Zafer Selçuk Tuncer

Ovarian carcinoma associated with endometriosis.

OBJECTIVES Previous studies have suggested an association between endometriosis and development of ovarian cancer. A study was performed to evaluate the cases of ovarian carcinoma associated with endometriosis. STUDY DESIGN The study includes patients with ovarian carcinoma associated with endometriosis diagnosed between 2000 and 2010 at Hacettepe University Hospital, Ankara, Turkey. A total of 1086 patients who underwent surgical staging for ovarian carcinoma were analyzed retrospectively for the presence of histologically documented endometriosis. The clinical and pathological characteristics of 45 ovarian carcinoma patients associated with endometriosis were evaluated including histologic subtype, stage and grade. RESULTS Ovarian carcinoma was found to be associated with endometriosis in 4.1% (45/1086) of the cases. Of them, 17 patients (37.8%) had clear cell, 15 (33.3%) had endometrioid, 6 (13.3%) had serous papillary, 4 (8.9%) had mucinous and the remaining 3 patients had an undifferentiated subtype of ovarian carcinoma. Twenty-three (51.1%) patients had stage I, 4 (8.9%) had stage II and 18 (40.0%) had stage III disease. The frequency of coexistence of endometriosis was 20.4% (17/83) for clear cell carcinoma and 9.3% (15/161) for endometrioid cell carcinoma. CONCLUSIONS Only a small proportion of ovarian cancer cases were found to be associated with endometriosis. Endometriosis was most frequently associated with clear cell and endometrioid types of ovarian carcinoma. Ovarian carcinoma associated with endometriosis seems to represent a distinct disease entity with different histological subtypes, early presentation and a relatively favorable outcome.

Tuboovarian Abscess due to Colonic Diverticulitis in a Virgin Patient with Morbid Obesity: A Case Report.

Since tuboovarian abscess is almost always a complication of pelvic inflammatory disease, it is rarely observed in virgins. A 30-year-old virgin patient presented with pelvic pain, fever, and vaginal spotting for the previous three weeks. Her abdominopelvic computed tomography scan revealed bilateral multiseptated cystic masses with prominent air-fluid levels suggesting tuboovarian abscesses. The sigmoid colon was lying between two tuboovarian masses, and its borders could not be distinguished from the ovaries. The patient was presumed to have bilateral tuboovarian abscesses which developed as a complication of the sigmoid diverticulitis. She was administered intravenous antibiotic therapy followed by percutaneous drainage under ultrasonographic guidance. She was discharged on the twenty second day with prominent clinical and radiological improvement. Diverticulitis may be a reason for development of tuboovarian abscess in a virgin patient. Early recognition of the condition with percutaneous drainage in addition to antibiotic therapy helps to have an uncomplicated recovery.

Adnexal masses in women with breast cancer

Adnexal masses detected in breast cancer survivors are of particular concern because of the increased risk of ovarian malignancy.

Impaired antioxidant enzyme functions with increased lipid peroxidation in epithelial ovarian cancer

We aimed to identify the possible role of oxidant–antioxidant status in epithelial ovarian cancer (EOC) by measuring (a) antioxidant enzyme (AOE) activities [total superoxide dismutase (SODtotal), manganese‐SOD (Mn‐SOD), copper,zinc‐SOD (Cu,Zn‐SOD), catalase (CAT) and glutathione peroxidase (GPx1)], (b) Mn‐SOD protein expression, (c) lipid peroxidation markers [malondialdehyde (MDA), 8‐epi‐prostaglandin‐F2α (8‐epi‐PGF2α)] and by evaluating the possible correlations between tumor biomarkers, reproductive hormone levels and all measured parameters, comprehensively. The data obtained from the patients with EOC (M, n = 26) evaluated according to the histopathological/clinical characteristics of tumors and compared with data of healthy controls [Ctissue (C1) and Cblood/urine (C2), n = 30, respectively). Significantly, low activities of tumor SODtotal (52%), Mn‐SOD (42%), Cu,Zn‐SOD (55%); high activities of tumor and erythrocyte CAT (66%, 33% respectively) and tumor GPx1 (60%); high levels of tumor Mn‐SOD protein expression; tumor MDA (193%) and urinary 8‐epi‐PGF2α (179%) were observed in serous EOC tumors (M1, n = 18) compared with controls (P < 0.05). However, higher levels of tumor MDA, Mn‐SOD protein expression and urinary 8‐epi‐PGF2α were observed along with lower tumor CAT activity in poorly differentiated or undifferentiated (grade 3, G 3) versus well or moderately well differentiated (grade 1‐2, G 1‐2) serous EOC tumors. Obtained data indicate the presence of a severe redox imbalance in EOC and draw attention to the criticial role of AOEs in the pathogenesis of the disease.

