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The aim of this study was to investigate the effect of drains used in current clinical practice on operation parameters and post-operative morbidity. The comprehensive data obtained through the prospective design were analysed in detail according to whether abdominal drainage was applied. Abdominal drainage was present in 44.1% of patients who met the inclusion criteria. Drains were placed significantly more frequently during oncologic surgery (

Aim: To investigate the CA-125 levels in uterine serous carcinoma (UPSC) patients to predict the extent of disease. Materials and Method: Medical records of patients operated for UPSC/mix serous carcinoma, endometrioid carcinoma; their preoperative CA-125 levels, as well as parameters including age, tumor size, lymph node involvement, lymphovascular space invasion (LVSI), depth of myometrial invasion (MI) and stage were documented. Results: Twenty-six UPSC/mix serous carcinoma cases and forty-five endometrioid carcinoma cases were included. When we analyzed the serous cancer group in terms of CA-125; there was no association between CA-125 and age (≤60 vs >60), tumor size (≤40 vs >40mm), MI, lymph node metastasis or LVSI. The mean CA-125 levels were significantly higher among patients with stage III/IV (median=54 U/ml), compared to stage I/II (median=11 U/mL). The mean CA-125 value for tumors spread beyond the uterus were 281.2 U/ml, and 14.3 U/ml for the tumors confined within the uterus (p=0.002). The optimum threshold value to predict extrauterine spread was 28.5 U/mL. CA-125 level was related to extrauterine involvement and advanced stage. Conclusion: CA-125 level is a useful test for extrauterine involvement and advanced stage. We suggest a less aggressive treatment modality with CA-125

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.

Studies on eosinophils have mostly been directed to parasitic infections and allergic diseases, but the role of eosinophils in oncology has been largely ignored. Eosinophils are an important modulator of the immune response and components of the inflammatory process against the tumor. This study was performed to investigate the pre-operative peripheral blood eosinophil percentages in patients with a histopathologically diagnosed pure endometrioid type endometrial carcinoma.Patients’ data were analyzed in two groups as present/absent according to whether there are tumor metastases in the adnexes, lymph nodes, cervical stroma, and whether there was lymphovascular space invasion. FIGO grade was taken as the basis of the tumor grade: Low-grade equated to grade 1 or 2, and high-grade equated to grade 3. The requirement for lymph node dissection was based on the Mayo criteria.The data of a total of 268 patients were included. The mean percentage of eosinophils in high-grade patients (n=29) was 2.75±0.35, and was significantly higher than the mean percentage of eosinophils of found in low-grade patients (n=239), which was 1.79±0.09 (p=0.013). Receiver operator curve analysis showed that a cut-off eosinophil percentage of 1.95% resulted in a sensitivity of 62% and specificity of 67% (p=0.004).Eosinophil percentages, which are a simple, easily accessible, and inexpensive can be an important pre-operative predictive tool. Eosinophil percentages can be used in determining the need for surgical staging in endometrial cancer.

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.

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.

Aim To analyze the risk factors of lymph node involvement in pure endometrioid type endometrial cancer and assess factors that necessitate lymphadenectomy. Methods Patients who had been operated on due to endometrial cancer and whose final pathology was reported as pure endometrioid carcinoma between January 2014 and January 2020 were assessed. Hysterectomy, bilateral salpingo-oophorectomy, and systematic lymphadenectomy were performed in all patients. All specimens were reported by expert gynecopathologists. Results The lymph node positivity rate was 14.4%. When the study population was classified according to the Mayo risk criteria; lymph node involvement in the low-risk and high-risk groups was 9.1% and 14.8%, respectively and there was no statistically difference (p > 0.05). The median of tumor size and the rate of deep myometrial invasion, lymphovascular space invasion, adnexal involvement, FIGO grade 3 tumor were found significantly higher in the positive lymph node group in univariate analysis. In the receiver operating characteristic curve analysis, the cut-off value of the tumor diameter was determined as 47.5 mm (sensitivity 85%, specificity 62%). Every 10 mm increase in tumor diameter increased the risk of lymph node involvement 10 times. Conclusion This study defined that the tumor diameter is an independent predictor for lymphatic dissemination. In the future, it could be shown that even with new modeling based on tumor diameter, lymphadenectomy or adjuvant radiotherapy requirements would be reevaluated.

