Fırat Ortaç

Myomectomy during cesarean section

The aim of this study is to evaluate the intra and post-operative risks of myomectomies during cesarean section. It was reported that it would be better to avoid myomectomies at cesarean section unless the myoma are pedunculated and can easily be excised considering the risk of uncontrolw x lable hemorrhage 1 . In this study, we report our experience of 22 myomectomies performed for Ž . large myomas )5 cm during cesarean section, between May 1994 and September 1998 at the Department of Gynecology in Ankara University Hospital. Indications for myomectomies include: Ž patients’ desire, symptomatic pain, labor obstruc. tion malpresentation myomas, probability of adverse effect for future pregnancies, and post-operative complications. Our technique comprises performing a linear uterine incision as well as possible on the most prominent part of the leiomyoma avoiding sec-

Immunohistochemical analysis of c-myc, c-jun and estrogen receptor in normal, hyperplastic and neoplastic endometrium

To evaluate the role of c-jun and c-myc proto-oncogenes in normal, hyperplastic and neoplastic endometrium in relation to estrogen receptor (ER) status and to investigate whether these genes can be related to other histopathological features of endometrial carcinoma, 32 endometrial carcinomas, 38 endometrial hyperplasias and 22 cyclic endometria (10 proliferative and 12 secretory) were evaluated histologically. Endometrial hyperplasia cases were classified as simple and complex hyperplasia without atypia, and atypical hyperplasia. Endometrial carcinoma cases were subtyped according to the International Society of Gynecological Pathologists. Modified FIGO system was used for both grading and staging. Immunohistochemical examination was performed using antibodies to ER-alpha, c-myc and c-jun with streptavidin-biotin-peroxidase technique. The mean percentage of ER-alpha positive cells changed cyclically during the menstrual cycle, and it was the highest (96%) and the lowest (31.6%) in proliferative and carcinomatous endometrium, respectively. There was a statistically significant difference between proliferative and secretory phases and proliferative and carcinomatous endometrium in relation to ER-alpha staining (p<0.05). There was also a statistically significant difference with respect to ER-alpha reactivity between secretory phase and each hyperplastic group, as well as between the carcinoma group and each hyperplastic group (p<0.05). Although not significant, the mean percentage of c-myc expressing cells in the carcinoma group was higher (15.3%) than that of proliferative phase and hyperplastic groups. The mean percentage of c-jun positive cells in proliferative endometrium was slightly higher than in secretory endometrium, and it was the highest in atypical hyperplastic endometrium (28.3%), but there was no statistically significant difference between the groups. In carcinoma cases, a positive correlation was observed between c-jun positivity and tumor grade (p=0.027, r=0.3908), but such a correlation with c-myc was not found. A positive correlation was detected between ER-alpha and c-myc expression (p=0.038, r=0.3686). A progressive loss of ER seems to be correlated with increasing malignant transformation. C-myc expression might play a role in the development of endometrial carcinoma via ER. The association between c-jun and ER appears to be lost in endometrial carcinoma. The relationship between c-myc, c-jun and ER appears to be altered in endometrial carcinoma compared to that of menstrual endometrium.

Primary ovarian leiomyosarcoma: a review of the clinical and immunohistochemical features of the rare tumor.

Primary pure ovarian leiomyosarcomas constitute a malignant subgroup of ovarian smooth muscle tumors which comprise only 1% of ovarian tumors. Their origin, etiology, histologic features, clinical behavior, and optimal treatment are still obscure. Malignant behavior is almost always associated with any 2 of coagulative necrosis, cellular atypia, and mitotic index greater than 10. Immunohistochemical and electron microscopic evaluations may improve diagnostic accuracy. Traditionally, International Federation of Gynecology and Obstetrics (FIGO) staging and treatment of ovarian sarcomas have been the same as for epithelial ovarian carcinomas. Although surgery was performed for all cases, the extent of surgery is debatable. Benefit and modality of adjuvant therapy is controversial. The prognosis of primary pure ovarian leiomyosarcomas is extremely poor depending on tumor stage, tumor size, grade, and mitotic index and mostly recurs in abdomen and pelvis. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader should be able to state how rare primary ovarian leiomyosarcoma (POLMS) is, explain that because of its rarity the best diagnostic and treatment modalities are not conclusive, and recall that the authors reviewed the literature to bring the readership current on POLMS.

A Turkish Gynecologic Oncology Group study of fertility-sparing treatment for early-stage endometrial cancer.

To analyze the results of fertility‐sparing treatment of early‐stage endometrial cancer (EC) in patients treated at Turkish gynecologic oncology centers, and to present a review of the literature.

