Neslihan Bayramoğlu Tepe

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.

Use of Bladder Filling to Prevent Urinary System Complications in the Management of Placenta Percreta: a Randomized Prospective Study

Introduction The aim of our study was to evaluate the effect of filling the bladder on peripartum genitourinary injuries (especially bladder complications) in women with placenta percreta and to compare patient characteristics. Material and Methods Our prospective cohort study consisted of pregnant women with placenta percreta who underwent planned cesarean hysterectomy at the Department of Obstetrics and Gynecology of Gaziantep University Hospital between January 2015 and July 2016. Bladders were filled with 300 ml saline solution to determine surgical borders better and enable dissection of the lower uterine segment without excessive bleeding or unintended injury. Results A total of 66 women were included in the study: 32 women whose bladders were filled during surgery (filled-bladder group) and 34 women whose bladders were not filled (not filled-bladder group). Comparisons of demographic and obstetrical data, surgical parameters, the need for transfusion, and bladder injury rates revealed no significant differences between the two groups. We did not observe any beneficial effect of filling the bladder on preventing urinary complications compared with the women whose bladders were not filled (p = 0.339). Conclusions Filling the bladder with saline solution and mobilization of the bladder from the lower uterine segment did not have a statistically significant beneficial effect on preventing complications of the genitourinary system. But although the beneficial effects were not significant, shorter operation times, shorter postoperative hospital stays, and fewer bladder injuries were noted in patients whose bladders were filled.

The re-awakening of hCG expression. Its role in the diagnosis of cervical squamous cell carcinoma

Objectives: To compare immunohistochemical detection of Human chorionic gonadotropin (hCG) expression in paraffin embedded tissue of squamous cell carcinomas (SCC) and high grade squamous intraepithelial lesions (HSIL). Methods: The samples in this retrospective study were obtained from the archives of the Pathology Department at Gaziantep University, Gaziantep, Turkey, over the period from January 2012 to September 2016. The study group consisted of 55 cases of SCC and 45 cases of HSIL. Tissue expression of hCG was detected by specific binding of anti-hCG antibody using an automated immunohistochemistry staining device. The categorical variables of intensity and coverage were analyzed statistically using Pearson Chi-Square test. Results: High grade squamous cell lesions cases showed weak (84.4%, n=38/45) to no (15.6%, n=7/45) staining for hCG. None of the HSIL cases showed strong positivity. Strong positivity for hCG was detected in 90.9% (n=50/55) of SCC cases. Conclusion: Our study supports the association of ectopic hCG expression in cancer pathogenesis by demonstrating strong hCG immunoreactivity only in SCC cases. This finding can be helpful in supporting the diagnosis of invasive carcinoma in small or fragmented biopsies, which can on their own be confusing for the pathologists.

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.

Gastrointestinal system-derived secondary gynecologic tumors: 10 years experience at a single center

Aim: To perform a retrospective review of gynecologic malignancies originating from gastrointestinal system. Material and Methods: The study included 35 patients who underwent surgery at Gaziantep University, Faculty of Medicine, Department of Gynecology and Obstetrics from January 2007 to December 2017 and they were diagnosed with secondary gynecological malignancies originating from the gastrointestinal system (GIS) in their pathological examination. The patientsÂ’ age, primary tumor, and metastatic tumor localization and size were recorded. The malignancies were classified based on origin, as those arising from the colon, appendix, pancreas, stomach, peritoneum, and those of an unknown origin. Results: The mean age of the patients was 50.8 years (min: 24, max: 98) and the mean tumor diameter was 9.8 cm (min: 2 cm, max: 23 cm). Malignancies originating from the colon were most common secondary gynecologic malignancies. The primary tumor was localized at the colon in 21 patients (60%), stomach in eight (22.8%), and in the pancreas in one patient, appendix in one patient and peritoneum in one patient (2.8%). The origin of the primary tumor could not be determined in three patients (8.5%) as follow-up was not performed in our hospital for these patients. Of the malignancies originating from the colon (n=21), 16 (76.1%) metastasized to the ovaries, four (19%) to the vagina, and one (4.7%) to the cervix, while all tumors originating from the stomach, peritoneum, pancreas, appendix and those derived from the GIS without specific origin metastasized to the ovaries. Of the ovarian metastases, 26 (86.6%) were bilateral while four (13.3%) were unilateral. In metastatic tumors, pathological diagnoses included adenocarcinoma, signet ring cell carcinoma and mucinous carcinoma. Conclusion: Female genital system is among the substantial targets of metastasis of GIS-derived tumors. Metastatic tumors have a more aggressive behavior. Metastatic tumors must be distinguished from primary tumors as treatment modalities differ in these tumors. For these reasons, a multidisciplinary approach should be employed in the diagnosis, management and follow-up of cases, and the genital system should be screened carefully during both preoperative assessment and postoperative follow-up in patients with primary GIS malignancies.

Emergency peripartum hysterectomy: single center ten-year experience

Abstract Purpose: The purpose of our study is to determine the incidence, risk factors, indications, outcomes, and complications of emergency peripartum hysterectomy (EPH) performed in a university hospital. Methods: This retrospective study includes 54 cases of EPH performed at the department of obstetrics and gynecology of Gaziantep University Hospital between the years 2005–2015. We included all hysterectomy cases during the first 24 h after delivery beyond 20 weeks of gestation. We compared the most common indications of EPH between each other. Results: There were 54 EPH out of 8922 deliveries with an incidence of 6.1 per 1000 deliveries during the study period. The most common indication was abnormal placentation (74.0%). Urinary tract injury (33.4%) was the most common intraoperative complication. Bilateral hypogastric artery ligation, urinary tract injury, type of hysterectomy, post-op stay in the hospital, delivery in another hospital and other complications were significantly related to the type of EPH indication (p < 0.05). Conclusion: Abnormal placentation was the most common indication for EPH. Previous CS can be suggested as a high-risk factor for abnormal placentation. The delivery should be performed in appropriate clinical settings with experienced surgeons when high-risk factors like abnormal placentations are determined preoperatively.

Analysis of cystic hygroma diagnosed in the prenatal period: 5-years’ experience at a tertiary hospital in Southeastern Turkey

Abstract Purpose: Our aim was to evaluate the association of cystic hygroma (CH) with fetal malformations and also to investigate the outcome of fetuses with CH diagnosed in the prenatal period. Methods: We divided the CH patients into two main groups as isolated CH or CH associated with the congenital structural abnormality (CSA) by measuring the thickness of CH and showing other fetal abnormalities. Pregnancy outcomes were recorded as spontaneous abortion, elective termination, intrauterine death, live birth, postnatal death, and lost to follow-up. Results: There were 74 cases of fetal CH including 19 in CSA-CH group and 55 in isolated-CH group diagnosed between 11 and 21 weeks’ gestation. Karyotype analysis of these 28 patients revealed 18 (64.2%) normal karyotypes. Pregnancy outcomes included 54 elective terminations, five postnatal deaths, one spontaneous abortion, six live births, four intrauterine deaths, and four patients were lost to follow-up. Conclusion: In the presence of any CSA concurrent with CH, prognosis may be considered as poor and any additional help of fetal karyotyping is questionable. But fetal karyotyping may be advocated in counseling patients with isolated CH, in which a better prognosis and resolvement of CH may be expected in case of a normal karyotype.

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.