[Show abstract][Hide abstract] ABSTRACT: Sarcoma botryoides of cervix is a rare variant of rhabdomyosarcomas (RMS) of female genital tract. It is usually diagnosed in first or second decade of life. In this case report, we aimed to present a 21 year-old nulligravid patient who was diagnosed with embryonal RMS of the cervix, to discuss the treatment options that have been stated in the literature, and to highlight the advantage of fertility sparing management in these young patients.
We report a 21-year-old nulligravid woman complaining about a mass protruding from introitus, which was represented with a 8×7 cm "grape-like" cervical polyp on speculum examination. The histopathologic examination of the biopsy taken was combined with immunohistochemical staining with desmin, myogenin, S100, vimentin, and myoglobin. Colposcopy, second biopsy, and positron emission tomography were used during the follow-up. The histopathologic examination revealed embryonal RMS of cervix. She received three cycles of combination chemotherapy, doxorubicin and ifosfamide. She refused to have a surgery because of an unplanned, desired pregnancy at two months after the chemotherapy. She was lost during the follow-up. After having an uneventful pregnancy and a successful delivery, she reapplied at postpartum 6(th) month. Colposcopic evaluation revealed a local polypoid area, the histopathologic examination of biopsy suggested recurrence even though positron emission tomography scans were unremarkable. Therefore complementary treatment was planned as conization and pelvic lymphadenectomy. The histopathology revealed no residual tumor on the conization material and no involvement of pelvic lymph nodes.
Fertility sparing management, including doxorubicin and ifosfamid combination in chemotherapy step, can be management option. Pregnancy and successful delivery is possible during the treatment. Colposcopy has importance for early detection of recurrences.
Iranian Journal of Reproductive Medicine 02/2015; 13(2):113-6. · 0.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives. Possible primary sites of pelvic serous cancers are, fallopian tubes, ovaries or peritoneum. Recent studies have revealed that a portion of these tumors originates from serous tubal intraepithelial carcinoma (STIC) at the distal end of fallopian tubes. In this study, the association of STIC with pelvic serous carcinomas and the pathologic parameters that indicate the tubes as the primary site were assessed. Methods. In total, 495 pairs of fallopian tubes obtained via total abdominal hysterectomy and bilateral salpingo-oophorectomy between 2011 and 2013 were examined according to SEE-FIM protocol. Hematoxylin and eosin-stained slides were examined by pathologists. Suspicious areas were immunostained with p53 and Ki-67 to diagnose STIC precisely. Results. Of the 495 cases, 110 cases were malignant. Among 34 cases of non-uterine serous carcinomas, 13 were diagnosed with STIC. STIC was located at the fimbrial end of the fallopian tubes in 12 cases. No STIC was identified in the gynecologic malignancies other than non-uterine serous pelvic carcinomas and benign gynecologic pathologies. Comparison of the ovarian and tubal cancer cases with and without STIC did not reveal a factor that helps to define the primary site. STIC was an important factor associated in a higher portion of the cases with bilateral ovarian cancer. Conclusion. The role of STIC in carcinogenesis continues to be discussed as it is unknown whether STIC is the precursor lesion or just associates with the malignancies. Discovering the accurate precursor lesions and tumor carcinogenesis is essential to prevent these malignancies and to develop early diagnostic methods.
[Show abstract][Hide abstract] ABSTRACT: Objective: To determine of 53 cases with borderline ovarian tumors according to clinical features, treatment methods, recurrence and
Material and Methods: Fifty-three patients with borderline ovarian tumors operated in Zeynep Kamil Hospital between 2001-2011
are included. Demographic and clinical findings, surgical methods, wish for the preservation of fertility, recurrences and survivals were
Results: Average age of patients were 45.4±15.5. Time at diagnosis 56.6% of the patients were in postmenopausal, 43.4% of patients
were in premenopausal period. %67.9 of the patients had serous, 26.4% of them had musinous histologic type and 5.7% of them had
mixt type. Tumor markers were elevated (≥35IU/ml) in %62,3 of the patients before the surgery. One of the patients were treated with
total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO), 7 of the patients (13.2%) were treated with unilateral
salpingoophorectomy (USO) and biopsy from other ovary, 14 of the patients (26.4%) were treated with USO+bilateral pelvic and paraaortic
lymphadenectomy (BPPLND) and omentectomy, 31 of patients (58.5%) were treated with TAH+BSO+BPPLND+omentectomy. Forty-nine of
the patients (92.45%) were stage I. 39.6% (n=21) of the patients were treated with fertility sparing surgery but five of them were reoperated
in 1 year. Totally 30.2% (n=16) of the patients were treated with fertility sparing surgery. We have had 5 babies and 1 ectopic pregnancy
after fertility sparing surgery. Furthermore we have not seen any recurrence during our follows-up.