Background: glandular cell abnormalities may indicate the presence of pre-malignant or malignant lesions. Aim: this study aimed to investigate the relationship between atypical glandular cells (AGC) and patients' demographics, histopathological outcomes, Human Papillomavirus (HPV) test results. Material and methods: between January 2015 and December 2019, women with AGC on Pap tests were retrieved from the hospital electronic database. The patients with AGC on cervicovaginal smears who underwent further pathological, laboratory, and imaging diagnostic testing and who were followed up at least 1-year were included in the study, while those who had a history of cervical dysplasia or cancer, lost during follow-up, or had missing data were excluded. Results: of 85,692 Pap smears, 114 (0.13%) were diagnosed with AGC, of those 88 cases were eligible for final analysis. Gynecological malignancies were detected in 13 (14.8%) patients; including 6 (6.8%) endometrioid endometrial cancers, 3 (3.4%) non-endometrioid endometrial cancers, 2 (2.3%) cervical adenocarcinomas, 1 (1.1%) cervical squamous cell carcinoma, and 1 (1.1%) high-grade tubal serous cancer. Multivariate analysis revealed that presence of concomitant abnormal squamous lesion (P = 0.002), being 50 years and older (P = 0.028), HPV positivity (P < 0.001), and menopause (P = 0.023) were risk factors for significant pathology. Conclusion: the diagnosis of AGC may be related to the preneoplastic/neoplastic processes. A further comprehensive histopathological examination is required in women with AGC, aged 50 years and older, postmenopausal, HPV-positivity and concomitant squamous cell abnormality Clinicians should consider ovarian pathologies when there is no pathological finding on endometrial or cervical histopathological examination., NA

Amaç: Tersiyer bir merkeze kolposkopik inceleme için refere edilen hastaların Human Papillomavirus (HPV) hakkındaki bilgilerini ve HPV aşısına yaklaşımını değerlendirmeyi amaçladık. Gereçler ve Yöntem: 01.12.2018 ile 01.05.2019 tarihleri arasında üçüncü basamak sağlık kuruluşunda kolposkopik inceleme yapılan 197 HPV pozitif hasta çalışmaya dahil edildi. Bulgular: Hastaların yaş ortalamaları 38,60±8,78 idi. Hastaların yaklaşık %56,9’unun HPV aşısı hakkında bilgisi olmasına rağmen, %86,8’i her kadının aşı yaptırması gerektiğini düşünmüyordu. HPV aşısı yaptırmama sebebi olarak da hastaların %40,6’sı hekimlerin aralarında bir fikir birliği olmadığını söylemiştir. HPV hakkında önceden bilgi sahibi olan ile olmayan hastalar arasında eğitim durumu açısından istatiksel bir farklılık bulunmamıştır (p=0,291). HPV hakkında önceden bilgisi olanların %55,7’si düzenli smear yaptırdığını bildirmiştir. HPV hakkında bilgisi olan hastalar ile olmayan hastalar arsında düzenli smear taraması yaptırması açısından anlamlı fark vardı (p=0,001). Sonuç: Hastaların HPV hakkında bilgisi olduğu halde HPV aşısının güvenliği ve aşının koruması hakkında endişeye sahiptiler., Objective: We aimed to examine knowledge of Human Papillomavirus (HPV) and perspectives about HPV vaccine of patients referred to a tertiary hospital for colposcopic examination. Material and Methods: One hundred ninety-seven HPV positive patients undergoing colposcopic examination at a tertiary center between 01.12.2018 and 01.05.2019 were included to the study. Results: The mean age of the patients was 38.60 ± 8.78 years. Although 56.9% of the patients had knowledge of HPV vaccine, 86.8% of the patients did not consider that every woman should be vaccinated. About 41% of the patients stated that there was no consensus among physicians as a reason why women did not have HPV vaccination. There was no statistically significant difference between patients with and without knowledge of HPV in terms of educational status (p=0.291) About 56% of the patients with knowledge of HPV stated that they had regular smear tests. There was a statistically significant difference between patients with and without knowledge of HPV in terms of having regular smear tests (p=0.001). Conclusion: Although patients had knowledge of HPV, they had anxieties about vaccine safety and vaccination coverage.

Background: Sarcoidosis is usually diagnosed by ruling out other granulomatous inflammatory diseases. Rarely, it may be suspected with a pathological examination after surgical intervention for another disease. The sarcoid reaction is noninfectious granulomatous lymphadenitis which can occur at nodes draining a neoplasm. We demonstrated granulomatous lesions masquerading metastasis by Positron Emission Tomography/Computed Tomography (PET/CT) in endometrial cancer. We presented two cases of endometrial cancer with sarcoidosis and sarcoid-like reactions because of their challenging clinical and radiological findings. Cases: In case 1, there was diffuse granulomatous inflammation (no metastasis) in lymph nodes (n=92) and giant cells containing calcifications (Schaumann bodies). In case 2, PET/CT revealed hypermetabolism with malignancy suspicion in the pelvic lymph nodes (maximum standardized uptake value= 13) and pathological evaluation reported a 4.5 cm tumor within the uterine cavity without any nodal metastasis. Results: PET/CT has no role in the evaluation of differential diagnosis between granulomatous lymphadenitis and metastatic disease. Conclusions: Granulomatous lesions might mimic the metastasis of coexisting malignant diseases.

