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Objective: The aim of this study was to compare the power of preoperative transvaginal ultrasonography, intraoperative macroscopic examination, and frozen section for predicting deep myometrial invasion in endometrial cancer., Methods: This is a retrospective review involving 68 patients who underwent surgical staging for endometrial cancer from 2014 to 2017. Patients with grade 3 endometrial cancer and non-endometrioid tumors were excluded. The findings related to preoperative transvaginal ultrasonography, intraoperative macroscopic examination, and frozen section were compared with definitive histopathological diagnosis., Results: The mean age, gravidity, and body mass index of the patients were 58.1±8.9 years (range: 30-80 years), 3.2±2.1 (range: 0-9), and 33.5±6.6 kg/m2 (range: 20-52 kg/m2), respectively. Only 11 (16.2%) patients were in the premenopausal period, while 57 (83.8%) were in the postmenopausal period. Grade 1 endometrial cancer was found in 29 patients (42.6%) and grade 2 tumors were specified in 39 patients (57.4%). Stage IA disease was found in 45 (66.2%) patients, while stage IB disease was observed in 23 (33.8%) patients. The 5-year survival rate was 91.2%. The sensitivity of preoperative transvaginal ultrasonography, intraoperative macroscopic examination, and frozen section were 56, 34, and 52%, respectively, for predicting deep myometrial invasion. In contrast, the specificity of preoperative ultrasonography, intraoperative macroscopic examination, and frozen section were 86, 100, and 100%, respectively., Conclusion: Transvaginal ultrasonography and intraoperative frozen section were found to have similar sensitivity and specificity for predicting deep myometrial invasion. Preoperative transvaginal ultrasonography appears as an efficient approach for predicting endometrial cancers with deep myometrial invasion.

This was a randomized, placebo-controlled study. The sample consisted of 3 groups of patients: an experimental group, massage application with lavender oil (n = 15); a placebo group, massage application with ultrasound gel (n = 15); and a control group (n = 15). Massage application was performed 3 hours after analgesic application. Pain levels of the patients in the experiment and placebo groups were evaluated with a Verbal Rating Scale (VRS) at the 30th minute and the 3rd hour after the application. Similarly, the pain level of patients in the control group was also evaluated with the VRS at 3 hours after the initial analgesic administration and following the 30th minute and the 3rd hour. Generally, the VRS scores of the 3 groups did not show a significant difference in terms of group and time interaction (P = .221). However, there was a significant difference in VRS scores between the experimental and control groups at the 30th minute after the massage (P = .036). This difference was caused by the lower pain level of the group, which had massage with lavender (2.66 ± .89) compared with the control group (3.80 ± 1.01). According to the study results, while only hand massage application after gynecologic surgery was effective for a short period in decreasing postoperative pain, it was determined that massage application with lavender had a longer effect in decreasing postoperative pain. The results of this study showed that this inexpensive and easy-to-apply method can be safely performed by nurses on postoperative patients and can support pain management of patients in the first hours after gynecologic surgery., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Increased levels of endoglin may represent a new reagent of active neovascularization and angiogenesis process in various cancer types. The prognostic value of tumor CD105 (endoglin) expression in cervical squamous cell cancer (CSCC) patients treated with radical radiotherapy (RT) ± chemotherapy was investigated., Materials and Methods: CD105 (endoglin) expression was assessed by immunohistochemical methods in seventy patients, who were treated with radical RT ± chemotherapy for CSCC. The prognostic effects of CD105 on patient and treatment characteristics, local-regional control, and survival were assessed., Results: The median follow-up was 24 (5-99) months for the whole cohort. The median CD105 microvessel density was 55.5 (range; 12-136). Age (≤61 vs. >61 years; P = 0.015), lymph node metastasis status (absent vs. present; P = 0.028), International Federation of Gynecology and Obstetrics stage (Ib-IIa vs. IIb-IVa; P = 0.036), cycles of concurrent chemotherapy (1-3 vs. 4-6 cycles; P = 0.001), and hemoglobin levels (≤10 g/dL vs. >10 g/dL; P = 0.006) appeared to associate significantly with overall survival on univariate analysis., Discussion: No correlation was identified between the tumor CD105 (endoglin) expression and survival in CSCC patients treated with radical RT ± chemotherapy., Competing Interests: There are no conflicts of interest

Objective: To determine factors influencing overall survival following recurrence (OSFR) in women with low-risk endometrial cancer (EC) treated with surgery alone., Methods: A multicenter, retrospective department database review was performed to identify patients with recurrent "low-risk EC" (patients having less than 50% myometrial invasion [MMI] with grade 1 or 2 endometrioid EC) at 10 gynecologic oncology centers in Turkey. Demographic, clinicopathological, and survival data were collected., Results: We identified 67 patients who developed recurrence of their EC after initially being diagnosed and treated for low-risk EC. For the entire study cohort, the median time to recurrence (TTR) was 23 months (95% confidence interval [CI]=11.5-34.5; standard error [SE]=5.8) and the median OSFR was 59 months (95% CI=12.7-105.2; SE=23.5). We observed 32 (47.8%) isolated vaginal recurrences, 6 (9%) nodal failures, 19 (28.4%) peritoneal failures, and 10 (14.9%) hematogenous disseminations. Overall, 45 relapses (67.2%) were loco-regional whereas 22 (32.8%) were extrapelvic. According to the Gynecologic Oncology Group (GOG) Trial-99, 7 (10.4%) out of 67 women with recurrent low-risk EC were qualified as high-intermediate risk (HIR). The 5-year OSFR rate was significantly higher for patients with TTR ≥36 months compared to those with TTR <36 months (74.3% compared to 33%, p=0.001). On multivariate analysis for OSFR, TTR <36 months (hazard ratio [HR]=8.46; 95% CI=1.65-43.36; p=0.010) and presence of HIR criteria (HR=4.62; 95% CI=1.69-12.58; p=0.003) were significant predictors., Conclusion: Low-risk EC patients recurring earlier than 36 months and those carrying HIR criteria seem more likely to succumb to their tumors after recurrence., Competing Interests: No potential conflict of interest relevant to this article was reported., (Copyright © 2017. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology)

Purpose: The purpose of this study is to evaluate the prognostic role of preoperative neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) and the need for para-aortic lymphadectomy in patients with primary fallopian tube carcinoma (PFTC)., Materials and Methods: Ninety-one patients with a diagnosis of PFTC were identified through the gynecologic oncology service database of six academic centers. Clinicopathological, surgical, and complete blood count data were collected., Results: In univariate analysis, advanced stage, suboptimal surgery, and NLR > 2.7 were significant prognostic factors for progression-free survival, whereas in multivariate analysis, only advanced stage and suboptimal surgery were significant. In addition, in univariate analysis, cancer antigen 125 ≥ 35 U/mL, ascites, advanced stage, suboptimal surgery, NLR > 2.7, PLR > 233.3, platelet count ≥ 400,000 cells/mm(3), staging type, and histological subtype were significant prognostic factors for overall survival (OS); however, in multivariate analysis, only advanced stage, suboptimal surgery, NLR > 2.7, and staging type were significant. Inclusion of pelvic and para-aortic lymphadenectomy in surgery showed significant association with longer OS, with a mean and median OS of 42.0 months and 35.5 months (range, 22 to 78 months), respectively, vs. 33.5 months and 27.5 months (range, 14 to 76 months), respectively, for patients who underwent surgery without para-aortic lymphadenectomy (hazard ratio, 3.1; 95% confidence interval, 1.4 to 5.7; p=0.002)., Conclusion: NLR (in both univariate and multivariate analysis) and PLR (only in univariate analysis) were prognostic factors in PFTC. NLR and PLR are inexpensive and easy tests to perform. In addition, patients with PFTC who underwent bilateral pelvic and para-aortic lymphadenectomy had longer OS.