In vitro chemosensitivity in ovarian carcinoma: Comparison of three leading assays.

OBJECTIVE An alternative approach to the current therapy of ovarian carcinoma is the individualization of treatment by determining the sensitivity of tumoral tissue to chemotherapeutic agents before the initiation of chemotherapy. The objectives of the study are to determine the efficacy of in vitro chemosensitivity assays in ovarian carcinoma and to measure the correlation of three leading assays. MATERIAL AND METHODS Fresh tumoral tissue samples of 26 newly diagnosed primary ovarian cancer patients were studied with 3-(4,5-dimeth-ylthiazol-2-yl)-2,5-diphenyltetrazolyum bromide (MTT) assay, adenosine triphosphate-tumor chemosensitivity assay (ATP-TCA) and differential staining cytotoxicity (DISC) assays. Chemosensitivity of tumors were studied for paclitaxel, carboplatin, docetaxel, topotecan, gemcitabine, and doxorubicin with each of the three assays. Subgroup analysis was performed for stage, grade, and histologic type. RESULTS The in vitro chemosensitivity results of MTT, ATP, and DISC assays were found to be similar. The subgroups in which in vitro assays would be more useful were encountered for patients with advanced stage and serous histology ovarian carcinoma. CONCLUSIONS In vitro chemosensitivity can be determined in ovarian carcinoma with ATP, MTT, or DISC assays before the initiation of chemotherapy. These three assays correlate well with each other and are particularly useful for serous and advanced cancers. Large prospective studies comparing standard versus assay-directed therapy with an endpoint of overall survival are required before routine clinical utilization of these assays.

Assessment of oxidant-antioxidant status alterations with tumor biomarkers and reproductive system hormones in uterine MYOMAS

OBJECTIVES Uterine myomas (UM) are responsible for significant morbidity and have adverse effects on quality of life in women. Reactive oxygen species (ROS) and antioxidant enzymes (AOE), as well as sex steroids play important roles in the reproductive physiology processes. Thus, we aimed to investigate the role of oxidant-antioxidant status in UM by measuring the AOE activities and lipid peroxidation (LPO) levels. This is the first study assessing these parameters together in UM based on also menopausal status and evaluating possible correlations between AOE activities, LPO markers, tumor biomarkers, female reproductive system hormone levels, comprehensively. STUDY DESIGN The study group consisted of patients who have undergone surgical resection with confirmed pathology of uterine myoma (UM, n = 25) and divided into subgroups; premenopausal (UMpre) and postmenopausal (UMpost). Erythrocyte copper-zinc superoxide dismutase (Cu,Zn-SOD), catalase (CAT), glutathione peroxidase (GPx1) activities were measured along with plasma malondialdehyde (MDA) and urinary 8-epi-prostaglandin F2α (8-epi-PGF2α) levels in patients with UM. The obtained data were compared to the data of healthy individuals (C, n = 25) and its subgroups; premenopausal (Cpre) and postmenopausal (Cpost). RESULTS All AOE activities were higher (∼40% for Cu,Zn-SOD, p = 0.003; ∼55% for CAT, p = 0.001; ∼15% for GPx1, p = 0.169) and the LPO levels were lower (∼60% for MDA, p = 0.011 and ∼45% for 8-epi-PGF2α, p = 0.055) in patients with UM vs control. Approximately similar alterations were observed in UMpre vs Cpre and in UMpost vs Cpost. A significant negative correlation between erythrocyte Cu,Zn-SOD activity and plasma MDA levels (r = -0.431, p = 0.005) was reported. CONCLUSION Decreased LPO levels might be the consequence of compensator high antioxidant enzyme activities against mild oxidative stress in the circulation of patients with UM. The marked negative correlation between erythrocyte Cu,Zn-SOD activity and plasma MDA levels also supported this finding.

