Ilker Kahramanoglu

Synchronous Primary Cancers of the Endometrium and Ovary With the Same Histopathologic Type Versus Endometrial Cancer With Ovarian Metastasis: A Single Institution Review of 72 Cases.

Objective The purpose of this study was to evaluate the clinicopathological characteristics and survival outcomes of women with simultaneous endometrial and ovarian carcinomas having the same histopathologic type. Materials and Methods A review of medical records from 1997 to 2015 identified 72 patients with simultaneous carcinomas of the endometrium and ovary with the same histopathologic type. Patients with synchronous primary cancers of endometrium and ovary (SCEOs) were compared with patients with primary endometrial cancer with ovarian metastasis (ECOM). Clinical and pathological data were obtained from the patients’ medical records. Clinicopathological variables including categorical data were analyzed by &khgr;2 or Fisher exact test and continuous data by a Student t test. A Kaplan-Meier survival analysis was performed and compared by using the log-rank test. Results A univariate and multivariate analysis of 72 patients with SCEO with the same histopathologic type revealed that SCEO is an independent prognostic factor of 10-year overall survival. There were 31 patients in the SCEO group and 41 patients in the ECOM group. With a mean follow-up time of 68.2 months, the 10-year overall survival rates were 61.3% and 36.6% in SCEO and ECOM groups, respectively (P = 0.029). Age, menopausal status, stage of ovarian cancer, performing lymphadenectomy, grade of endometrial tumor, omental metastasis, and residual tumor were found to be significant risk factors for recurrence in the synchronous group. Conclusions The differentiation between SCEO and ECOM is of great clinical importance while our results showed a better prognosis for patients with SCEO compared with patients with ECOM. More aggressive therapeutic approaches may be considered for patients with SCEO who are older, postmenopausal, and/or have advanced grade of endometrial tumor, omental metastasis, and residual tumor. Lymphadenectomy should be performed in every patient with SCEO.

The impact of mode of delivery on the sexual function of primiparous women: a prospective study

AimThe purpose of this study was to evaluate the impact of mode of delivery on the sexual function of women using the Female Sexual Function Index (FSFI).MethodsThis was a prospective study of 452 nulliparous women, comparing their sexual function before and after birth. A Turkish version of the FSFI questionnaire was administered within the first 8 weeks of pregnancy, at 3 and 6 months postpartum in a face-to-face manner and subsequently at the 12th month and 24th month over the telephone.ResultsAge, BMI, education level, house income, duration of marriage, birthweight, and feeding at each time point were similar between group 1 [vaginal birth and mediolateral episiotomy (MLE)] and group 2 [caesarean section (CS)]. In the postpartum period, there were 265 and 138 participants at 3rd month, 216 and 121 participants at 6th month, 189 and 111 participants at 12th month, and 133 and 85 participants at 24th month in group 1 and 2, respectively. The FSFI total scores decreased at 3 and 6 months postpartum in both groups (27.3 to 23.1 in group 1 and 27.5 to 25 in group 2; p < 0.05 for both). Desire, arousal, lubrication, satisfaction and pain scores were significantly decreased at 3 months postpartum in group (1) In group 1, desire, arousal and pain scores remained decreased at the 6th month compared to initial scores. Group 2 had significantly lower desire, lubrication, satisfaction and pain scores at 3 months postpartum compared to their initial scores. Decline in desire and lubrication domains persisted at the 6th month for group (2) None of the FSFI domain scores differed after 6th months when compared to pre-delivery scores in both groups. Compared with the caesarean group, the vaginal birth with MLE group had lower satisfaction and higher pain levels at 3 months postpartum (p < 0.0001, for both). None of the FSFI domains differed at the 6th, 12th or the 24th month between the groups.ConclusionOur study revealed that caesarean section is not superior to vaginal birth in terms of preservation of normal sexual function, regardless of short-term postpartum effects. Women should be informed that, irrespective of their type of delivery, sexual function 6 months after childbirth is similar to that in pre-pregnancy.

Rare cutaneous metastasis in vulvar squamous cell carcinoma without any distant organ spread.

Vulvar cancer is the fourth most common gynaecologic cancer, representing 5% of malignancies of the female genital tract. It occurs most commonly in post-menopausal women with a mean age of 65. In recent years, an increase in incidence rates in young women has been observed. In the United States, about 4900 cases of vulvar cancer are diagnosed and 1000 patients die of vulvar cancer per year (Siegel et al. 2014). Two different pathways for vulvar carcinogenesis have been identified: HPV-dependent and induced by chronic inflammation. HPV is responsible for 60% for all cases. Of the vulvar cancers related to HPV about 55.5% are caused by two strains, HPV-16 or HPV-33 (Insinga et al. 2008). There are three ways that vulvar cancer spreads. First, direct extension to adjacent structures, such as vagina, urethra, clitoris, anüs. A second way of spread is by the lymphatic route. The third way of tumour spread is the haematogenous route associated with advanced disease. Cutaneous metastasis of vulvar cancer is very rare and only nine cases had been reported till 2010 (Wang et al. 2010).

