Search

OBJECTIVE: Endometrial cancer is the most common gynecological cancer in developed countries. Our study aims to determine the effect of the time between diagnosis and surgery of endometrial cancer on the prognosis of the disease. STUDY DESIGN: Patients who were diagnosed with epithelial type endometrial cancer and did not receive preoperative chemotherapy, radiotherapy, or hormonal therapy were included in the study. RESULTS: Two hundred eighty-five patients were included in the study. We divided the patients into two groups regarding before and after 8 weeks from diagnosis to surgery. Clinical characteristics of the patients were comparable between the groups, except for comorbid conditions and body mass index. Using cox-regression analysis, time to operation did not have a significant effect on both recurrence and cancer-associated death risk. The log-rank test analysis also showed that there was no significant difference in progression-free survival and disease-specific survival between the patients. There was no significant difference between the groups in terms of progression-free survival and disease-specific survival for cases with endometrioid type grade 1-2 tumors. There was also no significant difference between the groups regarding progression-free survival and disease-specific survival in the patients with tumors of endometrioid type grade 3 and non-endometrioid histology. CONCLUSION: Time delay between diagnosis to surgery of the patients with endometrial cancer has no prognostic importance for recurrence and survival outcomes.

To investigate whether CD73 had a role in the pathogenesis of polypoid endometriosis. Our study included 15 cases of polypoid endometriosis, which were diagnosed between 2005 and 2019. Clinical findings were gathered from archive files of relevant clinics and pathology reports. All glass slides were re-examined for confirmation of the diagnosis and the detection of additional microscopic findings. An immunohistochemical examination was performed using anti CD73 antibodies in 15 cases of polypoid endometriosis, and also in a control group that contained 9 cases of endometrial polyps and 9 cases of ovarian conventional endometriosis. In addition to standard gynecologic operations, major non-gynecologic procedures had to be performed in 7 cases. In two cases, the surgical team comprised only general surgeons, and a misdiagnosis of carcinoma was made during the frozen section in one case. The majority of the cases displayed gross polypoid lesions that measured 0.7–13 cm. The most common sites were the ovary and rectosigmoid colon. Microscopically, all lesions exhibited a fibrovascular stroma reminiscent of endometrial stroma, whereas glandular features varied. Immunohistochemical examinations revealed a significant loss of CD73 expression in the stroma of polypoid endometriosis in contrast to the control cases, which retained stromal CD73 expression (p

AIM This study aimed to evaluate the prognostic significance of adequate lymph node dissection (LND) (≥10 pelvic lymph nodes (LNs) and ≥ 5 paraaortic LNs removed) in patients with International Federation of Gynecology and Obstetrics (FIGO) stage II endometrioid endometrial cancer (EEC). METHODS A multicenter department database review was performed to identify patients who had been operated and diagnosed with stage II EEC at seven centers in Turkey retrospectively. Demographic, clinicopathological, and survival data were collected and analyzed. RESULTS We identified 284 women with stage II EEC. There were 170 (59.9%) patients in the adequate lymph node dissection (LND) group and 114 (40.1%) in the inadequate LND group. The 5-year overall survival (OS) rate of the inadequate LND group was significantly lower than that of the adequate LND group (84.1% vs. 89.1%, respectively; p = 0.028). In multivariate analysis, presence of lymphovascular space invasion (LVSI) (hazard ratio [HR]: 2.39, 95% confidence interval [CI]: 1.23-4.63; p = 0.009), age ≥ 60 (HR: 3.30, 95% CI: 1.65-6.57; p = 0.001], and absence of adjuvant therapy (HR: 2.74, 95% CI: 1.40-5.35; p = 0.003) remained as independent risk factors for decreased 5-year disease-free survival (DFS). Inadequate LND (HR: 2.34, 95% CI: 1.18-4.63; p

Aim Endometrial cancer is the most common cancer of the female reproductive tract in the developed countries. There are many risk factors defined for the development of endometrial cancer, including obesity. We aimed to evaluate the significance of adiposity on the survival outcomes of the patients with endometrial cancer. Methods The patients diagnosed with endometrial cancer and underwent surgery between April 2009 and October 2017 were retrospectively reviewed. The visceral adipose tissue and subcutaneous adipose tissue volumes were measured at the level of umbilicus on single-slice magnetic resonance imaging. Visceral adiposity index was calculated. Patients were compared regarding their clinical, demographical, pathologic and survival characteristics. Patients divided into low visceral adiposity (≤0.265, group 1) and high visceral adiposity (>0.265, group 2). Results A total of 186 patients were included in this retrospective study. There was no significant difference in terms of the demographical, clinical and tumor characteristics of the patients, except age, menopausal status, subcutaneous adipose tissue and visceral adipose tissue. Although no significant difference in progression-free survival and disease-specific survival was noted between groups (P = 0.181), more patients in group 2 died because of endometrial cancer as statistically significant (P = 0.024). Disease-specific survival showed a significant difference between groups according to the log-rank test. Conclusion Visceral adiposity tissue is a significant and reliable prognostic indicator for endometrial cancer prognosis. Women diagnosed with endometrial cancer should be informed about the deleterious effects of visceral adiposity on disease-specific survival.

This study was conducted to compare the long-term oncological outcomes of laparotomy and laparoscopic surgeries in endometrial cancer under the light of the 2016 ESMO-ESGO-ESTRO risk classification system, with particular focus on the high–intermediate-and high-risk categories. Using multicentric databases between January 2005 and January 2016, disease-free and overall survivals of 2745 endometrial cancer cases were compared according to the surgery route (laparotomy vs. laparoscopy). The high–intermediate-and high-risk patients were defined with respect to the 2016 ESMO-ESGO-ESTRO risk classification system, and they were analyzed with respect to differences in survival rates. Of the 2745 patients, 1743 (63.5%) were operated by laparotomy, and the remaining were operated with laparoscopy. The total numbers of high–intermediate- and high-risk endometrial cancer cases were 734 (45%) patients in the laparotomy group and 307 (30.7%) patients in the laparoscopy group. Disease-free and overall survivals were not statistically different when compared between laparoscopy and laparotomy groups in terms of low-, intermediate-, high–intermediateand high-risk endometrial cancer. In conclusion, regardless of the endometrial cancer risk category, long-term oncological outcomes of the laparoscopic approach were found to be comparable to those treated with laparotomy. Our results are encouraging to consider laparoscopic surgery for high–intermediate- and high-risk endometrial cancer cases., NA

Introduction/Background* The term vaginal intraepithelial neoplasia (VaIN) refers to a premalignant lesion that has the potential to progress to invasive cancer. VaIN is a very rare disease and represents less than 1% of all female genital intraepithelial neoplastic lesions. Several studies have shown that high-risk (hr) HPV infection is an important factor in the development of VaIN. Although p16INK4A/Ki67 markers have been studied many times in cervical dysplastic lesions, they have rarely been used in vaginal dysplastic lesions. In the present study, we aimed to analyze the role of p16 and Ki67 levels on the progression or regression of VaIN together with HPV infection in vaginal epithelial cells with neoplastic changes. Methodology Cases of VaIN1, and VaIN2/3 were retrospectively identified from the surgical pathology files at the Department of Pathology, Istanbul Medical Faculty, Istanbul University from 2003 to 2020. A total of 10 cases of VAIN1, and 38 cases of VAIN2/3were identified. The primary endpoints of the study were the recurrence of VAIN and progression to vaginal carcinoma. Result(s)* Most of HPV positive cases (22 out of 36) were infected with HPV16 subtype (61.1%). One patient had HPV18 subtype (5.9%) infection. There was a significant correlation between the expression of p16INK4A and Ki67 together with the disease recurrence. Patients with strong expression of both p16INK4A and Ki67 had a significantly higher disease recurrence (p=0.010). Furthermore, we observed that the patients with strong expression of p16INK4A and Ki67 together, had the recurrence of the disease less than 12 months (p=0.041). Patients with strong expression of both p16INK4A and Ki67 had a significantly higher disease progression to invasive cancer (p=0.015). hr HPV positivity was significantly related with moderate or strong expression of p16 and ki67 (p=0.002). Conclusion* Strong expressions of p16INK4A and Ki67 together in vaginal tissue, had a significantly higher risk of recurrence. Furthermore, with strong expression of both markers together, the disease recurred more rapidly. In addition, strong expression of both markers might be associated with malignant progression. Finally, rate of infection with HPV18 subtype might be less than expected in patients with VaIN. These results need to be confirmed in future prospective studies.