Pruritus of the vulva is a common symptom among patients attending to outpatient clinics. In the present study, we aimed to assess pathologies causing vulval pruritus in the reliability of biopsy in a tertiary referral centre. A total of 137 patients undergoing vulval colposcopy because of vulval pruritus were reviewed from the hospital records retrospectively. The mean age of the patients was 47.61 ± 11.88 years and 36.5% of the patients were postmenopausal. In 101 (73.7%) of the patients, macroscopic lesions were present. In 88 (64.2%) of the patients, tolidine-positive stained areas were determined under colposcopy. In total, 68 (49.6%) of the lesions were plain, whereas 51 (37.2%) of them were depigmented. Lichen simplex chronicus, lichen sclerosis and chronic inflammation were the major pathologies associated with vulval pruritus (25.5%, n = 35; 20.4%, n = 28; 14.6%, n = 20). In conclusion, several pathologies out of vulvovaginal candidiasis may lead to vulval pruritus and clinicians should be aware of the importance of biopsy in determining the underlying pathology.

Objective: The objective of this study was to evaluate the frequency of genitourinary symptoms and their relationships with several factors in a large cohort of postmenopausal women in Turkey., Methods: We performed a cross-sectional study to review genitourinary complaints among 1,328 postmenopausal women; 1,071 of these women were enrolled in the study. They were questioned about their vaginal and urinary symptoms, and the relationships between these symptoms and their demographic characteristics were evaluated., Results: The most common vaginal and urinary symptoms were dryness (n = 358; 33.4%) and nocturia (n = 421; 39.3%), respectively. Cigarette smoking and regular exercise were not associated with any vaginal symptoms (P > 0.05), with the exception of an association between regular exercise and vaginal dryness (P = 0.026). Nocturia was more common in women older than 60 years (P = 0.001) and in obese women (P = 0.013). Based on multiple binary logistic regression analysis, lower educational status (primary school vs secondary school or higher) and higher parity were the factors most significantly associated with the appearance of at least three vaginal symptoms. Lower educational status was associated with vaginal pain (P = 0.002; odds ratio [OR], 1.75), itching (P < 0.001; OR, 1.23), and discharge (P = 0.011; OR, 1.46). Higher parity was associated with vaginal itching (P < 0.001; OR, 1.23), discharge (P = 0.07; OR, 1.18), and burning (P = 0.012; OR, 1.16). Body mass index (BMI) was the only factor that was significantly associated with the appearance of at least three urinary symptoms, with each one-unit increase in BMI increasing the risk of urgency (P < 0.001; OR, 1.06), nocturia (P < 0.001; OR, 1.06), and frequency (P = 0.009; OR, 1.04)., Conclusions: We identify associations between the frequency of genitourinary complaints and educational status, parity, and BMI. There is no association between regular exercise and urogenital symptoms. However, prospective studies are needed to evaluate the effects of regular exercise on urogenital symptoms. When examining postmenopausal women with risk factors for urinary and vaginal symptoms, clinicians should evaluate these symptoms more thoroughly to facilitate earlier treatment.

Aim: Borderline ovarian tumors(BOT) account for ten to 20 percent of all epitelial ovarian carcinomas and often occur in reproductive ages. The aim of this study was to evaluate the clinical and reproductive outcomes of patients who were diagnosed with BOT and underwent fertility sparing surgery., Materials and Methods: Patients younger than 40 years who underwent fertility sparing surgery for BOT from 2004 to 2012 were reviewed retrospectively and were evaluated according to the reproductive and clinical outcomes., Results: Twenty-eight patients younger than 40 years with BOT underwent fertility sparing surgery. Median follow up time was 42 +/- 28.1 months. During the follow up period, two patients (7.1%) developed recurrence at 35 and 36 months, respectively. Five (17.9%) out of 28 patients became pregnant during the follow up period., Conclusion: Fertility sparing surgery should be the first choice for the treatment of BOT in patients who wish to preserve fertility.

Background: To evaluate and compare the efficacy of vaginal misoprostol and a rectal nonsteroidal anti-inflammatory drug (NSAID) on pain relief during Pipelle endometrial biopsies in a placebo-controlled randomized study., Methods: One hundred and fifty-one women who had an indication for a Pipelle endometrial biopsy were randomized into three groups as follows: group 1, vaginal misoprostol; group 2, rectal NSAID, and group 3, control. After the procedure, the women were asked to record their pain severity on a visual analog scale. The secondary outcome of the study was patient acceptability, and vasovagal symptoms and analgesic requirements after the procedure were also recorded., Results: There were no statistically significant differences in the demographic characteristics of the patients. The primary study outcome was the comparison of the median visual analog scale pain scores of groups 1 and 2 versus group 3 (controls); no statistically significant differences were found (p = 0.502). In addition, the patient acceptability (Likert scale), vasovagal symptoms and analgesic requirements after the procedure were similar among the groups (p = 0.204, 1 and 0.546, respectively)., Conclusion: Our study did not demonstrate a reduction in pain relief during Pipelle endometrial biopsies for patients receiving vaginal misoprostol or a rectal NSAID when compared to patients receiving placebo treatment., (© 2014 S. Karger AG, Basel.)

Objective: To evaluate the relationship between urogenital symptoms and climacteric complaints, including anxiety, depression, somatic, vasomotor and sexual subscores according to the Greene Climacteric Scale (GCS)., Methods: We retrospectively reviewed the records of 1278 patients and the 908 patients who fulfilled the inclusion criteria were included in the study. The relationships were evaluated between GCS and vaginal symptoms, including vaginal pain, dyspareunia, itching, discharge, burning, dryness, and postcoital bleeding, and urinary symptoms, including dysuria, frequency, nocturia and incontinence, by using univariate and multivariate analyses., Results: Among vaginal symptoms, somatic and sexual scores and, among urinary symptoms, anxiety and somatic scores were found to be the most associated factors. Of the vaginal symptoms, the highest odds ratios for somatic score and sexual score were found to be 2.21 (95% confidence interval (CI) 1.69-2.88, p < 0.001) and 2.08 (95% CI 1.70-2.56, p = 0.029), respectively. Multivariate logistic regression analyses for urinary symptoms revealed that the highest odds ratios for anxiety, somatic, depression and sexual scores were 1.53 (95% CI 1.20-1.95, p = 0.001), 1.92 (95% CI 1.38-2.66, p = 0.01), 1.47 (95% CI 1.11-1.94, p = 0.007), and 1.28 (95% CI 1.06-1.55, p < 0.001), respectively., Conclusions: There is a strong relationship between urogenital symptoms and GCS subscores. Therefore, clinicians should be aware of urogenital problems in the presence of severe climacteric symptoms and this may provide earlier treatment for urogenital complaints.

Objectives: We hypothesized that sonographically guided core biopsy is an effective method for the differential diagnosis of adnexal masses and evaluated patients who underwent core biopsies in our gynecologic oncology department., Methods: We reviewed the medical records of 55 patients who underwent sonographically guided core biopsies in our gynecologic oncology department between 2010 and 2013. Patients with suspected ovarian malignancies who were unsuitable for optimal debulking surgery and patients at risk for higher morbidity and mortality because of a poor performance status, suspected nongynecologic tumors, and peritoneal tuberculosis were indicated for sonographically guided biopsy., Results: The indications for sonographically guided core biopsy were candidacy for suboptimal cytoreduction (n = 32 [58.2%]), a poor performance status (n = 11 [20.0%]), and suspected nongynecologic tumors (n = 12 [21.8%]). Histopathologic evaluations revealed primary ovarian tumors in 36 patients (65.5%). Tuberculosis was found to be the second most common disease (n = 8 [14.5%]) among the patients who underwent core biopsies. In 2 patients (3.6%), histologic examination revealed metastatic colorectal cancer., Conclusions: Sonographically guided core biopsy may be preferred as a minimally invasive procedure for managing adnexal masses, particularly in patients with advanced ovarian cancer and high comorbidities who might benefit from neoadjuvant chemotherapy and in cases of suspected nongynecologic tumors, including pelvic tuberculosis.