The aim of this study was to investigate whether patients with CIN 2/3 with different amount of distance to negative cone biopsy margin differ in terms of post-conization follow-up results. Cold-knife cone specimens with a negative surgical margin with a diagnosis of CIN-2/3 were selected. The minimum distance between the margin and lesion was categorised as less than 2 mm (Group-1), 2-5 mm (Group-2), or more than 5 mm (Group-3). There were no statistically significant differences between groups in terms of postoperative cone-biopsy results (

Background Human papillomavirus (HPV) is a primary risk factor for cervical cancer. HPV 16 and 18 are the two most carcinogenic genotypes and have been reported in the majority of cervical cancer. High-risk HPVs (hrHPVs) other than HPV 16/18 cause approximately a quarter of cervical cancers. We aimed to present the colposcopy-guided biopsy results of non-16/18 hrHPV-infected women with negative cytology. Methods This is a retrospective cohort study conducted on 752 patients between the ages of 30-65 years with non-16/18 hrHPV and negative cytology undergoing colposcopy-guided biopsy at a tertiary gynecological cancer center between January-2016 and January-2019. Results The mean age of the women was 42.35±9.41 years. Cervical intraepithelial neoplasia (CIN) 2+ lesion was detected in 49 (6.5%) women with negative cytology. The rate of CIN 2+ lesions in women with abnormal cytology was 12.8%. Patients with abnormal cytology had about 2.1 and 2.4 times increased the odds of CIN 2+ lesion in cervical biopsy and endocervical curettage specimens, respectively. CIN 3+ lesion was detected in 20 (2.7%) women with negative cytology. One (0.1%) of the patients with HPV 39 and negative cytology had invasive cervical cancer. The two most common HPV subtypes were HPV 31 and HPV 51. Conclusions The risk of cervical preinvasive lesions still can be detected and cannot be completely eliminated among hrHPV other than 16/18-infected women with negative cytology. Based on the results of this study, referral of non-16/18 hrHPV-infected women with negative cytology to colposcopy is supported as a credible and feasible strategy.

HİDROSALPİNKS TANISINDA ULTRASONOGRAFİ VE HİSTEROSALPİNGOGRAFİ YETERİNCE GÜVENİLİR Mİ? ÖZET AMAÇ:İnfertil hastaların uterin boşluğu ve fallop tüplerini ilk basamak değerlendirme ultrasonografi (USG) ile olup bir sonraki aşamada diğer gelişmiş ve etkili yöntemler olmasına rağmen histerosalpingografi (HSG) ucuz, kolaylıkla erişilebilir ve yorumlanması kolay olduğundan yaygın olarak kullanılmaktadır. Çalışmamızda HSG ve USG sonucunda hidrosalpinks ön tanısı konulan hastaların laparoskopi ile korelasyonunu değerlendirerek HSG’nin ve USG’nin hidrosalpinks tanısı koymadaki değeri ve birbirlerine üstünlüğü olup olmadığını göstermeyi amaçladık.YÖNTEM:Çalışmaya 1 Ağustos 2015 ile 1 Nisan 2017 tarihleri arasında hastanemizin kadın doğum polikliniklerine infertilite nedeniyle ile başvuran HSG’de ya da USG’de hidrosalpinks saptanan 48 hasta dahil edildi. Tüm hastalar genel anestezi altında, laparoskopi ile opere edildi. Laparoskopide her iki tuba serbest metilen mavisi geçişi değerlendirildi. HSG veya USG sonucu ile laparoskopi sonucunun korele olmaması HSG’nin ya da USG’nin yanlış teşhisi olarak değerlendirildi. Laparoskopide patolojik bulguların olması halinde HSG ya da USG teşhisi doğru olarak kabul edildi. BULGULAR:48 hastanın 30’u primer infertil 18’i sekonder infertildi. 26 hastaya HSG ile hidrosalpinks düşünüldü. Laparoskopi sonrası 15’inde (%57,7) hidrosalpinks doğrulandı. 25 hastaya USG ile hidrosalpinks ön tanısıyla laparoskopi yapıldı. 17’sinde (%68) hidrosalpinks doğrulandı. 3 hastada hem USG de hemde HSG de hidrosalpinks mevcuttu. Bu hastalarda USG bulgularının laparoskopi ile korelasyonu değerlendirildi. Hsg’nin teşhis doğruluğu (%57,7) USG’nin teşhis doğruluğu (%68) ile arasında istatistiksel bir fark saptanmadı. (P=0,638). SONUÇ: İnfertilitenin ilk basamak değerlendirmelerinden olan USG ve HSG ile ucuz ve kolay bir şekilde hidrosalpinks tanısı konulabilir. Anahtar sözcükler: Hidrosalpinks, İnfertilte, Laparoskopi