Objective: The aim of this study was to investigate the clinicopathological features and survival of patients with undifferentiated endometrial carcinoma (UEC). Methods: Patients who were operated between 2006 and 2014 for endometrial cancer (EC) in the same center were retrospectively reviewed from the clinical archive. Data were obtained from patient files. Survival curves and rates were calculated using the Kaplan-Meier method, and differences in survival were evaluated using the Log-Rank test. Results: In this study, 774 patients with EC were screened. According to the pathology report, 14 (1.8%) had undifferentiated type histology. The mean age, parity and body mass index (BMI) of the patients were 58.6 year (range 40-73); 3.28 (range 0-6) and 32.1 kg/m2 (range 22.8-41.7), respectively. Of the patients, 64% (n=9) had deep myometrial invasion, 93% (n=13) had lymphovascular space invasion, and 57% (n=8) had cervical involvement. Tumor size was greater than 5 cm in 64% (n=9) of the patients. Thirty five percent (n=5) of the patients were stage 1A, 21% (n=3) were stage 1B, 14% (n=2) were stage 2, 14% were stage 3C, and 14% were stage 4. As adjuvant therapy, 21% (n=3) of the patients received chemotherapy only, 14% (n=2) received radiotherapy only, and 57% (n=8) received chemotherapy and radiotherapy together. The mean follow-up duration was 36 months (range 4-104). In this period, survival rates were 77% for early-stage (FIGO 1-2) and 0% for advanced-stage (FIGO 3-4). The mean survival duration was 81 months in the early stage; 6.8 months in advanced stage (Log Rank test P value= 0.001). Conclusion: According to this study, UEC is highly associated with pathological poor prognostic factors such as deep myometrial invasion, lymphovascular space invasion, cervical involvement and large tumor size. Patients with advanced stage do not have the chance to survive. Long-term survival is possible if the diagnosis and treatment of the disease is achieved while the tumor is limited to the uterus.

Objectives This study aims to investigate the rates of extra-uterine metastases of non-endometrioid endometrial tumors limited to the half of the myometrium. Methods Patients operated for endometrial cancer between 2005-2015 in two gynecologic oncology centers were screened from clinical archives. The inclusion criteria were serous, clear cell, undifferentiated or carcinosarcoma histologies and less than half myometrial invasion. Each histological type was analyzed for adnexal metastasis, lymph node metastasis (pelvic/paraaortic) and omental metastasis. Results A total of 116 patients with the median age of 64 (34-72) were examined. Of the patients, 57 were serous (49.1%), 29 were clear cell (25.0%), 27 were carcinosarcoma (23.3%) and 3 (2.6%) were undifferentiated histologic type. Adnexal metastasis (over/tuba) was detected in 15 patients (12.9 %), nodal metastasis in 10 patients (8.6%), and omental metastasis in 15 patients (12.9%). The rates of adnexal metastases were calculated as 14% for serous type, 10% for clear cell type and 11% for carcinosarcoma. Omental metastasis rates were 11% for serous type, 17% for clear cell type and 15% for carcinosarcoma. The rates of extra-peritoneal nodal metastases were calculated as 12% for serous type, 7% for clear cell type and 4% for carcinosarcoma. Conclusion According to the findings obtained in this study, the rates of extra-uterine metastasis are high for serous, clear cell or carcinosarcoma types even in the early period. However, the lymph node metastasis in the carcinosarcoma seems to be lower. A comprehensive staging surgery should be planned for these patients, regardless of the depth of myometrial invasion.

Aim: The aim of this study was to determine the clinicopathological characteristics, treatment details and outcome of patients with brain metastasis from epithelial ovarian carcinoma (EOC). Methods: This study included 21 patients diagnosed with brain metastasis from EOC between 1999 and 2009. Results: Median age was 61 years (range 38-77). The median time elapsed from EOC diagnosis to brain metastasis detection was 32 months. Single brain metastases were found in 10 (48%) cases, and there was extra-cranial disease in 11 (52%) cases. During the mean 86 months of follow-up, 18 of the patients (86%) died of the disease and 3 (14%) were alive with disease. The median survival time after the initial diagnosis of brain metastasis was 9 months. The median overall survival (OS) from initial diagnosis of EOC was 50 months. In univariate analysis, prolonged time from initial diagnosis to central nervous system metastasis (more than 32 months) (p = 0.001), treatment with radiotherapy (p < 0.001), optimal cytoreductive operation (p = 0.02) were all positively correlated with OS. Conclusion: The prognosis of patients with brain metastasis from EOC is still poor. The significant predictors of survival in our series were whole brain radiotherapy, prolonged elapsed time from initial diagnosis to brain metastasis and optimal cytoreductive surgery.

The aim of this study was to reveal the results of hyperthermic intraperitoneal chemotherapy (HIPEC procedure) performed during cytoreductive surgery (CRS) in patients with endometrial cancer and epithelial ovarian cancer which included mainly platinum-resistant patients.Patients who underwent CRS+HIPEC between May 2015 and January 2020 were evaluated retrospectively. Surgical complications were graded according to the Clavien-Dindo classification.A total of 33 CRS+HIPEC procedures were performed in 32 patients, two of whom had recurrent endometrial cancer. Of the 30 patients with epithelial ovarian cancer (EOC), five underwent interval CRS+HIPEC, and remaining 25 patients underwent secondary CRS+HIPEC treatment due to relapsed disease. Eighteen of the patients with relapsed disease were platinum-resistant. The overall operative mortality and severe morbidity rates were %3 and 12%, respectively. For 30 patients with EOC, during a median follow-up period of 15 months, Kaplan-Meier survival analysis revealed a 1-year OS and PFS rates of 69.7% and 30.3%, respectively. Moreover, in the subgroup analysis of the platinum-resistant cohort, median OS and PFS were 14 and five months, respectively.CRS+HIPEC procedures had acceptable severe morbidity and mortality rates. In addition, patients with recurrent EOC and without a visible residual disease at the end of cytoreductive surgery had, though not statistically significant, longer OS . HIPEC administration during CRS was not associated with adverse outcomes in the platinum-resistant EOC cohort. The short-term results of the current study are promising.Bu çalışmanın amacı, ağırlıklı olarak platine dirençli hastalardan oluşan epitelyal over kanserli ve endometriyal kanserli hastalarda sitoredüktif cerrahi (SRC) esnasında yapılan HİPEK işleminin sonuçlarını ortaya koymaktır.Mayıs 2015-0cak 2020 arasında SRC sonrası HİPEK uygulanan hastaların bilgileri retrospektif olarak değerlendirildi. Cerrahi komplikasyonlar, Clavien-Dindo sınıflamasına göre sınıflandırıldı.32 hastaya SRC+HİPEK uygulandı. Tedavinin uygulandığı hastalardan 2 tanesi endometriyum kanseriydi. Epitelyal over kanseri olan 30 hastanın 5 tanesine interval SRC+HİPEK yapıldı. Nüks epitelyal over kanseri olan 25 hastaya ise sekonder SRC+HİPEK uygulandı. Nüks epitelyal over kanserli 18 hasta platine dirençliydi. Retrospektif olarak operasyona bağlı mortalite %3 ve ciddi morbidite %12 olarak saptandı Epitelyal over kanseri olan 30 hastanın ortance takip süresi 15 ay idi. Kaplan-Meier sağkalım l istatistik testine göre 1 yıllık toplam sağkalım %69 ve hastalıksız sağkalım %30.3 olarak hesaplandı.SRC+HİPEK prosedürünün kabul edilebilir ciddi morbidite ve mortalite oranları vardır. Öte yandan, tam sitoredüktif cerrahi geçiren nüks epitelyal over kanserli hastaların genel sağkalımlarının sayısal olarak daha uzun olduğu ancak bunun istatistiksel olarak anlamlı olmadığı görülmüştür. SRC esnasında HİPEK uygulaması, platine dirençli epitelyal over kanseri kohortunda olumsuz sonuçlarla ilişkili bulunmamıştır. Mevcut çalışmanın kısa dönem sonuçları umut vericidir.

