A Gurbuz

Gynecologic Oncology Group, Buffalo, New York, United States

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Publications (39)56.98 Total impact

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    ABSTRACT: This study aimed to analyze the correlation between the histopathologic results of excisional procedure and cervical punch biopsy and to investigate the accuracy rates of colposcopic punch biopsy and cervical cytology to detect cervical intraepithelial neoplasia (CIN) grade 2 and/or more severe lesions (CIN 2+). Two hundred six patients who underwent excisional procedure in the gynecologic oncology clinic of the Zeynep Kamil Women and Children Diseases Education and Research Hospital between 2004 and 2011 were enrolled in a retrospective study. The correlation between the pathologic findings gained by excisional procedure and punch biopsy was weak ( p = .0001, κ = 0.03). The overall concordance rate between the pathologic findings of cervical biopsy and excisional procedure was 57.29%. The rates of detecting more severe lesions by excisional procedure when compared to biopsies (biopsy underestimation) were 71.42%, 22.91%, 37.03%, and 12.72% for biopsy results with negative, CIN 1, CIN 2, and CIN 3/adenocarcinoma in situ lesions, respectively. Similarly, the rates of less severe lesions diagnosed by excisional procedure when compared to biopsies (biopsy overestimation) were 29.16%, 40.74%, and 15.45% for biopsy results with CIN 1, CIN 2, and CIN 3/adenocarcinoma in situ lesions, respectively. The rate of CIN 2+ lesions after excisional procedure in cases with previous biopsy results with either negative or CIN 1 was 27.27%. Our results suggested that colposcopy-directed biopsy was neither a good diagnostic nor a reliable management method. We think that the indications of conization should be enlarged to avoid overlooking high-grade lesions.
    Journal of Lower Genital Tract Disease 03/2014; · 1.21 Impact Factor
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    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. · 0.84 Impact Factor
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    ABSTRACT: Metastasis of colorectal adenocarcinoma of the ovary is not an uncommon occurrence and ovarian metastases from colorectal carcinoma frequently mimic endometrioid and mucinous primary ovarian carcinoma. The clinical and pathologic features of metastatic colorectal adenocarcinoma involving the ovary is reviewed with particular focus on the diagnostic challenge of distinguishing these secondary ovarian tumors from primary ovarian neoplasm. Immunohistochemical stains that may be useful in the differential diagnosis of metastatic colorectal tumors to the ovary and primary ovarian tumors are detailed.
    World journal of gastrointestinal surgery. 04/2010; 2(4):109-16.
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    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. · 2.15 Impact Factor
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    ABSTRACT: To investigate the relationship between cerebral palsy (CP) and perinatal and intrapartum risk factors and markers of birth asphyxia. This was a retrospective case-control study of 101 children with CP and 308 controls who were born at the Zeynep Kamil Hospital between 1990 and 2000. The roles of possible perinatal and intrapartum risk factors were investigated in CP development. Chi-square tests, Fisher's exact tests, Student t-tests, and regression analysis were used for statistical analysis (p < 0.05). The only significant perinatal risk factor was neonatal weight of <2500 grams. The CP rate in the presence of solely intrapartum risk factors was estimated as 24.7% (n = 25). In 39.6% of cases, no risk factor could be identified. When regression analysis was performed, the following factors were significant: decreased beat-to-beat variability on electronic fetal monitoring (EFM) (p = 0.02), an Apgar score of <7 at 1 and 5 minutes (p = 0.02), and the necessity for neonatal intensive care unit admission (p < 0.0001). Intrapartum risk factors were significantly more frequent in the CP group (p < 0.01). An increased cesarean section rate could not prevent CP, suggesting that the hypoxic insult that causes CP might be of chronic onset. The development of diagnostic tests to detect non-reassuring fetal status in its intrauterine life and interventions at appropriate times may decrease the CP rate.
    Journal of Maternal-Fetal and Neonatal Medicine 04/2006; 19(3):147-55. · 1.52 Impact Factor
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    ABSTRACT: The outcome of 11 cases with vaginal agenesis who underwent intestinal vaginoplasties are presented. Patients were between 18 and 37 years old. Ileum vaginoplasty and sigmoid colon vaginoplasty were carried out in two and nine cases, respectively. Ileum necrosis at donor site requiring ileum resection and bilateral ileostomy encountered in one of the cases was the major complication. Mild stenosis responsive to finger dilatation had been detected in two women with sigmoid vaginoplasty. Excess mucous production, long operation time, and shortness of mesentery of ileum led us to abandon ileum vaginoplasty, and sigmoid colon vaginoplasty was performed in the following cases with vaginal agenesis. All of the neovaginas were patent and functional. We suggest sigmoid colon vaginoplasty as the treatment of choice because of its large lumen, thick walls resistant to trauma, adequate secretion allowing lubrication, not necessitating prolonged dilatation, short recovery time compared with ileum vaginoplasties; and in patients reluctance to prolonged use of dilatators or in those who experienced previous failure of the other treatment modalities.