Amac: Primer amacimiz postkoital kanama sikayeti ile gelen hastalarda sitolojinin preinvaziv ve/veya invaziv servikal patolojilerin tespit edilmesinde etkinligini arastirmak iken sekonder amacimiz siddetli kanama, anormal sitoloji ve normal sitoloji durumlarinda yonetim seklini belirlemektir. Gerec ve Yontemler: Ocak 2013 ile Eylul 2016 tarihleri arasinda Zeynep Kamil Kadin ve Cocuk Hastaliklari Egitim ve Arastirma Hastanesi’ne postkoital kanama sikayeti ile basvuran ve kolposkopi yapilan 317 hasta retrospektif olarak, asiri kanama nedeniyle smear alinamayanlar (Grup 1), smear sonucu normal olanlar (Grup 2) ve smear sonucu anormal olanlar (Grup 3) seklinde 3 gruba ayrildi. Biyopsi sonuclari hem gruplar arasinda hem de menopoz statulerine gore karsilastirildi. Istatistik icin SPSS 15 kullanildi. Pap smear icin preinvaziv ve invaziv patoloji acisindan sensitivite ve spesifisite hesaplandi. Bulgular: Gruplar arasinda menopoz orani ve yas acisindan fark gozlenmedi. Toplam hasta grubunda en yuksek invaziv kanser oranlari siddetli kanama nedeniyle smear alinamayan ( grup 1) hastalarda, en dusuk oranlar ise normal sitolojili (grup 2) hastalarda gozlendi (%12.5, %1.9 ve %4; sirasiyla, p< 0.0001). Invaziv kanser acisindan sadece grup 1-2 arasinda (p=0.0034), preinvaziv/invaziv kanser acisindan ise hem grup 1-3 (p=0.004) hem de grup 2-3 arasinda istatistiksel olarak anlamli fark oldugu gozlendi (p

Objectives: This study was conducted to compare pregnancy outcomes of early-middle adolescent, late adolescent and adult women. Material and methods: The study focused on early-middle adolescent (n = 145), late adolescent (n = 1655) and adult (n = 1585) women who gave birth during 2014 through 2017, utilizing data obtained from the Zeynep Kamil Women and Children’s Health Training and Research Hospital. Pregnancy outcomes were determined according to the rates of preg¬nancy complications, including method of delivery, birth weight, as well as the rate of newborn intensive care admissions. Results: Comparisons between the studied groups for various pregnancy complications showed highest rates of pre¬term deliveries (PD), preterm premature rupture of membranes (PPROM) and neonatal intensive care unit admission in early-middle adolescent group, whereas the highest cesarean section rates were observed in the adult group (p < 0.001). Conclusions: Analysis of the data revealed that adolescent pregnancy, especially the early-middle adolescent pregnancies, is associated with increased risks of adverse pregnancy outcomes.

Background: Ovarian cancer is one of the highest mortality cancers in gynaecology. Discrimination of benign masses from malignant ones may sometimes become a challenge for the clinician since there is not a reliable tumour marker, thus some unnecessary, highly morbid operations can be performed. Aims: To explore the efficacy of human epididymis 4 (HE 4) and cancer antigen 125 (CA 125) markers in differentiating malignant and benign pelvic masses of ovarian origin and to identify the cut-off points for those markers. Study Design: Prospective study. Methods: Fifty-one patients who were diagnosed and planned to undergo surgery for ovarian mass between June 2008 and December 2008 were enrolled into this study. Preoperative venous blood samples were taken and frozen for marker investigation and final diagnoses were concluded by histopathological examination. After recruitment of all cases CA 125 and HE 4 levels were evaluated. Results: The statistical analysis did not indicate any statistically significant difference between the CA 125 levels of the patients with malignant and benign adnexal masses (p=0.105). The HE 4 levels of the patients with malignant adnexal masses were higher at a statistically significant level compared to the patients with benign adnexal masses (p=0.002). For HE 4 tumour marker and at the cut-off point of >25 pM, sensitivity was 1, specificity 0.40, positive cut-off value 0.19, negative cut-off value 1, accuracy 0.47 and positive likelihood ratio 1.65. Conclusion: Human epididymis 4 is a better diagnostic tool than CA 125 in benign-malignant discrimination of adnexal masses. The cut-off value of 25 pmol/L for human epididymis 4 will contribute to providing proper guidance to patients with adnexal masses and applying the proper treatment method.

Objective This study aimed to analyze the correlation between the histopathologic results of excisional procedure and cervical punch biopsy and to investigate the accuracy rates of colposcopic punch biopsy and cervical cytology to detect cervical intraepithelial neoplasia (CIN) grade 2 and/or more severe lesions (CIN 2+). Materials and methods Two hundred six patients who underwent excisional procedure in the gynecologic oncology clinic of the Zeynep Kamil Women and Children Diseases Education and Research Hospital between 2004 and 2011 were enrolled in a retrospective study. Results The correlation between the pathologic findings gained by excisional procedure and punch biopsy was weak ( p = .0001, κ = 0.03). The overall concordance rate between the pathologic findings of cervical biopsy and excisional procedure was 57.29%. The rates of detecting more severe lesions by excisional procedure when compared to biopsies (biopsy underestimation) were 71.42%, 22.91%, 37.03%, and 12.72% for biopsy results with negative, CIN 1, CIN 2, and CIN 3/adenocarcinoma in situ lesions, respectively. Similarly, the rates of less severe lesions diagnosed by excisional procedure when compared to biopsies (biopsy overestimation) were 29.16%, 40.74%, and 15.45% for biopsy results with CIN 1, CIN 2, and CIN 3/adenocarcinoma in situ lesions, respectively. The rate of CIN 2+ lesions after excisional procedure in cases with previous biopsy results with either negative or CIN 1 was 27.27%. Conclusions Our results suggested that colposcopy-directed biopsy was neither a good diagnostic nor a reliable management method. We think that the indications of conization should be enlarged to avoid overlooking high-grade lesions.

