Aynur Mustafa

An unexpected reason for elevated human chorionic gonadotropin in a young woman. Cervical squamous carcinoma

Human chorionic gonadotropin has been used for decades, in addition to specific investigations, to detect pregnancy, trophoblastic tumors, as well as congenital defects. Rarely, it can be elevated in non-trophoblastic tumors such as squamous cell cancers and germ cell tumors. A 33-year-old Asian Syrian female had irregular menses accompanied with feelings of heaviness in the vagina. In addition to routine investigations, we measured the serum beta human chorionic gonadotropin (ß-HCG) level (based on the patient’s complaint of amenorrhea), which was 50.05 ml UI/ml. Cervical biopsy revealed a non-keratinized large cell squamous carcinoma. After excluding other causes, ß-hCG elevation was explained by the ectopic secretion of cancer cells line. Cervical biopsy was suggestive of large cell non-keratinizing squamous cell carcinoma and positive for human chorionic gonadotropin on immunohistochemistry. As a result, we manage the possibility of ectopic secretion of ß-HCG from non- trophoblastic disease.

Summary of 2185 prenatal invasive procedures in a single center: A retrospective analysis

Objective: To determine the frequency, indications, and outcomes of diagnostic invasive prenatal procedures (DIPP) performed in a university hospital. Materials and Methods: This retrospective, observational study included 2185 cases of DIPP (chorionic villus sampling, amniocentesis, and cordocentesis) performed at the department of obstetrics and gynecology of a university hospital between 2010 and 2016. We included all DIPP cases performed between 11 and 24 weeks of gestation. We compared the different types of DIPP performed in our hospital. Results: Two thousand one hundred eighty-five procedures were performed (1853 amniocenteses, 326 chorionic villus sampling, and 6 cordocenteses). The main indication for performing invasive procedures was abnormal results of aneuploidy screening for trisomy 21, followed by maternal age, and fetal structural abnormality. The fetal karyotype was altered in 154 (26.1%) cases. Trisomy 21 was the most common aneuploidy followed by trisomy 18, monosomy X, and trisomy 13. Fetal karyotype could not be revealed in 42 (2%) cases due to maternal contamination in 18 cases, inadequate sampling in 4 cases, and failure of cell culture in 27 cases. There were 2 pregnancy losses due to the invasive procedure (only in amniocentesis). Conclusion: The ideal approach to pregnancies with a detected chromosomal abnormality should be tailored according to the individual choice of the couples regarding whether they decide for or against a child with a known chromosomal abnormality.

Conjoined twins in a triplet pregnancy. A rare obstetrical dilemma

Conjoined twins are derived from division of a single fertilized ovum after the twelfth day of fertilization. Triplet conjoined twin is considered as a unique phenomenon that is accompanied with a wide variety of congenital abnormalities and also hazardous consequences for both fetuses and parents. We present an extremely rare case of conjoined twins in a triplet pregnancy with symmetric thoracoomphalopagus that was diagnosed in prenatal period by using ultrasound scanning and MRI. In triplet pregnancies, we should be aware about the possibility of conjoined twins. If there are severe congenital malformations, termination of pregnancy should be recommended immediately after the diagnosis regardless of gestational age, particularly in early gestational age.

Chondrosarcoma mimicking an adnexal mass: A very rare case report

Chondrosarcoma is considered as a common primary bone sarcoma. These sarcomas can form large masses without any specific symptoms because there are no barriers in pelvic anatomy to prevent the enlargement of tumors, and can mimic ovarian masses. We present a pelvic chondrosarcoma in a woman aged 37 years who was misdiagnosed as having an ovarian mass due to the limited information obtained from imaging studies. Pelvic chondrosarcoma should be considered in patients who have pelvic masses with solid components. It should be kept in mind that interventions should be performed at centers where there are orthopedic surgeons with experience of this subject.

Is ultrasound-guided suction curettage a reliable option for treatment of cesarean scar pregnancy? A cross-sectional retrospective study

Abstract Purpose: The purpose of our study is to present clinical courses and outcomes of 50 first-trimester cesarean scar pregnancy (CSP) cases, which are managed either with transabdominal ultrasound (TAUS)-guided suction curettage alone or abdominal hysterotomy. Methods: We retrospectively analyzed our records from 2011 to 2016 at a single-center. TAUS-guided suction curettage alone was preferred in hemodynamically stable patients when the myometrial thickness was ≥3 mm and there was no vascular invasion. If the myometrial thickness was <3 mm and/or vascular invasion was present, then hysterotomy was preferred. Results: Statistical analysis of age, gravidity, parity, history of previous CS (≥3 or <3), presence of embryonic cardiac activity, complaints (vaginal bleeding, pelvic pain, or both), preoperative and postoperative hemoglobin levels (g/dl), blood transfusion, initial serum β-hCG levels, and duration to resolution of β-hCG demonstrated no significant difference between TAUS-guided suction curettage and abdominal hysterotomy groups. There was a significant difference between two groups in terms of postoperative length of stay in the hospital and gestational age. Conclusion: TAUS-guided suction curettage in selected cases may be considered as a reliable first-line treatment option due to its low cost, ease of application, lower side-effect profile, and potentially minimal influence on future fertility in CSP patients that are hemodynamically stable.

Early vulvar and umbilical incisional scar recurrence of cervical squamous cell carcinoma: Earlier than usually expected

Cutaneous metastasis is considered as a hazardous condition depending on the mean survival around 9 months, which usually originates from cancers of the breast, lung, ovary, colon, and rarely from the cervix. The crucial prognostic factor of cutaneous metastasis depends on the period between the primary malignancy and cutaneous metastasis. We report two cases of the unusual presentation of squamous cell cancer of the cervix that developed vulvar and umbilical metastasis in the 5th month of primary treatment. Both of our patients survived for 11 months following the primary treatment. In addition, our first case is the earliest vulvar recurrence of cervical carcinoma in the English literature following appropriate medical and surgical management.

Fetal kidney length as a useful adjunct parameter for better determination of gestational age

Objectives: To determine the validity of fetal kidney length and amniotic fluid index (AFI) in labor dating. Methods: This prospective study included 180 pregnant women followed up in the outpatient clinic at the Department of Obstetrics and Gynecology, Gaziantep University, Turkey, between January 2014 and January 2015. The gestational age (GA) was estimated by early fetal ultrasound measures and last menstrual period. Routine fetal biometric parameters, fetal kidney length, and amniotic fluid index were measured. We studied the correlation between fetal kidney length, amniotic fluid index, and gestational age. Result: The mean gestational age depending on last menstrual period and early ultrasound was 31.98±4.29 (24-39 weeks). The mean kidney length was 35.66±6.61 (19-49 mm). There was a significant correlation between gestational age and fetal kidney length (r=0.947, p=0.001). However, there was a moderate negative correlation between GA and AFI. Adding fetal kidney length to the routine biometrics improved the effectiveness of the model used to estimate GA (R2=0.965 to R2=0.987). Conclusion: Gestational age can be better predicted by adding fetal kidney length to other routine parameters.