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This study investigates the impact of radiotherapy (RT) on lower urinary tract symptoms (LUTS) in patients with gynecologic malignancies, focusing on those who have undergone surgical treatment. We conducted a cross-sectional study from January to June 2023 at a tertiary hospital's outpatient polyclinic. Participants included patients with early-stage cervical cancer and endometrial cancer who received adjuvant RT postsurgery, and advanced cervical cancer patients who received primary RT. Patients were divided into two groups: those who received RT (RT (+)) and those who did not receive (RT (-)). Sociodemographic data were collected and LUTS were assessed using the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms (ICIQ-FLUTS). Out of 64 patients, 38 (59%) did not receive RT and 26 (41%) received RT. The RT (+) group had significantly higher scores in filling (p=0.038), voiding (p=0.046), and incontinence (p=0.012) compared to the RT (-) group. Additionally, the RT (+) group reported a significantly lower quality of life (p=0.009). Our study found that radiotherapy is associated with increased lower urinary tract dysfunction, including symptoms in the filling, voiding, and incontinence phases. Patients who received RT also experienced a decreased quality of life compared to the RT (-) group. These findings highlight the need for comprehensive management of LUTS in patients undergoing radiotherapy for gynecologic cancers. [ABSTRACT FROM AUTHOR]

Some smooth muscle tumors do not meet the histologic criteria for definite benign-malignant distinction and this rare group is thus classified as smooth muscle tumors of uncertain malignant potential (STUMP). Due to the high heterogeneity, there are no standard guidelines for the diagnosis, treatment, and follow-up of uterine STUMPs. So, we aimed to evaluate the treatment modalities in patients with/without fertility desires. The size, mitotic count, presence of necrosis and atypia of tumors were obtained from the final pathology reports. Patients were followed up with electronically merged records via telephone until October 2022. Recurrence, time to recurrence, and recurrence histopathology were included in the study. Myomectomy was performed in 50% of the patients. Frozen section was not considered necessary in 57.1% of all patients and 50% of the patients who underwent frozen section were reported as benign. The median follow-up was 64.5 months. Tumor necrosis was observed in 14.3% of patients. The median mitosis count was calculated as 2.5 (1-9) per 10 high-power fields. The recurrence rate was calculated to be 7.2%. The accuracy of a frozen section diagnosis may not always be reliable, it is often confirmed after the final pathology has been reported. Patients who desire fertility can be supported. Our research indicates that recurrence rates could be lower in centers where experienced pathologists are making the diagnosis. [ABSTRACT FROM AUTHOR]

Background: To evaluate the efficacy of the preoperative ultrasonographic sliding sign in predicting intra-abdominal adhesions. Methods: This was a single-center, double-blinded, prospective observational study undertaken from March and September 2021 on 110 patients with a history of previous abdominal surgery. All patients who were scheduled for laparoscopy underwent slide test in 5 zones of abdomen: right lower quadrant, left lower quadrant, previous operation site, vesicouterine pouch, and rectovaginal pouch. Adhesions were assessed by the same gynecologic surgeon using ultrasonography before the surgery and by gynecological surgeons during surgery, and by a third gynecologic surgeon to compare the preoperative slide test findings and laparoscopic findings after the surgery. Results: Seventy-three (66.4%) patients underwent laparoscopic surgery, and 37 (33.6%) patients underwent laparotomy. The mean age of patients was 46.9 ± 1.0 years. Sensitivity, specificity, and positive and negative predictive values of preoperative ultrasonography in predicting adhesions were 89.5%, 91.7%, 97.5%, and 71.0%, respectively. The accuracy of the slide test was calculated as 90.0%. It was found that as the total number of cesarean sections increased the estimates of vesicouterine adhesions and actual adhesions increased (P =.008). Also, the prediction of intra-abdominal adhesions and actual adhesions significantly increased as the total number of surgical operations increased (P =.002). Conclusions: Intra-abdominal adhesions can be detected with the slide test, which is a non-invasive and well-tolerated procedure. Slide test can guide the physician before the elective operation in patients with previous abdominal surgery and may assist in counseling patients. [ABSTRACT FROM AUTHOR]

Objective: To compare leiomyoma variants and leiomyosarcoma (LMS) in terms of clinicopathological characteristics. Material and Methods: We evaluated the clinical and pathology outcomes of 57 patients who underwent myomectomy or hysterectomy between September 2013 and August 2022 and were diagnosed with cellular leiomyoma (CL), mitotically active leiomyoma (MAL), leiomyoma with bizarre nuclei (LBN), or LMS. Intraoperative frozen results were compared with the final pathology results. Leiomyoma variants (CL, MAL, and LBN) were compared with each other and with LMS. Results: Patients in the LMS group were older than those in the leiomyoma variants group (p<0.001). Frozen results in the variant group was 6.7% malignant, whereas 100% in the LMS group. Age (p=0.207), menopausal status (p=0.347), fibroid size (p=0.432), and number (p=0.598) did not differ between CL, MAL, and LBN groups. The median follow-up of leiomyoma variants and LMS groups was 61 months (4-105 months) and 20.5 months (6-85 months), respectively. No recurrence was observed in leiomyoma variants group whereas, recurrence was observed in 5 patients, and 3 patients died after recurrence in the LMS group. Conclusion: In this study, no recurrence was observed in the leiomyoma variants groups during the follow-up period and the prognosis is favorable. Not all tumors in the group of leiomyoma variants already meet the diagnostic criteria for LMS. Therefore, the detailed naming of the leiomyoma variants by subgroups does not seem to be of additional benefit for patient follow-up. [ABSTRACT FROM AUTHOR]