We aimed to evaluate the influence of surgical intervention on gestational and neonatal outcomes in women who underwent elective surgery in the second trimester of gestation because of an adnexal mass. We retrospectively reviewed the hospital records of women who underwent elective surgery for adnexal masses in the second trimester of gestation between 2006 and 2012. The ages of the women ranged between 17 and 33 years. Eight women underwent a laparotomy, and one woman, who aborted on the day of the operation, underwent a laparoscopy. Dermoid cysts, cystadenoma and borderline ovarian tumours were present in four, two and two of the women, respectively. Eight women had no complications after surgery and delivered healthy newborns at term. We concluded that elective surgery on an adnexal mass in the second trimester of gestation is safe for both the mother and the fetus.

The objective of this study was to use mean platelet volume (MPV) as a measure of platelet activation in patients with endometrial adenocarcinoma and healthy controls. There was a total of 310 patients with endometrial adenocarcinoma retrospectively evaluated and 250 healthy controls. Preoperative haemoglobin, platelet counts and mean platelet volume were evaluated and statistical tests were conducted to determine the differences among early and advanced disease groups and controls. Median haemoglobin (13.0 vs 13.3 g/dl) and platelet count (282,000 vs 280,000/μl) values were similar in patients with endometrial adenocarcinoma and healthy controls (p > 0.05). Subjects with endometrial cancer exhibited slightly higher MPV than the control group (8.4 fl vs 8.2 fl) (p = 0.048). In patients with advanced-stage endometrial cancer, haemoglobin was significantly lower (p < 0.05) and MPV was significantly higher (p < 0.05) than in either patients with early-stage endometrial cancer or the control group. It was concluded that MPV was found to be a marker for predicting advanced-stage endometrial cancers.

Acute abdomen with hemoperitoneum is a very rare entity in postmenopausal women due to gynecologic conditions. A 54-year-old, postmenopausal woman was brought to emergency department with severe abdominal pain. Physical examination revealed acute abdomen findings with 15 cm pelvic mass on the right adnexal region. Immediate exploratory laparotomy was performed. During laparotomy 1000 cc of bloodstained fluid, ruptured and actively bleeding large mass arising from right ovary was observed. Right salpingo-oopherectomy was performed in emergency conditions, and pathology report revealed an adult type of granulosa cell tumor. After this result, staging surgery was performed and patient was diagnosed as granulosa cell tumor stage 1 c. Cisplatin, etoposide, and bleomycin chemotherapy was given. Clinicians should be aware of granulosa cell tumors which may occur at any age and prone to rupture. Frozen section will be helpful in order to avoid incomplete surgeries especially in postmenopausal women presented with intra-abdominal bleeding.

Purpose of Investigation: The aim of the study was to show the role of the cytoskeletal proteins CK8 and CK18 in endometrial cancer invasion and to histopathologically classify endometrial cancer patients., Methods: This study was a prospective analysis of 49 histologic samples of consecutively surgically operated endometrial cancer patients. After histopathologic classification the most invasive tumor area was selected for immunohistochemistry. Monoclonal antihuman keratin Ab-4 and keratin Ab-1 were applied., Results: CK8 and CK18 stained tumoral tissue and tumoral cell debris in the lymphovascular space were significantly correlated with stage (p < or = 0.005)., Conclusions: To understand the causes of early treatment failure in endometrial cancer patients, further studies are needed to show the role of enhancing factors of endometrial cancer invasion.

In an aim to evaluate the diagnostic efficacy of preoperative abdominal-pelvic CT for the prediction of suboptimal cytoreduction of epithelial ovarian carcinoma (EOC) at primary surgery, CT scans of 48 patients who underwent primary surgery for EOC were retrospectively analyzed. The presence of at least one of the following CT findings: multiple implants > 1 cm in maximum diameter in the mesenteria of the small or large intestines, porta hepatis or intersegmental fissure or on the hepatic surface, diaphragmatic peritoneum, gastrohepatic or gastrosplenic ligaments or the extension of tumor infiltration > 2 cm on the omentum towards the spleen or stomach or the intestines encased by the tumor > 2 cm, diffuse peritoneal thickening or invasion of the lateral pelvic wall > 1 cm or multiple lymph nodes > 1 cm at the cardiophrenic and suprarenal levels were accepted as the critical markers for predicting suboptimal cytoreduction. Suboptimal surgery, defined as leaving a residual tumor mass > 1 cm, was determined in 18 (37.5%) patients. CT predicted suboptimal cytoreduction with 83.3% (15/18) sensitivity, 90% (27/30) specificity and 87.5% (42/48) accuracy. PPV and NPV values were 83.3% (15/18) and 90% (27/30), respectively. These results suggested that preoperative CT could successfully predict suboptimal surgery in patients with EOC.

Purpose of Investigation: Actin bundling protein fascin has been previously associated with tumor progression in human cancers. We evaluated whether fascin also plays a role in endometrioid carcinomas., Methods: Cases of 28 proliferative and hyperplastic endometrium and 43 endometrioid carcinomas were examined by immunohistochemistry using antihuman fascin antibody., Results: Weak fascin expression in glandular epithelium was observed in 39% of non-neoplastic samples and various degrees of fascin expression were observed in 74% of neoplastic samples. The number of positively stained samples and intensity of epithelial staining were significantly higher in endometrioid carcinoma compared to the non-neoplastic group (p < 0.001). The number of positively stained samples and total fascin scores of stroma were significantly higher in proliferative and hyperplastic endometrium biopsies compared to the endometrioid carcinoma (p < 0.001). Higher grade endometrioid carcinoma cases had significantly increased total epithelial fascin scores (.042, p < 0.05). There was also a significant difference between tumor grade and patient survival (.040, p < 0.05). There was a significant correlation between microvessel count and disease-free survival (r = .412, p = .006). In the proliferative and hyperplastic endometrial biopsies microvessels stained homogeneously in all cases (28/28), but in the endometrioid carcinoma group eight out of 43 cases showed heterogeneous fascin staining of microvessels. The difference was significant (.019, p < 0.05)., Conclusions: Our study supported the dynamic role of actin bundling protein fascin in generating and maintaining endometrial neoplasms. It also showed that in the development of neoplasia, stromal fascin expression decreases but epithelial fascin expression up-regulates.

Purpose of Investigation: The aim of the study was to compare the fascin expression pattern and histopathologic features of malign epithelial ovarian tumors obtained by the primary and secondary surgeries., Methods: The samples of 94 epithelial ovarian carcinomas, 35 secondary surgeries for ovarian carcinomas, 13 borderline epithelial ovarian tumors, 25 cystadenomas and four normal ovarian tissues were stained by means of fascin immunohistochemistry. Secondary surgeries included in the study were secondary cytoreduction at the time of second-look laparotomy (SLL), interval debulking surgery after neoadjuvant chemotherapy or secondary cytoreductive surgery in patients with recurrent epithelial ovarian carcinoma., Results: Mean rank value of the stromal fascin score was higher in 94 cases of malign epithelial ovarian carcinomas than borderline epithelial tumors, cystadenomas and normal ovaries (.000, p < 0.001). There was no significant difference in terms of total epithelial fascin score (.685, p > 0.05) and total stromal fascin score (.572, p > 0.05) between the primary and the secondary surgeries of epithelial ovarian carcinomas., Conclusions: Regarding the results of stromal fascin expression in 94 epithelial ovarian carcinomas, we hypothesized that cell-matrix interaction was an important step in the progression of malign epithelial ovarian neoplasms. Our study showed that the initial tumorigenic phenotype did not change with time and use of cisplatinum-based combination chemotherapy. Further studies with close follow-up of patients are necessary to reveal the role of fascin on matrix degradation mechanisms which might be the cause of the recurrences in ovarian neoplasms.