Objective: Our objective was to assess the patients who have probable early stage ovarian cancer. Materal and Method: Between 2010-2018, 208 patients with isolated adnexal masses who underwent surgery due to presumed malignancy were analyzed. We excluded patients with radiologic evidence of ascites and tumour implants. Results: According to the final pathology reports, 52 (25%) of 208 patients had benign tumours, 46 (22%) were borderline, and 110 (53%) patients’ tumours were malignant. The most unexpected benign tumours were serous cystadenofibroma. Of the malignant tumours, 3 were uterine sarcomas, 8 were metastatic ovarian tumours (all gastrointestinal origin), and 99 were primary ovarian cancers. Seventy-six of 99 primary ovarian cancers were epithelial and 23 were nonepithelial. The most common histologic types were respectively serous and endometrioid adenocarcinoma. Seventy-six percent of primary ovarian cancers were early stage (stage 1-2) and 24% were advanced stage (stage 3-4). Conclusion: Patients with a suspicious adnexal mass, even if ascites or carcinomatosis are not existing, have a high rate of malignancy and should be managed considering this risk., Amaç: Amacımız muhtemelen malign adneksiyel kitlesi olan hastaları değerlendirmektir. Gereç ve Yöntem: 2010-2018 yılları arasında salt adneksiyal kitlesi olan ve malignite riski nedeniyle ameliyat yapılan 208 hastanın medikal verileri incelendi. Radyolojik olarak asit ve tümöral implant bulgusu olan hastalar çalışma dışı bırakıldı. Bulgular: Nihai patoloji raporlarına göre 208 hastanın 52'si (%25) benign, 46'sı (%22) borderline ve 110'u (%53) malign idi. En beklenmedik benign tümör seröz kistadenofibrom idi. Malign tümörlerin 3'ü uterin sarkom, 8'i metastatik over kanseri (tümü gastrointestinal kaynaklı), 99'u primer over kanseri idi. Doksan dokuz primer over kanserinin 76'sı epitelyal, 23'ü nonepitelyal idi. En sık görülen histolojik tipler sırasıyla, seröz ve endometrioid adenokarsinom idi. Primer over kanserlerinin %76'sı erken evrede (evre 1-2), %24'ü ileri evrede (evre 3-4) idi. Sonuç: Şüpheli adneksiyal kitlesi olan hastalarda, asit veya karsinomatosiz bulgusu olmasa bile, yüksek malignite riski mevcuttur ve bu risk göz önünde bulundurularak yönetilmelidir.

Objective To evaluate the outcomes of surgical treatment in patients with chemoradiotherapy (CRT)-resistant and locally advanced cervical cancer (LACC). Methods Patients with LACC who underwent surgery due to resistance to CRT between 2005 and 2015 were reviewed retrospectively. Disease-free survival (DFS) and overall survival (OS) related factors were analyzed. Results A total of 23 patients were included in the study and the median age was 51 years old. A total of 14 patients (60.8%) experienced recurrence; among these recurrences, 8 of them were local, 5 were distant, 1 was both distant and local. A total of 9 patients (39%) died. The Median DFS and OS durations were 15 and 32 months, respectively. A total of 17 patients (74%) had undergone simple hysterectomy, 4 (17%) radical hysterectomy, and 2 (9%) total pelvic exenteration. Postoperative grade 3 and 4 complications were seen in 12 patients (52%). Macroscopic tumor presence in the pathology specimen was associated with distant recurrence and positive surgical margins with local recurrence (Log-Rank test p = 0.029 and p = 0.048, respectively). The only factor associated with OS was surgical margin positivity (Log-Rank test p = 0.008). The type of surgery, grades 3 and 4 postoperative complications, brachytherapy, and tumor histology were not associated with recurrence. Conclusion In patients with LACC, hysterectomy is an option in the presence of a central residual tumor after CRT. However, the risk of grades 3 and 4 complications of performed surgery is high. The presence of macroscopic tumor in the pathology specimen and positive surgical margins are poor prognostic factors. The goal of the surgeon should be to achieve a negative surgical margin. It does not seem important if the surgery is simple or radical.

Purpose: we aimed to investigate whether systematic pelvic and paraaortic lymph node dissection delivers any survival advantage in a subgroup of patients with type II endometrial carcinoma and carcinosarcoma. Methods: we evaluated 135 patients with clinically early-stage (Stage I-II) type II endometrial carcinoma and carcinosarcoma who underwent systematic pelvic and paraaortic lymph node dissection or who did not undergo any lymph node dissection. Results: overall survival (OS) and recurrence-free survivals (RFS) were significantly longer in the systematic lymph node dissection group (hazard ratio 0.28, 95% CI 0.13-0.62 p=0.002 for OS and hazard ratio 0.31, 95% CI 0.14-0.69 p=0.004 for RFS). Multivariate analysis showed that lymph node dissection, age, lymph node metastasis, and adjuvant therapy were independent prognostic variables of OS and RFS. Conclusions: systematic pelvic and paraaortic lymph node dissection independently and significantly prolongs the survival of patients with early-stage type II endometrial carcinoma and carcinosarcoma., NA

Introduction/Background Adnexal mass is one of the leading causes of admission to the gynecology clinics. Distinction and early diagnosis of malignancy are critical points that the surgical procedure (laparotomy/ laparoscopy, incision type, debulking) and experience/ competence of the surgeon play a major role in the prognosis of the patient who has malignancy. Some of existing indexes are too complex to be used in daily practice, and some contain markers that cannot be done anywhere.Risk of malignancy index(RMI) is practical and simple. Methodology Between January 2010 and December 2018, 264 patients who had purely adnexal mass and underwent surgery due to presumed malignancy were analyzed. Since 56 patients had data loss, 208 patients were included in the study. RMI-3 and RMI-4 scores were calculated retrospectively. Results According to the final pathology reports, 52 (25%) of 208 patients were benign, 46 (22%) were borderline and 110 (53%) were malignant. Age and menopausal status were significantly different only in borderline group (table 1). Of malignant tumors, 3 were uterine sarcomas, 8 were metastatic ovarian tumors (all gastrointestinal origin), 99 were primary ovarian cancers. 76 of primary ovarian cancers were epithelial and 23 were nonepithelial. The most common type were respectively serous and endometrioid adenocarcinoma. 76% of primary ovarian cancers were at early stage (stage1–2) and 24% were at advanced stage (stage 3–4). RMI-3 and RMI-4 were both have low specificity, sensitivity and predictive values (table 2). The most unexpected benign tumors were serous cystadenofibroma(%24). Conclusion For patients with adnexal masses who are not easily accessible to gynecological oncologists, the ability to differentiate benign/ malignant in less specialized hospitals by simple methods will prevent unnecessary referrals and inadequate surgical procedures. This index and our approach are not sufficient.New techniques need to be developed. Disclosure Nothing to disclose