Objective: The clinical outcome of high-risk HPV (hr-HPV) infection varies according to genotype(s). Patients may harbor either one single hr-HPV (s-HPV) or multiple HPV (m-HPV) genotypes. Recently, the relationship between m-HPV infections and high-grade dysplasia has been investigated, and controversial results have been obtained. Therefore, the clinical significance of m-HPV is not clear. This study aimed to evaluate which group is associated with higher grade dysplasia by analyzing colposcopic punch biopsies. Material and Methods: A total of 690 patients who were scheduled for a diagnostic excisional procedure between April 2016 and January 2019 due to the detection of high-grade cervical intraepithelial neoplasia (CIN 2/3) in colposcopy were included. Patients who were not scheduled for colposcopic examination or cervical punch biopsy, or who were scheduled for an excisional procedure due to smear-biopsy incompatibility or persistent low-grade dysplasia were excluded. Patients with a negative HPV test and an unknown HPV genotype were also excluded. Results: Among the patients scheduled for excision (n=404), 74.5% had a s-HPV and 25.5% had a m-HPV infection. The proportion of CIN 1, 2 and 3 per patient in the m-HPV group was significantly higher than the s-HPV group (p=0.017). When this analysis was made for the number of CIN 2+3 per patient in the s-HPV and m-HPV groups, it was 1.29 (389/301) and 1.36 (140/103), respectively, and no difference was found (p=0.491). Conclusion: Patients in the m-HPV group, who underwent more colposcopic cervical biopsies, had higher numbers of CIN lesions, regardless of age and cytology results. [ABSTRACT FROM AUTHOR]

Objective. Human papillomavirus (HPV) infection is a risk factor for cervical carcinoma. Over 100 types of HPV have been identified. The excisional procedures are recommended for women with high-grade cervical intraepithelial neoplasia. Surgical margin status is an important predictor of the risk of relapse. The aim of the current study was to evaluate whether HPV genotype is a predictive factor of positive surgical margin after cervical cone excision. Materials and Methods. The records of 448 HPV-infected patients who underwent loop electrosurgical excision or cold knife conization at a tertiary gynecological cancer center were retrospectively reviewed. The patients were divided into 6 groups according to HPV positivity: HPV 16 only, HPV 18 only, HPV 16/18, other high-risk HPV (hrHPV), HPV 16/hrHPV, and HPV 18/hrHPV. Results. There was no significant difference between the HPV groups in terms of age, parity, menopausal status, endocervical canal involvement, conization method, and the rates of positive margin (P =.15, P =.49, P =.07, P =.20, P =.24, P =.39, respectively). Conclusion. The results show that HPV subtypes might not be associated with endocervical canal involvement and the rates of positive margin. In addition, margin status was not related to the conization method and the number of excised cervical tissue. [ABSTRACT FROM AUTHOR]

Introduction. This study aimed to determine whether endocervical glandular involvement by squamous intraepithelial lesion would differ with respect to the depth of the excised specimen and analyze the related factors that may define endocervical glandular involvement among cases treated with cone biopsy. Methods. Between April 2016 and December 2018, women who underwent colposcopy and excisional procedures in the department of gynecologic oncology were retrospectively investigated. Patients with multiple specimens, or whose specimen depths were not measured, and a negative/unknown HPV status were excluded from the study. Also, patients with no dysplasia or microinvasive/invasive cancer in the final pathology report and those who had not undergone endocervical curettage during colposcopy were excluded. HPV genotypes, degree of dysplasia, surgical margin status, and specimen depth were documented from medical records. Further, the association of these factors with endocervical glandular involvement was evaluated. Results: A total of 321 patients who fulfilled the criteria were included in the study, with a mean age of 41.9 years. In total, 101 patients (31.5%) had endocervical glandular involvement. The mean excised specimen depth was 17.04 mm; 17.9 and 16.7 mm for the positive and negative glandular involvement groups, respectively (p =.13). The mean ages were 42.7 and 41.6 years for these groups, respectively (p =.32). There was no association between the HPV genotypes and glandular involvement. Conclusions: Endocervical glandular involvement is not associated with the depth of the excised specimen. A deeper cone biopsy may not necessarily enable a more effective treatment of the disease. [ABSTRACT FROM AUTHOR]

In a partial molar pregnancy, the level of β-Human chorionic gonadotropin (β-HCG) is often within a large spectrum. An extremely high level of β-HCG levels (>1.000.000) is only 2-3% of partial moles. Partial molar pregnancy commonly presented with mildly elevated HCG (<100,000), vaginal bleeding, abortion and rarely complicated with medical complications and theca lutein cysts. We present a case with extremely high HCG levels (1.861.011 IU / L) in the early second trimester and complicated by maternal anemia, hyperthyroidism, proteinuric hypertension, hirsutism, and enlarged bilateral theca lutein cysts. During follow-up, the patient's HCG level returned to normal after 27 weeks. Clinicians should keep in mind that partial mole hydatidiform may be presented with very high HCG levels. They should be aware of the medical conditions that may complicate this disease and adopt a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

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