Purpose of Investigation: The aim of the study was to investigate the role of fascin in tumor progression and to investigate the role of fascin on endothelial cell migration and angiogenesis in ovarian neoplasms., Methods: In the study, 94 malign epithelial ovarian neoplasms, 13 borderline epithelial ovarian neoplasms, 25 serous and mucinous cystadenomas and four normal ovarian tissues were examined by means of immunohistochemistry, using monoclonal antihuman fascin antibody, clone IM20., Results: Total stromal fascin score in cases of borderline and malign epithelial ovarian tumors was significantly higher compared to normal ovaries and benign epithelial ovarian tumors (.000, p < 0.001). There was no statistically significant difference in terms of total epithelial fascin scores of samples between groups (.080, p > 0.05). Presence of vascular invasion (.000, p < 0.001), psammomatous calcifications (.001, p = 0.001), and lymphocytic infiltration (.000, p < 0.001) were significantly higher in malign neoplasms. There was no significant difference in terms of mean microvessel count and homogeneous or heterogeneous fascin expression of microvessels between the benign and malign groups (respectively p = .228 and p = .143)., Conclusions: This study suggests that up-regulation of fascin in tumoral tissue may promote invasion of ovarian carcinoma by cell-matrix adhesion.

The concomitant phenomenon of a third trimester pregnancy with a significant degree of pelvic organ prolapse is extremely rare. We report on a patient with pelvic organ prolapse complicating third trimester pregnancy treated by concomitant cesarean hysterectomy and abdominal sacrocolpopexy. A 30-year-old woman, gravida 6, parity 5, was admitted to the hospital with uterine contractions in week 35 of gestation. Pelvic examination in the dorsal lithotomy position revealed a stage 3 pelvic organ prolapse. A cesarean hysterectomy was performed. After hysterectomy, the vaginal cuff was suspended to the periosteum overlying the sacral promontory. Cesarean hysterectomy might be a therapeutic option for women who have completed their families and are suffering from severe pelvic organ prolapse complicating third trimester pregnancy, particularly in developing countries where access to health care is limited., (Copyright (c) 2006 S. Karger AG, Basel.)

Objective: To evaluate the sequential genomic copy alterations related to the development of precursor lesions and endometrioid-type endometrial carcinomas, and its association with cellular atypia., Study Design: Paraffin-embedded tissue specimens from 32 cases of endometrial hyperplasia, 15 of endometrial carcinoma, and 20 of normal endometrial tissue were retrospectively evaluated by the comparative genomic hybridization (CGH) technique. The average number of copy alterations (ANCA) index was used to define the incidence of genomic imbalances in each tissue group. Identified sequential genetic abnormalities were compared with the final histopathological diagnosis and the cellular atypia., Results: Detectable and consistent chromosomal imbalances were found in 13 hyperplasia and 9 carcinoma specimens. There was a significant correlation between ANCA value and degree of cellular atypia and tumor grade. While 1p36-pter, 20q deletions, and 4q overrepresentation were the most prevalent imbalances detected in both complex hyperplasia and complex atypical hyperplasia, 17q22-qter deletion and amplification of 2p34 were only seen in hyperplasia with atypical cells. Overrepresentations of chromosomes 8q, 1q, and 3q are the most frequent aberrations in endometrial carcinomas, but were absent from all the precursor lesions except one. Underrepresentations of chromosomes 1p36-pter and 10q are the other commonly seen aberrations in carcinomas, the latter being more frequent in moderately differentiated than in poorly differentiated lesions., Conclusions: Different patterns of chromosomal aberrations are seen in precursor lesions than in endometrial carcinomas, except for the loss of 1p36-pter. The presence of 1p deletion in both endometrial hyperplasia and cancer specimens suggests that this is an early event in the development of carcinoma. These results support a stepwise mode of tumorigenesis with accumulation of a series of genomic copy alterations in endometrial carcinogenesis.

Malignant neoplasms of the fallopian tube are the rarest of the gynecologic cancers. The frequency of histologic subtypes has been difficult to ascertain from the literature because most authors have not classified these tumors according to their cell types. Papillary serous adenocarcinoma appears to be the most common histologic type. On the contrary, mixed cell types of fallopian tube carcinoma have rarely been reported in the literature. A case of mixed serous and endometrioid carcinoma of the fallopian tube is presented and the related literature is reviewed.

Purpose of Investigation: Our objectives were (1) to examine expression of fascin in cervical tissues with chronic inflammation, intraepithelial neoplasms and invasive carcinomas, and (2) to investigate the role of fascin on endothelial migration and angiogenesis in cervical neoplasms., Methods: In this study we investigated by means of immunohistochemistry fascin expression in 92 cervical biopsy samples representative of chronic inflammation (n=13), squamous intraepithelial lesions (SILs, n = 33) and invasive carcinomas (n = 46)., Results: Various degrees of fascin expression were observed in 94% of the samples of SILs, in 67% of the samples of invasive cervical carcinoma and in 69% of the samples of chronic inflammation. Total epithelial fascin scores of samples were significantly higher in high-grade (H)SILs compared to low-grade (L)SILs, invasive carcinoma and chronic inflammation of the cervix (p < 0.05). Mean microvessel count was 55.00 +/- 5.17 in HSILs, 40.76 +/- 3.57 in LSILs, 37.11 +/- 2.91 in carcinoma and 25.69 +/- 3.98 in chronic inflammation. We found a significantly higher microvessel count in HSILs compared to invasive carcinoma and chronic inflammation (respectively, p = .004, p = .000)., Conclusion: Epithelial fascin expression up-regulated when the malignant tumor cell phenotype had occurred in the cervix. Similarly, microvessel count increased with the beginning of cervical tumorigenesis.

Routine dilatation and curettage (D&C) in all patients with postmenopausal bleeding (PMB) is debatable, as 70%-80% will eventually receive benign diagnoses. Endometrial thickness (ET) measurements by transvaginal ultrasonography (TVUS) are used with high sensitivity to detect patients who would benefit from D&C, yet they suffer from low specificity that fails to reduce undue invasive procedures. The aim of this study was to define optimal cutoffs for ET in diagnosing endometrial pathologies in PMB and to assess a possible complementary role for Doppler ultrasonography. The study population consisted of 97 women with PMB; 39, 22 and 36 of whom had endometrial cancer (EC), benign endometrial pathologies and normal endometrial findings, respectively, defined by D&C performed after TVUS, which was used to measure uterine dimensions and ET, together with pulsatility and resistance indices (PI and RI, respectively) of the uterine arteries. Receiver operating characteristics curves revealed ET to be the most valuable parameter to prognosticate both EC and any endometrial pathology (sensitivities of 90% and 89%, and specificities of 79% and 94% with optimal cutoffs of 9.6 and 7.7 mm, respectively). Binary logistic regression revealed uterine artery RI to be the only independent variable that could be used together with ET, which increased the sensitivity of ET to 97% and 93% for EC and any endometrial pathology, but caused its specificity to regress to 58% and 53%, respectively. Same levels of sensitivity, yet better levels of specificity of 60% and 89%, respectively, were attained by using a cutoff of 6.3 mm for ET alone. Assessing uterine artery Doppler indices has no complementary role for measuring ET in evaluating PMB.

Objective: To evaluate the effectiveness of CO(2) laser ablation of vaginal intraepithelial neoplasia (VAIN) and to define prognostic factors., Study Design: Medical records of 24 patients with VAIN II or III, treated by CO(2) laser ablation from 1990 to 1998 were reviewed. The grade, location, and focality of the lesions, the age, follow-up period and menopausal status of the patients, the power and duration of laser ablation, the presence of concurrent cervical or vulvar neoplasia or previous hysterectomy were evaluated as possible prognostic factors., Results: Ablations of the VAIN were successfully accomplished in all of the patients with a mean period of 25.2+10.2 min, including additional simultaneous ablations of the cervix or vulva in eight (33.3%) patients. There was no early or late major complication. VAIN was completely eliminated in 17 (70.8%) patients after the first and in 19 (79.2%) patients after multiple episodes of ablation with a mean follow-up of 26.7+19.6 months. VAIN progressed to invasive vaginal carcinoma in one woman. None of the evaluated prognostic factors was found to be related to the persistence or recurrence., Conclusion: CO(2) laser ablation was a safe and effective method for the treatment of VAIN. However, since no prognostic factor was defined, all patients should be closely evaluated for persistence, recurrence or progression to invasion.

