Sinan Berkman

Celsite port and catheter as an intraperitoneal access device in the treatment of ovarian cancer.

In ovarian cancer, development of safe and effective methods for providing long‐term access to the peritoneal cavity has become increasingly important.

Clinicopathologic and survival analyses of synchronous primary endometrial and epithelial ovarian cancers

The aim of the study was to describe clinicopathologic characteristics, survival outcomes and the factors associated with recurrence in patients diagnosed with synchronous primary endometrial and epithelial ovarian cancers.

Aggressive Angiomyxoma of the Pelviperineum: Surgical Treatment through a Perineal Incision

Aggressive angiomyxoma is a rare benign tumor of the pelvic soft tissue in women of reproductive age. The tumor is locally infiltrative and tends to recur. Herein is presented a case report of aggressive angiomyxoma that was totally excised using a transperineal approach. A 35-year-old woman had an aggressive angiomyxoma of the vulva and pelvis, with swelling of the right labium majus pudendi. Three years previously, she had undergone incomplete excision of the same type of pelviperineal mass via the transabdominal route. After a complete workup, a transperineal minimally invasive approach was used to excise the 20-cm mass filling the right side of the pelvis. Histopathologic findings were consistent with a diagnosis of aggressive angiomyxoma. Although often misdiagnosed as various other benign genital disorders, angiomyxoma usually is manifested as a soft nontender mass. After a thorough examination and full radiologic workup, a small transperineal incision may be sufficient for complete removal of the tumor.

Microarray detection of human papilloma virus genotypes among Turkish women with abnormal cytology at a colposcopy unit.

OBJECTIVE There is a well-known association between human papilloma virus (HPV) and cervical neoplasia. The aim of this study was to investigate the types of HPV DNA and to compare the results with colposcopic findings among women with abnormal cytology. MATERIAL AND METHODS A series of 76 consecutive women attending the clinic with the usual referral indications (ASC-US or higher in Pap) were examined by the conventional diagnostic tools (PAP smear, colposcopy,punch biopsy) and subjected to HPV testing. For HPV genotyping, we used a commercially avaliable HPV DNA chip (Genomica-CLART) which is a PCR based microarray system.The HPV test detected 35types of HPV (HPV-6/-11/-16/-18/-26/-31/-33/-35/-39/-40/-42/-43/-44/-45/-51/-52/-53/-54/-56/-58/-59/-61/-62/-66/-70/-71/-72/-73/-81/-83/84/-85/-89). RESULTS Overall, 44.7% of all patients were HPV positive. HPV was positive in 35%, 51.9%, 77.7% of the ASCUS, LSIL and HSIL groups respectively and HPV 16 was the most prevalent type in all groups. 6 %of patients had mutiple infections. 57.8% of biopsy proven SILs were HPV positive. The most prevalent HPV type was HPV 16 (54.5%).Colposcopic assessment revealed pathologic findings in 94.7% of biopsy proven SIL cases. CONCLUSION Although it has been reported that the prevalence of HPV in the general population is lower than Western countries, and the prevalence and distribution of genotypes are smilar in patients with abnormal cytology. Further population based studies are needed to determine the prevalance and type distribution of HPV with normal and abnormal cytology in Turkish women. Despite the new technological progress in HPV virion, colposcopy is still very important diagnostic tool in the management of abnormal smears.

Efficacy of endocervical curettage and CA-125 measurement in endometrial serous carcinoma: A case series and literature review

Objective: This is a case series and literature review of patients with endometrial serous carcinoma (ESC) in which endocervical curettage (ECC) and CA-125 measurement were utilized as a diagnostic procedure in preoperative staging. Materials and Methods: The patients were treated in the gynecologic oncology clinic of İstanbul University Faculty of Medicine between January 2005, and January 2015. A total of 37 patients were included in the final analysis. Results: ECC accurately predicted ESC in 22 patients (59.5%). The mean pre-operative serum CA-125 level was 73.24±3.30 IU/mL; pre-operative serum CA-125 levels were elevated above 35 IU/mL in 25 patients (69%). Conclusion: ECC is an acceptable diagnostic tool to predict the presence or absence of cervical involvement in endometrial cancer. On the other hand, its accuracy in specific subgroups requires further analysis in carefully designed prospective studies. Furthermore, pre-operative serum CA-125 levels may be important for management and counseling in the subgroup of women with ESC.