    International Urogynecology Journal 02/2006; 17(1):40-5. · 2.17 Impact Factor
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    ABSTRACT: A case of cervical large-cell neuroendocrine carcinoma with mucinous-type cervical adenocarcinoma component adjacent to it is presented, and its histopathogenesis and clinical course are discussed under the light of the literature.
    International Journal of Gynecological Cancer 01/2006; 16(1):438-42. · 1.94 Impact Factor
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    ABSTRACT: Microglandular adenocarcinoma is a rare type of endometrium carcinoma and had some potential diagnostic problems with difficulties in discriminating from some malign and benign lesions of cervix. A 70-year-old woman misdiagnosed as cervical adenocarcinoma was referred to our clinic, and the lesion was ultimately evaluated as microglandular adenocarcinoma in repeat of endometrial curettage specimen. Postoperatively, histopathologic examination of specimen revealed grade 1 microglandular adenocarcinoma. To our best knowledge, this is the twelfth case of uterine carcinoma simulating microglandular hyperplasia in the literature. Because microglandular adenocarcinoma can be confused with benign lesions like microglandular hyperplasia and malignant lesions of cervix, we aim to discuss the clinical, demographic and immunohistochemical characteristics of the patients with microglandular adenocarcinoma useful in differential diagnosis.
    Gynecologic Oncology 01/2006; 99(3):778-81. · 3.93 Impact Factor
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    ABSTRACT: Peritoneal tuberculosis mimics advanced ovarian cancer because of the similarities in clinical signs and symptoms such as ascites, pelvic and abdominal pain and mass, and elevation of serum CA125 level. We have presented four cases of peritoneal tuberculosis that underwent exploratory laparotomy for suspected advanced ovarian cancer during a 3-year period. Definitive diagnosis of tuberculosis was performed at laparotomy in all the cases. The frozen-section analysis seems to be the gold standard in the differential diagnosis. In view of these data, clinical diagnosis of advanced ovarian cancer is not sufficient for administering neoadjuvant chemotherapy. Cytologic or pathologic findings must be consistent with ovarian cancer for candidates who are being considered for neoadjuvant chemotherapy.
    International Journal of Gynecological Cancer 01/2006; 16 Suppl 1:307-12. · 1.94 Impact Factor
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    ABSTRACT: Colorectal carcinoma during pregnancy is a very rare event. We presented a woman with metachronous metastatic ovarian tumor existing 1 year after surgical removal of perforated sigmoid colon carcinoma encountered during cesarean section of woman of 36-week gestation for fetal distress. Pregnant women with suspicious abdominal mass should be evaluated for a possible colorectal carcinoma even in the absence of any other gastrointestinal symptoms associated with it and undergo rectal examination and sigmoidoscopy. In addition, as synchronous and metachronous ovarian metastases are common in these patients, ovaries must be evaluated carefully by bisection during operation for possible metastasis, and in women who do not have a desire for fertility, prophylactic oophorectomy seems an appropriate treatment modality for resecting synchronous metastasis and preventing future metastasis.
    International Journal of Gynecological Cancer 01/2006; 16 Suppl 1:330-3. · 1.94 Impact Factor
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    ABSTRACT: A 40-year-old woman with mucoepidermoid variant of adenosquamous carcinoma arising in dermoid cyst in left ovary is presented. The patient was staged as IC. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and pelvic and para-aortic lymph node sampling were carried out. The disease recurred in postoperative 12th month. To our best knowledge, this is 12th case of adenosquamous carcinoma in dermoid cyst and third case of mucoepidermoid variant of adenosquamous carcinoma in the literature.
    International Journal of Gynecological Cancer 01/2006; 16 Suppl 1:379-84. · 1.94 Impact Factor
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    ABSTRACT: The clinicopathologic findings of the third case of androgenic adult granulosa cell tumor in patients younger than 15 years was presented and discussed in the light of the literature. A patient complaining of secondary amenorrhea and hirsutism with elevated levels of plasma total testosterone, dehydroepiandrosterone sulfate, free androgen index and serum inhibin A, and a left ovarian septated, cystic mass was admitted to the hospital. The inhibin A level was within normal levels in the first month postoperatively. Inhibin A could be a tumor marker of utmost importance particularly in patients with androgenic or hyperestrogenic symptoms, especially in cases where benign criteria are abundant such as young age, nonincreased levels of classic tumor markers, and ultrasonographic appearance without any suspicion of malignancy.