Purpose: To investigate the prognostic value of p53 overexpression in endometrial adenocarcinoma cases of different stages and histologic subtypes., Methods: One hundred and eleven surgically staged endometrial carcinoma (EC) cases from 1996 to 2000 constituted this retrospective study group. Prognostic factors determined through the evaluation of surgery specimens by co-author pathologist, were surgical stage, tumor size, histology, histologic and nuclear grade, myometrial invasion, adnexal/serosal metastasis, peritoneal cytology, retroperitoneal lymph node involvement p53 overexpression was assessed via immunohistochemical staining. Tissues that expressed p53 were considered as positive p53 staining. In terms of degree of staining, 1-29%, 30-90% and 80-100% of tumoral tissue stained with p53 were considered to be mild, moderate and high p53 staining, respectively., Results: Mean age and follow-up period of the study group were 58.2 +/- 10.6 years and 33.4 +/- 2.7 months, respectively. Percentages of cases surgically staged as early (I-II) and advanced (III-IV) FIGO stages were 65.8% (n: 73) and 34.2% (n: 38), respectively. Cases with positive p53 staining had a significantly high mean survival period compared with those with negative p53 staining (86.6 +/- 6.0 vs 49.1 +/- 8.1, p < 0.001). p53 overexpression was statistically detected to be high in Stage III-IV tumors, non-endometrioid histologic subtypes (p = 0.019), histologic and nuclear grade 2-3 tumors (p < 0.001), adnexal/serosal metastasis (p = 0.001), lymph node involvement (p = 0.012), and positive peritoneal cytology (p = 0.017). The degree of p53 staining was remarkably correlated with survival. In cases with mild and high p53 staining, mean survival times were 47.1 +/- 7.0 months and 57.0 +/- 13.1 months, respectively (p = 0.0003) compared to those with high p53 staining. On univariate analysis, all of the prognosticators, including p53 staining (p < 0.001) and degree of p53 staining (p < 0.001) appeared to be independent risk factors for poor prognosis. On multivariate analysis, only pelvic lymph node involvement (p = 0.03), serosal/adnexal involvement (p = 0.004), and positive peritoneal cytology (p = 0.01) were found to be independent prognosticators of survival while p53 expression (p = 0.743) and degree of p53 staining (p = 0.802) were not detected as independent prognosticators., Conclusion: p53 overexpression is strongly related to poor prognostic indicators in endometrial adenocarcinoma. Although in this study p53 overexpression was not detected as an independent prognosticator, additional studies with large data set are needed to evaluate the prognostic value of p53 expression.

Purpose of the Investigation: To determine the diagnostic value of serum vascular endothelial growth factor (VEGF) in the preoperative assessment of the nature of ovarian masses., Materials and Methods: A prospective cohort study was conducted from August 2001 to September 2002 on 40 premenopausal and 23 postmenopausal patients with ovarian masses. During preoperative workup, patient age, serum Ca-125 levels, serum VEGF levels, and tumor volume based on ultrasonographic examination were determined. Laparoscopic (n=23) or laparotomic (n=39) approaches were undertaken to obtain the final pathologic result. According to the final ovarian pathology, follicular cysts, corpus luteum cysts and endometriomas were grouped as non-neoplastic ovarian masses (n=40, group I). Serous or mucinous cyctadenomas, dermoid tumors and fibromas were allocated into the neoplastic benign ovarian mass group (n=10, group II). Primary malignant ovarian neoplasms were categorized into the neoplastic-malign group (n=12, group III)., Results: Mean ages of cases among groups I, II and III were 39.0 +/- 2.0, 42.2 +/- 5.2 and 56.9 +/- 4.2, respectively. As age of the cases enrolled in this sudy increased, the more likely was the occurrence of neoplastic malign ovarian pathologies (p < 0.001). Among postmenopausal cases diagnosed with an ovarian mass, serum Ca-125 levels were 113.5 +/- 20 IU/ml compared to those in premenopausal cases (85.8 +/- 16.0, p = 0.05). The values for serum VEGF values among pre- and postmenopausal ovarian masses were 46.2 +/- 6.7 pg/ml and 68.2 +/- 7.9, respectively (p = 0.04). In group I, serum VEGF levels of endometriomas (56.5 +/- 1.5 pg/ml) were higher compared to those of follicular or corpus luteum cysts (30.6 +/- 2.8, p = 0.05). In contrast, tumor size appeared to be larger in non-endometriotic. non-neoplastic cysts (10.1 +/- 2.0 cm), compared to endometriomas (6.4 +/- 0.6 cm, p < 0.01). Serum VEGF levels of group III were higher than other groups (p < 0.001). With respect to the discriminating benign or malign nature of the mass, with a specific cut-off value of serum VEGF level of 68.7 pg/ml, the sensitivity, specificity, positive and negative likelihood ratios were 92.3%, 88.0%, 3.3 and 0.1, respectively. For serum Ca-125 levels, the sensitivity, specificity, positive and negative likelihood ratio with a statistically relevant cut-off value of 102 IU/ml were, 76.9%, 76.0%, 3.21 and 0.3, respectively. Area under curve (AUC) for serum VEGF and Ca-125 values were 0.938 (95% CI: 0.81-0.96) and 0.769 (95% CI: 0.64-0.86), respectively (p = 0.02). Among the postmenopausal group, AUC for serum VEGF and Ca-125 was detected as 0.902 (95% CI: 0.70-0.98) and 0.873 (95% CI: 0.66-0.91) (p = 0.14)., Conclusion: Serum VEGF has the potential to be considered as a tumor marker with a good diagnostic relevance in differentiating the nature of ovarian masses.

Purpose of Investigation: To determine the expression of matrix metalloproteinase-9 (MMP-9) expression in malignant and borderline ovarian tumors and its correlation to prognosis., Methods: Forty-five patients with primary epithelial ovarian tumors were enrolled in this retrospective study from 1988 to 2002. Only malignant (n = 30) and borderline (n = 15) ovarian tumors constituted the study group. All cases were surgically staged according to FIGO criteria. Patient characteristics and clinico-pathological findings were obtained from hospital records. Paraffin-embedded tissue blocks were treated with MMP-9 immunohistochemical stain. The percentage of the total number of tumors staining positively was categorised and awarded a score of 0 to 4: < 5% as 0, < or = 6-25% as 1, 26-50% as 2, 51-75% as 3 and 76-100% as 4. The intensity of immunostaining was scored on a 3-point scale: 1, weak; 2, moderate and 3, intense. A weighed score for each tumor specimen was produced by multiplying the percentage score with the intensity score and was defined as the 'epithelial MMP-9 score'. Stromal staining was also assessed as weak, moderate and intense. Cases with final epithelial MMP-9 scores < or = 6 and > 6 were then recategorised into two groups, accordingly. Based on degree of stromal staining, cases were recategorised into two final groups as mildly stained and intense or moderately stained. Tumor stages were regrouped as early (Stage I-II) and late (Stage III-IV), respectively., Results: Mean ages of cases with malignant and borderline ovarian tumors were 57.2 +/- 3.1 and 49.7 +/- 2.1 years, respectively. Epithelial MMP-9 scores were higher in malignant tumors compared to borderline tumors (p = 0.014). However, with regard to stromal MMP-9 staining, no significant difference was observed among malignant and borderline tumors (p = 0.113). Among malignant ovarian tumors, epithelial MMP-9 scores did not differ between early versus late-staged and well versus poorly differentiated tumors. Median survival time of cases with epithelial MMP-9 scores < or = 6 and > 6 were 24 months and 32 months, respectively (log-rank: 0.93, p = 0.335). Cases with weak stromal MMP-9 staining had a longer median survival (48 months) compared to cases with moderate or intense stromal MMP-9 staining (24 months, log-rank: 4.46, p = 0.03)., Conclusion: Epithelial MMP-9 expression generally appears in the malignant form of ovarian tumors compared to borderline tumors. MMP-9 expression in the stroma but not in the epithelium contributes to poor survival in ovarian cancers.

