenopausal women in Turkey.

Objective: The objective of this study was to collect data on the prevalence and risk factors of urogenital symptoms in postmenopausal women in Turkey. Design: The study was performed with the participation of 510 postmenopausal women who presented to previously defined clinics for reasons other than urogenital complaints. Women completed a questionnaire including questions about their demographic properties and their urogenital symptoms. Data were analyzed by SPSS 10.0. The chi-square test was the statistical test of choice. Results: The mean age of participants was 58.64 ± 8.14 years. The mean age of menopause was 47.21 ± 4.36 years. Urinary frequency was found to be the most common postmenopausal urogenital symptom (16.5%), followed by stress incontinence (10.4%), dyspareunia (10%), and vaginal dryness (9.6%). Risk factors investigated were found not to affect the prevalence of the vaginal symptoms in postmenopausal women. Dysuria was found to be more common in women with diabetes mellitus (P = 0.022) and in women who had given birth to more children (P = 0.018). Stress incontinence was more common in those 60 years of age or older (P = 0.03), in those who had been in the postmenopausal period for more than 20 years (P = 0.01), and in those who had more than three pregnancies (P = 0.047) or who had given birth to more than three children (P = 0.011). Diabetes mellitus (P = 0.001) and use of hormone therapy (P = 0.001) significantly increased the prevalence of urinary frequency. Conclusions: Urogenital symptoms observed in our population were found to be fewer than reported previously. Symptoms that appear in the postmenopausal period may be related to several factors such as age, number of births, time elapsed since menopause, presence of diabetes mellitus, and use of hormone therapy, but this topic requires further study.

Distribution of contraceptive use in a Turkish population

OBJECTIVE This study is designed to estimate the distribution of contraceptive use among reproductive age women in a Turkish population (Turkey). STUDY DESIGN We included 2365 women of reproductive age in this study. Women were given a questionnaire via a face-to-face interview. RESULTS During the time period just after marriage, 1914 women (80.9%) declared that they did not use any type of contraception. Among 451 women who had used a contraceptive method just after marriage, the most commonly used method was condoms (34.2%), followed by oral contraceptives (31.2%) and coitus interruptus (25.9%). When their history of contraceptive use was asked, 1903 women (80.2%) stated that they used a method of contraception while 462 women (19.5%) had never used any type of contraceptive. Distribution of contraceptive methods among women was analyzed and intrauterine devices were detected to be the most commonly used method (n=1046, 55%). CONCLUSION A point that should be emphasized is that there is a marked increase in contraceptive prevalence, and expansion of family planning activities in Turkey. This change, we believe, is due to improvements in health services of Turkey, realized in recent years.

Recurrent mucinous cystadenoma: a laparoscopic approach

The second most common epithelial tumor of the ovary is mucinous-type, and it constitutes 8–10% of all ovarian tumors. The recurrence of mucinous cystadenoma is very rare after complete excision. Only four such cases have been reported till date. The case presented in this report is the fifth, who had her initial surgery performed by gynecologic oncology team by laparotomy and was followed up by the same group. After recurrence at the same ovary, the patient underwent laparoscopic evaluation and unilateral salpingoophorectomy was performed. The final histopathological diagnosis was mucinous cystadenoma, just the same as the initial cyst.

Prevalence of human papillomavirus (HPV) and HPV-16 genotyping by real-time PCR in patients with several cervical pathologies

PURPOSE this study was planned to evaluate the prevalence of HPV (excepting type 16) and HPV 16 by real-time PCR in colposcopy patients and to interprete the results with age, age of first sexual intercourse (FSI), parity and Pap smear results. METHODS one hundred and two colposcopy patients (50 and 52 of the patients were classified as colposcopy positive and negative, respectively) applying to Gynecology clinic were included. HPV (excepting type 16) and HPV 16 were detected by realtime PCR using the L1 region. Real-time nested amplifications of MY09/11 products were done by GP5+/GP6+ primers and Cyanine-5 labeled HPV and HPV 16 DNA specific probe after HPV DNA extraction by phenol chloroform isoamylalcohol. RESULTS HPV (excepting type 16) and HPV 16 were positive in 12% and 18% of the colposcopy positive patients respectively. HPV (excepting type 16) and HPV 16 were positive in 5.7% and 3.8% of the colposcopy negative patients, respectively. CONCLUSION there was a statistically significant difference between colposcopy positive and colposcopy negative patients comparing HPV 16 with total HPV positivity (p = 0.021 for type 16 and p = 0.010 for total HPV) but there was not a statistically significant difference between colposcopy positive and colposcopy negative patients when we compared HPV (excepting type 16) positivity (p = 0.314). In conclusion, HPV detection and typing may be helpful for cervical cancer screening and prevention.

Lipid peroxidation in nuchal cord cases: implication for fetal distress

Objective. To examine whether nuchal cord affects fetal lipid peroxidation and cord arterial blood gases, and thus to determine whether lipid peroxidation can show intrapartum distress. Methods. Pregnant women giving birth to a baby with nuchal cord (n = 32) formed the study group and others without this condition made up the control group (n = 36). The maternal malondialdehyde levels (MDA) before and after delivery as well as fetal umbilical cord MDA and arterial blood gases were measured in both the groups. Results. Mean cord MDA level was higher in the study group (p < 0.02) and was significantly higher than maternal MDA level after birth within the same group (p = 0.007). Cord blood gases as well as neonatal and labour characteristics showed no difference, except for variable decelerations, which were 2.2 times more common in the study group. Correlations between maternal MDA levels before and after delivery, umbilical cord MDA and arterial blood gases were non-significant in the nuchal cord group. Conclusions. During delivery, nuchal cord increases lipid peroxidation without causing significant fetal acidemia. Level of lipid peroxidation may be a more sensitive indicator of intrapartum distress than results of acid–base studies.

Carcinoma of the fallopian tube presenting as an axillary palpable mass.

Figure 1. Haematoxylin and eosin (H & E) staining showing marked cytological atypia (a, b) and strong nuclear staining for epithelial membrane antigen (EMA) (c); CA125 (d); Wilms tumour-1 gene (WT-1) (e); and oestrogen receptor (ER) (f), indicated metastatic serous cancer in sections from the axillary lymph node. Revol M , Servant J-M , Banzet P . 2006 . Surgical treatment of male-to-female transsexuals: a ten-year experience assessment . Annales de Chirurgie Plastique et Esthetique 51 : 499 – 511 . Selvaggi G , Ceulemans P , De Cuypere G et al . 2005 . Gender identity disorder: general overview and surgical treatment for vaginoplasty in male-to-female transsexuals . Plastic and Reconstructive Surgery 116 : 135e – 145e . Unger CA . 2013 . Care of the transgender patient: the role of the gynecologist . American Journal of Obstetrics and Gynecology 210 : 16 – 26 .