Conclusion: Borderline ovarian tumors have perfect prognosis. Conservative treatment of borderline ovarian tumors should be consider in
patients with fertilty desire and at reproductive age but patients should be warned for recurrences rates. Our experiences are coherent
[Show abstract][Hide abstract] ABSTRACT: This study aimed to evaluate and reexamine materials of the patients with cervical biopsy revealing cervical intraepithelial neoplasia and their cone biopsies revealing no lesion.
Twenty-five patients with cervical biopsy revealing cervical intraepithelial neoplasia and cone biopsies revealing no lesion among 202 patients who had undergone cervical conization after colposcopically derived cervical biopsy between 2005 and 2011 were included in this study. Ki67 and P16 were applied to the all biopsy slides. The conization blocks of patients whose reevaluation results of the original biopsy slides were positive were completely sectioned to reexamine the presence of any lesion, and suspicious areas were stained with Ki67 and P16.
Of the 25 patients' punch biopsies, no lesion was detected in 13 patients. The false positivity of first punch biopsy (52%) was the main reason for negative cone biopsy result after positive punch biopsy. Punch biopsies of the other 12 patients confirmed the lesions previously diagnosed. The detailed examination of conization specimens of the latter group showed 3 new low-grade cervical intraepithelial neoplasia, which had not been identified before.
Discordance between cervical biopsy findings and cervical conization findings could result from misdiagnosis of cervical biopsy, failure in preparation of the whole conization material, and technical difficulties of conization. Ki67 and P16 staining can be used in such cases to clarify the diagnosis.
[Show abstract][Hide abstract] ABSTRACT: Objective: We aimed to evaluate uterine junctional zone thickness, cervical length and bioelectrical impedance analysis of body composition in women with endometriosis. Material and Methods: This is a prospective study conducted in a tertiary teaching hospital. A total of 73 patients were included in the study. Endometriosis was surgically diagnosed in 36 patients (study group). The control group included 37 patients. Main outcome measure(s): Bioelectrical impedance analysis was used to measure body composition. Uterine junctional zone thickness and cervical length were measured by transvaginal ultrasonography. Results: Patients' characteristics (age, gravida, parity, live baby, age of menarche, lengths of menstrual cycle, percentage of patients with dysmenorrhea, positive family history), body mass index (BMI) (kg/m(2)), amount of body fat (kg), percentage of body fat were not statistically different between the two groups (p>0.05). The length of menstruation and cervical length were longer in women with endometriosis. Similarly, the inner myometrium was thicker in women with endometriosis than the control group. Conclusion: The relation between endometriosis and demographic features such as age, gravida, parity, gravida, BMI, lengths of the menstrual cycle, age of menarche are controversial. Longer cervical length and thicker inner myometrial layer may be important in the etiopathogenesis of endometriosis.
Balkan Journal of Medical Genetics 12/2012; 29(4):410-3. DOI:10.5152/balkanmedj.2012.042 · 0.17 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of the present study was to evaluate the efficacy of passive uterine straightening during intrauterine insemination (IUI).
A randomized controlled trial was conducted at Zeynep Kamil Maternity and Pediatric Research and Training Hospital. Participants were 460 women with unexplained infertility. Interventions were IUI by passive straightening of the uterus by means of bladder filling, or IUI performed with an empty bladder. Main outcome measures included pregnancy rate and difficulty of IUI.
Four hundred and sixty couples were allocated: 230 couples were allocated to the full bladder group, and 230 couples were allocated to the empty bladder group (control). The pregnancy rate was higher in the full bladder group than in the empty bladder (control) group (P=0.03, 13.5% vs 7.4%; relative risk [RR] 1.95 for pregnant patients; 95% confidence intervals [CI] 1.048-3.637). The risk of undergoing difficult IUI was higher in the empty bladder group than the full bladder group (P<0.001; 10.0% vs 37.8%, RR 0.18 for difficulty IUI; 95% CI 0.11-0.30). The clinical pregnancy rate was also higher in the group of patients who had easy IUI than in the group of patients who had difficult IUI (P<0.05, 12.7% [42/331] vs 5.5% [6/110]); RR 2.51 for pregnancy; 95% CI 1.04-6.09).
Passive straightening of the uterus makes the procedure less difficult and improves the clinical pregnancy rate.