Introduction/Background It has been reported that the incidence of ovarian tumours accompanying gestation is between 1–2.%. Methodology In our study, 60 pregnant patient were included, who applied to tertied medical centre of gynecology and obstetrics policlinics in between january 2011–may 2015, and whose obstetric evaluations complied with the criterion. Results During the antenatal track, 33 (%55) pregnannt patients were decided to be followed staying conservative under the control of adnexial masses for 26 (%43.3) pregnant patients operations in early pregnancy or evaluation of adnexial masses in caesarian, and/or malignity caused staging surgery was planned 1 (%1.7) pregnant patient was suggested therapotic termination and later chemoteraphy upon clear diagnosis of malignity in early pregnancy. Radiological diagnosis and track of adnexial masses via ultrasound was applied on 11 (18.3) pregnant patients, while magnetic resonance imaging scan wanted from 49 (%81.7) pregnant patients who were strongly doubted to have malignity of ultrasound .and the management/control of adnexial bulk of pregnancy was made through the magnetic resonance imaging symptom and interpretation. Ultrasound and magnetic resonance imaging symptoms were interpreted in the side of strong bening symptoms for 38 (%63) pregnant patients, while it was malign for 22 (%36.7) pregnant patients under the light of the pathologic results of operated patients, bening cyctic structures were detected on 44 (%73.3) pregnant patients, borderline cyctic structures on 3 (% 5) ang malign cyctic structures on 6 (% 10) of them myoma uteri was detected on 4 (%6.7) of the pregnant patients applied due to adnexial masses. Conclusion This facilitates diagnosis as USG and MR are relative cheap and harmless. In this study when radiologic findings in 22 patients who show malignancy symptoms are compared to the post-op pathologic findings, only 8 (%36.4) patients were diagnosed as malignant tumours. Disclosure Nothing to disclose.

Introduction/Background The most common cause of death due to endometrial cancer depends on the high risk histologies as we call type 2 cancer. There is no definite recommendation for early stage disease in the international guidelines. We aimed to investigate different adjuvant modalities in high grade endometrioid and non-endometrioid FIGO stage 1 and 2 patients. Methodology Retrospective database review was performed to identify endometrial cancer patients which were surgically staged between 2006 and 2016 in Istanbul Faculty of Medicine. Patients were compared regarding their clinical, demographical, surgical and pathological differences using independent two test and chi-square test. Kaplan-Meier method was used to calculate disease progression free survival and overall survival in women with type 2 endometrium cancer followed with two different treatment modalities postoperatively. Results A total of 124 patients were included. Mean age and body mass index (BMI) were 63.1 years and 31.8 kg/m2. Thirty-eight (30.6%) patients were grade 3 endometrioid, twenty-seven (21.8%) patients were serous type endometrial cancer. Pelvic lymphadenectomy were done for all patients and mean lymph node was 13.3. Adjuvant treatments were brachytherapy (12.9%), pelvic radiotherapy (27.4%), chemotherapy+brachytherapy (22.6%), chemotherapy+pelvic radiotherapy (22.6%) and chemotherapy alone (14.5%). Patients were divided into two groups as chemotherapy and radiotherapy. Age, BMI, pelvic and para-aortic lymph node numbers, presence of lympho-vascular space invasion were not statistically significant different between groups. High grade endometrioid cancer and stage 1b disease were statistically significantly higher in radiotherapy group (p Conclusion Chemotherapy seems to be a better option for early stage type 2 endometrial cancer. Disclosure Nothing to disclose.

Introduction/Background In this study we aimed to compare the long-term oncological outcomes of laparotomy (LT) and laparoscopic (LS) surgeries in endometrial cancer under the light of 2016 ESMO-ESGO-ESTRO risk classification system, focusing on the high intermediate and high-risk categories. Methodology Using multicentric database, overall (OS) and disease-free survivals (DFS) of 2745 endometrial cancer cases were compared according the surgery route, laparotomy vs laparoscopy. A sub-analysis was performed considering the 2016 ESMO-ESGO-ESTRO risk classification for endometrial cancer. Thus, high intermediate and high-risk patients were grouped and a comparison was made between the groups. Results Among the enrolled patients 1743 (63.5%) were operated by laparotomy and 1002 (36.5%) were operated with laparoscopy. The total number of high intermediate and high-risk endometrial cancer cases was 734 (45%) patients in the LT group and 307 (30.7%) patients in the LS group. OS and DFS were not statistically different when compared between LS and LT groups in terms of low, intermediate, high intermediate and high-risk endometrial cancer. Conclusion Regardless of the endometrial cancer risk category, long-term oncologic outcomes of LS were found to be comparable to those treated classically with LT. Our results are encouraging for primarily considering laparoscopic surgery for high intermediate and high-risk endometrial cancer cases in order to minimize surgical morbidity, as adjuvant therapies will mostly be offered to this population. It should be strongly emphasized that this suggestion is limited to gynecological oncology centers with high laparoscopical experience. Disclosure Nothing to disclose.

Introduction/Background The purpose of this study was to investigate prognostic factors associated with overall survival (OS) in endometrioid endometrial cancer (EC). Methodology A multicenter, retrospective department database review was performed to identify patients with endometrioid EC at seven high-volume gynecologic oncology centers in Turkey. A total of 4993 women who had undergone primary surgery between 1999 and 2018 were included. Women were staged according to the 2009 FIGO staging system. Kaplan-Meier method was used to generate survival data. Factors predictive of outcome were analyzed using Cox proportional hazards models. Results Three thousand two hundred and nineteen women (64.5%) were classified as stage IA, 1034 (20.7%) as IB, 286 (5.7%) as II, 72 (1.4%) as IIIA, 15 (0.3%) as IIIB, 173 (3.55) as IIIC1, 128 (2.6%) as IIIC2, and 66 (1.3%) as stage IV. The median age at surgery was 58 years (range, 21–94 years), and the median duration of follow-up was 47 months (range, 3–227 months). For the entire cohort, the 5-year disease-free survival was 75.1% whereas the 5-year OS was 82.2%. Age ≥60 years (Hazard ratio [HR]: 1.21, 95% confidence interval [CI]:1.06–1.40; p=0.005), myometrial invasion (MMI) ≥1/2 (HR: 1.19, 95% CI:1.02–1.41; p=0.02), lymphovascular space invasion (LVSI) (HR: 1.29, 95% CI:1.05–1.58; p=0.01), and baseline serum CA 125 ≥35 U/ml (HR: 1.29, 95% CI:1.08-1.55; p=0.005) were identified as independent prognostic factors for decreased OS. Conclusion Age ≥60 years, MMI ≥1/2, LVSI, and baseline serum CA 125≥35 U/ml seem to be independent prognostic factors for decreased OS in Turkish endometrioid EC population. Disclosure Nothing to disclose.

Objective The aim of the study is to investigate factors related to overall survival in advanced stage ovarian, tubal, or peritoneal cancer and to identify strong and weak prognostic factors. Methods We retrospectively reviewed 190 patients who underwent primary cytoreductive surgery between 2003 and 2013. Results Median overall survival duration was founded 58 months (95% CI 49–67). Five-year overall survival ratio was 48.5%. Presence of tumour at upper abdomen, suboptimal cytoreduction (residual >1 cm), surgery without lymphadenectomy, and presence of peritoneal ascites more than 1 L had a significantly negative effect on overall survival, but not histological grade and CA-125 level, by univariate Cox analysis. Age and presence of tumour in the upper abdomen were independent poor prognostic factors according to multivariate Cox model (HR 1.025; 95% CI 1.009–1.040 and HR 1.533; 95% CI 1.039–2.263, respectively). Conclusion This study supports that the presence of tumour in the upper abdomen is the most important independent poor prognostic factor in patients with performed primary surgery for advanced stage ovarian, tubal, and peritoneal cancer. Upper abdominal metastasis is the most important predictive factor for optimal cytoreduction ( P 0.001, HR 6.567; 95% CI 3.059–14.096).

