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

No consensus exists on the subsequent management strategy of patients who exhibit positive surgical margin (PSM) after re-excision of high-grade cervical intraepithelial neoplasia (CIN). The aim of the study is to examine the predictors related to the persistence of high-grade CIN lesions after re-excision, where PSM was left behind.The present retrospective study included patients with PSM who underwent repeated conization due to residual high-grade CIN lesions between January 2005 and December 2019. The SPSS software v20.0 was used for data interpretation and statistical analysis. P values less than 0.05 were accepted as statistically significant.Repeat conization was performed in 91 patients, 43 (47.3%) presented with PSM with high-grade CIN, 6 (6.5%) presented with micro-invasive carcinoma, and 42 (46.2%) presented with clear surgical margin or CIN 1 at the surgical margin. At the time of conization, patients who presented with lesions5 mm in repeat cone specimens, exhibited a significantly higher rate of residual disease (p0.001). Besides, the involvement of the endocervical margin with high-grade CIN was the predictor of residual disease in repeat cone specimens (p = 0.006).In the cone specimen, the presence of lesion size greater than 5 mm and involvement of the endocervical margin were the predictors of high-grade residual disease after re-excision. Whether it is the first or second procedure, great care must be given to excise the lesion entirely at the time of the conization, preferably in one piece.

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

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

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

Aim: The optimal number of neoadjuvant chemotherapy (NACT) cycles is unclear in epithelial ovarian cancer. Our study aimed to evaluate the effect of the number of NACT cycles before interval debulking surgery on survival. Methods: Data of 221 patients with advanced-stage serous epithelial ovarian cancer (EOC) were retrospectively evaluated. The patients were divided into groups as who received 3 cycles of NACT (group A), 4-5 cycles of NACT (group B), and 6 cycles of NACT (group C). Results: There were 67 (30%) patients in group A, 70 (32%) in group B, and 84 (38%) in group C. Median overall survival (OS) was 61 (range 43–79) months for group A, 44 (range 36–52) months for group B, and 39 (range 27–50) months for group C. In addition, median disease-free survival (DFS) was 23.1 (range 8.5–32.1) months for group A, 19.2 (range 10.1–28.4) months for group B, and 21.5 (range 16–27) months for group C. Patients receiving >3 NACT cycles had worse OS than patients who received 3 NACT cycles (for group A vs. B, p = 0.018; for group A vs. C, p = 0.049). However, in terms of DFS, patients receiving 3 NACT cycles had no statistically significant difference compared to patients who received >3 NACT cycles. Conclusions: Patients with advanced-stage serous EOC who received more than 3 cycles of NACT had poor OS. However, there was no statistical difference in terms of DFS. In addition, >3 cycles of NACT did not increase the probability of achieving complete cytoreduction at the time of surgery.

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

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

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

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

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

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

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

ÖZET:Amaç: Primer kemoradyoterapi tedavisi almış ileri evre serviks kanserli hastalarda uterusa sınırlı rezidü tümör miktarının sağkalıma etkisini belirlemek ve bu tarz tümörlerde görüntüleme yöntemlerinin rezidü tümör saptamadaki başarısı saptamakMateryal Metod: İstanbul Universitesi İstanbul Tıp Fakültesi Jinekolojik Onkoloji Kliniğinde 2009 Nisan-2017 Mayıs ayları arasında opere edilen 31 hasta çalışmaya dahil edilmiştir. Bu hastaların klinikopatolojik özellikleri değerlendirilmiştir. Hastalar operasyon öncesi Magnetik Rezonans inceleme (MRI) ve/veya Pozitron Emisyon Tomografi (PET-BT) ile değerlendirilmiştir. Hastalar operasyon sonrası uterus materyalinde tümör miktarına göre i) rezidu tümör yok ii) rezidü tümör 10 mm olarak üç gruba ayrılmış ve hastalıksız sağkalım incelemesi yapılmıştır.Sonuçlar: Ortanca yaş 54 olarak hesaplanmıştır. MRI rezidü tümör saptamada sensitivitesi %75 spesifitesi %50 ; PET-BT sensitivitesi %54.5 spesifitesi %50 olarak saptanmıştır. Bir yıllık hastalıksız sağkalım oranları rezidü olmayan, mikroskobik rezidü olan ve makroskobik rezidü olan hastalarda sırası ile %92.3, %80 ve %38.5 olarak tespit edildi. Yorum: Irradiye serviks kanserinde rezidü tümör saptamada görüntüleme yöntemlerinin başarısı kısıtlıdır. Histopatolojik olarak saptanmış rezidü tümörün büyüklüğü arttıkça hastalıksız sağkalım rakamları azalmaktadır.

