Selçuk Ayas

Elevated ghrelin levels in the peritoneal fluid of patients with endometriosis: associations with vascular endothelial growth factor (VEGF) and inflammatory cytokines

OBJECTIVE To study ghrelin concentrations in the peritoneal fluid of women with endometriosis and of control women without pelvic pathology and its associations with the levels of proinflammatory cytokines and vascular endothelial growth factor (VEGF). DESIGN Case-control study. SETTING University research institution and hospital. PATIENT(S) Forty-six nonobese women with laparoscopically and histopathologically confirmed endometriosis and 20 control women without pelvic pathology. INTERVENTION(S) Peritoneal fluid was aspirated during routine diagnostic laparoscopic examination. MAIN OUTCOME MEASURE(S) Concentrations of ghrelin and inflammatory cytokines (interleukin [IL]-1 beta, IL-6, tumor necrosis factor [TNF], and VEGF) in the peritoneal fluid were evaluated by specific enzyme immunoassay and enzyme-linked immunosorbent assays, respectively. RESULT(S) Ghrelin concentrations in the peritoneal fluid of women with endometriosis were significantly increased as compared with control subjects. Peritoneal ghrelin levels in patients with endometriosis were strongly positively associated with VEGF (r(s) = 0.625). There was no correlation between ghrelin and IL-1 beta, IL-6, or TNF. CONCLUSION(S) The results of the present study show that endometriosis is associated with increased peritoneal ghrelin levels. The association between ghrelin and endometriotic lesion vascularization remains to be elucidated.

The association of serous tubal intraepithelial carcinoma with gynecologic pathologies and its role in pelvic serous cancer

OBJECTIVES Possible primary sites of pelvic serous cancers are, fallopian tubes, ovaries or peritoneum. Recent studies have revealed that a portion of these tumors originates from serous tubal intraepithelial carcinoma (STIC) at the distal end of fallopian tubes. In this study, the association of STIC with pelvic serous carcinomas and the pathologic parameters that indicate the tubes as the primary site were assessed. METHODS In total, 495 pairs of fallopian tubes obtained via total abdominal hysterectomy and bilateral salpingo-oophorectomy between 2011 and 2013 were examined according to SEE-FIM protocol. Hematoxylin and eosin-stained slides were examined by pathologists. Suspicious areas were immunostained with p53 and Ki-67 to diagnose STIC precisely. RESULTS Of the 495 cases, 110 cases were malignant. Among 34 cases of non-uterine serous carcinomas, 13 were diagnosed with STIC. STIC was located at the fimbrial end of the fallopian tubes in 12 cases. No STIC was identified in the gynecologic malignancies other than non-uterine serous pelvic carcinomas and benign gynecologic pathologies. Comparison of the ovarian and tubal cancer cases with and without STIC did not reveal a factor that helps to define the primary site. STIC was an important factor associated in a higher portion of the cases with bilateral ovarian cancer. CONCLUSION The role of STIC in carcinogenesis continues to be discussed as it is unknown whether STIC is the precursor lesion or just associates with the malignancies. Discovering the accurate precursor lesions and tumor carcinogenesis is essential to prevent these malignancies and to develop early diagnostic methods.

Is interstitial pregnancy clinically different from cornual pregnancy? A case report.

Interstitial pregnancy is a rare form of ectopic pregnancy with significant risk for morbidity. A 32-year-old woman, was brought to the emergency department with severe abdominal pain and syncope. There was no history of menolipsis and usage of any contraceptive methods. Serum ß hCG arrival was 11224 IU/L. Trans-vaginal ultrasound scan showed an empty uterus with a displaced 16 × 26 mm gestation sac on the left corn of the uterine cavity which surrounded by a thin myometrium. Free abdominal fluid and coagulum were also detected in the cul-de-sac. She was haemodynamically unstable. A ruptured ectopic pregnancy was diagnosed in the left uterine cornu during emergency laparotomy. Cornual resection was performed. Interstitial and cornual pregnancies should be considered as two different clinical situations. It is important to enhance the clinicians suspicion about interstitial/cornual pregnancy. Thus, more detailed examination by transvaginal ultrasonography may contribute for accurate localization and diagnosis.

Comparison of the Classical Method and SEE-FIM Protocol in Detecting Microscopic Lesions in Fallopian Tubes with Gynecological Lesions.

Background The objective of this study was to compare the classical method and Sectioning and Extensively Examining the Fimbriated End Protocol (SEE-FIM) in detecting microscopic lesions in fallopian tubes with gynecological lesions. Methods From a total of 1,118 cases, 582 with various parts of both fallopian tubes sampled in three-ring-shape sections and 536 sampled with the SEE-FIM protocol were included in this study. Pathological findings of cases with endometrial carcinoma, non-uterine pelvic malignant tumor, ovarian borderline tumors, premalignancy, and benign lesions were compared. Results We detected two tubal infiltrative carcinomas among 40 uterine endometrioid adenocarcinomas, 15 serous tubal intraepithelial carcinomas in 39 non-uterine pelvic serous high-grade carcinoma cases, seven papillary tubal hyperplasias in 13 serous borderline tumor cases, and 11 endometriotic foci and four adenomatoid tumors among all cases sampled with the SEE-FIM protocol. Using the classical method, we detected only one serous tubal intraepithelial carcinoma in 113 non-uterine pelvic serous high-grade carcinoma cases and two papillary tubal hyperplasia cases in 31 serous borderline tumors. We did not identify additional findings in 185 uterine endometrioid carcinoma cases, and neither endometriotic focus nor adenomatoid tumor was shown in other lesions by the classical method. Conclusions Benign, premalignant, and malignant lesions can possibly be missed using the classical method. The SEE-FIM protocol should be considered especially in cases of endometrial carcinoma, nonuterine pelvic serous cancers, or serous borderline ovarian tumors. For other lesions, at least a detailed examination of the fimbrial end should be undertaken.

