Cagdas Turkyilmaz

Prevention of paclitaxel and cisplatin induced ovarian damage in rats by a gonadotropin-releasing hormone agonist.

OBJECTIVE To evaluate the protective effect of GnRH agonist for the prevention of ovarian reserve during treatment with paclitaxel and cisplatin. DESIGN Experimental study. SETTINGS University-based research laboratory. ANIMAL(S) Seventy female Wistar-Albino rats. INTERVENTION(S) Each group consisted of 10 rats. Group 1 served as controls. Groups without GnRH agonist (groups 2, 3, and 4) were administered paclitaxel and cisplatin, respectively; the remaining groups (groups 5, 6, and 7) were given the same regimens with GnRH agonist. The GnRH agonist (leuprolide acetate; 2.5 microg/d subcutaneously for 5 weeks) was started four weeks before chemotherapy to achieve anovulation. Paclitaxel (7.5 mg/kg) and cisplatin (5 mg/kg) were administered intraperitoneally on the 28th day as a single dose. MAIN OUTCOME MEASURE(S) One week after the chemotherapy, the animals were euthanized and primordial, primary, secondary, and tertiary follicle counts were evaluated. RESULT(S) Primordial, primary, and tertiary follicle counts in group 5 (paclitaxel plus GnRH agonist) and tertiary follicles in groups 2 and 3 had not decreased, but there was a significant decrease in other treatment groups compared with controls (P < 0.05). Binary comparison between all groups demonstrated that the primordial follicle count in group 5 was comparable to those of the controls. CONCLUSION(S) Paclitaxel plus GnRH agonist treatment may be an appropriate option for patients deserving further fertility in the preservation of primordial follicles.

Prenatal sonographic findings in a fetus with splenogonadal fusion limb defect syndrome

Splenogonadal fusion limb defect syndrome (SGFLD) is a very rare abnormality. We report on a case with prenatal sonographic findings of a fetus with postnatally diagnosed SGFLD syndrome. This is also the second case of prenatal ultrasonographic diagnosis of gastrointestinal malrotation associated with SGFLD. A 26‐year‐old primigravid woman was referred to our clinic because of nonvisualization of both fetal femoral bones at 20 weeks of gestation. A detailed sonographic examination showed complete bilateral absence of lower limbs, micrognathia, single umbilical artery and a right‐sided stomach. Autopsy confirmed prenatal sonographic findings and additionally showed that the spleen was abnormally connected to the left gonad by a fibrous band. In conclusion, although all limbs and both sides were equally affected in most of the reported cases, SGFLD syndrome should be considered in cases with terminal limb defects of lower limbs.

Selective ovarian vein sampling can be crucial to localize a Leydig cell tumor: An unusual case in a postmenopausal woman

Leydig cell tumors of the ovary are very rare, frequently associated with symptoms of virilization in postmenopausal patients. It is sometimes difficult to localize the tumor precisely even with modern imaging techniques. A 62-year-old patient presented with recent onset of rapidly progressive virilization including increased hirsutism, progressive balding, deepening voice and enlargement of the clitoris. Initial laboratory examination revealed a total serum testosterone level of 1330 ng/dL. Serum dehydroepiandrosterone sulfate, androstenedione and 17 hydroxyprogesterone levels were all within normal limits. Extensive pre-operative evaluations included transvaginal ultrasound, abdominal computed tomography and magnetic resonance imaging failed to localize the tumor. Therefore, selective ovarian venous hormonal sampling (SOVHS) was performed and they revealed that the total serum testosterone level was significantly higher in the left than in the right ovarian vein (7000 ng/dL vs. 225 ng/dL). A total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed. Microscopic examination of the left ovary revealed a Leydig cell tumor. In conclusion, when the precise location of the tumor is not determined pre-operatively, SOVHS may be valuable to make accurate diagnosis.

P33.19: Prenatal diagnosis of Klippel–Trenaunay–Weber syndrome

VATER association was firsts described as a combination of three or more of these defects: vertebral defects (V), anal atresia (A), esophageal atresia and/or tracheo-esophageal fistula (TE), and radial and renal anomalies (R standing for both of them). No specific cause has been identified and causal heterogeneity seems to be most acceptable conclusion. By the other hand, placental chorioangioma is a benign vascular tumor found in about 1% of pregnancies at routine histological examination of the placenta. Tumors that are large enough to produce clinical symptoms and that can be visualized on sonography are uncommon. Potential fetal complications include polyhydramnios, fetal hydrops, fetal growth restriction and fetal demise. No association has been described between chorioangioma and VATER association. Patient, 20 years old, followed in Fetal Medicine Service of UNIFESP/EPM, due to fetal malformation. The following findings were observed in ultrasound, using Sonoace 80 000 LIVE (Medison, Seoul, Korea): large intestine dilatation, horseshoe kidney, genital anomaly and ventricular septal defect. The fetal Magnetic Resonance confirmed these findings. No placental neoplasms were diagnosed on sonography or fetal Magnetic Resonance. During gestation also occurred oligoamnio and fetal growing restriction. Patient went to vaginal delivery by 37 weeks of gestation, newborn 2.260 g of weight, clinically with atresia anal and genital anomalies (micropenis and hypospadia). Colostomy was realized with 24 hours of life. After exams, horseshoe kidney, lombar hemivertebra L3, ventricular septal defect, pulmonary stenosis, patent foramen ovale were described. Kariotype 46 XY. At 39th day of life, infant developed intestinal volvulus and infection. At 59th day of life, infant died due to septic shock. Necropsy confirmed all alterations described. Histologic examination of placenta has found the presence of chorioangioma.