This study was conducted to determine the demographic and clinicopathologic characteristics and evaluate the prognostic value of various factors, such as the extensiveness of surgery, related to the tumour itself and the clinical features in the recurrence of borderline ovarian tumours (BOT). We retrospectively evaluated the data of 103 patients with a borderline ovarian tumours treated at our institution between the years 2000 and 2012. The median age was 37 (16-79) years and the majority of the patients were premenopausal (76.7%). During the follow-up, 16 recurrences were observed (15.5%). The multivariate analysis showed that the micropapillary architecture and fertility sparing surgery were the only significant independent predictors for the development of a recurrence amongst all of the demographic and clinicopathological features. In our study group, we identified that the micropapillary architecture itself and the fertility sparing surgery had a significant impact on the development of a BOT recurrence. The patients who possess these features should be followed up more closely for a long time period. Impact statement What is already known on this subject? A borderline ovarian tumour is known as a recurrent disease. The recurrence rate varies between 5 and 20%. It is well known in the literature that patients treated by an oophorectomy have a relatively lower risk of development of a recurrence compared to the patients treated by cystectomy. What do the results of this study add? Although some of the clinicopathological features are shown to be risk factors for the development of a recurrence in many studies, some of the pathological-clinical and the demographic features have not been described as yet, or have been considered to be equivocal regarding the development of a recurrence. In this study, we investigate all possible demographic, pathological, and clinical factors associated with a recurrence. Not only the well-known pathological characteristics but also the new pathological parameters and clinical approaches have been investigated. For instance, microinvasion architecture and lymphadenectomy speculated in the literature as the risk factors for the development of a recurrence, have not been identified as risk factors in our study. On the other hand, our statistical analyses have revealed that micropapillary architecture should be described as a risk factor for the development of a recurrence. What are the implications of these findings for clinical practice and/or further research? We hope our study becomes influential in the literature on the field of a micropapillary architecture and the development of a recurrence. The patients carrying this feature have to be followed up very closely and carefully. Furthermore, our findings have indicated no significant relation between the performing of a lymphadenectomy and the rate of a recurrence. This result might be encouraging for the gynaecological surgeons to refrain from a lymphadenectomy for the borderline ovarian tumours.

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

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

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

OBJECTIVE: To analyze the relationship between transvaginal ultrasonography (TU), hysteroscopy and endometrial histology in asymptomatic postmenopausal women with breast cancer using tamoxifen, in terms of hyperplasias. Design: Prospective study Setting: University clinic Patients: 69 postmenopausal aymptomatic breast cancer women on tamoxifen Interventions: TU and hysteroscopy plus endometrial biopsy Main Outcome Measures: Sensitivity specifity, positive and negative predictive values of diagnostic procedures were calculated. The relationship between duration of tamoxifen use and development of hyperplasias are calculated by using simple logistic regression. RESULTS: Most common abnormality encountered was polyps (60.9%). A case of endometrioid adenocarcinoma on a polyp and 6 cases of hyperplasia (one atypical hyperplasia) along with the polyps were categorized into “polyps only” by hysteroscopy. Hence all would have been missed if biopsies if biopies were not taken. Positive predictive value (PPV) of TU was calculated to be 69.6%. Sensitivity and PPV of hysteroscopy is low for hyperplasia (33.3% and 50% respectively). A positive correlation was noted (p = 0.002) between duration of tamoxifen use and development of hyperplasia related changes. CONCLUSIONS: Long term use of tamoxifen in ostmenopausal asymptomatic breast cancer patients is associated with higher incidence of hyperplasia related changes. Hyperplasia might coexist with or on a polyp, therefore hysteroscopy might miss these pathologies if ample amount of biopsies are not taken.