Objective To review the clinicopathologic and survival outcomes of patients with serous endometrial cancer (EC) and to investigate subgroup analysis based on pure serous and mixed serous EC subtypes. Material and methods Patients who underwent EC surgery between 2002 and 2014 and who were reported as serous EC were enrolled in the study. All patients were diagnosed as having serous EC or mixed serous EC with serous component higher than 10% based on the postoperative pathology report. Results A total of 93 patients were analyzed. The median disease-free and overall survival (OS) durations were 49.6 and 32.2 months, respectively. Forty-three patients (46.2%) relapsed and 35 patients (37.6%) died. The histologic type was pure serous EC in 52 (55.9%) and mixed EC in 41 (44.9%) patients. There was no statistical difference between the pure serous and mixed serous groups in terms of age, International Federation of Gynecology and Obstetrics stage, lymphadenectomy, lymph node metastasis or adjuvant therapy combinations. Twenty-nine (55.8%) patients in the pure serous group and 14 (34.1%) in the mixed serous group hade recurrence (p=0.038). Twenty-five (48.1%) patients in the pure serous group and 10 (24.4%) in the mixed serous group died (p=0.034). In the pure serous group, the mean disease-free and OS durations were shorter than in the mixed serous group (59 vs. 81 months and 73 vs. 95 months, log-rank p=0.055 and 0.041, respectively). Histologic type was a significant prognostic factor on recurrence and OS in the univariate analysis (Hazard ratio: 2.404, 95% Confidence interval: 1.01-5.71; 2.027, respectively), but not in the multivariate analysis, which included disease stage and age of the patients. Conclusion Compared with pure serous and mixed serous endometrium cancer groups, primary surgical treatments, clinicopathologic features and adjuvant treatments were similar, but there was a survival difference. Patients with pure serous cancer had a worse prognosis. However histology was not an independent factor for survival.

To investigate the survival-related factors of patients with advanced stage ovarian cancer who underwent debulking surgery after neoadjuvant chemotherapy (NAC).Two hundred three patients with stage IIIC to IV ovarian cancer who underwent debulking surgery after NAC between 2002 and 2012 were retrospectively analyzed. Overall survival-associated factors, including the performance of optimal surgery, the timing of NAC cycles, the presence of tumour regression according to the pathology report, and lymphadenectomy, were explored using logistic regression analyses.Of the 203 patients, 82% (n = 165) underwent optimal surgery. The median follow-up time was 34 months (range 1-124), and the median overall survival was 37.5 months (95% CI 32.6-42.3). The 5-year overall survival rate was 31.3%. Performance of optimal surgery;4 NAC cycles; presence of tumour regression (either macroscopically, microscopically, or no tumour present) in the omentum according to the pathology report; and lymphadenectomy were found to be statistically significant based on a univariate Cox analysis. Of these factors,1 cm residual tumour, no tumour regression in the omentum according to the pathology report, and4 NAC cycles were significant predictors of a poor prognosis based on a multivariate Cox model (hazard ratio [HR] 1.62, 95% CI 1.02-2.59; HR 2.07, 95% CI 1.36-3.17; HR 1.55, 95% CI 1.07-2.34, respectively).Results of the study support that1 cm residual tumour at the end of the surgery, the presence of a macroscopic tumour in the omentum, and4 NAC cycles were independent poor prognostic factors in patients with advanced stage ovarian, tubal, or peritoneal cancer who underwent surgery after NAC.

Objective: The aim of this study was to compare the survival durations of patients with uterine carcinosarcoma with the survival of patients with serous endometrial cancer.Method: Patients who were operated for endometrial cancer between 2002 and 2014 were screened from clinic archive. Patients with histological tumor type carcinosarcoma or serous type were included in the study.Results: Total number of patients was 99; 53 of them had carcinosarcoma and 46 had serous histology. Median disease-free survival was 20 (2-27) months in carcinosarcoma and 36 (3-180) months in serous type (Log-Rank test p=0.156). Median overall survival duration was 28 (4-170) months for carcinosarcoma and 46 (3-180) months for serous (p=0.105). The 5-year overall survival rate was 41.2% in carcinosarcoma histology and 55.4% in serous histology. After recurrence, patients with carcinosarcoma histology survived for an average of 8 (1-19) months, while those with serous histology survived for an average of 14 (2-43) months (p=0.090).Conclusion: According to the results of Log-Rank test analysis, no statistically significant survival difference between the patients with uterin carcinosarcoma and with serous endometrial cancer was found. However, disease-free survival, overall survival, and survival duration after recurrence are longer in serous histology than in carcinosarcoma., Amaç: Bu çalışmanın amacı uterin karsinosarkomlu hastaların yaşam süresini, seröz endometrial kanserli hastaların yaşam süreleri ile karşılaştırmaktı.Yöntem: 2002-2014 yılları arasında endometriyal kanser nedeniyle opere edilen hastalar klinik arşivinden tarandı. Çalışmaya histolojik tümör tipi karsinosarkom veya seröz tip olan hastalar dahil edildi.Bulgular: Toplam hasta sayısı 99; bunların 53’ünde karsinosarkom, 46’sında seröz histoloji saptandı. Medyan hastalıksız sağkalım süresi karsinosarkomda 20 (2-27) ay ve seröz tipte 36 (3-180) aydı (Log-Rank testi p=0,156). Medyan sağkalım süresi karsinosarkom için 28 (4-170) ay, seröz için 46 (3-180) aydı (p=0,105). Beş yıllık genel sağkalım oranı, karsinosarkom histolojisinde %41,2 iken, seröz histolojide %55,4 idi. Nüksten sonra, karsinosarkom histolojisi olan hastalar ortalama 8 (1-19) ay, seröz histolojisi olanlar ortalama 14 (2-43 ay) yaşamışlardı (p=0,090).Sonuç: Log-Rank test analizi sonuçlarına göre, uterin karsinosarkomlu ve seröz endometriyal kanserli hastalar arasında istatistiksel olarak anlamlı bir sağkalım farkı bulunmadı. Bununla birlikte, hastalıksız sağkalım, genel sağkalım ve nüks sonrası sağkalım süresi seröz histolojide karsinosarkomdan daha uzundur.

Çevik, Nazife (Arel Author), PurposeOvarian cancer (OC) is first gynaecologic cancer that causes women death and epithelial ovarian cancer (EOC) is the most lethal ovarian cancer type. While treatment is commonly successful, some cases (10-20%) show resistance to chemotherapy which is followed by recurrence. MicroRNA (miRNA) based diagnosis methods are slightly important for recurrent ovarian cancer diagnosis. We aimed to detect novel circulating miRNAs to be used as an early diagnosis and prediction tools for recurrent EOC.MethodsIn this study, recurrent EOC serum samples and healthy control serum samples were compared for miRNA expression analysis by microarray. Microarray results were analyzed by bioinformatics tools and differentially expressed hsa-miR-1273g-3p was obtained. After microarray analysis, differentially expressed hsa-miR-1273g-3p was validated by Real-Time PCR (RT-qPCR). The relation between target genes of hsa-miR-1273g-3p and ovarian cancer were examined by Pathway Studio((R)) (v.11.4.0.8).ResultsThe expression of hsa-miR-1273g-3p was found to be significantly down-regulated by t test Bonferroni FWER corrected p2, in recurrence EOC compare with healthy controls groups. The RT-qPCR results confirmed that relative expressions of the serum hsa-miR-1273g-3p were significantly down-regulated in patients with recurrent EOC (p=0.0275). Serum hsa-miR-1273g-3p levels could discriminate patients with recurrent EOC from healthy controls, with a power area under the curve (AUC) of 0.7.ConclusionThis study suggested that hsa-miR-1273g-3p plays a significant role in regulation of related genes, which are TNF-alfa, COL1A1, MMP-2, MMP-9, with recurrent EOC outcome. hsa-miR-1273g-3p may be used as a prognostic marker for recurrent EOC after chemotherapy.