MERKEZİ SİNİR SİSTEMİ METASTAZI İLE SEYREDEN EPİTELYAL OVER KANSERİ - OLGU SUNUMU

Epithelial ovarian cancer rarely metastasizes to central nervous system (CNS). We present a case of ovarian cancer with CNS metastasis. The patient presented with ascites, left ovarian mass and increased serum level of CA-125. The diagnosis was ovarian cancer and the patient underwent to debulking surgery. Pathologic diagnosis was serous carcinoma moderately differentiated containing clear cell components and arising from left ovary. The stage was 3 C mixed ovarian epithelial carcinoma and the patient received 9 courses of adjuvant chemotherapy (Paclitaxel 300 mg + Carboplatin 750 mg). Second look laparotomy was subsequently performed which showed no tumoral lesion. 10 months later, the patient presented with the complaint of severe headache. Magnetic resonance imaging (MRI) of the brain revealed 3 metastases. Palliative radiotherapy and oral dexamethasone were started but the patient was lost to follow up within two months. The frequency of CNS metastases of epithelial ovarian cancer range between 1-6% in autopsy series and 0.5-12% in clinical series. The metastases may be isolated or multiple. The existence of multiple brain metastases is a poor prognostic factor. The treatment options are chemotherapy, radiation therapy and surgery. The appropriate treatment should be chosen on an individual basis. Corticosteroids, antiepileptics and mannitol can be used in palliative care for the patients with poor survival.

TUBAOVARYAN APSENİN KLİNİK YÖNETİMİ

Amac: Retrospektif olarak, tubo-ovaryan abse (TOA) olgularinin yonetimini belirlemek ve opere edilen hastalardaki komplikasyonlari ortaya koymak. Materyal ve metod: 1988-2010 yillari arasinda, klinik ve sonografik olarak TOA tanisi almis 108 hastanin dosyasi retrospektif olarak incelendi. Hastalarin hepsine ilk olarak genis spektrumlu antibiyotik tedavisi baslanmisti. Buna gore 47 (%43) hastanin antibiyotik tedavisine yanit verdigi, 61 (%57) hastaya ise cerrahi girisim gerektigi belirlendi. Hastalar demografik ve sonografik bulgularina gore kiyaslandi. Takip dosyalari incelenerek postoperatif komplikasyonlar belirlendi. Bulgular: Medikal tedaviye yanit veren hastalarin ortalama yasi (38±2,8) ve yanit vermeyen hastalarin ortalama yasi (38±3,4) arasinda fark bulunmadi. Benzer sekilde hastalarin ortalama gravide ve pariteleri, rahimici arac (RIA) kullanimi ve tup ligasyonu acisindan da istatistiksel fark gorulmedi. TOA boyutu (p=0,008) ve absenin bilateral olmasi (p=0,002) cerrahi yapilan grupta anlamli olarak daha fazla bulundu. Hospitalizasyon suresi konzervatif tedavi edilen grupta daha kisa idi (8,21 ± 1,9) (p<0,05). Konzervatif tedaviye yanit veren grubun %85’i Klindamisin + Gentamisin ± (Amoksisilin+Klavulonik asit) ile tedavi edildi (p=0,0043). Cerrahi yapilan grupta genel komplikasyon orani %40 (25/61) bulundu. Bu komplikasyonlar; 18 hastada kan transfuzyonu (%29, 18/61), 7 hastada cilt-cilt alti enfeksiyonu (%11, 7/61), 1 hastada stumpf hematomu (%1, 1/61), 1 hastada evisserasyon (%1, 1/61), 1 hastada barsak yaralanmasi (%1, 1/61) ve 2 hastada mesane yaralanmasi (%3, 2/61) seklinde idi. Sonuc: TOA olgularinda ilk basamak tedavi, genis spektrumlu antibiyoterapi olmakla birlikte abse boyutunun arttigi, absenin bilateral oldugu hastalarin onemli bir bolumunde ek mudahele (cerrahi) gerekmektedir Anahtar kelimeler: Tubo-ovaryan abse yonetimi; cerrahi; konzervatif tedavi

Gebelikte adneksiyel kitleye yaklaşım: 27 olgunun analizi ve literatürün gözden geçirilmesi

The incidence of adnexal masses in pregnancy is approximately 1%. Most of them are corpus luteum and benign physiological cysts seen in first trimester. 90% of these cysts are resolved spontaneously in the second trimester. The rate of complication such as torsion and rupture in persisted cysts is about 25%. The risk of malignancy is between 2-5%. It is reasonable to perform surgery in cysts with high risk of malignancy or in cysts susceptible to complication, other masses can be treated conservatively. Suitable time for surgery is between 16th and 18th weeks of gestation. The traditional method of management of adnexal masses in pregnancy is laparatomy but in certain conditions laparoscopy can be performed. Most of the ovarian cancers detected inpregnacy are germ cell tumors and these can be operated conservatively. In this paper management of adnexal masses in pregnancy, difficulties in diagnosis, treatment methods and timing were mentioned. Besides that, 27 adnexal masses diagnosed during pregnancy in our clinic were analyzed under the view of the literature. i