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

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

The aim of this study is to determine the thymidine labeling index and its prognostic role in patients with ovarian cancer.Tumor cell proliferation in 32 patients with primary ovarian cancer admitted to Istanbul Medical Faculty, Department of Obstetrics and Gynecology, between 1993 and 1997 was investigated using the [3H]thymidine labeling index (TLI). TLI results were compared with other clinical and histopathologic prognostic parameters.The mean and median TLI values of the patients were 9.3+/-6.2% and 9.20% (range: 0.4-23.0%), respectively. Sixteen patients showed high proliferation rates (mean TLI: 14.3%). These patients had an overall survival rate of 46.7% at 3 years. The mean TLI level and overall survival at 3 years in the low proliferation rate group were 4.4 and 68.8%, respectively. Patients with a high TLI had a significantly shorter survival compared to those with a low TLI (P0.01). There was tendency towards a higher TLI with advanced stage (P0.05). However, there was no statistically significant correlation between TLI and other prognostic parameters.TLI may have a predictive value in determining the outcome of patients with ovarian cancer. Further larger scale studies are needed before definite conclusions can be made about its role as a prognostic factor in this disease.

Background and AIMS: Massive ovarian edema, only around 80 cases reported in literature, is a rare entity often misdiagnosed for a malignancy posing the patient at risk for over-treatment with resultant hormonal dysfunction and infertility. METHODS: A 20-year-old nulliparous woman presented with a right adnexial mass of 17x8cm after 3 weeks of abdominal pain with presumptive diagnosis of ovarian malignancy. All tumor markers were in normal range. RESULTS: During laparotomy, a semi-twisted enlarged ovary was found. Frozen section of the wedge biopsy revealed massive ovarian edema. Oooferectomy was not performed. CONCLUSIONS: Massive ovarian edema should be kept in mind in differential diagnosis of solid ovarian masses in young women. Conservative surgery should be the rule in order to preserve future fertility.

We report a case of mucinous adenocarcinoma arising from mature cystic teratoma (MCT) of the ovary ascertained incidentally during pregnancy. An ovarian adnexal mass was seen in a 38-year-old pregnant woman during cesarean section. Oophorectomy revealed a mucinous adenocarcinoma arising from MCT with additional capsule invasion. Following this, staging procedures were applied. The patient was staged as IC and adjuvant chemotherapy was applied. She has remained disease-free for over 24 months. To our knowledge, this is a case of mucinous adenocarcinoma arising from MCT and the third case of malignant transformation from MCT in pregnancy in English literature.

The aim of the study was to define the prognostic role of the metastasis suppressor gene, nm23, in 50 patients with primary ovarian cancer. Immunohistochemical analysis was performed on formalin-fixed, paraffin-embedded specimens by the primary nm23 monoclonal antibody (Novocastra, NCL-nm23 clone 37.6). Forty-two specimens (84%) showed a positive nm23 staining. The nm23 staining was more intensive in patients with normal serum CA19.9 levels, patients with nonrecurrent disease, and alive patients (p < 0.05). Nm23 expression did not correlate with common clinicopathologic parameters such as histology, grade of differentiation, International Federation of Gynecology and Obstetrics stage, and CA-125. Although the difference was not statistically significant (p = 0.11), we found that nm23 may have a favorable prognostic factor in ovarian cancer. To clarify this subject further, prospective studies on a larger population are needed.

Background and Objectives In ovarian cancer, development of safe and effective methods for providing long-term access to the peritoneal cavity has become increasingly important. Methods A modified Port-A-Cath (Celsite®-port and catheters, B. Braun, Chasseneuil, France) was used in 56 patients with presumed epithelial ovarian cancer at the conclusion of primary or second-look laparotomy. In 37 patients, ports were located on the right costal margin in the midclavicular region and in 19 in the xiphoid region. Results In 56 catheters, 8 (13.8%) complications of severe or moderate degree during the treatment were registered. In-flow obstruction of device occurred in 6 patients, and there was 1 viscous perforation and 1 catheter related infectious peritonitis. Grade III–IV pain and in-flow obstruction were developed in the patients with ports implanted on the right costal margin but not with ports implanted in the xiphoid region. Conclusion The complication rate of intraperitoneal access devices is comparatively low. J. Surg. Oncol. 2000;74:223–226. © 2000 Wiley-Liss, Inc.