Objective: It is known that optimal or complete cytoreduction is the most important factor in patients with advanced ovarian cancer. The aim of this study was to examine the results of patients who did not undergo optimal cytoreduction and to examine subgroup analysis based on neoadjuvant chemotherapy (NAC). Material and Methods: Patients with advanced ovarian cancer and suboptimal surgery were retrospectively reviewed. Results: A total of 99 patients with a median age of 59.0 years (range, 22-87 years) were studied. The median follow-up time was 39±32.7 months, 81 patients (81.8%) died and 18 patients (18.2%) were alive. The five-year survival rate was 27.6%. Of the patients, 37 (37.4%) were underwent surgery after NAC, 62 (62.3%) were primary. More patients with NAC died within 3 years compared with those without NAC (83.9% vs 56.0%) (p=0.015). Patients with NAC had less tumor spread (presence of visible tumor in the upper abdomen during surgery) (29.7% vs 72.6%; p

Aim 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. Material and Methods In this retrospective study, 50 patients who were diagnosed with synchronous primary endometrial and epithelial ovarian cancers and underwent surgery between 1998 and 2010 were reviewed. Results In our study, the median age at the time of diagnosis was 53 years (range 28–79). The most common presenting symptom was abnormal uterine bleeding with a ratio of 36%. Fifty-four percent of the patients had endometrioid type endometrial cancer and endometrioid type ovarian cancer. All patients were surgically staged and the majority of the patients were in stage I for both endometrial cancer (58%) and ovarian cancer (60%). Nearly one-third (32%) of the patients had a recurrence during the follow-up period and by Cox regression analysis the level of cancer antigen 125 (P = 0.023) at diagnosis, serous or clear-cell histopathologic type ovarian cancer (P = 0.029) and stage of endometrial cancer above I (P = 0.048) were found to be independent risk factors associated with development of recurrence. Patients with endometrioid type endometrium histology and endometrioid type ovarian histology had favorable prognosis with 120.00 months mean disease-free survival and 92% disease-free survival rate at 36 months. Conclusion In our cohort, we found that endometrioid/endometrioid type synchronous primary endometrial and ovarian cancer had different clinical histopathologic characteristics and favorable prognosis compared to the other histologic types of these cancers. Histopathologic type of the ovarian cancer component, stage of endometrial cancer and level of cancer antigen 125 at diagnosis were observed to have a great influence on the development of recurrence and survival of synchronous primary carcinomas of the endometrium and ovary.

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.

Lymphangioleiomyomatosis is a very rare disease that primarily affects the lungs. The atypical smooth muscle cells in these tumors stain both with smooth muscle markers and melanocytic markers characteristically like their counterparts in other members of the PEComa family. Extrapulmonary lymphangioleiomyomatosis, especially without pulmonary involvement, is extremely rare. The clinical importance of lymphangioleiomyomatosis lies in the fact that it may mimic other malignant diseases, such as lymphoma or sarcoma. Here, we report a case of extrapulmonary lymphangioleiomyomatosis without involvement of the lungs, in a patient pre-diagnosed as having lymphoma metastasized to the uterus or uterine sarcoma.

Aim of the Study: The purpose of this study was to identify specific circulating microRNAs (miRNAs) and investigate expression level of their target genes for evaluation of pathogenesis of epithelial ovarian cancer (EOC). Materials and Methods: In this study, we have studied on EOC patients' serum and whole blood, healthy control (HC) serum, and whole blood samples. Sixteen serum samples were collected to compare miRNA expression analysis through microarray. According to microarray results, one of the dysregulated miRNA in serum, hsa-let-7d-3p, was validated by RT-qPCR for discriminate two groups. The hsa-let-7d-3p is one of the tumor suppressive let-7d family members. Let-7d is downregulated in numerous types of cancer, including ovarian cancer and directly targets various oncogenes. We analyzed the let-7d targets, which are High Mobility Group A2 (HMGA2) and (Kirsten Rat Sarcoma Viral Oncogene Homolog), as the oncogenes that are associated with EOC. The relation between target genes of hsa-let-7d-3p and EOC has been examined by Pathway Studio. Twenty serum and whole blood samples collected to analyze expression level of target genes were analyzed by real-time PCR. Results: 31 significantly dysregulated miRNAs were identified by microarray in serum. Hsa-let-7d-3p has been selected for the validation, according to P-value and dysregulated level. RT-qPCR results showed that hsa-let-7d-3p could discriminate EOC patients from HC (P = 0.0484, AUC = 0.7). Furthermore, we identified hsa-let-7d-3p's target genes (HMGA2, KRAS) by bioinformatic analysis. The expression level of genes could discriminate patients with EOC from HC, with a power area under the ROC curves (AUC) of 62 and 64.2, respectively. Conclusion: HMGA2 and KRAS could be translationally downregulated by the hsa-let-7d-3p, and the loss of hsa-let-7d-3p expression led to the progression of EOC related to the tumorigenesis, invasion, and metastasis.

Background The purpose of this study was to determine the benefit of tertiary cytoreductive surgery (TC) for secondary recurrent epithelial ovarian cancer (EOC), focusing on whether optimal cytoreduction has an impact on disease-free survival, and whether certain patient characteristics could identify ideal candidates for TC. Materials and methods Retrospective analysis of secondary recurrent EOC patients undergoing TC at three Turkish tertiary institutions from May 1997 to July 2014 was performed. All patients had previously received primary cytoreduction followed by intravenous platinum-based chemotherapy and secondary cytoreduction for first recurrence. Clinical and pathological data were obtained from the patients' medical records. Survival analysis was caried out using the Kaplan Meier method. Actuarial curves were compared by the two tailed Logrank test with a statistical significance level of 0.05. Results Median age of the patients was 49.6 years (range, 30-67) and thirty-eight (72%) had stage III-IV disease at initial diagnosis. Twenty six (49%) had optimal and 27 (51%) suboptimal cytoreduction during tertiary debulking surgery . Optimal initial cytoreduction, time to first recurrence, optimal secondary cytoreduction, time interval between secondary cytoreduction and secondary recurrence, size of recurrence, disease status at last follow-up were found to be significant risk factors to predict optimal TC. Optimal cytoreduction in initial and tertiary surgery and serum CA-125 level prior to TC were independent prognostic factors on univariate analysis. Conclusions Our results and a literature review clearly showed that maximal surgical effort should be made in TC, since patients undergoing optimal TC have a better survival. Thus, patients with secondary recurrent EOC in whom optimal cytoreduction can be achieved should be actively selected.

This study aimed to investigate whether a selected immunohistochemical panel (estrogen receptor, p53, ARID1A, PPP2R1A, HNF-1β) could contribute to the diagnostic process of high-grade endometrial carcinomas (HG-ECs). We also aimed to analyze the correlation of these immunohistochemical results with several morphologic variables and survival data. After revising the diagnosis of 78 HG-ECs, immunohistochemical analysis was performed for each case. After immunohistochemical analysis, a specific diagnosis of prototypic HG-EC was established in most of the cases that were uncertain due to morphologic ambiguity. In the univariate analysis, older patient age, type II morphology, undifferentiated carcinoma and carcinosarcoma type of histology, altered p53 immunostaining, strong membranous staining of PPP2R1A, presence of lymphovascular invasion in serous carcinoma, and microcystic, elongated, and fragmented-type infiltration pattern in endometrioid carcinoma were significantly related to poor prognosis. In the multivariate analysis, only older patient age and carcinosarcoma or undifferentiated/dedifferentiated carcinoma type histology were found to be significantly poor prognostic factors (P=0.011), whereas advanced FIGO stage and type II histology were found to be correlated with poor prognosis, but did not reach statistical significance. We suggest that immunohistochemistry should be used in the differential diagnosis of HG-ECs, especially those with ambiguous morphology. Markers used in this study made a valuable contribution to the diagnostic process as well as prediction of prognosis.