Shorter the cervix, more difficult the placenta percreta operations

Abstract Background: To determine the impact of cervical length (CL) on the clinical outcome of patients undergoing peripartum hysterectomy due to placenta previa/percreta. Objective: To assess the association of CL with clinical outcomes in such patients. Methods: We analyzed the data of patients who were diagnosed with anterior placenta previa/percreta prenatally and subsequently underwent peripartum hysterectomy at our tertiary care institution between 2004 and 2014. The sonographic images and measurements of CL were obtained from prospectively collected database. The duration of operation, units of blood products transfused, and length of stay in the hospital were recorded. Patients were stratified according to CL, and receiver-operating characteristics curves were used to determine the cut-off length for identification of patients at high risk of intra-operative difficulty. Results: Sixty-one patients were included in this study. Number of packages of ES were correlated with the the duration of operation (r = 0.666, p < 0.001) and the CL (−0.793, p < 0.001). Number of packages of fresh frozen plasma was significantly correlated with the CL (−0.642, p < 0.001) and the duration of operation (r = 0.606, p < 0.001). Gestational age (AUC = 0.683, p = 0.014) and the CL (AUC = 0.980, p < 0.014) were significant predictors for the number of ES transfused > 4 packages. The cut-off value of four packages was determined according to the median level of packages transfused. Optimal cut-off value for the CL to predict transfusion ≤ 4 packages was 20.5 with 93% sensitivity and the 99% specificity. Conclusions: Short cervix appears to be a cause of difficulty in placenta previa/percreta operations. CL may also help in determining the timing of delivery in placenta percreta patients.

Surgical Treatment of Metastatic Ovarian Tumors From Extragenital Primary Sites.

Objective The purpose of this study was to investigate the outcomes and prognostic factors of metastasectomy in patients with metastatic ovarian tumors from extragenital primary sites. Materials and Methods All patients with pathologically confirmed metastatic ovarian tumors between January 1997 and June 2015 were included in this study. A total of 131 patients were identified. The data were obtained from the patients’ medical records. Clinicopathological features were evaluated by both univariate and multivariate analyses. Results The primary sites were colorectal region (53.4%), stomach (26%), and breast (13%). Preoperative serum CA 125 and CA 19-9 levels were elevated in 29.4% and 39.8% of the patients, respectively. Cytoreductive surgery was performed in 41.2% of the patients. Seventy-three (55.7%) patients had no residual disease after surgery. Sixty-six (49.6%) patients had combined metastases at the time of the surgery to sites including the liver, pancreas, lung, bone, lymph nodes, bladder, or the intestine. With a median follow-up of 33 months, the median survival time was 22 months. The estimated 5-year survival probability is 0.26. On univariate analysis, primary cancer site, combined metastasis outside the ovaries, residual disease, preoperative serum CA 125 and CA 19-9 levels, and histologic type were significant parameters for overall survival. Furthermore, residual disease, preoperative serum CA 19-9 level, and primary cancer site were found to be independent prognostic factors on multivariate analysis. Conclusions The most common primary sites for ovarian metastasis are gastrointestinal tract. Metastasectomy may have beneficial effects on survival, especially if the residual disease is less than 5 mm. Prospective studies warranted to evaluate the value of metastasectomy in patients with ovarian metastasis.

The Combination of Preoperative Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography and Sentinel Lymph Node Mapping in the Surgical Management of Endometrioid Endometrial Cancer.

Objective The goal of this study was to evaluate the combination of sentinel lymph node (SLN) mapping and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) scan in detection of lymph node involvement in patients with endometrioid endometrial cancer (EEC). Methods/Materials Ninety-five patients with EEC who had preoperative PET/CT imaging and underwent SLN mapping were retrospectively analyzed. Methylene blue dye was used and injected to the cervix at 3- and 9-o’clock positions (a total of 4 mL). Pelvic lymphadenectomy was performed on all of the patients after SLN mapping. If the SLN was negative in the initial hematoxylin and eosin staining, an ultrastaging study was performed for the SLNs. Results Sentinel lymph nodes were detected in 77 (81.1%) of 95 patients, with a mean of 2.951–9 SLNs. There was only 1 case (1.4%) with a positive SLN in the intraoperative frozen section examination in those patients with negative PET/CT findings and in whom SLNs were detected (n = 70). Among the remaining 69 patients with negative preoperative PET/CT findings and negative frozen section results for the SLNs, there were 2 patients with SLN involvement in the final ultrastaging pathology. In the patient-based analyses, the sensitivity, specificity, and positive and negative predictive values of the PET/CT and SLN frozen section were 33%, 100%, 100%, and 97.1%, respectively. Conclusions As no metastases in the nonsentinel pelvic lymph nodes were found in patients with EEC who had both negative PET/CT findings and frozen section results of the SLNs in both hemipelvises, we suggest using both methods to reduce the incidence of unnecessary systematic lymphadenectomy.