Objective: To assess angiogenesis in preinvasive and invasive cervical lesions and its prognostic value in squamous cell carcinoma (SCC)., Methods: Twenty-seven cervical intraepithelial lesions (CIN I, II and III), 27 Stage Ib-IIa SCC and 12 normal cervical epithelium were included in the study. Clinico-pathological prognostic factors were re-evaluated from the patients' files and previous tissue sections. Microvessel density (MVD), a marker for angiogenesis, was assessed from new tissue blocks by an immunohistochemical staining method. Statistical tests included Kruskall-Wallis analysis, the Mann-Whitney U-test, Fisher's exact t-test to analyse the categorical data and Cox regression and Kaplan-Meier survival analyses to define the effect of prognosticators on survival., Results: CIN II and III lesions had significantly higher MVD counts than normal epithelium and CIN I lesions, both of which had similar MVD count. Compared to preinvasive lesions invasive SCC had significantly higher MVD counts. Among SCC cases, only pelvic lymph node involvement appeared to be independent risk factor on unvariate analysis. However, MVD, as a cut-off value of 21 determined by ROC analysis, was found to be an independent prognosticator in early stage SCC cases by multivariate analysis., Conclusion: Despite the small number of enrolled cases, the results of this study suggest that angiogenesis involved in the development and progression of cervical neoplasms and MVD might be used as a prognostic factor.

Purpose: To assess microvessel density (MVD) as a marker for angiogenesis in endometrial carcinoma (EC) and normal endometrium at the proliferative and secretory phase, and to determine its prognostic value on survival among cases with EC., Methods: Forty-three endometrial carcinoma cases were surgically staged and recruited for this case-control study. Tissue specimens from hysterectomies due to benign conditions (uterine descensus, myoma uteri, chronic pelvic pain, adenomyosis), that belonged to proliferative (n = 10) and secretory (n = 10) endometrium (n = 10), were studied as the control group (n = 20). MVD was assessed in hot areas where a high density of microvessels were detected within tumoral tissue and normal endometrium at proliferative and secretory phases. Among EC, various prognosticators such as tumor stage, histological and nuclear grade, tumor size, lympho-vascular space involvement (LVSI), cervical involvement, myometrial invasion, adnexal and lymph node involvement, peritoneal cytology and MVD were analysed in regard to survival., Results: The mean age of cases with EC was 58.3 +/- 1.4. MVD was apparently high in EC cases (p < 0.05). Among control cases, endometrium from proliferative and secretory phases of the menstrual cycle was not statistically different (48.5 +/- 3.6 vs 47.4 +/- 3.8, respectively). MVD was correlated with high surgical stage (p < 0.001), cervical involvement (p = 0.01), adnexal involvement (p = 0.04), lympho-vascular space involvement (p = 0.02), pelvic and para-aortic lymph node metastasis (p < 0.001) and positive peritoneal cytology (p < 0.001). On univariate analysis, with a MVD cut-off value of 81/0.739 mm2, surgical stage (p < 0.001), LVSI (p < 0.001), retroperitoneal lymph node involvement (p < 0.001), adnexal metastasis (p < 0.001), peritoneal cytology (p = 0.005) and MVD count (p < 0.001) appeared to be independent factors for survival. On multivariate analysis, only pelvic lymph node involvement (p = 0.03) and MVD (p = 0.02) were found to be independent prognosticators on survival., Conclusions: Angiogenesis is apparent in both initial and further evolution of a tumoral process. MVD appears to have a substantial prognostic value on survival in EC cases.

With the aim to describe preoperative computed tomography (CT) findings, the clinical, histopathological, and CT findings of the 12 consecutive patients with a confirmed diagnosis of primary peritoneal serous papillary carcinoma (PPSPC) were retrospectively evaluated. Of the 12 patients with a mean age of 57.5 +/- 10.3 years, ten (83.3%) were postmenopausal. Serum Ca-125 levels were elevated in all patients. Ten (83.3%) had Stage III and two (16.7%) patients had Stage IV disease and none of the excised ovaries had deep parenchymal involvement. The most common CT findings were the omental (n = 11), mesenterial (n = 11) and parietal peritoneal involvements (n = 10), and variable amount of ascites (n = 10). Pelvic peritoneal involvement in four (33.3%) patients was so extensive that it resembled a mass in the Douglas pouch. Thickening of the wall of gastrointestinal viscera (n = 9), lymphadenopathy (n = 5) and pleural effusion (n = 5) were the other CT findings and calcification was seen in only three (25.0%) patients. Although, none of them was characteristic, CT features of diffuse peritoneal, omental and mesenterial involvement especially in middle-aged or elderly postmenopausal women with normal-size ovaries in the absence of an identifiable primary site in conjunction with elevated level of serum CA-125 should suggest the possibility of PPSPC.

Objectives: To determine the efficacy of intravaginal maximal electrical stimulation for the treatment of refractive detrusor instability., Methods: Thirty-five consecutive patients, treated by maximal electrical stimulation for pure refractive detrusor instability were evaluated subjectively by patient's questionnaires and 24-h urinary diary and objectively by 1-h standardized pad test and subtracted cystometry before and 1 week after the treatment. Paired-t and chi(2)-tests were used for the statistical analysis of the data., Results: Thirty-one (88.6%) of the 35 patients were found to be either cured or improved, subjectively. The overall objective success rates based on the 1-h pad test and subtracted cystometry were 80.0% and 74.3%, respectively. The results of all subjective and objective assessment tests, except postvoiding residual urine volume, improved significantly after the treatment (P<0.01). No significant adverse effect related to the treatment was observed, except vaginal irritation noted only by 5 (14.3%) patients., Conclusion: Maximal electrical stimulation could offer a safe, non-invasive and effective treatment for patients with detrusor instability who respond poorly to other conservative therapies.

A 38-year-old woman presented with a 1-week history of low back pain, distension, weakness, and loss of appetite. Laboratory studies showed a serum CA-125 level of 281 U/ml (normal value 1.2-32 U/ml). Abdominopelvic sonography revealed massive ascites, left pleural effusion, and a heterogeneous, hypoechogenic, and smoothly outlined solid mass. The mass had a close proximity and to the anterior side of the right ovary. Doppler sonography showed that the mass was hypervascularized. Computed tomography demonstrated numerous, tortuous vascular structures around the mass and along the omentum indicating its auxiliary vascularization from the omentum. Exploratory laparotomy and histopathological examination revealed pedunculated leiomyoma with parasitized blood supply from the omentum. Ascites and pleural effusion disappeared 6 months after surgery. We present the clinical and CT features of a parasitic leiomyoma adhering to the omentum.

Objectives: To relate uterine artery blood flow characteristics to serum human chorionic gonadotropin (hCG) levels in patients with gestational trophoblastic disease (GTD)., Study Design: Twenty-one patients with GTD were investigated by serum hCG titers and Doppler ultrasonography of uterine arteries. The relations between the Doppler indices and the serum hCG titers were evaluated by paired-t, Mann-Whitney U tests, and Pearson's correlation analysis., Results: Significant but weak negative correlations were observed between systole/diastole (S/D) ratios, resistance indices (RIs) and pulsatility indices (PIs) and the absolute values of serum hCG levels with correlation coefficients of -0.31, -0.37, and -0.33 (P < 0.05). However, the same Doppler indices had more significant and strong negative correlations with the logarithmic values of the serum hCG levels with correlation coefficients of -0.65, -0.58, and -0.63, respectively (P < 0.01). Five patients who received chemotherapy had significantly lower Doppler indices than those 16 patients with spontaneous regression (P < 0.001)., Conclusions: Uterine artery Doppler indices might be used for the surveillance of the patients with GTD.