To measure the feasibility of sentinel lymph node technique in endometrial cancer.The study was designed as a prospective non-randomized case-control trial. Between 2010-2011, in Istanbul University, Istanbul Medical Faculty, Gynecologic Oncology department, 26 patients who were preoperatively evaluated as endometrial cancer enrolled in the study. Patients' detailed informed consent and ethics committee approval were obtained. Sentinel lymph node (SLN) detection rate was determined as the primary outcome. Sensitivity, specificity, positive and negative predictive values and particularly false negative results were determined as secondary outcomes. As a technique of SLN, injection of methylene blue to the subserosal myometrium of the uterine fundus via 5 cc syringe following peritoneal aspiration cytology procedure was obtained. Surgery was made after injection for an average of 5 minutes due to the physiological spread of the blue dye. Then, the standard protocol of hysterectomy was performed and the retroperitoneum was opened to perform lymphadenectomy. The presence of lymph node regions, and presence of a sentinel node was recorded on the trial record form. Positive staining nodes were sent separately for pathological examination. In the course of the study due to insufficient rate of staining, the technique has been changed to cervical and multiple uterine injections.As the primary outcome, an SLN positivity rate of 23% in 6 patients with a total of 8 lymph nodes were found. The remarkable finding was that in the first technique, the rate was 1/16 (6%), while the second technique, 5/10 (50%), respectively. The difference is statistically significant (p=0.001). In endometrial cancer stage I and II, secondary outcomes for sensitivity, specificity, positive predictive value, negative predictive value were 23%, 0%, 100%, 43%, respectively. Because there were no metastatic lymph nodes found, false negative rate was 0%.SLN approach is not valuable enough to eliminate the need for lymphadenectomy. On the other hand, it facilitates scanning micrometastases and ultrastaging, while its clinical value has not yet been established. However, according to the recent pilot studies, it provides a means for assessing micrometastases for the medium-risk group for local recurrence.Sentinel lenf nodu tekniğinin endometriyum kanserinde uygulanabilirli ğini ölçmek.Prospektif non-randomize vaka kontrol çalış-ması olarak, 2010–2011 yılları arasında İstanbul Üniversitesi İstanbul Tıp Fakültesi, Kadın Hastalıkları ve Doğum Anabilim Dalı, Jinekolojik Onkoloji servisinde yapılan preoperatif değerlendirmesi endometriyum kanseri saptanan 26 olgu çalışmaya alındı. Çalışma için hastalardan aydınlatılmış onam formları ile etik kurul onayı alındı. Birincil sonuç olarak sentinel lenf nodu (SLN) saptanma oranı, sekonder sonuç olarak da yalancı negatiflik başta olmak üzere duyarlılık, özgüllük, pozitif ve negatif prediktif değerlerin saptanması belirlendi. SLN tekni- ği olarak periton yıkantı sitolojisini takiben uterus fundusta subserozal myometriyuma 5 cc injektör ile metilen mavisi verildi. Boya verilmesini takiben ortalama 5 dakika cerrahiye ara verilerek boya maddenin yayılması beklendi. Broad ligaman ve tubalar klempe edilerek tümör hücrelerinin mobilizasyonunun engellenmesi amaçlandı. Ardından standart histerektomi protokolü uygulandı. Retroperitoneum açılarak lenfadenektomi yapıldı. Çalışma formuna, çıkarılan lenf nodu bölgeleri ve varsa sentinel nodu varlığı kaydedildi. Pozitif boyanma gösteren lenf nodlarının patolojik incelemeye ayrıca gönderilmesi öngörüldü. Çalışmanın seyrinde boyanma oranı yetersiz görüldüğü için servikal ve multipl uterus injeksiyonu tekniğine geçildi.Primer sonuç olan SLN pozitifliği 6 hastada toplam 8 lenf nodu ile %23 oranında bulunmuştur. İlk teknikte oran 1/16 (%6) iken ikinci teknikte 5/10 (%50) olarak bulunmuştur. Aradaki fark istatistiksel olarak anlamlıdır (p=0.001). Sekonder sonuçlar olarak evre I ve II endometriyum kanserinde SLN tekniğinin duyarlılığı %23, özgüllüğü %0, pozitif prediktif değeri %100, negatif prediktif değeri %43 olarak bulunmuştur. Yalancı negatiflik değeri de pozitif lenf nodu bulunmad ığından %0’da kalmıştır.SLN yaklaşımı lenfadenektomi ihtiyacını bertaraf edecek kadar değerli olmamakla birlikte rutin pratikte tüm lenf nodlarına uygulaman ın mümkün görünmediği ve tedavi yönetiminde oturmuş bir yeri olmayan ancak pilot çalışmalarda elde edilen verilere göre nüks için orta risk grubu kabul edilen mikrometastaz incelemesine imkan vererek ultrastaging şansı yaratmaktadır.

Aims The aim of this study was to describe the impact of postoperative adjuvant treatment modalities and identify risk factors associated with recurrence and survival rates in women diagnosed with early stage type II endometrial cancer and carcinosarcoma. Methods In this retrospective study, patients diagnosed with early stage (stages I-II) carcinosarcoma and type II endometrial cancer were reviewed. All women underwent comprehensive surgical staging. Postoperative treatment options of chemotherapy (CT), radiotherapy (RT), observation (OBS) and chemotherapy–radiotherapy (CT-RT) combination were compared in terms of recurrence and survival outcome. Results In CT-RT treatment arm, recurrence rate was found as 12.5% and this result is significantly lower than the other treatment approaches (P = 0.01 CT alone: 33.3%, RT alone: 26.7%, OBS: 62.5%). Three-year disease free survival(DFS) rate and overall survival (OS) rate were statistically higher for the group of women treated with combination of CT-RT (92–95%) compared to the women treated with RT alone (65–72%), treated with CT alone (67–74%) and women who received no adjuvant therapy (38–45%). The multivariate analysis revealed that carcinosarcoma histology was associated with shortened DFS and OS (P = 0.001, P = 0.002). On the other hand, being at stage Ia (P = 0.01, P = 0.04) and receiving adjuvant treatment of CT-RT combination (P = 0.005, P = 0.002) appeared to lead to increased DFS and OS rates. Conclusions We identified that a combination treatment of chemotherapy and radiotherapy is superior compared to other postoperative adjuvant treatment approaches concerning PFS, OS and recurrence rates in stages I-II of type II endometrial cancers and uterine carcinosarcoma.

Objectives. To evaluate the level of expression of estrogen receptor (ER), progesterone receptor (PR), p53 and Ki-67 in patients with leiomyosarcoma and to investigate the effect of these and to identify the clinical parameters on prognosis. Materials and methods. Twenty-four patients operated for LMS of uterine origin between 1994 and 2003 at Istanbul Medical School, Department of Obstetrics and Gynecology and Division of Gynecologic Oncology constituted our study group. The data of all patients were updated via mail or phone. The effects of stage, grade, chemotherapy, radiotherapy, number of mitoses, presence of necrosis, Ki-67 and p53 expression, presence of estrogen and progesterone receptors on survival were evaluated. Results. The mean follow-up period of patients is 30.42 ± 25.15 months. The mean overall survival for all LMS patients was estimated to be 48.4 ± 10.38 months. The cumulative survival ratio in the 33rd month was 33.08. Age, menopausal status, history of prior radiotherapy, number of mitoses had no statistically significant effect on overall survival in our study although stage had a significant effect. Finding of greater than 10% steroid receptor expression has a positive effect on survival ([ER P = 0.019; log rank = 5.49] and [PR P = 0.023; log rank = 5.14]). The median value of Ki-67 was calculated to be 30. There was a survival advantage in patients with Ki-67 expression ( P = 0.034; log rank = 4.49) below the median value. p53 levels had no significant effect on survival ( P = 0.336; log rank = 0.92). Conclusion. Surgical staging is an important prognostic factor in LMS patients, while number of mitoses and grade of the tumor also seem to affect prognosis. Contrary to the current literature, our findings suggest that estrogen and progesterone receptor positivity greater than 10% may be associated with a better prognosis.

Human chorionic gonadotropin bears structural homology to pituitary thyrotropin. The extremely elevated levels of human chorionic gonadotropin in patients with molar pregnancy or other trophoblastic diseases can lead to hyperthyroidism. We describe a patient with molar pregnancy who had secondary hyperthyroidism prepared rapidly by plasmapheresis for surgery. The clinical picture improved dramatically after the first plasmapheresis. Three subsequent plasmapheresis provided a 75.1% decrease in serum free T3 concentrations and 63.9% free T4 concentrations and recovery after evacuation. This is the first use of plasmapheresis in rapid preparation of a patient who had secondary hyperthyroidism due to molar pregnancy.

