Sunduz Ozlem Altinkaya

Genetic abnormalities in Turkish women with premature ovarian failure

To identify the distribution of cytogenetic abnormalities among Turkish women with premature ovarian failure (POF).

Primary Malignant Melanoma of the Female Genital Tract

OBJECTIVE Malignant melanoma, which has a highly malignant potential, is a tumor of the skin and mucosal membranes. Malignant melanomas of the female genital tract, including the vulva and vagina, are rare. Their overall prognosis is poor and is worse than that for cutaneous melanomas. CASE REPORTS Clinical data for five patients with primary malignant melanoma are presented. Diagnosis was based on histologic and immunohistochemical examinations. Case 1 was a 58-year-old woman with mucosal lentiginous melanoma of the vulva. The other four patients, all of whom were over 40 years old, had vaginal melanomas. They were all treated with surgery, and three also received postoperative adjuvant therapy with interferon alpha-2b. Despite this, three of the patients died owing to widespread disease. CONCLUSION Although malignant melanoma of the female genital tract is uncommon, elderly women should undergo regular gynecologic examinations and suspicious pigmented lesions should be biopsied. The use of immunohistochemical assays could markedly improve diagnosis. However, the prognosis for these tumors is poor, regardless of the treatment delivered, and they are associated with a high rate of recurrence and low long-term survival. Surgery is the best available treatment for controlling and potentially curing malignant melanomas.

Interleukin-6 levels in relation with hormonal and metabolic profile in patients with polycystic ovary syndrome

Abstract Objective: The aim of this study was to evaluate serum concentrations of interleukin-6 (IL-6) in relation with hormonal and metabolic profile in patients with and without polycystic ovary syndrome (PCOS). Methods: A total of 40 women with PCOS and 40 age-matched controls were eligible for the study. Hirsutism scores, hormonal and metabolic profile as well as IL-6 levels were evaluated in each subject. Results: Women with PCOS exhibited higher body mass index (BMI) and serum concentrations of IL-6 levels than controls (p < 0.05); however, levels of IL-6 were not significantly increased when compared with BMI-matched controls (p > 0.05). IL-6 levels were significantly correlated positively with BMI and triglyceride levels; however, negatively correlated with high-density lipoprotein levels. Conclusion: The data of this study suggested that serum IL-6 levels were found to be higher in women with PCOS as compared to controls; however, IL-6 levels might be dependent on nutritional status but not on PCOS per se. Raised serum IL-6 levels may be related to BMI and serum lipid levels and may be a predictor for cardiometabolic risks.

Extraovarian conditions mimicking ovarian cancer: a single center experience of 15 years

ObjectiveThis study aims to review cases of extra-ovarian conditions that resembled ovarian malignancy and thus, to evaluate the distribution of primary pathology mimicking ovarian malignancy.MethodsA retrospective review of women, with final pathology of extra-ovarian diseases mimicking ovarian malignancy, which were managed at Zekai Tahir Burak Women’s Health Education and Research Hospital, from January 1995 to April 2010 was undertaken.ResultsAmong the 2,210 women treated during the study period, extra-ovarian diseases accounted for 5.11% (113/2,210) of all the cases. Of the 113 extra-ovarian diseases, 42 (37.17%) were peritoneal tuberculosis, 25 (22.13%) were gastrointestinal malignancies, 20 (17.70%) were pelvic abscess, 8 (7.08%) were pelvic echinococcosis, 8 (7.08) were schwannoma and other retroperitoneal tumors, 4 (3.53%) were malignant lymphoma, 2 (1.77%) were chronic ectopic pregnancy, gossypiboma, and mesenteric cyst, respectively.ConclusionMedical awareness of infectious diseases such as peritoneal tuberculosis, pelvic abscess, and pelvic echinococcosis in the differential diagnosis of ovarian malignancy is still lacking, especially in developing countries. In addition, in case of a pelvic mass, gastrointestinal and retroperitoneal tumors and malignant lymphoma should always be considered to avoid pitfalls in diagnosis and therapy.