Background: To evaluate the effectiveness of a new ultrasonographic method for discrimination of successful and failed anti-incontinence operations., Methods: Ninety-six patients who had undergone anti-incontinence operations for the diagnosis of pure genuine stress incontinence due to bladder neck hypermobility were evaluated by perineal ultrasonography and 1 hr standardized pad test 6, 12 and 24 months after their operations. The distances from the bladder neck to the lower tip (A) and to the posterior midpoint of symphysis pubis (B) were measured at rest and during stress. Bladder neck mobility (Mu) was obtained by two-caliper method. After superimposing the symphysis pubis of the frozen images, the bladder neck positions at rest and during stress were plotted on an x-y coordinate system by using computer programs and the corresponding x and y-values (X and Y) calculated and the second bladder neck mobility (Mc) were measured on the x-y coordinate system by computer. Unpaired and paired-t-tests were used for statistical analysis., Results: Ten (10.4%) patients had recurrent urinary incontinence, while 86 (89.6%) were continent 24 months after the operation. The incontinent patients had significantly longer Mu, Mc and distance B during stress and lower X and Y-values during stress than the continent patients at the last control (P < 0.001). When the previous results were compared, the incontinent patients had significantly lower Y-values during stress and greater Mc values beginning 6 months after the operation, while they were still continent (P < 0.01). Once present, the significant differences between the incontinent versus continent patients persisted from that point onward., Conclusions: Measurement of the bladder neck mobility on an x-y co-ordinate system could discriminate the failed and successful operations and predict the outcome of the surgery.

Objective: In order to determine the significance of proliferative activity (PA) in endometrial carcinomas, we analysed the expression of cell cycle-related antigens in routinely processed tissue., Materials and Methods: Serial sections of 113 endometrial carcinoma specimens were immunostained with the monoclonal antibody DNA Topoisomerase II-alpha (Ki-S1). In addition to Topoisomerase II-alpha (Ki-S1) staining, histologic type, International Federation of Gynecology and Obstetrics (FIGO) stage. FIMO grade, depth of myometrial invasion, tumor size, lymphovascular space invasion, serosal and/or adnexal involvement, lymph node metastasis, age and peritoneal cytology were evaluated as prognostic indicators. The median follow-up time was 23 (range, 1 to 126 ) months., Results: FIGO stage, FIGO grade, tumor size, lymphovascular space invasion, lymph node metastasis, peritoneal cytology and Topoisomerase II-alpha (Ki-S1) expression all significantly influenced survival in univariate analyses (p < or = 0.05). In the Cox regression analysis, Topoisomerase II-alpha (Ki-S1), serosal and/or adnexal involvement, and lymph node metastasis expression were the only variables with independent prognostic impact (p < or = 0.05), whereas FIGO stage, FIGO grade, histologic type FIGO grade, depth of invasion, tumor size, lymphovascular space invasion, age and peritoneal cytology had no independent influence (p > 0.05). Topoisomerase II-alpha (Ki-S1) staining was significantly elevated in advanced (Stage II, III, IV) as opposed to early (Stage I) carcinomas (p < or = 0.05)., Conclusion: The association with established prognosticators for endometrial carcinomas, and the results of uni- and multivariate analysis indicate that the additional evaluation of DNA Topoisomerase II-alpha (Ki-S1) peptide antibody (PA) is useful for classifying patients into subgroups with low and high risk of relapse which might help to individualize the therapeutic strategy in endometrial carcinomas.

Purpose of Investigation: To determine the rates of hydatidiform mole (HM) cases at extreme reproductive life in a developing country., Methods: A descriptive study was performed to assess the number of pregnancies and deliveries in Turkey, from 1932 to 2000, based on nationally or internationally published data from different university and state maternity hospitals., Results: A spectrum of prevalence rates in different hospitals were depicted. Almost all of represented data were hospital-based. Percentages of all HM cases < 19 years old and > 40 years old compared to the total number of HMs in each study were not mentioned. In addition, the number of HM compared to total number of deliveries and pregnancies in those age groups were not provided in those studies., Conclusion: There appears to be a need for further descriptive studies on a national basis, in regard to assess total number of HM cases per total pregnancies and deliveries for those age groups.

Pelvic abscess is a rare entity in pregnancy. The true etiology is uncertain but a flare-up of an old pelvic inflammatory disease is most likely. Usually, these patients undergo laparotomy and these abscesses are discovered incidentally, as described in our series. Surgical drainage and conservative surgical procedures under antibiotics are recommended during pregnancy albeit there is no consensus on patient management. Through this report, we aim to discuss this clinical entity and to underline the importance of patient management in case of its diagnosis., (Copyright 2002 S. Karger AG, Basel)

Purpose: To determine the correlation between bcl-2 expression and clinicopathological findings in cervical intraepithelial neoplasias (CIN I, II, III) and invasive cervical lesions, and its effect on overall survival rate., Methods: Fifty specimens derived from 22 preinvasive and invasive cervical cancer cases up to surgical stage IIb (21 squamous cervical carcinoma and 7 adenocarcinoma cases) were preserved in paraffin blocks from primary surgery and constituted the study group. Tissues were processed and stained by immunohistochemical methods to assess the degree of bcl-2 expression., Results: Positive bcl-2 expression was detected in 54% (13/21) of invasive lesions, while negative in 46% of cases. In CIN's, overall bcl-2 positivity was detected in 68% of cases. Bcl-2 expression was highly relevant between low grade (CIN I) and high grade (CIN II-III) lesions (p < 0.05). As regards degree of tissue staining for bcl-2 in CIN III cases, a statistically relevant difference was detected in comparison with low-grade preinvasive lesions (p < 0.05). In invasive cervical cancer cases, patients with bcl-2 positivity had a longer survival rate. By using the Cox regression model, univariate analysis did not show any specific prognostic factor to be important for survival rate, whereas, on multivariate analysis, histopathologic subtypes (p = 0.0390) and stage of tumor (p = 0.0451) had a statistically significant impact on overall survival rate., Conclusions: Bcl-2 expression, especially in preinvasive lesions, may play a role in the apoptotic process and be regarded as a marker for disease progression. In invasive cervical carcinomas, bcl-2 expression has not been shown to be effective in overall survival rates.

Objective: To assess the value of P-glycoprotein (Pgp) expression in advanced epithelial ovarian cancer with regard to clinicopathological findings and disease prognosis., Methods: Twenty-four cases diagnosed as primary epithelial ovarian malignancies, between 1993-1999, were enrolled in this study. All of the cases had undergone cytoreductive surgery and an optimal staging procedure. Following cytoreductive surgery, in 18 patients, cisplatin+cyclophosphamide, and in six patients, cisplatin+paclitaxel combination chemotherapy regimens were initiated. After six courses of chemotherapy, cases were evaluated by pelvic examination, transvaginal ultrasound, pelvi-abdominal tomography and serum Ca-125 levels for the presence of residual disease. Following this evaluation residual tumor was detected in 14 cases and secondary cytoreductive surgery was undergone. In ten cases without any clinical and laboratory confirmation of the presence of tumor, second-look laparotomy was performed. In 24 epithelial ovarian cancer cases, both in primary or secondary cytoreductive surgery, Pgp expression was determined by immunohistochemical methods., Results: Following primary surgery, in 25% (6/24) of cases, analysis of tumor specimens showed presence of Pgp expression. In cases recurring after first-line chemotherapy, Pgp expression was not statistically different in regard to chemotherapy regimen (p = 0.098). Pgp expression in tumoral tissues after chemotherapy did show a higher Pgp expression than before chemotherapy (p = 0.016). No significant correlation was relevant between Pgp expression and Ca-125 levels, histopathological differentiation, histologic subgroups of tumor, primary and residual tumor sizes and overall survival., Conclusion: In epithelial ovarian cancer, Pgp expression has no effect on overall disease survival.

