Derin Kösebay

Prevalence of endometriosis in malignant epithelial ovary tumours

Abstract Objective : To determine the prevalence of ovarian endometriosis in malignant epithelial ovarian tumours. Study design : A retrospective analysis of 160 malignant and 23 borderline ovarian tumours during the period 1995–2001. Results : Fourteen (7.7%) of the tumours contained endometriosis. This affected 22% of the endometrioid and 10.8% of the mixed adenocarcinomas. The mean age of the ovarian endometriosis patients was 43±13 range 26–70 years. The incidence in borderline tumours 13% (3/23) was higher than that in ovarian cancer 6.9% (11/160) ( P >0.05). Eight (57%) of cases were classified as atypical and six (43%) as typical endometriosis. Nine cases were FIGO (International Federation of Gynaecology and Obstetrics) stage I and 5 stage III. Conclusions : Both malignant and borderline ovarian tumours are associated with ovarian endometriosis. In addition, atypical endometriosis was found associated with endometrioid and mixed epithelial ovarian tumours.

Ultrasonographic appearance of endometrium in postmenopausal breast cancer patients receiving tamoxifen.

OBJECTIVES To assess the ultrasonographic appearance and associated pathological changes of the endometrium in postmenopausal breast cancer patients with tamoxifen therapy. STUDY DESIGN Forty-eight postmenopausal breast cancer patients receiving 20 mg/day tamoxifen for 6-84 months (mean 29) and 38 control breast cancer patients without any hormonal treatment were examined by transvaginal ultrasonography and endometrial biopsy. Any thickening of the endometrium with cystic formations or homogeneous endometrial thickening > 10 mm detected by ultrasonography was defined as abnormal endometrial appearance. Homogeneous endometrial thickening < 10 mm without cystic formations was accepted as normal. Statistical analysis was performed using the Students t-test and Mann-Whitney U test. RESULTS The two groups were similar in age and menopausal period. The patients on tamoxifen therapy had a thicker endometrium (8.6 +/- 6.6 mm) than the non-treated women (4.8 +/- 3.1 mm), which was found to be a statistically significant difference (P < 0.01). The sonographic evaluations showed abnormal endometrial appearance in 8 cases of tamoxifen treated women while the others revealed homogeneous thickness < 10 mm without cystic formations or a thin linear echo with or without fluid in the endometrial cavity. All 8 patients with cystic appearance had endometrial thickness > 10 mm. Only 1 patient had endometrial cancer on biopsy and no pathology was observed in the remaining 7 patients. In the control group, only 1 patient had abnormal ultrasonographic finding who had insufficient endometrial tissue on biopsy. CONCLUSIONS Tamoxifen can produce a sonographic image of the endometrium that resembles endometrial neoplasia. It is suggested that the discrepancy between the sonographic findings and histology may be the result of the stromal edema of the endometrium from tamoxifen treatment. Until more data are gathered, all postmenopausal breast cancer patients who are being treated with tamoxifen should have a periodic ultrasonographic examination and those presenting with a sonogram suggestive of endometrial pathology should undergo biopsy.

Appendectomy in the surgical staging of ovarian carcinoma

Objectives: Extensive debulking is accepted as the primary method of operative management for carcinoma of the ovary. However, there is no consensus regarding the role of appendectomy in primary surgical treatment. The aim of this study was to assess the role of appendectomy in the surgical staging and cytoreduction of ovarian carcinoma. Methods: The study was a retrospective review of 90 primary malignant ovarian carcinoma patients who had an appendectomy in addition to primary cytoreductive surgery. Results: Out of 90 patients, 10 (11.1%) had metastasis to the appendix. The rate of metastasis to the appendix was 11.5% (9/78) in malignant epithelial ovarian carcinomas and 8.3% (1/12) in non‐epithelial ovarian tumors. Of the patients with metastasis in the appendix, malignant epithelial ovarian tumors were identified in 90% (serous: 70%; clear cell: 20%), and non‐epithelial malignant ovarian tumor were disclosed in 10% (granulosa cell carcinoma). There were no metastases to the appendix in the other histological types. Although metastasis to the appendix was not observed in early stage ovarian carcinomas, it was detected in 21.4% (9/42) of stage III and 50% (1/2) of stage IV. Macroscopic tumor metastasis in the abdomen was noted in all patients with metastasis to the appendix. Conclusion: Appendectomy for stage I and II patients was not beneficial and did not affect final staging. As a result, for the proper staging of ovarian carcinoma there is no advantage to the addition of routine appendectomy to primary cytoreductive surgery in early stage (stage I and II) malignant epithelial ovarian tumors. Appendectomy would contribute to the cytoreduction of advanced stage disease if it is macroscopically involved.

Radical versus conservative surgery for vulvar carcinoma

The comparison of the radical and conservative surgical approaches for vulvar carcinoma in relation to the rate of recurrence and complications.