Tissue Trauma in Abdominal and Laparoscopic-Assisted Vaginal Hysterectomy

STUDY OBJECTIVE To compare the degree of tissue damage between abdominal and laparoscopic-assisted hysterectomy. DESIGN Prospective, randomized, controlled study (Canadian Task Force classification I). SETTING University hospital. PATIENTS Forty-six women. INTERVENTION Laparoscopic-assisted and abdominal hysterectomy. MEASUREMENTS AND MAIN RESULTS The degree of tissue injury caused by surgical trauma was assessed by measuring plasma levels of creatine phosphokinase (CPK), C-reactive protein (CRP), lactic dehydrogenase (LDH), and CA 125 in patients undergoing laparoscopic-assisted (n = 23) and abdominal hysterectomy (n = 23). Plasma levels of CPK-MB isoenzyme were measured in order to exclude the possibility of myocardial injury. Blood samples were taken preoperatively, and on the first and second postoperative days. There was no difference in demographic characteristics between the groups. One patient in the laparotomy group and two patients in the laparoscopy group were excluded from analysis due to bladder injury, postoperative thrombophlebitis, and conversion to laparotomy because of severe adhesions. The mean operation time was longer (105.5 +/- 23.1 minutes vs 77.3 +/- 18.7 minutes, p < .001), but the duration of hospital stay was shorter (2.7 +/- 0.8 days vs 4.3 +/- 1.4 days, p < .001) and analgesic requirement was lower in the laparoscopy group compared with the abdominal group. We observed significant postoperative increases in CRP and CPK in both groups on postoperative days 1 and 2, whereas the increase in LDH was significant only in the laparotomy group on postoperative day 2. There were no significant changes in CPK-MB and CA 125. Moreover, mean plasma levels of CRP and CPK were significantly higher in the laparotomy group on postoperative days 1 and 2 than in the laparoscopy group (p < .05). CONCLUSION Surgery is a significant cause of tissue injury that can be assessed by specific enzymes and proteins. We suggest that laparoscopic surgery causes less tissue damage as assessed by lower postoperative CRP and CPK values, and that less tissue trauma related with laparoscopic surgery may account for early mobilization and reduced analgesic requirement in these patients.

Laparoscopic Management of a Translocated Intrauterine Device Perforating the Bowel

A woman underwent operative laparoscopy to manage a dislocated intrauterine device that perforated her bowel. The surgical procedure was uncomplicated, and postoperative recovery was uneventful.

Elevated CA 125 in Meigs syndrome

woman complaining of increased abdominal girth over 5 months. Abdominal and pelvic examinations revealed a 15 x 10 x 10 cm, mobile, hard mass on left side with obvious ascites. Chest radiography revealed pleural effusion on both sides. Ultrasonography of the abdomen and pelvis demonstrated a 18 x 9 x 15 cm, solid mass in the left lower quadrant with ascites. Blood tests were normal except for a serum CA 125 level of 743.6 IU/ml obtained 3 days before the laparotomy. The patient underwent an exploratory laparotomy under general anesthesia. On opening the abdomen, we noted clear, straw colored ascites, a

A case report of multicentric verrucous carcinoma of the female genital tract

BACKGROUND Verrucous carcinoma is a variant of squamous cell carcinoma with distinct features including slow locally invasive growth and verrucous appearance. Verrucous carcinoma of the vagina is considered an extremely rare lesion because only 17 cases have been reported in the literature. CASE We report a case of vaginal verrucous carcinoma with a second focus in the cervix. The patient was treated with surgery and adjuvant interferon therapy for local recurrence. Human papillomavirus was detected in both vaginal and cervical tumor tissue by immunohistochemistry. CONCLUSION Diagnosis of verrucous carcinoma may be difficult, particularly if biopsy specimen involves only the surface epithelium. The role of human papillomavirus as an etiologic agent in verrucous carcinoma is still a matter of discussion. Effective management requires surgical resection. The efficiencies of radiotherapy and interferon therapy are discussed.

Long‐term oncological and reproductive outcomes of fertility‐sparing cytoreductive surgery in females aged 25 years and younger with malignant ovarian germ cell tumors

To evaluate the long‐term oncological and reproductive outcomes of patients aged 25 years and younger who were treated by fertility‐sparing cytoreductive surgery (FSCS) plus adjuvant chemotherapy (ACT) or observation alone for malignant ovarian germ cell tumors (MOGCT).

Identification of point mutations and large rearrangements in the BRCA1 gene in 667 Turkish unselected ovarian cancer patients.

OBJECTIVE The aim of this study was to evaluate the prevalence and spectrum of a known founder mutation, 5382insC and large genomic rearrangements (LGRs) in BRCA1 in ovarian cancer patients in Turkey. The additional aim was to determine the genetic testing strategy in Turkish breast/ovarian cancer family. METHODS Six hundred and sixty-seven ovarian cancer patients from five large geographical regions in Turkey, 61 of which had family history of breast/ovarian cancer, were tested for the mutation 5382insC by mutagenically separated polymerase chain reaction and direct sequencing of the entire coding sequence and the splicing sites. Additionally, multiplex ligation-dependent probe amplification (MLPA) was performed for large mutational scanning of BRCA1 gene in unselected ovarian cancer. RESULTS In this study, BRCA1 point mutations were observed in 1% of all patients and 9.8% of familial cases: 5382insC, unique novel missense variant-G1748S and unclassified splice site variant IVS20+5A>T. 5382insC was observed in two patients. However, G1748S, previously unreported, was found in four patients and thus led to the conclusion that this mutation may be unique to Turkey. A splice site variant, IVS20+5A>T, was detected in three patients, with two of them including G1748S and IVS20+5A>T, together. Using MLPA, six different distinct LGRs in BRCA1 were observed: the deletion of E1A-1B-2, E11, E17-19, E18 and E18-19 and duplication of E5-9. The prevalence of LGRs in this study was 40.9% among patients with family history. The deletion of E1A-1B-2 was the common mutation, and patients with this deletion were referred to us from four different geographical regions in Turkey. Therefore, it was hypothesized that this deletion covering E1-2 is common in Turkey. CONCLUSION LGRs in BRCA1 were strongly associated with positive family history among the Turkish population. On the basis of these findings, it can be recommended that a low-cost screening for LGRs in BRCA1 may be the first-line mutation detection method in families with strong breast/ovarian cancer history in Turkey.