OBJECTIVE The aim of this study was to evaluate the diagnostic value of 2-(fluorine-18)-fluoro-2-deoxy-D-glucose ((18)F-FDG) PET/CT in comparison with MRI for the detection of recurrent ovarian cancer. METHODS Forty-seven patients with suspected ovarian cancer recurrence after total ablative or cytoreductive surgery, as well as neoadjuvant or adjuvant chemotherapy, who had undergone (18)F-FDG PET/CT imaging were recruited for the present study. All patients also underwent MRI within a month of (18)F-FDG PET/CT for the same purpose. Recurrent cancer in the abdomen and pelvis was evaluated in each of the 47 patients and classified as either distant metastasis or local pelvic recurrence involving the vaginal stump, peritoneal implants, supradiaphragmatic region, and/or abdominal and pelvic lymph nodes. Special attention was paid to peritoneal implants. These were divided into five groups according to size of the implants: less than 0.5 cm (group 1), 0.5-1 cm (group 2), 1-2 cm (group 3), 2-3 cm (group 4), and larger than 3 cm (group 5). PET/CT findings were compared with abdominopelvic MR findings. Statistical analysis was carried out using the Wilcoxon signed rank test. RESULTS Thirty-nine of 47 patients were found to have recurrent ovarian cancer. Both PET/CT and MRI were negative for recurrence in six patients. Overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of PET/CT were 97.5, 100, 100, 87.5, and 97.8%, respectively, whereas those of MRI were 95, 85.7, 97.4, 75, and 93.6%, respectively. For the peritoneal implants in groups 2 and 3, the sensitivity, negative predictive value, and diagnostic accuracy values of PET/CT were significantly better than those of MRI (P

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.

Aims and background It has been appreciated for some time that the lack of detection of ovarian cancer at clinical and pathological (second-look laparotomy) evaluation is not synonymous with cure. The goal of this study was to define clinical risk factors for recurrence after complete pathological response to postoperative chemotherapy in patients with epithelial ovarian cancer. Methods Fifty-seven patients who met the inclusion criteria of our study were evaluated. The characteristics (age, menopausal status, histological subtype, tumor grade, presence of ascites at diagnosis, type of omentectomy, FIGO stage, and residual tumor volume after primary surgery) of patients with and those without tumor recurrence were compared. Results The median follow-up was 52 months (range, 15–142 months). The overall survival rates of the patients were 100%, 96%, and 87% at 1, 3 and 5 years, respectively. At the time of the study analysis, 21 of 57 (37%) patients had recurrent disease. The median time to recurrence was 16 months. Recurrences were most frequent in the pelvis and abdominal cavity (38%). Age, menopausal status, stage at diagnosis, and residual tumor volume after initial surgery were significantly related to the risk of recurrence in univariate analysis (P = 0.039, 0.038, 0.004, and 0.000, respectively). Residual tumor volume after initial surgery was found to be the only significant independent prognostic factor (P = 0.049, HR: 0.16, 95% CI: 0.02–0.99). Conclusion We believe it is necessary to conduct randomized studies on this issue because insight into predictors of recurrence after pathological complete response to postoperative chemotherapy could be used to select patients for trials of consolidation therapy.

We present a case of uterine perivascular epithelioid cell tumor (PEComa) coexisting with both pulmonary lymphangioleiomyomatosis and renal angiomyolipoma. The patient was a 42-year-old woman, suffering from massive abnormal uterine bleeding, progressive dyspnea, and arterial hypertension. Her clinical history included diagnoses of bilateral renal angiomyolipoma and pulmonary lymphangioleiomyomatosis. The patient underwent a subtotal hysterectomy and the specimen contained a subserosal tumor with irregular outlines in addition to uterine leiomyomata. The uterine tumor was histologically composed of solid sheets and tonguelike infiltration and lymphangioleiomyomalike structures within the myometrium, formed by epithelioid cells with ovoid to round nuclei and clear to light eosinophilic cytoplasms. The tumor did not display any morphologic sign of malignancy. The tumor cells showed expression of HMB-45 and smooth muscle markers. Ultrastructural analysis revealed abundant cytoplasmic microfilaments and rare small cytoplasmic bodies with a gridlike lining. We conclude that identification of lymphangioleiomyomalike growth pattern may aid in the differential diagnosis of uterine PEComa and suggest using both PEComa and smooth muscle tumor terminology.

We present a case of placental toxoplasmosis with granulomatous villitis. The patient was a 26-year-old gravida 1 female with the findings of intrauterine death at 16th week of gestation. The pregnancy was terminated. Pathological examination revealed an autolysed fetus and a placenta with necrotizing granulomas within the villous stroma. Encysted Toxoplasma gondii was rarely observed within the granulomas and serologic examination of the mother confirmed acute toxoplasmosis. A fluorocein in situ hybridization examination, using sex chromosome probes, revealed that the villous granulomas were formed by inflammatory cells, originated from the maternal immune system. In conclusion, T. gondii should be taken into consideration as a rare cause of placental granulomatous inflammation. To the best of our knowledge, this is the first case of granulomatous villitis due to toxoplasmosis, in which formation by maternal inflammatory cells has been demonstrated.

The objective was to determine whether therapeutic amniocentesis may improve outcomes in patients with twin-twin transfusion syndrome.Eleven patients were managed aggressively with repetitive serial amniocenteses, and six patients were managed conservatively.The time interval between diagnosis and delivery was 17.4 days more in the amniodrainage group, but the difference between the groups was not significant (68.3+/-41.9 days in the therapeutic amniocentesis group and 50.83+/-29.7 days in the expectant management group [p=0.384]). The overall survival rate of the two groups was 38.2%, and was not significantly different between groups (40.9% in the amniocentesis group and 33.3% in the expectant management group; p=1.00). Two of nine (22.2%) infants in the amnioreduction group, and one of four (25.0%) infants in the expectantly managed group had neurological symptoms.Our results did not show a significant benefit of aggressive therapeutic amniocentesis. A slight improvement in perinatal outcome was observed.

A 36-year-old woman, gravid 3, para 1, abortus 1, was admitted to our department at 10 weeks and 4 days of gestation with the diagnosis of cervical pregnancy and multiple uterine fibroids. After admission she underwent angiographic embolization of bilateral uterine arteries followed by intraamniotic 70-mg methotrexate injection. Despite being given a second dose of methotrexate injection 1 week later, the gestational sac did not resolve spontaneously, thus vacuum evacuation and curettage of the cervical canal was required on the 15th day of embolization. The patient was discharged in good condition. She had no complaints by post-operative at month 11, except amenorrhea. Her uterine fibroids markedly decreased in size after the procedure. As a result, embolization of uterine arteries provided surgical evacuation of cervical pregnancy with minimal hemorrhage, and the patient's potential fertility was preserved, but a long-term amenorrhea was observed.

Ovarian hyperstimulation syndrome (OHSS) is a life- threatening complication of controlled ovarian stimulation. One of the main symptoms of OHSS is ascites. Treatment is symptomatic with resolution of the symptoms over days to weeks. We report a case of severe OHSS with persistent ascites 18 months after the diagnosis. Persistent ascites secondary to OHSS was diagnosed and single dose leuprolide acetate depot 11.25 mg was administered. At follow-up, no ascites was observed.

A woman was referred to our hospital with the working diagnosis of ovarian malignancy. While she was undergoing both clinical and radiological evaluation and monitoring, a decrease in the size of the ovarian mass was noted. After further evaluation via laboratory findings and tissue biopsy, we arrived at a final diagnosis of sarcoidosis, which is very unusual in the ovaries. Our case places emphasis on the importance of considering rare entities, such as ovarian sarcoidosis, and the importance of radiologic changes in solid ovarian mass dimensions over time.