Background: To evaluate the effects of severe cystocele on lower urinary tract function., Methods: Urogynecologic evaluation composed of patient questionnaire, urinary diary, pad test, Q-tip test, perineal ultrasonography and cystometry was performed on 60 patients with reducible grade III or IV cystocele before and after reduction of the prolapsed organs. The data were analyzed by Paired-t and Chi-square tests and Pearson's correlation analysis., Results: One-hour pad test revealed that 17 (28.3%) of the 60 patients with reducible severe cystocele had no demonstrable urinary incontinence, while 26 (43.3%) had mild and 17 (28.3%) had moderate or severe incontinence. However, all patients had moderate or severe incontinence after reduction with vaginal packing (p<0.001). The vaginal packing had no significant effect on the maximum bladder capacity, the intravesical pressure at maximum capacity and the frequency of detrusor instability (33.3%). Whereas, urine loss after 1-hour pad test, bladder neck mobility, straining Q-tip angle and PUVA increased significantly after reduction of the cystocele (p<0.01)., Conclusions: As grade III or IV cystocele may mask the presence and severity of urinary stress incontinence, preoperative urogynecological evaluation should be done after reduction of the cystocele.

We discuss the clinical presentation and consequences of pelvic tuberculosis in the context of 3 cases having developed typical signs and symptoms of ascites and abdominal mass. These cases are reported to emphasize the difficulty of early diagnosis and treatment of the disease., (Copyright 2001 S. Karger AG, Basel)

Objective: To assess the cellular DNA status of epithelial ovarian cancers with regard to clinicopathological findings and its effect on prognosis., Materials and Methods: Twenty-six consecutive patients with a diagnosis of epithelial ovarian cancer who had been treated by primary surgery and six courses of platinum-based chemotherapy were enrolled in this study. Second-look laparotomy (SLL) was performed in all cases following confirmation of the clinical remission state. Surgical stage, tumor grade, initial tumor volume, residual tumor volume, histopathologic differentiation, and SLL findings were analyzed in correlation with DNA ploidy and DNA index. DNA analysis was performed via DNA flow cytometry through paraffin-embedded tissue specimens., Results: Of 26 patients, flow cytometric studies revealed 16 aneuploidy cases (61.5%). DNA index values ranged from 1.1 to 1.82 (average 1.29 +/- 0.28). The flow cytometry coefficient of variation mean value was set to 6.7. Taking the cutoff value of 1.2 for DNA indices, a fairly good correlation was detected between DNA ploidy and DNA indices (p < 0.001). The aneuploidy incidence was found to be high in advanced and poorly differentiated tumors (p < 0.05). There was statistically more residual tumor volume in aneuploid tumors during primary cytoreductive surgery and also higher recurrence rates following six courses of chemotherapy compared with diploid tumors (p < 0.05). No significant correlation was detected between the histopathologic subtypes and tumor volume (p > 0.05). Residual tumor volumes were larger in cases with DNA indices of 1.2 yielding higher residual tumor volume following surgery and being in good correlation with SLL results (p < 0.05). The mean survival rates of cases with aneuploid tumor and a DNA index of >1.2 were low compared to those with diploid tumors and DNA indices of <1.2 tumors (p < 0.05)., Conclusion: DNA ploidy and DNA indices are important prognosticators for malignant epithelial ovarian tumors. They should be evaluated together with the patient's clinical status and other prognostic factors., (Copyright 2001 S. Karger AG, Basel)

A case of seven consecutive hydatidiform moles is presented. All of her pregnancies revealed a molar pregnancy, 4 of which were demonstrated histopathologically. In the context of this study, the potential risk for malignant transformation and the obstetric outcome are highlighted. The literature regarding recurrent molar pregnancies is reviewed., (Copyright 2001 S. Karger AG, Basel)

Objectives: To evaluate the factors that may affect the selection of a reversible or an irreversible contraceptive method., Methods: In an urban area of a developing country, demographic characteristics, educational and income levels, and previously used contraceptive methods were retrospectively reviewed for 3 years from the files of women who had chosen reversible or irreversible contraceptive methods. Student's t test and the chi2 test were used to analyze the data obtained from the two groups of women., Results: Out of a total of 8078 women, 595 (7.4%) selected surgical sterilization, while 7483 (92.6%) preferred reversible methods such as intrauterine devices (38.1%), combined oral contraceptives (13.9%), condoms (40%) and Norplant (0.6%). Compared to those who preferred reversible methods, the women with surgical sterilization had a higher mean age (33.9 +/- 4.2 years versus 29.6 +/- 3.9 years), mean gravidity (3.8 +/- 0.9 versus 2.3 +/- 1.2) and mean number of living children (2.6 +/- 0.8 versus 2.1 +/- 1.1) (p < 0.01). These women had also higher rates of high-school education (37.3% versus 30.1%) and previous modern contraceptive use (78.1% versus 71.2%) (p < 0.01). None of the women with surgical sterilization, but 1770 (33.0%) of those who chose reversible methods, had fewer than two living children., Conclusions: These data suggest that irreversible contraceptive methods tend to be chosen by older women with higher educational levels, who have decided that their family is complete and who have at least two children.

Background: To assess the correlation between the severity of incontinence and some ultrasonographic parameters used to document the mobility of bladder neck., Methods: The severity of the incontinence and mobility the bladder neck were evaluated by pad test and perineal ultrasonography respectively in 74 patients with pure anatomic stress incontinence. During perineal ultrasonography, distances from the bladder neck to the lower tip (A) and to the posterior midpoint of symphysis pubis (B) were measured at rest and during stress. The first bladder neck mobility was obtained by two caliper method (Mu). After superimposing the symphysis pubis of the frozen images, the bladder neck positions at rest and during stress were plotted on an x-y coordinate system by using computer programs and the corresponding X and Y values were calculated. The second bladder neck mobility was measured on this x-y coordinate system (Mc). Paired t-test and correlation analysis were used for statistical analysis of the data., Results: The mean Mc was significantly higher than the mean Mu (p<0.01). Compared to the values at rest, the mean distance A did not change significantly; however, the mean distance B increased, and X and Y values decreased significantly during stress (p<0.01). The amount of urine leaked per hour had significant positive correlation with distance B-stress and Mc and significant negative correlation with Y-rest, X-stress and Y-stress (p<0.05-0.001)., Conclusion: These data suggested that the bladder neck mobility was underestimated when it was measured by two caliper method and the absolute positions or mobility of the bladder neck measured by computer on an x-y coordinate system could effectively document the severity of the decreased support of bladder neck.

Purpose of Investigation: To define the deletion or over-expression of p53 genes and their prognostic significance in epithelial ovarian cancers., Methods: A total of 26 patients with epithelial ovarian cancer, who had undergone second-look laparotomy after primary surgery and six courses of platinum-based chemotherapy were included in the study. Paraffin-embedded archival tissue samples of all cases were examined for deletion and over-expression of p53 gene by FISH and immunohistochemical methods, respectively. The relation between these findings and clinico-pathological prognosticators or survival of the patients were analyzed by the Fisher Exact chi2 test, Cox regression model and life table analysis., Results: p53 gene deletion, related to single or double allele, was determined in all cases with a range of 6% to 75% of the cancer cells. When 40% was accepted as the cut-off ratio for the deletion rate, seven (26.9%) of the cases were observed to have p53 deletion. Although p53 over-expression was defined in 12 (46.1%) patients, four of whom were also accompanied by p53 deletion, there was no relation between the p53 deletion and over-expression (p>0.05). p53 deletion was also not related to any prognostic factors or survival of the patients (p>0.05). However, cases with p53 over-expression had significantly more advanced stage and higher-grade tumors, and shorter median survival (p>0.05-0.01)., Conclusion: p53 gene mutation determined by over-expression of p53 protein has been suggested as an important prognostic factor for epithelial ovarian cancer, however, it has not always been accompanied by p53 deletion.