Veysel Sal

Intravenous Leiomyoma with Extension to the Heart: A Case Report and Review of the Literature

Introduction. Intravenous leiomyomatosis with cardiac extension is an extremely rare uterine tumor. We report here a case of intravenous leiomyoma extending to the right atrium, diagnosed in a patient having leiomyoma. Case Presentation. A 39-year-old woman with no symptoms and a past medical history of two myomectomy operations (7 and 3 years previously) was admitted to our clinic for routine control. We detected a uterine fibroid of 8 centimeters and 4 small solid masses of 1-2 centimeters near the uterus and ovaries at vaginal ultrasonography. Computed tomography (CT) was performed to investigate the abdominal cavity. It revealed a mass originating from the left common iliac vein, which invaded the inferior vena cava (IVC) and extended to the right atrium in addition to the uterine fibroids and pelvic masses. The operation was performed with a combined team of gynecologists and cardiac surgeons and a one-stage operation was accomplished. The postoperative course was uneventful. Conclusion. Abdominal CT is a useful imaging technique for the diagnosis of unusual pathology in a patient with uterine fibroid having suspicious pelvic masses. Also, when a right atrial mass is identified in a female with a prior history of hysterectomy because of leiomyoma or in whom there is a uterine myoma, then intravenous leiomyomatosis should be considered.

Rare cutaneous metastasis in vulvar squamous cell carcinoma without any distant organ spread.

Vulvar cancer is the fourth most common gynaecologic cancer, representing 5% of malignancies of the female genital tract. It occurs most commonly in post-menopausal women with a mean age of 65. In recent years, an increase in incidence rates in young women has been observed. In the United States, about 4900 cases of vulvar cancer are diagnosed and 1000 patients die of vulvar cancer per year (Siegel et al. 2014). Two different pathways for vulvar carcinogenesis have been identified: HPV-dependent and induced by chronic inflammation. HPV is responsible for 60% for all cases. Of the vulvar cancers related to HPV about 55.5% are caused by two strains, HPV-16 or HPV-33 (Insinga et al. 2008). There are three ways that vulvar cancer spreads. First, direct extension to adjacent structures, such as vagina, urethra, clitoris, anüs. A second way of spread is by the lymphatic route. The third way of tumour spread is the haematogenous route associated with advanced disease. Cutaneous metastasis of vulvar cancer is very rare and only nine cases had been reported till 2010 (Wang et al. 2010).

Randomized Trial of Oral Misoprostol Treatment for Cervical Ripening Before Tandem Application in Cervix Cancer

PURPOSE To investigate the efficacy of oral misoprostol administered to facilitate tandem application to the cervix as a part of brachytherapy in patients with cervical cancer. METHODS AND MATERIALS Eighty patients with cervical cancer who had been planned to undergo brachytherapy at Dr. Lütfi Kırdar Kartal Training and Research Hospital were evaluated in a double-blind, prospective, randomized trial. Patients were divided randomly into two groups of 40 patients. The first and second groups received 400 μg of misoprostol orally and placebo, respectively, 3 h before tandem application. The two groups were compared in terms of age, diameter of tumor, parity, age at first intercourse, amount of bleeding and pain at first tandem application, length of endometrial cavity measured by hysterometer, and size of Hegar dilators used for cervical dilatation. RESULTS Of all cases, 63.6%, 16.3%, 10%, 6.3%, 2.5%, and 1.3% were Stage IIB, IIIB, IIIA, IVA, IIA and IIC, respectively. Mean (±SD) age (range) was 49.3 ± 13.1 (25-83) years and 56.6 ± 13.2 (30-78) years in the study and control groups, respectively (p = 0.015). Age at first intercourse, diameter of tumor, parity, amount of bleeding at first tandem application, and length of endometrial cavity measured by hysterometer were not significantly different between the two groups. Pain score was significantly higher in the control group (p < 0.001). Application was significantly easier in the study group compared with controls (p < 0.001). Average size of initial Hegar dilators used for cervical dilatation was significantly higher in the study group compared with controls (p = 0.017). CONCLUSION Administration of misoprostol 400 μg orally for cervical ripening before tandem application facilitates the procedure, increases patient tolerability and comfort, and may decrease complication rates.