Journal of Obstetrics and Gynaecology Research 11/2011; 38(1):291-6. DOI:10.1111/j.1447-0756.2011.01684.x · 0.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Placental site trophoblastic tumor is a rare form of gestational trophoblastic disease, derived from invasive implantation site (intermediate) trophoblastic cells. It is frequently resistant to chemotherapy. Patients with metastases, however, frequently have progressive disease and die despite surgery and multiagent chemotherapy. In this case, a 24-year-old woman was referred because of intermittent vaginal bleeding episodes for 5 months following delivery. Multiple metastases in lungs, liver, kidneys, breast, pancreas, and adrenal and thyroid glands were detected. Combination therapy including surgery and multiagent chemotherapy was planned. Hysterectomy and pelvic lymph node dissection were performed. All metastatic lesions disappeared with EMA-CO treatment. However four courses of BEP regimen, salvage therapy, was performed for plateauing hCG level. Surgery and multiagent chemotherapy seem mainstay of treatment of cases having multiple metastases of PSTTs.
Medical Oncology 06/2008; 26(1):96-100. DOI:10.1007/s12032-008-9076-9 · 2.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Primary peritoneal carcinoma (PPC) occurs mostly in older women and rarely in women under 50 years of age. The mean age of patients with PPC in our study was 65.5 years. We present the clinical and demographic data, management of cases and the results of six women who underwent exploratory laparotomy between January 2003 and August 2006.
European journal of gynaecological oncology 02/2007; 28(4):330-1. · 0.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Pregnancy complicated by endodermal sinus tumor (EST) of the ovary has rarely been reported.
A huge ovarian EST causing bowel obstruction was found in a 22-year-old patient at 34 weeks of gestation. Abnormally high alpha-fetoprotein (AFP) levels suggested a malignant germ cell tumor of the ovary. The patient was submitted to cesarean section and fertility sparing surgery, and then received four courses of combination chemotherapy. There was no evidence of recurrence 19 months after initial treatment but transvaginal ultrasound (US) evaluation showed an intrauterine pregnancy of six weeks. We delivered a 3,200 g healthy male baby with Apgar scores of 8 and 9 by elective cesarean section at 39 weeks of gestation.
Successful outcome of a second pregnancy is possible after treatment with fertility sparing surgery and combination chemotherapy for an endodermal sinus tumor associated with a first pregnancy. Moreover checking of weekly AFP levels and performing monthly abdominal US could be effective for surveillance of these pregnancies. However management of EST during pregnancy should be based on consideration of the patient's presenting condition, preferences, and gestational age.
European journal of gynaecological oncology 02/2007; 28(2):155-9. · 0.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We aimed to investigate the utility and efficacy of the Keyes skin biopsy instrument for cervical biopsy procedures.
A prospective clinical trial was conducted on 50 women with cervical lesions. Colposcopy-guided cervical biopsies were collected using a Keyes biopsy punch and a Kevorkian biopsy forceps and the two methods were compared with definitive histopathological examination of the specimens obtained by the loop electrosurgical excision procedure (LEEP), conization or hysterectomy.
There were no differences in speed of collection, diagnostic value of specimens, complication rates, or sample quality. The sensitivity, specificity, positive and negative predictivity of specimens were all 100% for both methods.
The Keyes biopsy punch was found to be a safe, rapid and accurate diagnostic tool in cervical biopsy procedures. Based on the results of this study, the use of a Keyes punch instrument can be recommended as an alternative to other cervical biopsy methods.
European journal of gynaecological oncology 02/2007; 28(3):214-6. · 0.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Cesarean scar pregnancy is implantation of the pregnancy within the fibrous tissue of the cesarean scar which is completely surrounded by myometrium.
A 32-year-old woman, gravida 2, para 1 presented at our emergency department with mild lower abdominal pain and minimal vaginal bleeding. She was diagnosed with cesarean scar pregnancy. Conservative treatment with methotrexate 50 mg/m2 was administered IM on days 0 and 8. Her betaHCG value was zero at the 14th week after beginning of the treatment.
Repeated methotrexate administration in the management of cesarean scar pregnancy should be attempted in informed patients who especially desire fertility and can be closely followed up.
[Show abstract][Hide abstract] ABSTRACT: Primary carcinoma of the fallopian tube is rare and its preoperative diagnosis difficult due to the lack of specific symptoms. In this report we present a rare case of primary carcinoma of the fallopian tube with synchronous cervical high-grade squamous intraepithelial lesion (HSIL). A 39-year-old women was admitted to our hospital for routine gynecological examination and underwent surgery because of the finding of HSIL on a routine papanicolaou smear. The histological diagnosis on cervical biopsy and conization material were of cervical intraepithelial neoplasia III (CIN III). Serous carcinoma of the fallopian tube was incidentally found during a planned hysterectomy operation. Postoperatively the patient received six cycles of adjuvant chemotherapy (carboplatin and paclitaxel) and is still under routine control. In conclusion, the genital tract should be examined in detail in case of any existence of a primary genital tumor and CA125 should be added to the examination.
