Rıza Efendi Karaca

Comparison of four malignancy risk indices in the detection of malignant ovarian masses

Objective The aim of this study was to evaluate the ability of four risk of malignancy indices (RMI) to detect malignant ovarian tumors. Methods This is a prospective study of 100 women admitted to the Department of Obstetrics and Gynecology of Gulhane Military Medicine Academy for surgical exploration of pelvic masses. To diagnose malignant ovarian tumors, the sensitivity, specificity, negative and positive predictive values and diagnostic accuracy of four RMIs (RMI 1, RMI 2, RMI 3, and RMI 4) were obtained. Results In our study we found that there is no statistically significant difference in the performance of four different RMIs in discriminating malignancy. We think that malignancy risk indices is more reliable than the menopausal status, serum CA-125 levels, ultrasound features and tumor size separately in detecting malignancy. Conclusion We concluded that any of the four malignancy risk indices described can be used for selection of cases for optimal therapy. These methods are simple techniques that can be used even in less-specialized gynecology clinics to facilitate the selection of cases for referral to an oncological unit.

HPV Types in Turkey: Multicenter Hospital Based Evaluation of 6388 Patients in Turkish Gynecologic Oncology Group Centers Türkiye'deki HPV Tipleri: Türk Jinekolojik Onkoloji Grubuna Üye Merkezlere Başvuran 6388 Hastanin Retrospektif Analizi

Abstract Objective: To evaluate the prevalence of HPV DNA and cervical cytological abnormalities, to compare cervical cytology results and HPV DNA and to define HPV types distribution in a large series of Turkish women who have undergone HPV analysis in hospitals that are members of the Turkish Gynecological Oncology Group. Material and Method: Between 2006 and 2010, a total of 6388 patients’ data was retrospectively evaluated at 12 healthcare centers in Turkey. Demographic characteristics, cervical cytology results, HPV status and types were compared. Results: The mean age of the patients was 38.9±10.2. Overall, 25% of the women were found to be HPV positive. Presence of HPV-DNA among patients with abnormal and normal cytology was 52% and 27%, respectively. There was significant difference with respect to decades of life and HPV positivity (p < 0.05). HPV was positive in (within the HPV (+) patients) 37%, 9%, 27%, 20%, 22%, and 41% of the ASCUS, ASC-H, LSIL HSIL, glandular cell abnormalities, and SCC cases respectively The most common HPV types in our study were as follows; HPV 16 (32%), HPV 6 (17%), HPV 11 (9%), HPV 18 (8%), HPV 31 (6%), HPV 51 (5%), HPV 33 (3%). Conclusion: In this hospital based retrospective analysis, HPV genotypes in Turkish women with normal and abnormal cytology are similar to those reported from western countries. Further population based prospective multicenter studies are necessary to determine non-hospital based HPV prevalence in Turkish women Öz Amaç: Türkiyedeki HPV tiplerinin geniş bir seri ile ortaya konması amacı ile Türk Jinekolojik Onkoloji grubuna üye hastanelerde HPV analizi yapılan hastaların sonuçlarının retrospektif olarak değerlendirilmesi ve sitolojik anormalliklerdeki HPV tiplerinin belirlenmesi. Gereç ve Yöntem: 2006 ve 2010 yılları arasında 12 ayrı merkeze başvuran smear ve HPV analizi yapılan toplam 6388 hasta retrospektif olarak incelenmiştir. Hastaların demografik bilgileri, smear sonuçları, HPV tipleri online olarak toplanıp analiz edilmiştir. Bulgular:Ortalama hasta yaşı 38.9±10.2 idi. Tüm grup değerlendirildiğinde, %25 hastada HPV pozitif olarak saptandı. Anormal sitolojisi olanlarda HPV pozitifliği %57 iken normal pap testi olanlarda HPV pozitifliği %27 oranında tespit edildi. Hastaların yaşam dekadları ile HPV pozitifliği arasında anlamlı bir ilişki bulundu (p<0,05) HPV pozitifliği ASCUS, ASC-H, LSIL, HSIL, glandüler anormallikler ve skuamöz hücreli karsinom için sırasıyla %37, %9, %27, %20, %22, %41 idi. En sık görülen HPV tipleri sırasıyla HPV 16 (%32), HPV 6 (%17), HPV 11 (%9), HPV 18 (%8), HPV 31 (%6), HPV 51 (%5), HPV 33 (%3) idi. Sonuç:Bu hastane temelli retrospektif analizde HPV tipleri gelişmiş batı ülkelerinde rapor edilen tiplerle benzer olarak tespit edildi. Ülkemizdeki gerçek popülasyon temelli HPV prevalansı ve tiplerinin belirlenmesi için hastane temelli olmayan çok merkezli geniş sayıda hasta içeren serilere ihtiyaç vardır