Efficacy of passive uterine straightening during intrauterine insemination on pregnancy rates and ease of technique

Aim:  The aim of the present study was to evaluate the efficacy of passive uterine straightening during intrauterine insemination (IUI).

Use of clomiphene citrate alone, urinary follicle-stimulating hormone alone, or both combined sequentially in patients with unexplained subfertility undergoing intrauterine insemination: a randomized trial

Objective: To compare the successes of clomiphene citrate (CC) alone, pure human urinary follicle-stimulating hormone (uFSH) alone, and both combined sequentially in patients with unexplained subfertility couples undergoing intrauterine insemination (IUI). Materials and Methods: Patients aged 18-38 years who had a normal uterine cavity, at least one normal fallopian tube, and regular menses and were unable to conceive despite unprotected intercourse for at least 12 months were randomized to receive CC alone, uFSH alone, or sequential CC and uFSH before a single IUI. The primary outcomes were clinical pregnancy and live birth rates. The study was approved by the ethics committee of our institution. Results: A total of 135 patients were randomized, and 121 of these were able to complete the study. Of these, 30% (n=36) had CC alone, 34% (n=41) had uFSH alone, and 36% (n=44) had sequential CC and uFSH. The three groups did not significantly differ in terms of age, duration of infertility, hormone levels, and semen parameters. For CC alone, uFSH alone, and sequential CC plus uFSH groups, pregnancy rates were 8.3%, 17.1%, and 18.2%, respectively (p>0.05), and live birth rates were 8.3%, 12.1%, and 13.6%, respectively (p>0.05). Conclusion: In women with unexplained infertility, use of uFSH seemed to increase the success rate compared with CC alone. The sequential regime can significantly reduce the treatment cost if gonadotropin/IUI cycles are planned.

Servikal konizasyon sonrası cerrahi sınır pozitifliği olan ve histerektomi yapılan 252 olgunun değerlendirilmesi

Aim: To evaluate final pathological results of hysterecto mies which were done after the finding of positive cervical conization margin. Material and Method: Thirty-five patients underwent hysterectomy after cervical conization revealing positive surgical margins among 252 patients who had undergone cervical conization between 2005 and 2013 were included in this study. Results: Mean age of the patients were 38,79±8, 82. Hysterectomies were performed in 1,57 ± 1,24 months following conization. Dysplasia was revealed in only 9 hysterectomy specimens (9/35), 6 High grade CIN, 3 Low grade CIN.

Comparison of the distinctive pathological features of and p16 and c-Kitexpression levels in benign and malignant endometrial polyps

BACKGROUND/AIM Histopathological examination is crucial for the effective management of endometrial polyps. Immunohistochemical markers such as p16 and c-Kit may facilitate the differential diagnoses of benign and malignant polyps. The aim of the present study was to explore the expression levels of c-Kit (CD117) and p16 in endometrial polyps of postmenopausal women. MATERIALS AND METHODS Twenty-five hysterectomy specimens with malignant endometrial polyps and hysterectomy or polypectomy specimens featuring 55 benign polyps were studied. The polyps were immunohistochemically stained for p16 and c-Kit, and differences in the expression levels of these proteins in the glandular and stromal components of benign polyps and the benign regions of the malignant polyps were assessed by using Fishers exact test. RESULTS The glandular components of malignant polyps exhibited significantly more intense p16 immunostaining than did benign polyps. Most immunoreactive cells were glandular cells exhibiting tubal metaplasia. The stromal components of either type of polyp did not differ in terms of p16 immunostaining. The extent of c-Kit immunostaining in benign and malignant polyps was similar. CONCLUSION The extensive tubal metaplasia in and the p16 immunoreactivity of the glandular components of malignant polyps may be useful to distinguish such polyps from benign polyps.

Gebeliğe eşlik eden overin küçük hücreli karsinomunun büyük hücreli varyantı: olgu sunumu

A rare case of large-cell variant of small cell carcinoma of the ovary diagnosed in a 23 years old G1P1 patient with a 35-week gestation is presented and discussed. The patient died of disease progression within 1 year of diagnosis.

Tuba üterina leiomyomu

Department Of Gynecology And Obstetrics, Zeynep Kamil Women And Children^ Research And Training Hospital, Istanbul, Turkey Leiomyoma of the fallopian tube is extremely rare. These tumors tend to be single, small and asymptomatic. They are typically incidental findings seen at autopsy or unrelated surgical procedures. In this study, we present two cases with leiomyoma offollapian tube.