European journal of gynaecological oncology 02/2007; 28(6):501-2. · 0.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Vulvar melanoma is rare and has a worse prognosis and higher recurrence rate than cutaneous melanoma. Multifocality is also more common in vulvar melanomas. A case having synchronous cervix and vulvar malign melanoma is presented and discussed in the light of the literature whether it is a metastasis of vulvar malign melanoma to cervix or multifocal originated disease. In conclusion, it is important to evaluate the whole genital system in vulvar melanomas as it is in squamous cancers.
International Journal of Gynecological Cancer 03/2006; 16(2):917-20. DOI:10.1111/j.1525-1438.2006.00227.x · 1.95 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: ABSTRACT
Objective: To asses the concordance of FIGO grade of endometrial adenocarcinomas in endometrial curettings
and subsequent hysterectomy specimens.
Methods and Results: Curetting materials and subsequent hysterectomy specimens from the pathology reports
of 48 patients were studied.Concordance was 70% for grade 1, 70% for grade 2, 100% for grade 3 carcinomas,
and the overall concordance 77%.The concordance for grade 3 tumours was significantly higher than for grade
1 and 2.
Conclusion: The grade of endometrial adenocarcinoma sometimes differs in the initial curettage sample from
that in the final hysterectomy specimen.This may have important implications for patient management
especially for tumours that yield grade 1 and 2 biopsies.
Keywords: FIGO grade, Endometrial adenocarcinoma
[Show abstract][Hide abstract] ABSTRACT: Endometrial polyps are localised hyperplastic overgrowths of glands and stroma that form a projection above the uterine surface. They may be sessile or pedunculated and rarely include foci of neoplastic growth. 1 They are common during the reproductive years, occurring in up to 24% of women, and the rate increases with age. 2 The most common symptom is abnormal uterine bleeding (AUB), but patients may be totally asymptomatic. Endometrial polyps may cause infertility. Although the precise mechanism by which they do this is unclear, their removal has been reported to increase fertility. 3 Hysteroscopy is the only technique that provides direct visualisation of the uterine cavity, and it is therefore more effective than other procedures in the diagnosis and treatment of endometrial disease. 4 Further research should support and encourage this useful procedure. 5 The aim of the present study was to assess the efficacy of treatment of endometrial polyps by operative hysteroscopy, and determine reproductive benefits and the recurrence rate. Material and methods Study design This prospective long-term follow-up study commenced in January 2006 in a tertiary teaching hospital. Objective. To assess the results of resection of endometrial polyps by means of diagnostic hysteroscopy. Material and methods. This was a prospective long-term follow-up study in a tertiary teaching hospital. A total of 102 patients were included, of whom 83 completed follow-up. Results. Eighty-three patients (81.4%) completed follow-up and underwent hysteroscopic evaluation. The recurrence rate was 2.5% (2/83) and the pregnancy rate after hysteroscopic polypectomy 60.9% (14/23). Further treatment was needed in 3 patients in the premenopausal group. Conclusions. Hysteroscopic resection of endometrial polyps is safe and effective, and should be encouraged. With regard to treatment of infertility, results were promising. A levonorgestrel-releasing intra-uterine device can be considered when polyps recur or menstrual abnormalities persist. SAJOG menorrhagia, metrorrhagia or intermenstrual bleeding. Infertility was defined as inability of a couple having frequent intercourse and not using contraception to conceive within 1 year. Exclusion criteria were failure to comply with follow-up requirements, receiving an additional hysteroscopic inter vention (e.g. hysteroscopic myomectomy or hysteroscopic septum resection), and being found to have no endometrial polyps on histological evaluation. A 5 mm diagnostic hysteroscope (Karl Storz GbmH & Co., Tutlingen, Germany) was used for diagnostic hysteroscopy. No anaesthesia was needed during this procedure. Hysteroscopic polypectomy was performed electrosurgically with a continuous-flow operative hysteroscope (Karl Storz GbmH & Co., Tutlingen, Germany) equipped with a 7 or 9 mm operative sheath and a 12-degree optic. Sterile 1.5% glycine solution was used as a distending medium and fluid balance was carefully monitored. Operative hysteroscopy was performed with the patient under general anaesthesia. Informed consent was obtained from all patients. Baseline characteristics, including age, number of pregnancies, number of births, confinement details, laboratory results and ultrasound findings, were recorded.