Case report of a rare dermatosis in pregnancy: Impetigo herpetiformis

Impetigo herpetiformis (IH) is a very rare type of dermatosis seen in pregnancy. According to the published work, IH during pregnancy is associated with the risk of stillbirth, and obstetric management in such cases is very important. Early recognition is important to reduce both maternal and fetal morbidity. We present a case of IH resistant to corticosteroid therapy in a 27‐year‐old pregnant woman where the pregnancy was terminated by the induction of labor.

Green serum and pregnancy: Case report

OBJECTIVES This report investigates the etiology of green serum within pregnancy. PATIENT AND METHODS A 24-year-old patient applied to our clinic for a routine control examination at her 25th week of pregnancy. In her repeated blood analysis, green serum was observed after centrifugation of the blood sample taken for an oral glucose tolerance test. After that, records of the patients blood samples collected at the 9th and 12th weeks of pregnancy to verify that these serum samples were yellow were retrospectively examined. RESULTS In the literature, no green serum case without an accompanying increase in serum ceruloplasmin level has been reported. The routine blood biochemistry of alanine transaminase: 8 U/L (10-40 U/L), aspartate amino transferase: 10 U/L (10-40 U/L), gamma glutamyl transferase: 17 U/L (7-40 U/L), indirect bilirubin 5.13 μmol/L (0.0-18 μmol/L), and total bilirubin 11.9 μmol/L (0.0-24 μmol/L). The level of serum copper detected was 0.172 μmol/L (0.14-0.173 μmol/L) and of ceruloplasmin was 600 mg/L (260-630 mg/L) within the normal reference interval. CONCLUSIONS This case proves that generation of green serum in pregnancy is not only due to an increased serum ceruloplasmin but can also be caused by other factors. Additional studies need to be performed to understand the pathophysiological mechanism and future effects of the appearance of green serum during pregnancy.

Using Wood's Light as a Diagnostic Tool for Vaginal Atrophy.

INTRODUCTION Woods light lamp is a device that emits ultraviolet (UV) light and is a useful diagnostic tool for dermatologic disorders. The change in the thickness of vaginal mucosa, in vaginal atrophy, causes a change in its colour under Woods light. We wanted to assess the feasibility of Woods light (WL) as a diagnostic tool for vaginal atrophy. MATERIALS AND METHODS The study was conducted at the Department of Obstetrics and Gynaecology from 1 March 2013 to 1 September 2014. We evaluated 45 healthy postmenopausal women with atrophic vaginitis (study group) and 45 healthy, reproductive-aged women as a control group. All patients underwent WL and routine gynaecological examinations for this study. RESULTS Ninety patients were selected for this study: 45 postmenopausal women suffering atrophic vaginitis symptoms like vaginal dryness, dyspareunia, vulvar pruritus, and signs like pale, smooth, dry, fragile vaginal epithelium, areas of petechiae, and rash, and 45 healthy reproductive-aged women without vaginal atrophy. Thirty-six of the postmenopausal womens vaginal mucosa appeared pale royal green under WL indicative of vaginal atrophy. Thirty-nine of reproductive-aged womens (n: 45) vaginal mucosa were not visualized as pale royal green fluorescent images under the WL. CONCLUSION Using Woods light to diagnose vaginal atrophy is a new use for the old device and may be a reliable, and cheap tool for diagnosing vaginal atrophy. Diagnostic accuracy and cost-effectiveness of Woods light will be better optimized in further trials.

Vulvar Anjiyomiyofibroblastom: Bir Olgu Sunumu

Angiomyofibroblastoma (AMFB) is a rare seen mesenchymal tumor that is categorized as a genital stromal tumor. It is commonly seen in the middle-aged women usually affecting the labia majora and rarely the vagina. A variant called AMFB-like tumors are also rarely seen in male patients. AMFB with its clinical presentation and location can be wrongly diagnosed as an aggressive angiomyxomas, bartholin cyst or lower genital tract lipomas. In the patients who are applying because of the vulvar mass, AMFB should not be forgotten for the pre-diagnosis. The treatment is generally simple surgical excision.In this case, AMFB was reported with a wrongly pre-diagnosis as a bartholin cyst to which a medical treatment had been given.