Vascular endothelial growth factor in adnexal masses

Objectives: To determine cyst fluid and serum vascular endothelial growth factor (VEGF) concentrations in patients with ovarian masses and to investigate the efficiency of this modulator in the clinical management of cystic pelvic masses. Methods: Needle puncture for cyst fluid aspiration were performed on 88 cystic ovarian masses intraoperatively. Forty‐five patients with benign and 43 patients with malignant ovarian pathology were analyzed for cyst fluid and serum VEGF concentrations. Both cystic fluid and serum VEGF concentration were determined by enzyme‐linked immunosorbent assay (ELISA). Results: Cyst fluid VEGF levels of malignant cysts (40.65±17.69 ng/ml) were significantly higher than those of benign cysts (12.53±6.13 ng/ml; P<0.001). Similarly, higher serum VEGF concentrations were found in patients with malignant disease (0.72±0.17 ng/ml) compared with benign cysts (0.33±0.11 ng/ml; P<0.001). A statistically significant correlation was observed between cyst fluid and serum VEGF levels in both malignant and benign cysts. For serum VEGF, at a cut‐off value of 0.41 ng/ml; sensitivity, specificity, PPV, and NPV were 95%, 78%, 80% and 95%, respectively. No significant correlation between cyst fluid VEGF concentration and tumor stage or grade could be found. Conclusions: Significantly higher concentrations of VEGF are present in cyst fluid and serum of patients with malignant ovarian cysts compared with benign ovarian ones. There is no relation between VEGF and tumor stage or grade.

A strong prognostic variable in endometrial carcinoma

The purpose of this study was to determine the role of flow cytometric S‐phase fraction as a prognostic factor in patients with endometrial adenocarcinoma.

Endometrial mixed mullerian tumor with heterologous elements following tamoxifen therapy for breast cancer: a case report and literature review

CASE A 67-year-old multiparous woman received 20mg tamoxifen daily for four years after surgical treatment of breast cancer. She presented with vaginal bleeding. Uterine curettage revealed a uterine MMT with heterologous elements. She was treated surgically with adjuvant radiotherapy. Tumor cells were found to be estrogen receptor negative and progesterone receptor positive. Uterine MMT may be linked to long term use of tamoxifen. A mechanism in developing MMT other than estrogen receptor pathway may be possible.

A huge abdominal mass mimicking ovarian cancer: p53-negative but aneuploid myxoid leiomyosarcoma of the uterus

OBJECTIVE Less than 20 myxoid leiomyosarcoma cases were reported in literature. Since, these tumors are very rare and may exhibit highly malignant behavior despite their low mitotic index, clinical course and optimum type of therapy of myxoid variant of leiomyosarcoma were not well understood. The goal of this report is to contribute the better understanding of this rare type of tumor. METHODS A 39-year-old woman presented with a huge abdominal cystic mass. Laparotomy was performed and frozen section diagnosis was low-grade uterine leiomyosarcoma. TAH-BSO, omentectomy, pelvic lymph node and peritoneal samplings were carried out. No chemotherapy was performed after surgical therapy. RESULTS Final histopathological diagnosis was uterine myxoid leiomyosarcoma. The tumor was p53-negative and had aneuploid DNA content. The patient tolerated well the operation and she is alive and free of disease after 24 months of primary surgical treatment. CONCLUSION Uterine myxoid leiomyosarcoma may present a huge abdominal cystic mass and can be treated successfully with surgery alone.

The efficacy of hysteroscopy for endometrial pathology: the experience of a university clinic on diagnostic accuracy and the comparison with the other methods

Hysteroscopy procedures were retrospectively reviewed in order to reveal the diagnostic accuracy and the efficiency of the diagnostic procedures (transvaginal ultrasonography/TvUsg, saline infusion sonography/SIS, hysteroscopy) for an educational institution in the management of abnormal uterine bleeding. The study was completed in the Department of Gynecology and Obstetrics of the Istanbul University Cerrahpaşa School of Medicine by reviewing the hospital records of the patients on whom hysteroscopy had been performed between 1 January 1997 and 31 December 2002. The records of 385 patients were eligible. The sensitivity, specificity and positive and negative predictive values for saline infusion sonography and hysteroscopy were calculated for specific histopathological diagnoses. The sensitivity and specificity of hysteroscopy for the detection of endometrial polyps were calculated as 83.9 and 63.0%, respectively. The positive predictive value (PPV) was 74.6% and negative predictive value (NPV) 75.2%. The sensitivity and specificity of saline infusion sonography for the detection of endometrial polyps were found to be 87.2 and 33.3%, respectively. PPV was 71.4% and NPV was 57.6% for SIS. The sensitivity and specificity of hysteroscopy for the detection of submucosal leiomyoma were determined to be 80.0 and 92.4%, respectively. PPV was 43.2% and NPV was 98.0%. The sensitivity and specificity of SIS for the detection of submucosal leiomyoma were 71.4 and 92.3%, respectively. PPV was calculated as 52.6% and NPV as 75.2% for SIS. Due to its high diagnostic accuracy and lower complication rate even in the educational setting, we believe that hysteroscopy will retain its place as the “gold standard” procedure for the investigation of endometrial pathology.