Tufan Bilgin

Coexisting endometrial cancer in patients with a preoperative diagnosis of atypical endometrial hyperplasia

Aim: To investigate the possibility of coexisting endometrial cancer (EC) in patients with atypical endometrial hyperplasia (AEH).

Effects of hormone replacement therapy regimens on mammographic breast density: The role of progestins

Aim:  To evaluate the effects of different regimens of hormone replacement therapy (HRT) on mammographic breast density.

Expression of cyclin D1 in normal, hyperplastic and neoplastic endometrium and its correlation with Ki-67 and clinicopathological variables

MethodsWe investigated cyclin D1 expression in proliferative endometrium, endometrial hyperplasia and endometrioid adenocarcinoma, and examined the correlation of cyclin D1 expression with Ki67 as a cell proliferation associated marker. Immunohistochemical expression of cyclin D1 and Ki67 were studied in 30 cases with endometrial carcinoma, 14 cases with atypical hyperplasia, 15 cases with simple hyperplasia and 30 cases with proliferative endometrium.ResultsOne out of 30 patients (3.3%) with proliferative endometrium, 1 out of 14 patients (7.1%) with atypical hyperplasia, and 8 out of 30 patients (26.6%) with endometrial carcinoma were found to have immunoreactivity to cyclin D1. All cases of simple hyperplasia had negative staining for cyclin D1. A positive immunoreaction for Ki67 was obtained in all cases. Statistically significant difference was found in cyclin D1 immunoreactivity between both proliferative endometrium and adenocarcinoma, and simple hyperplasia and adenocarcinoma (p<0.05). In patients with adenocarcinoma, cyclin D1 immunoreactive cases had higher mean Ki67 values compared with the non-immunoreactive ones (p<0.05). Ki67 and cyclin D1 immunoreactivity had no impact on overall survival. Univariate analysis revealed a significant relationship between survival and grade and stage (p<0.01). Cyclin D1 expression was not correlated with age, depth of myometrial invasion, lymphovascular space involvement, grade, lymph node metastasis and stage.ConclusionCyclin D1 expression in endometrial carcinoma is higher than proliferative endometrium and simple hyperplasia. These findings support that cyclin D1 may play a role in endometrial carcinogenesis.

Angiogenesis in Endometrial Carcinoma: Correlation with Survival and Clinicopathologic Risk Factors

Association among angiogenesis, survival and clinicopathologic parameters in endometrial carcinoma was evaluated. Sixty patients who had been diagnosed as endometrial carcinoma, from 1993 to 1998, were included in the study. All patients had been surgically staged with bilateral pelvic and para-aortic lymph node dissection. All hysterectomy specimens were stained immunohistologically for factor VIII-related antigen. The area with the most intensified microvasculature was determined under low-power (×100) magnification, and the microvessel count of this area under high-power (×200) magnification was determined as the microvessel density (MVD) of the tumor. The mean MVD was 26.2 ± 13.0 (range 6–68), and it was considered as high (n = 24; 40%), moderate (n = 19; 31.7%) and low (n = 17; 28.3%) when the MVD was >30, between 15–30 and <15, respectively. Statistical analysis included Mann-Whitney, Kruskal-Wallis and Spearman rank correlation tests. The Kaplan-Meier method was used to evaluate the difference between angiogenesis and survival. Multivariate analysis with the Cox regression model was used in MVD values and different clinicopathological parameters. There was positive correlation between MVD increase and surgicopathological stage (p < 0.05). A significant difference was seen between MVD increase and lymph node metastasis (p < 0.05). There were no differences between MVD and age, histological type, grade and lymphovascular invasion. MVD did not change in association with myometrial invasion depth. There was a significant difference in means of survival between the low and high MVD groups (p = 0.01). However, MVD was not an independent prognostic factor in multivariate analysis. Increased angiogenesis was found to be associated with advanced stage and decreased survival in endometrial carcinoma.

Postoperative Adhesion Formation following Ovarian Reconstruction with Fibrin Glue in the Rabbit

To compare postoperative adhesion formation following ovarian reconstruction with fibrin glue or the microsurgical suturing technique, an experimental study was performed on sixteen adult female rabbits. While left ovaries were reapproximated with 6-0 coated polyglactin using a microsurgical technique, right ovaries were reconstructed with fibrin glue following ovarian bisection. Four weeks later, second-look laparotomies were performed to evaluate the adnexal adhesions. These were scored according to the American Fertility Society classification. Mean adnexal adhesion scores were 8.2 +/- 2.3 in the sutured ovary and 5.0 +/- 1.1 in the glued ovary (p > 0.05). Ovarian reconstruction with fibrin glue does not reduce postoperative adhesion when compared with the usual suturing technique.

A comparison of three histological grading systems in endometrial cancer

MethodsTo compare the architectural, nuclear and International Federation of Gynecology and Obstetrics (FIGO) grading systems in endometrial cancer 70 consecutive patients with endometrial cancer were retrospectively reevaluated with three grading systems. ResultsTwenty-eight (40%), 27 (38.6%) and 14 (20%) cases were reported to have different grades when architectural vs nuclear, architectural vs. FIGO and nuclear vs. FIGO grading systems were compared in evaluation, respectively. Only 3 (42.8%) of the seven died patients had grade 3 in all three grading systems. Five-year survival rates were 95.7, 80, and 78.6% for architectural grade 1, 2 and 3, respectively. Same rates were 96.7, 90.5, and 78.9% for nuclear and 96, 91.7 and 81% for FIGO grading systems, respectively.ConclusionsGrades of the tumors often change when different grading systems are used. Postoperative treatment should be considered when at least one of the grading systems indicates poor differentiation.

Ovarian endodermal sinus tumor in a 76-year-old woman.

A 76‐year‐old woman underwent surgery for pelvic mass, during which a 13 × 8‐cm right ovarian tumor was discovered. On histopathological examination, she was diagnosed with an endodermal sinus tumor with right tubal metastasis. The patient was treated with four cycles of Bleomycin, Etoposide and Cisplatin. She died of disseminated disease four years later.