Risk factors for recurrence of borderline ovarian tumours: A tertiary centre experience.

abstract The aim of this study was to evaluate the risk factors for recurrence of borderline ovarian tumours. This study investigated 127 women who were finally diagnosed with borderline epithelial ovarian tumours. Most of them were diagnosed in stage I (83.4%). With a median follow-up of 81.8 months (range: 14–205), the median time to recurrence was 22.4 months (range: 3–74). Five-year recurrence-free survival (RFS) and overall survival (OS) rates were 85.8% and 97.6%, respectively. In multivariate analysis, invasive implants and fertility-sparing surgery were found to be independent prognostic factors for 5-year RFS. Overall, 20 patients (15.7%) experienced relapse within the observation period. Although there is no consensus about high-risk category of borderline ovarian tumours, invasive implants and conservative surgery were closely related to the recurrence. Patients presenting these risk factors should undergo closer follow-up.

Primary signet ring cell carcinoma of the cervix: A case report and review of the literature.

Highlights • To date, only 18 cases with primary signet cell carcinoma of the cervix has been reported.• Differentiation of primary tumour from metastatic signet cell carcinoma carries significant important while treatment and prognosis differ significantly.

Is serum level of nestin useful in detecting epithelial ovarian cancer

The aim of the present study was to evaluate the usefulness of nestin as a discriminative marker between benign and malignant ovarian tumors.

Post-coital vaginal cuff dehiscence with small bowel evisceration after laparoscopic type II radical hysterectomy: A case report

Highlights • Vaginal cuff dehiscence with bowel evisceration is a medical emergency that requires prompt diagnosis and immediate surgical intervention.• Restarting coitus prior to wound healing after hysterectomy is the major risk factor for vaginal cuff dehiscence.• Following exclusion of any intestinal injury, vaginal repair can be performed.

Effects of Apigenin on Experimental Ischemia/Reperfusion Injury in the Rat Ovary

Background: Apigenin is a plant-derived compound belonging to the flavone class, which possess antioxidant, free-radical-scavenging and anti-inflammatory properties. Aims: To address the effects of apigenin on serum anti-mullerian hormone levels, tissue oxidative stress parameters and histopathological changes in ovarian ischemia/reperfusion injury. Study Design: Animal experiment. Methods: Twenty-eight female Wistar albino rats were randomly separated into four sections: Sham operation (group 1), ischemia/reperfusion plus saline (group 2), ischemia/reperfusion plus dimethyl sulfoxide (group 3) and ischemia/reperfusion plus apigenin (group 4). In all ischemia/reperfusion groups, a bilateral adnexal 3-h period of ischemia was performed, followed by 3-h of reperfusion. A single dose of 15 mg/kg apigenin was given intraperitoneally 60 min before reperfusion in group 4. After 3-h of reperfusion, both ovaries were removed, and blood samples were collected. The main outcome measures were serum anti-mullerian hormone levels, ovarian tissue malondialdehyde, total nitric oxide, Cu/Zn superoxide dismutase, catalase and glutathione levels and histopathological damage scores. Results: The ovarian tissue nitric oxide level was significantly lower, and the glutathione level was significantly higher in group 4 compared with groups 2 and 3. There was no significant difference in anti-mullerian hormone levels among the three ischemia/reperfusion groups. The histopathological damage score was lower in group 4 than in groups 2 and 3 (p>0.05). Conclusion: Administration of apigenin has no significant protective effect on ovarian reserve and tissue damage in ovarian ischemia/reperfusion injury.

Clot behind the blood: Cerebral vein thrombosis presenting with subarachnoid haemorrhage in a 28-week pregnant woman

Cerebral vein thrombosis (CVT) is a rare complication of pregnancy with usually a favourable prognosis. Diagnosis may be delayed, as physicians tend to avoid imaging in this group. Furthermore, its rare but important association with subarachnoid haemorrhage (SAH) may hinder CVT diagnosis, misguiding the treatment process. Herein, we report a very rare case of CVT associated with SAH during pregnancy, which was first seen in a rural hospital and underlines the pitfalls of the diagnosis and treatment processes in such a setting.

Isolated adnexal torsion in a 20-week spontaneous twin pregnancy

Highlights • Diagnosis of adnexal torsion can be difficult during pregnancy.• Delay in diagnosis can lead to necrosis and loss of the affected ovary.• Laparoscopy is an effective approach in diagnosis and treatment of adnexal torsion even in advanced pregnancies.