Placental respiratory chain complex activities in high risk pregnancies

Abstract Objectives: Mitochondrial oxidative phosphorylation is the key energy source for placental functions and fetal growth. The purpose of this study was to investigate the function of placenta in high risk pregnancies by measuring mitochondrial respiratory chain complex (RCC) activities, and to evaluate the correlation between double test risk ratio and RCC activities. Methods: The placenta samples were collected from 50 pregnant women. The controls consisted of 20 normal uncomplicated pregnancies and the study group (n = 30) consisted of preeclampsia (PE), intrauterin growth restriction (IUGR), advanced maternal age (AMA), twins and preterm deliveries. Complexes I, II–III, IV and citrate synthase (CS) activities were measured by spectrophotometric assays. Results: Complexes I, II–III and IV activities were significantly lower in the study group than the controls (p < 0.05). Complexes I and II–III activities were significantly reduced in placenta of preterm deliveries compared with the controls (p < 0.003). Double test risk ratio was above the cut-off limit (1:300) in 43% of the study group in which decreased complexes I and II–III activities were observed. Conclusions: Impaired placental mitochondria RCC functions can lead to adverse pregnancy outcomes. Pregnant women with high risk in double test should be monitored carefully in terms of PE, IUGR and preterm delivery.

Preoperative Pet/Ct Findings in Endometrial Cancer: A Study of 30 Cases

Objective: The aim of this study was to find out if preoperative PET/CT could be a substitute for staging surgery and whether SUVmax values correlate with prognostic factors of endometrium cancer. Study Design: 30 patients to whom18-fluorodeoxyglucose PET/CT scan was performed preoperatively were analyzed retrospectively. Standardized uptake value (SUV) was calculated on PET images. PET findings were compared with surgical and pathological findings. Results: SUVmax of the endometrioid type tumors were significantly higher than non-endometrioid types (p: 0.042). SUVmax significantly differ between histologic grades (p: 0.042). SUVmax did not differ between patients who had myometrial invasion less or more than 50% and who had lymphovascular invasion or not. There was not a significant difference between SUVmax and FIGO stages also. Possibility of extra-uterine lesion in PET/CT were significantly higher in late stages (p: 0.004). Sensitivity and specificity of PET/CT for detection of beyond stage 1 disease were 50% and 67% respectively and sensitivity and specificity of PET/CT for detection of lymph node metastasis were 40% and 86% respectively. Conclusion: PET/CT has moderate sensitivity for pre-operative detection of beyond stage 1 cancers but it has a high specificity and low-moderate sensitivity for detection of lymph node metastasis but has high specificity. Because the positive likelihood ratios are relatively low, PET/CT cannot be a substitute for staging surgery.

Over kanseri kliniğini taklit eden malign peritoneal mezotelyoma

Baslica bulgulari over kaynakli kitle, asit ve CA 125 yuksekligi oldugu icin over kanseri on tanisi ile cerrahiye alinan 78 yasindaki olgunun kesin tanisi ancak patoloji raporunun malign mezotelyoma olarak raporlanmasi uzerine konulabilmistir. Oykusunden yillar once yasadigi yer nedeniyle asbeste maruz kaldigi dusunulen hastada kesin tani ameliyat oncesi konulamamistir. Over kanseri ile klinik tablo acisindan benzerlikler gosterse de tedavileri ve sonuclari acisindan aralarinda farklilik bulunan bu malign peritoneal mezotelyoma olgusu ayirici taniya yardimci olmasi acisindan sunulmustur.

Cervical ripening balloon: A successful treatment for massive bleeding in cervical pregnancy

Cervical pregnancy (CP) is a rare and life-threatening form of ectopic pregnancy. The incidence of CP is estimated to be less than 1% of all ectopic pregnancies (Marcovici et al. 1994). Currently, there is no consensus about the optimal treatment for CP. However, general principles for the management of CP include the following goals: minimise the risk of haemorrhage, evacuate the gestational cervical product and preserve the patient’s fertility (Bianchi et al. 2011). Here, we report a case of cervical ectopic pregnancy at 9 weeks of gestation, with positive foetal cardiac activity. The patient was successfully treated with a multimodal intervention, including administration of intra-amniotic potassium chloride (KCL), systemic methotrexate (MTX), cervical curettage, and use of a cervical ripening balloon (CRB) tamponade for cervical bleeding.