Visfatin concentrations in patients with endometrial cancer

Abstract Objective: Visfatin is one of the most recent proteins shown to be highly expressed in adipose tissue. The purpose of this study was to determine visfatin levels in patients with endometrial cancer (EC). Methods: A total of 90 patients (46 EC patients and 44 healthy controls) were included in the study. Fasting venous blood samples were collected from all patients. Serum visfatin levels were measured by an enzyme-linked immunosorbent assay (ELISA). The correlation between serum visfatin levels and clinicopathologic variables were determined. Results: Serum visfatin levels were found to be higher in patients with EC (p < 0.001). Visfatin concentrations were positively correlated with age (p = 0.002, r = 0.323), body mass index (BMI) (p = 0.001, r = 0.354), fasting insulin (p = 0.002, r = 0.326), total cholesterol (TC) (p = 0.006, r = 0.285), triglyceride (TG) (p < 0.001, r = 0.364) levels and homeostasis model-resistance index (HOMA-IR) (p = 0.007, r = 0.281) of patients. By using classification and regression trees (C&RT) method, we found that visfatin predicted patients with EC 100% and controls 81.8%. Conclusion: Visfatin was the most important risk factor for occurrence of EC other than, age, BMI, Diabetes Mellitus and other biochemical factors like HDL, LDL, TG, TC. Clearly, there are largely unknown aspects of visfatin pathophysiology in EC and require further study.

The role of VEGF and its receptors in the etiology of early pregnancy loss

Abstract Objective: This study aimed to investigate the role of vascular endothelial growth factor (VEGF) and its receptors (VEGFR1, VEGFR2) in maternal and embryonic tissues in the etiology of early pregnancy loss. Methods: Immunohistochemistry was used to analyze the expression of VEGF and its receptors in placental and decidual tissues of 80 women with spontaneous incomplete abortion (n = 20), missed abortion (n = 20), blighted ovum (n = 20) and from early terminated pregnancies (n = 20). Results: Compared with the controls, all study groups showed weaker VEGF immunoreactivity in cytotrophoblasts and syncytiotrophoblasts of placental villi and endothelial cells of decidua (p = 0.002, p = 0.003, p < 0.001 respectively). Decidual endothelial cells of study groups except for blighted ovum showed weaker VEGFR1 immunoreactivity as compared to controls (p < 0.001). Placental villi cytotrophoblasts, syncytiotrophoblasts, decidual endothelial cells and endometrial gland epithelial cells showed weaker VEGFR2 immunoreactivity in all study groups compared to controls (p < 0.001). Placental villi endothelial cells showed the weakest VEGFR2 immunoreactivity in incomplete abortion group and the strongest staining in the blighted ovum group (p < 0.001). Conclusion: These results suggest that decreased expression of VEGFR1 in decidua and weaker VEGF and VEGFR2 expression in placental villi and decidua may be associated with early pregnancy loss.

Apelin levels in relation with hormonal and metabolic profile in patients with polycystic ovary syndrome

OBJECTIVE To evaluate serum concentrations of apelin in relation to the hormonal and metabolic profile in patients with and without polycystic ovary syndrome (PCOS). STUDY DESIGN A total of 45 women with PCOS and 45 age-matched controls were eligible for the study. Hirsutism scores, hormonal and metabolic profile as well as apelin levels were evaluated in each subject. RESULTS Women with PCOS exhibited lower serum concentrations of apelin than controls (194.1±50.7pg/ml versus 292.1±85.6pg/ml, p<0.001). Apelin levels were significantly correlated positively with body mass index (BMI), insulin, triglyceride (TG), free testosterone (fT) levels, modified Ferriman Gallwey scores and Homeostasis Model Assessment (HOMA) index; but negatively correlated with high density lipoprotein (HDL) levels in patients with PCOS (p<0.05). When overweight or obese (BMI≥25) and normal weight (BMI<25) women with PCOS were compared to BMI-matched controls, lower apelin levels were found in the PCOS group (226.7±45.4pg/ml versus 378.6±80.9pg/ml and 165.5±36.1 versus 249.0±46.6pg/ml, p<0.001, respectively). CONCLUSION The data suggest that serum apelin levels are lower in women with PCOS than in controls. Furthermore, apelin can be used as a specific marker for insulin sensitivity and lipid profile and this adipokine might play a role in the pathogenesis of PCOS.