Objective: The aim of our study was todetermine whether endocervical glandularinvolvement after excisional procedures isrelated to the depth of the removed conizationmaterial.Material and Methods: Between April 2016and December 2018, patients who underwentcolposcopy and excisional procedures in thedepartment of gynecologic oncology wereinvestigated retrospectively. Patients withmultiple pathology specimen pieces and thepatients whose cone depth was not measuredwere excluded from the study. Age,endocervical curettage (ECC) results duringcolposcopy, type of excisional procedure(LEEP or CKC), degree of dysplasia in conematerial, endocervical glandular involvementand cone depth were evaluated from medicalrecords.Results: Four hundred thirty patients includedin the study. The mean age was 41.3 years.Sixty-one patients who underwent LEEP and369 patients who underwent conization wereevaluated. Three hundred fifteen (73.2%) patients had noglandular involvement, while 115 patients(26.7%) had glandular involvement. In theanalyses, cone depth and endocervicalglandular involvement showed statisticallysignificant differences between the patientswith LEEP and CKC (p=0,049). Mean conedepth in LEEP group and CKC group were 7.9mm and 14.5 mm, respectively (p

Background : To investigate CA-125 levels in uterine papillary serous carcinoma (UPSC) patients.Material and method : From January 2010 to April 2019, we collected data of UPSC and preoperative CA-125 levels of patients. Subsequent parameters were evaluated; age, preoperative endometrial sampling results, tumor size, lymph node involvement, LVSI, depth of myometrial invasion, stage.Results : For the final analysis, 25 patients were eligible. Mean and %95 confidence interval for CA-125 levels in UPSC patients was 130.56 IU/ml (%95 CI : 5.18 - 255.93). Minimum was 4 and maximum was 1454 IU/ml (median= 19). Mean age was 63.04 + 8.7. In lymph node positive patients mean CA-125 was 114.8 IU/ml and lymph node negative patients 134.5 IU/ml (p=0,9). In patients with LVSI mean CA-125 level was 170.73 IU/ml and patients that didnu2019t present with LVSI 76.77 IU/ml (p=0.77). There was no relationship between the tumor size and CA-125 level (Pearson coefficient 0.069, p=0,745). In patients with more than %50 myometrial invasion, mean CA-125 level was 137.66 IU/ml and was less than 50% 126.56 IU/ml (p=0.932). Mean CA-125 level for tumors that were spread beyond the uterus were 257.08 IU/ml and for the tumors that were confined to the uterus were 13.76 IU/ml (p=0,043).Conclusion : Our results suggest that, preoperative CA-125 levels is a good predictor for extrauterine involvement and for advanced stage. There was no correlation between CA-125 and LVSI, lymph node positivity, myometrial invasion, age.

Objective: A number of cervical smears may exhibit unequivocal low-grade squamous intraepithelial lesions (LSIL) in association with atypical cells cytomorphologically suspicious, but not sufficient to be interpreted as high-grade squamous intraepithelial lesions (HSIL). These lesions are presently called LSIL, atypical squamous cells cannot exclude HSIL (LSIL/ASC-H). Previous studies have shown that LSIL/ASC-H and ASC-H are both equivocal for HSIL and have a high risk of underlying HSIL. However, in researching the literature only two studies were found which rendered the results as cervical intraepithelial neoplasia (CIN) 2 and CIN3 separately. The purpose of this study was to compare the distribution of biopsy results for CIN2 and CIN3 in patients with ASC-H, HSIL, and LSIL/ASC-H. Study Design: Between January 2005 and December 2011, cervicovaginal smears (98,594) with a diagnosis of ASC-H, LSIL, LSIL/ASC-H, or HSIL were re-evaluated to determine the prevalence of future lesion development. Results: A total of 252 patients who had histologic follow-up within a year were selected. Among these, LSIL/ASC-H (31.7%) had the highest prevalence of CIN2 between LSIL (9.3%), ASC-H (10%), and HSIL (16%). All differences were statistically significant. Conclusion: Because of the high predictive value of CIN2, LSIL/ASC-H may have further importance, especially in women of different age groups.