    International Journal of Gynecological Cancer 01/2006; 16 Suppl 1:368-74. · 1.94 Impact Factor
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    ABSTRACT: To determine the role of factor V Leiden and prothrombin gene mutation in the pathogenesis of unexplained second and third trimester nonrecurrent fetal loss. One hundred and fourteen women with unexplained nonrecurrent late fetal loss made up the study group, and 106 normal pregnant women with a history of delivery of at least one healthy fetus and no history of late fetal loss made up the control group. The study group was further divided into two subgroups: second (n = 36) and third (n = 78) trimester fetal loss. All women were tested for factor V Leiden and G20210A prothrombin gene mutations. Twenty-one (18.4%) of the women in the study group and seven (6.6%) of the women in the control group were heterozygous carriers of factor V Leiden mutation (OR = 3.19). Eleven (9.6%) of the women in the study group and three (2.8%) of the women in the control group were heterozygous carriers of prothrombin gene mutation (OR = 3.66). In assessing with regard to trimesters, 18 (23%) factor V Leiden and 10 (12.8%) prothrombin gene mutations were present in the group of third trimester fetal loss (OR = 4.24 and OR = 5.04, respectively). Three (8.3%) factor V Leiden and one (2.7%) prothrombin gene mutation were detected in women with second trimester fetal loss (OR = 1.28 and OR = 0.40, respectively). Factor V Leiden and prothrombin gene mutations were associated with third trimester nonrecurrent fetal loss. These mutations should be screened in women with third trimester but not second trimester unexplained nonrecurrent late fetal loss.
    Journal of Maternal-Fetal and Neonatal Medicine 12/2005; 18(5):299-304. · 1.52 Impact Factor
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    ABSTRACT: To construct a uterovaginal canal in a patient with a complete cervical agenesis and partial vaginal agenesis. Case report. Zeynep Kamil Women's and Children Hospital. A 15-year-old woman presented with lower abdominal pain. On examination, partial vaginal agenesis with a 4-cm vagina was noted. A pelvic ultrasonography revealed hematometra and the absence of a cervix. Surgical therapy included creation of an ostium by making 1.5-cm midline vertical hysterotomy incision, trimming away the fibrous tissue at the distal portion of uterus, and attaching the proximal end of the vagina to the uterus by the abdominal route. A stent was left in place for 2 weeks. Pelvic ultrasonography and clinical follow-up evaluation. Regular menstrual periods were observed for 6 months beginning at the first month. The follow-up pelvic ultrasonography was normal. Cervicoplasty attaching the mucosal lining of the endometrium to that of the vagina permits the creation of a patent cervical canal with short stenting time.
    Fertility and sterility 08/2005; 84(1):217. · 3.97 Impact Factor
  • Ayse Gurbuz, Ates Karateke, Canan Kabaca
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    ABSTRACT: To investigate whether there is any association between urinary or fecal incontinence and childhood bedwetting, and given such a relationship, to detect which type of urinary incontinence (UI) is associated with childhood bedwetting. In all, 1021 patients who were admitted to the outpatient gynaecology clinics of the authors' institution for an annual gynaecological examination were included in this descriptive clinical study. A simple multi-choice screening questionnaire was used to collect data for analysis. There was a history of bedwetting in childhood in 181 (21.1%) of women without and in 48 (29.6%) of those with UI; the difference was significant (chi-square, P < 0.05). Women with stress UI had significantly higher rates of enuresis in childhood (35.4%) than those without UI (21.1%; P = 0.003). Of women who had a history of bedwetting in childhood, 12.2% had stress UI, but only 6.4% of those with no such history had stress UI. Fecal incontinence was significantly more common in women with a history of bedwetting in childhood (P < 0.05). A history of childhood bedwetting seems to increase the risk of having UI, stress UI and fecal incontinence. Being aware of this association may provide an opportunity to avoid exposing these women to additional risk factors for these condition.