SIMULTANEOUS BILATERAL TUBAL PREGNANCY AFTER IN VITRO FERTILIZATION AND EMBRYO TRANSFER

OBJECTIVE Ectopic pregnancies are known to occur with increased frequency after in vitro fertilization (IVF) and related techniques. We present a case of bilateral tubal pregnancy following IVF and embryo transfer (ET). CASE REPORT A 27-year-old woman was referred to our IVF clinic because of primary infertility, and underwent three cycles of IVF-intracytoplasmic sperm injection treatment. In her third cycle, 32 days after ET, she suffered from pelvic pain and vaginal bleeding. Transvaginal ultrasonography revealed bilateral tubal ectopic pregnancy with fluid in the pouch of Douglas but no intrauterine gestational sac. One of the embryos had fetal heart motion. Laparoscopic bilateral salpingostomy was performed immediately. The postoperative course was uneventful. Pathologic examination also identified chorionic villi and placental tissue in both tubes, and an Arias-Stella reaction without villi in the endometrium. CONCLUSION The diagnosis of ectopic or heterotopic pregnancy should always be considered in patients undergoing IVF-ET because of its increased incidence with this technique compared with natural conception. Although the incidence of bilateral tubal pregnancy is not high, sonographers and surgeons should examine both adnexa when diagnosing an ectopic pregnancy, especially in IVF-ET patients. Early diagnosis is essential for the prevention of significant maternal morbidity and mortality.

Can Platelet Indices Be New Biomarkers for Severe Endometriosis

Objective. The aim of this study was to investigate whether platelet indices-mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) would be useful as noninvasive biomarkers for determining the severity of endometriosis. Methods. A retrospective review of the medical charts of 164 patients diagnosed with endometriosis and who were operated on between 2001 and 2013 was performed. The stage of endometriosis was determined according to revised American Society for Reproductive Medicine criteria. Results. In patients with advanced endometriosis (Stages 3-4), PLT, PCT levels were found to be significantly higher and MPV, PDW values to be significantly lower when compared to initial endometriosis (Stages 1-2). In addition, there was a significant positive correlation between PLT (r: 0.800, P: 0.001) and PCT (r: 0.727, P: 0.002) and the inflammatory marker white blood cell count (WBC). Conclusion. Our finding may not sufficient for employing platelet indices solely in this differential diagnosis, but our finding could provide a suggestion for clinical physicians so that attention is paid to the value of platelet indices and that these may be taken into account when making decisions about the initial or advanced stages of endometriosis.

Coexistence of borderline ovarian epithelial tumor, primary pelvic hydatid cyst, and lymphoepithelioma-like gastric carcinoma.

OBJECTIVES Borderline ovarian tumors (BOTs) represent a heterogeneous group of ovarian epithelial neoplasms. Despite a favorable prognosis, 10-20% of BOTs exhibit progressively worsening clinic. Primary involvement of pelvic organs with echinococcus is very rare. Lymphoepithelioma-like gastric carcinoma is a rare neoplasm of the stomach. CASE REPORT A 58-year-old woman referred with abdominal swelling and gastric complaints. Imaging studies revealed a huge cystic mass with multiple septations and solid component, another cystic mass with an appearance of cyst hydatid in the pelvis, and thickening of the small curvature of stomach. Gastroscopy revealed an ulcer with a suspicious malignant appearance, and histology of the endoscopic specimen showed severe chronic inflammation and lymphocytic infiltration. No other involvement of hydatid cyst was detected. In the exploration, there was a 25cm cystic lesion with solid components arising from right ovary, another 6cm cyst over the former, 7cm cystic lesion arising from left ovary, and 10cm mass near the small curvature of the stomach. Excision of the masses; total gastrectomy with esophagojejunal anastomosis; total abdominal hysterectomy; bilateral salpingo-oophorectomy; omentectomy; appendectomy; splenectomy; and pelvic, paraaortic, and coeliac lympadenectomy were performed. Final pathology revealed lymphoepithelioma-like gastric carcinoma, bilateral serous BOT, and hydatid cyst. DISCUSSION Hydatid cyst should always be considered in the differential diagnosis of abdominopelvic masses in endemic regions of the world. Preoperative diagnosis of primary pelvic hydatid disease is difficult and awareness of its possibility is very important especially in patients residing in or coming from endemic areas.