Classified among ovarian sex cord tumors, sclerosing stromal tumor(SST) is an extremely rare ovarian malignant tumor which occurs predominantlybetween the ages of 20 to 40. However small number of postmenopausal or childhood cases were reported.Lower abdomen USG and pelvic MRI indicated unilateral heterogencyctic mass in the 13 year old patient who presented to hospital withcomplaints of dysmenorrhoea and abnormal uterine hemorrage. This article coversimaging, operation, histopathological properties and distinctive diagnosis ofthe benign sclerosing stromal tumors (SST)., Overin sklerozanstromal tümörü (SST), over seks kord tümörleri içinde sınıflandırılan veoldukça nadir görülen benign karakterli bir tümördür. Bu tümörler çoğunlukla 20-40 yaş aralığında görülürler, ancak azsayıda olguda postmenopozal dönemde ya da çocukluk döneminde görülebilirler. 13 yaşında anormal uterin kanama ve dismenore yakınması ile başvuran adolesan kızda, alt batınultrasonografisi (USG) ve pelvik manyetik rezonans görüntülemede(MRG) unilateral heterojen kistik kitletespit edilmiştir. Bu makalede benign sklerozan stromal tümör olgusunun,görüntüleme, operasyon, histopatolojik özellikleri ve ayırıcı tanısısunulmuştur.

To investigate the relationship between cerebral palsy (CP) and perinatal and intrapartum risk factors and markers of birth asphyxia.This was a retrospective case-control study of 101 children with CP and 308 controls who were born at the Zeynep Kamil Hospital between 1990 and 2000. The roles of possible perinatal and intrapartum risk factors were investigated in CP development. Chi-square tests, Fisher's exact tests, Student t-tests, and regression analysis were used for statistical analysis (p0.05).The only significant perinatal risk factor was neonatal weight of2500 grams. The CP rate in the presence of solely intrapartum risk factors was estimated as 24.7% (n = 25). In 39.6% of cases, no risk factor could be identified. When regression analysis was performed, the following factors were significant: decreased beat-to-beat variability on electronic fetal monitoring (EFM) (p = 0.02), an Apgar score of7 at 1 and 5 minutes (p = 0.02), and the necessity for neonatal intensive care unit admission (p0.0001).Intrapartum risk factors were significantly more frequent in the CP group (p0.01). An increased cesarean section rate could not prevent CP, suggesting that the hypoxic insult that causes CP might be of chronic onset. The development of diagnostic tests to detect non-reassuring fetal status in its intrauterine life and interventions at appropriate times may decrease the CP rate.

The clinicopathologic findings of the third case of androgenic adult granulosa cell tumor in patients younger than 15 years was presented and discussed in the light of the literature. A patient complaining of secondary amenorrhea and hirsutism with elevated levels of plasma total testosterone, dehydroepiandrosterone sulfate, free androgen index and serum inhibin A, and a left ovarian septated, cystic mass was admitted to the hospital. The inhibin A level was within normal levels in the first month postoperatively. Inhibin A could be a tumor marker of utmost importance particularly in patients with androgenic or hyperestrogenic symptoms, especially in cases where benign criteria are abundant such as young age, nonincreased levels of classic tumor markers, and ultrasonographic appearance without any suspicion of malignancy.

We report a case of a rare, unusual benign tumor, the cotyledonoid leiomyoma or Sternberg tumor, detected incidentally in a 67-year-old woman who underwent total hysterectomy and bilateral salpingo-oophorectomy because of a persisting left ovarian cyst of 5 cm. This is the 14th case of cotyledonoid leiomyoma and 2nd case which had no intrauterine portion but had extrauterine extensions. At laparotomy, it was detected that a deep red nodular papillary tumor had been dissecting the posterior leaf of the left broad ligament, projecting into the abdominal cavity just near the left cornu of the uterus, and extending in downward direction. The remaining portion was lying between the layers of the left broad ligament and arose from the subserosa of the left side of the uterine isthmus. Although the bizarre and unusual shape was in favor of malignity, the frozen-section examination revealed a benign histology. Although the cotyledonoid leiomyoma is a benign entity, it may suggest a malignant disease owing to its unusual sarcomatoid appearance and its rarity. Therefore, awareness of obstetricians and gynecologists regarding this rare entity will prevent unnecessary anxiety and interventions.

The outcome of 11 cases with vaginal agenesis who underwent intestinal vaginoplasties are presented. Patients were between 18 and 37 years old. Ileum vaginoplasty and sigmoid colon vaginoplasty were carried out in two and nine cases, respectively. Ileum necrosis at donor site requiring ileum resection and bilateral ileostomy encountered in one of the cases was the major complication. Mild stenosis responsive to finger dilatation had been detected in two women with sigmoid vaginoplasty. Excess mucous production, long operation time, and shortness of mesentery of ileum led us to abandon ileum vaginoplasty, and sigmoid colon vaginoplasty was performed in the following cases with vaginal agenesis. All of the neovaginas were patent and functional. We suggest sigmoid colon vaginoplasty as the treatment of choice because of its large lumen, thick walls resistant to trauma, adequate secretion allowing lubrication, not necessitating prolonged dilatation, short recovery time compared with ileum vaginoplasties; and in patients reluctance to prolonged use of dilatators or in those who experienced previous failure of the other treatment modalities.