    BJU International 05/2005; 95(7):1058-62. · 3.05 Impact Factor
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    ABSTRACT: We report a case of a rare, unusual benign tumor, the cotyledonoid leiomyoma or Sternberg tumor, detected incidentally in a 67-year-old woman who underwent total hysterectomy and bilateral salpingo-oophorectomy because of a persisting left ovarian cyst of 5 cm. This is the 14th case of cotyledonoid leiomyoma and 2nd case which had no intrauterine portion but had extrauterine extensions. At laparotomy, it was detected that a deep red nodular papillary tumor had been dissecting the posterior leaf of the left broad ligament, projecting into the abdominal cavity just near the left cornu of the uterus, and extending in downward direction. The remaining portion was lying between the layers of the left broad ligament and arose from the subserosa of the left side of the uterine isthmus. Although the bizarre and unusual shape was in favor of malignity, the frozen-section examination revealed a benign histology. Although the cotyledonoid leiomyoma is a benign entity, it may suggest a malignant disease owing to its unusual sarcomatoid appearance and its rarity. Therefore, awareness of obstetricians and gynecologists regarding this rare entity will prevent unnecessary anxiety and interventions.
    International Journal of Gynecological Cancer 01/2005; 15(6):1218-21. · 1.94 Impact Factor
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    ABSTRACT: Liposarcoma of uterus is a very rare neoplasm encountered generally in the sixth or seventh decade of life. We reported the eighth case of uterine liposarcoma with extension to broad ligament in a 23-year-old woman who presented with pelvic pain, dysuria, and rapidly enlarging pelvic mass. During laparotomy, the mass was detected to be originated from the uterine cervix. In frozen section, no definitive diagnosis was established, and for preservation of fertility, extirpation of the mass was performed. The histopathologic examination of the specimen revealed liposarcoma. The tumor cells were diffusely and intensively immune reactive for vimentin and S-100, and negative for smooth muscle actin, desmin, h-caldesmon, pan cytokeratin, and CD10. Staining with periodic acid and Schiff, alcian blue, mucicarmine, and epithelial membrane antigen (EMA) were negative. No recurrence was detected in the postoperative seventh month. Present case is the youngest patient with uterine liposarcoma and also the first case detected in reproductive period.
    International Journal of Gynecological Cancer 01/2005; 15(6):1230-4. · 1.94 Impact Factor
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    ABSTRACT: It is difficult to differentiate between an endometrial stromal nodule (ESN) and endometrial stromal sarcoma (ESS) in curettage specimen, and the recommended therapy of endometrial stromal neoplasm is hysterectomy. If we could discriminate ESS from ESN in curettage specimens, there would be an opportunity to treat ESN by local excision rather than by hysterectomy. We analyzed MIB-1 and estrogen and progesterone receptor (ER/PR) expression in a retrospective series of 8 ESSs, 7 ESNs, and 17 highly cellular leiomyomas obtained from hysterectomy specimens. ESSs expressed MIB-1 more frequently than ESNs (P < 0.05), and ESSs had a tendency to express ER less frequently than ESNs (P= 0.08). We observed that in spite of showing MIB-1 expression to some extent, highly cellular leiomyomas usually could not reach ESSs' level and frequency of MIB-1 expression in the current study. Although MIB-1 and ER appear to be promising markers in the differential diagnosis of ESSs, a larger study would be necessary to confirm their validity.
    International Journal of Gynecological Cancer 01/2005; 15(2):337-42. · 1.94 Impact Factor
  • A Gurbuz, A Karateke, C Kabaca, G Kir
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    ABSTRACT: The objective of this article was to evaluate clinical significance of glandular atypia on Papanicolaou smear, to compare the Bethesda system (TBS) 2001 with the 1991 revision, and to determine whether there is any improvement in the cytohistologic correlation by the new system. Cytology files of 18,955 patients were reviewed for diagnosis of atypical glandular cells of undetermined significance (AGUS), and histopathology files were searched. Cervical smears of these patients were reclassified according to TBS 2001. Of the 18,955 specimens, 89 (0.46%) were diagnosed as AGUS. Of these 89 women, 76 (85.3%) accepted the follow-up protocol of our hospital. In reevaluation according to TBS 2001, 31 specimens were reevaluated as atypical glandular cells (AGC) and 3 were reevaluated as adenocarcinoma in situ, 8 as AGC with concomitant squamous cell abnormalities, 1 as atypical squamous cells that cannot exclude high-grade squamous intraepithelial lesions, and 33 as negative. Thirty-one (93.9%) of these 33 negative cases were in the AGUS-reactive category in the initial examination. The difference between the rates of the malignant pathologies in the AGUS (25%, 19/76) and in the AGC (42.8%, 18/42) categories was significant (chi(2)= 4.0, P= 0.04). The new terminology of AGC is more likely to suggest a clinically significant lesion than TBS 1991. Repeated cytologic testing during follow-up seems to be unacceptable.
    International Journal of Gynecological Cancer 01/2005; 15(5):903-10. · 1.94 Impact Factor
  • International Journal of Gynecology & Obstetrics 12/2004; 87(2):165-6. · 1.84 Impact Factor