Expression of PTEN and β-Catenin and Their Relationship With Clinicopathological and Prognostic Factors in Endometrioid Type Endometrial Cancer.

Objective The aim of this study was to investigate rates of expression of PTEN (phosphatase and tensin homolog deleted on chromosome 10) and &bgr;-catenin and their relationship with clinicopathological and prognostic factors in endometrioid type endometrial cancer (EC). Methods and Materials PTEN and &bgr;-catenin expressions of 59 operated patients with EC between January 2000 and December 2008 and followed-up until December 2014 in Cerrahpasa School of Medicine, Gynecologic Oncology Division, were evaluated retrospectively. Clinical data were obtained from patient files, and pathological data were obtained from pathology records. Each patient had 4 paraffin sections of tumoral tissue. These sections were stained by immunohistochemical methods. Clinical features and postoperative histopathologic findings were analyzed using Fisher exact test or the &khgr;2 test as appropriate. The Kaplan-Meier method was used to generate the survival curves. Results During median follow-up of 102 months, tumor recurrence and disease-related mortality were observed in 10 (16.9%) and 7 (11.9%) cases, respectively. Immunohistochemical staining of PTEN and &bgr;-catenin were positive in 61% and 69.5% of all cases, respectively. Positive staining of PTEN was positively correlated with myometrial invasion (P= 0.02). There was no correlation between &bgr;-catenin and clinicopathological factors. PTEN or &bgr;-catenin positivity were not significant prognostic factors for 5-year overall survival (P = 0.37, P = 0.62, respectively) and 5-year disease-free survival (P = 0.28, P = 0.58, respectively). Conclusions PTEN and &bgr;-catenin expressions cannot be used to determine prognosis in patients with EC as PTEN and &bgr;-catenin staining status were found to have no significant effect on 5-year overall survival and disease-free survival. Positive staining of PTEN may be associated with increased myometrial invasion. Meta-analyses and broader studies are needed to evaluate the prognostic value of PTEN and &bgr;-catenin in EC.

The Use of Risk of Malignancy Index for Adnexal Masses

Objective: To evaluate the effectiveness of the Risk of Malignancy Index (RMI) to identify cases with high potential of ovarian malignancy Methods: A total of 106 patients with adnexal masses were included in this prospective, observational study. The ultrasound findings, menopausal status and serum CA125 level were documented. Ultrasound characteristics, documented preoperatively, and assessed with RMI scoring to detect the relationship between benign and malign groups. The statistical analysis was done using statistical software (NCSS 2008). The sensitivity, specificity, positive and negative predictive value of serum CA125, ultrasound findings and menopausal status were calculated separately and combined into RMI. Results: The best cut-off value for the RMI was 189 with a sensitivity of 84.8%, a specificity of 81.6%, a PPV of 78% and a NPV of 87.5%. Conclusion: The present study demonstrated that RMI was a reliable method detecting pelvic masses with high risk of malignancy. Herewith, RMI leads selecting patients who need to be referred to gynecologic oncologists.

Five Cases of Non-Hodgkin B-Cell Lymphoma of the Ovary

The involvement of the ovary in lymphomatous process is rare. Such an involvement may occur in 2 ways, primary or secondary. We report 5 cases of ovarian non-Hodgkins lymphoma, with 3 of which primarily arising in the ovaries. Ovarian lymphoma can mimic more frequently occurring tumors including advanced epithelial carcinoma and radical surgery may be performed instead of a biopsy. The immunophenotypic and clinicopathologic features exhibited in this small series are described to call attention to early diagnosis and treatment of ovarian lymphoma. All patients were diagnosed as having DLBCL after ovary biopsy. Different treatment modalities were used and prognosis of the patients was reported.

Extragenital müllerian adenosarcoma in the pouch of douglas.

BACKGROUND Extragenital Müllerian adenosarcomas are extremely rare tumours characterised by a stromal component of low-grade malignancy and by a benign glandular epithelial component. CASE REPORT A 26-year-old woman was admitted to our clinic because of lower abdominal distension and left lower quadrant pain. Clinical and radiological examinations suggested an ovarian malignancy. Laparotomy revealed a cystic mass in the pouch of Douglas, originating from the left sacrouterine ligament. A total excision of the tumour was performed and showed low-grade adenosarcoma without sarcomatous overgrowth. Follow-up at 24 months after the surgery showed no evidence of recurrence. CONCLUSION Mullerian adenosarcoma located in the pouch of Douglas is rare. For treatment, success may be achieved with only excision of the tumour if there is no sarcomatous overgrowth or spread to adjacent tissues.