OBJECTIVE To investigate whether there is any association between urinary or fecal incontinence and childhood bedwetting, and given such a relationship, to detect which type of urinary incontinence (UI) is associated with childhood bedwetting. PATIENTS AND METHODS In all, 1021 patients who were admitted to the outpatient gynaecology clinics of the authors’ institution for an annual gynaecological examination were included in this descriptive clinical study. A simple multi-choice screening questionnaire was used to collect data for analysis. RESULTS There was a history of bedwetting in childhood in 181 (21.1%) of women without and in 48 (29.6%) of those with UI; the difference was significant (chi-square, P

This study was designed to determine whether betamethasone has any effect on 1-hour (50-g) glucose screening test in nongestational diabetic pregnancy, and if any exists, to determine if this effect is transient or permanent. If the effect is temporary, the study was designed to determine the duration of this glucose intolerance effect and to determine the timing of 1-hour glucose screening test after betamethasone usage. One hundred fourteen pregnant women with a diagnosis of preterm labor at 24 to 34 weeks gestation were enrolled into the prospective study. One-hour glucose screening test was performed before initiation of hydration treatment. Forty pregnant women with normal 1-hour glucose results, who also had responded to hydration therapy, made up our study group. Twenty-four hours, 72 hours, and 1 week after administration of betamethasone, 50-g glucose challenge tests were again performed. A 3-hour glucose tolerance test was performed in pregnant women, whose 1-hour screening test had been positive 1 week after corticosteroid administration. In the evaluation of data, one-way, variance analysis and Tukey's multiple comparison test were used. The mean value of 1-hour glucose results of 50-g challenge test at the 24 hours was significantly higher than the mean value of 1-hour glucose results of the test done initially before betamethasone administration and than those of the tests done at 72 hours and 1 week (p < 0.001 for these three groups). There was no statistically significant difference between the mean values of 1-hour glucose results of the test done before betamethasone administration and both the results of the tests done at 72 hours (p = 0.96) and 1 week (p = 0.99), separately. There was no significant difference between the mean 1-hour glucose results of the tests at 72 hours and 1 week (p = 0.99). The test results were positive in 42.5%, 10%, and 5% of the patients, respectively at 24 hours, 72 hours, and 1 week. The betamethasone administration significantly deteriorates 1-hour glucose screening test results in the nongestational diabetic patients but this effect of betamethasone is transient. Because of its high false-positivity at 24 hours (42.5%) and at 72 hours (10%) in women with initial negative 1-hour glucose screening test, we suggest that 1-hour glucose screening test in pregnant women be postponed at least 1 week after betamethasone administration or perform the test before administration of betamethasone.

Objective: To determine the outcome of sacrocervicopexy and combined operations in the treatment of uterovaginal prolapse in women with desire to preserving both uterus and fertility. Clinical Presentation and Intervention: Sacrocervicopexy with Prolene mesh and combined operations were performed in 3 women with total uterine prolapse because of the patient’s desire to retain fertility in 2 cases and refusal of hysterectomy in the 3rd patient. The 1st case was a 38-year-old woman, gravida 2, parity 1; the 2nd case a 42-year-old woman, gravida 3, parity 2, and the 3rd a 39-year-old woman, gravida 1, parity 1. Douglas pouch was obliterated with Moschcowitz operation. All of the women underwent sacrocervicopexy with Prolene mesh. The repair of a paravaginal defect and prophylactic Burch urethropexy were accomplished through entering Retzius’ space. Genital hiatus was narrowed via approximating levator muscles transvaginally. No serious intraoperative complications occurred and no recurrence was detected during the follow-up period. There was no postoperative complication except for some degree of pain in the 1st postoperative month in 1 case. Conclusion: The results indicate that sacrocervicopexy and repair of all concomitant defects in the pelvic floor are effective procedures in the treatment of uterovaginal prolapse in cases where there is a desire to retain fertility and uterus.

The aim of our study is to determine whether the serum human chorionic gonadotropin (hCG) level is helpful in the differential diagnosis and in the clinical management and follow-up of preeclampsia, superimposed preeclampsia, and chronic hypertension during the third trimester.Eighty hypertensive pregnant patients, who had been hospitalized, and 25 normotensive pregnant patients, who attended the outpatient perinatology clinic in Zeynep Kamil Women and Pediatric Diseases Education and Research Hospital between June 2001 and September 2001 were enrolled in the study. These patients were evaluated in five groups: mild preeclamptic, severe preeclamptic, superimposed preeclamptic, chronic hypertensive, and normotensive groups. The geometric means of hCG levels of these groups were compared with each other and cutoff levels for differential diagnosis were determined.The geometric mean of hCG levels was established as 17,361.31 mIU/mL in the mild preeclamptic group, 49,817.59 mIU/mL in the severe preeclamptic group, 41,101.09 mIU/mL in the superimposed preeclamptic group, 12,558.57 mIU/mL in the chronic hypertensive group, and 9647.98 mIU/mL in the normotensive group. When the geometric mean of the severe preeclamptic group was compared with the results of the normotensive patients, mild preeclamptic patients, chronic hypertensive patients, and superimposed preeclamptic patients, the mean hCG value of severe preeclamptic group was statistically significantly higher than all of the other groups (p0.001) except for the latter. The geometric mean of hCG levels of severe preeclamptic patients was compared with the geometric mean of hCG levels of superimposed preeclamptic patients (p0.05). The geometric mean of hCG levels in the chronic hypertensive group was lower than that of the superimposed preeclamptic group and the difference was statistically significant (p0.001). The geometric mean of hCG levels of the chronic hypertensive group was not significantly different from the results of the mild preeclamptic group and the normotensive group. There was, however, a statistically significant difference between the geometric means of hCG levels of mild preeclamptic patients and normotensive group (p0.001). The cutoff value of hCG was determined as 25,000 mIU/mL in differentiation of chronic hypertension from the severe preeclampsia, as 20,000 mIU/mL in differentiation of chronic hypertension from the superimposed preeclampsia, and as 30,000 mIU/mL in differentiation of severe preeclampsia from mild preeclampsia.The maternal serum hCG level is a useful laboratory tool when managing and treating hypertensive disorders that complicate pregnancy. The serum hCG level is especially significant in severe preeclampsia and superimposed preeclampsia. Therefore, a high serum hCG level can be a helpful marker in the diagnosis and clinical management by preventing possible complications resulting from severe and superimposed preeclampsia.

Objectives: We planned to determine whether the concentration of human chorionic gonadotropin (hCG) in cervical secretions could be a useful marker for accurate diagnosis of preterm labor, and whether the use of cervical hCG assay in combination with the Bishop score would improve the prediction of delivery within 7 days, and to determine the cut-off values for hCG in prediction of delivery within 100 h, 7 and 14 days, as well as before 35 and 37 weeks of gestation in a group of women at high risk for preterm delivery. Methods: The study was conducted in the perinatology department of Zeynep Kamil Women and Children Diseases Education and Research Hospital between February 2002 and February 2003. One hundered and two subjects with a diagnosis of threatened preterm labor with intact membranes were included in the study. For hCG measurements, a cotton swab was rolled intracervically for 10 s to absorb fluid. Bishop scores were assessed. The correlation test was employed for the variables influencing hCG values. The ROC curve analysis was used to establish an optimal cut-off concentration for cervical hCG and an optimal cut-off level for Bishop score. The continous variables were analyzed by the unpaired, independent, two-tailed t-test and categorical data were analyzed by the chi-square test. Results: A significant positive correlation was present between the cervical hCG concentrations and Bishop scores (r=0.72, P

Many formulas were devised to predict macrosomia. Sonographic measurement require additional training as well as more time to perform whereas amniotic fluid index (AFI) can be estimated in a few minutes and requires less formal training. The use of AFI should be accepted as an initial screening method to distinguish pregnancies at high risk for macrosomia and select those that could benefit from further detailed sonography. In conclusion this study focuses on determining: (1) if AFI can be used more efficiently in clinical management; (2) our own AFI cut-off value to predict fetal macrosomia in Turkish women. (excerpt)

WOS: 000298202800043, PubMed: 21733614, Objective: Urinary incontinence (UI) may affect a woman's physical and psychological well-being in different aspects. The aim of this study was to compare the effects of urinary stress incontinence (USI), detrusor overactivity (DO) and mixed urinary incontinence (MUI) on sexual function. Study design: One-hundred and seventy urinary incontinent, sexually active women were included in this cross-sectional study. After urodynamic evaluation, participants were divided into three subgroups as USI (n = 61), DO (n = 55) and MUI (n = 54). Patients were matched according to age, parity and body mass index (BMI), rendering the sample size to 41 patients in each group. Turkish version short form of the Pelvic Organ Prolapse/Incontinence Sexual Function Questionnaire (PISQ-12) was filled out by each of the participants. Totally, 52 patients were excluded from the study (47 could not be matched and 5 incomplete questionnaire). Demographic characteristics of the participants, total and three domain scores of PISQ-12 were compared among three UI subgroups. Results: The study group was consisted of 38 (32.2%) DO, 41(34.7%) USI and 39(33.1%) MUI patients. Demographic characteristics of the patients were similar in three subgroups. Patients with a diagnosis of MUI had significantly lower mean PISQ-12 scores than the ones with USI and DO whereas patients with USI had lower mean PISQ-12 scores than patients with DO. Conclusion: Although urinary stress incontinence effects sexual function more than detrusor overactivity in terms of PISQ-12 scores, mixed urinary incontinence has the greatest impact on sexual function when compared with urinary stress incontinence and detrusor overactivity. (C) 2011 Elsevier Ireland Ltd. All rights reserved.