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Purpose: To evaluate the clinicopathological characteristics and surgical outcomes in patients with pure ovarian immature teratomas (POITs). Materials and Methods: In this multicenter study, a retrospective review was made of the databases of six Gynecology Oncology Departments in Turkey to identify patients with POITs who had undergone surgery between 1993 and 2019. Results: Evaluation was made of 48 patients with a median age at diagnosis of 22.5 years (range, 15-37 years). In 40 (83%) patients, stage I was determined and in eight patients, an advanced stage (IIIB, IIIC, and IVB) was determined. Tumors were found to be grade I in 17 (35.4%) cases, grade II in 12 (25%), and grade III in 19 (39.6%). Fertility-sparing surgery was applied to 42 (87.5%) patients and radical surgery to 6 (12.5%). The median follow-up was 60 months (range, 3-246 months). Recurrence was seen in seven patients, all with grade III tumors. In the final pathological examination of recurrent tumors, mature teratoma was reported in five patients, and immature teratoma in one patient. Salvage surgery was not performed in one patient as the tumor was unresectable and so a regimen of bleomycin, etoposide, and cisplatin (BEP) was administered. Conclusion: POITs are rare tumors seen at a young age, and benign or malignant relapse can be seen in these tumors. In this cohort, the malignant recurrence rate was 4.1%, and the benign recurrence rate was 10.4%. All the recurrences were in grade III tumors. Benign recurrences can be treated with surgery alone and the malignant group should be treated with surgery followed by chemotherapy.

Amaç: Serviks kanseri hastalarında lenf nodu metastazının (LNM) değerlendirmesi tedavinin bireyselleştirilmesi için önemli bir konudur. Çalışmamızın amacı, serviks kanserli hastalarda LNM'nin prediktif faktörlerini belirlemektir. Gereç ve Yöntem: Bu retrospektif çalışmaya, 2007'den 2019'a kadar Uluslararası Jinekoloji ve Obstetrik Federasyonu (FIGO) evre IB1-IIA2'nin serviks kanseri hastaları dahil edildi. LNM insidanslarıyla beraber tek ve çok değişkenli modellerde pelvik ve paraaortik LNM için risk faktörlerinin prediktif değeri belirlendi. Bulgular: Çalışmaya dahil edilen 212 hastadan pelvik LNM olan hasta sayısı 81(%38.2), paraaortik LNM'li hasta sayısı 17(%8) idi. Serviks kanseri hastalarında multivariyant analize göre parametriyal tutulum (hazard ratio [HR]: 2.75, 95% confidence interval [CI], 1.18-6.40, p=0.019) ve lenfovasküler tutulum ([HR]: 3.83, 95% [CI], 1.76-8.38, p=0.001) pelvik LNM için bağımsız risk faktörleriydi iken paraaortik LNM için parametriyal tutulum bağımsız risk faktörüydü ([HR]: 3.62, 95% [CI], 1.20-10.98, p=0.023). Sonuç: Serviks kanseri hastalarında pelvik LNM'nin prediktif faktörleri parametrial tutulum ve LVSI iken paraaortik LNM için prediktif risk faktörü parametrial tutulumdu.

Özet Amaç: Bu çalışmada Evre IIIC1 ve evre IIIC2 endometrium kanserinde, hasta grupları arasında klinik, cerrahi ve patolojik risk faktörlerinin dağılımını incelemek ve farklılığı tanımlamak amaçlanmıştır. Gereçler ve Yöntem: Kliniğimizde FIGO 2009 kriterlerine göre evre IIIC1-2 endometrium kanseri tanısı alan 115 hasta çalışmaya dâhil edildi. Hastaların demografik, klinik, cerrahi ve patolojik özellikleri hasta dosyalarından ve patoloji raporlarından retrospektif olarak elde edildi. Bulgular: Hastaların 39’unda (%33.9) sadece pelvik lenf nodu metastazı, 14’ünde (%12.2) sadece paraaortik lenf nodu metastazı, 62’sinde (%53.9) ise hem pelvik hem paraaortik lenf nodu metastazı mevcuttu. Otuz dokuz (%33.9) hasta FIGO IIIC1, 76 (%66.1) hasta FIGO IIIC2 evredeydi. Evre IIIC2 hasta grubunda evre IIIC1’e göre derin myometrial invazyon ve malign peritoneal sitoloji istatistiksel olarak anlamlı yüksekti. Buna karşın yaş, tümör boyutu, çıkarılan lenf nodu sayısı, preoperatif CA 125 değeri, FIGO grade derecesi, lenfovasküler alan invazyonu, servikal tutulum durumu ve adneksal metastaz durumu ile hastalığın paraaortik bölgeye yayılıp yayılmaması arasında anlamlı farklılık gözlenmedi. Sonuç: Evre IIIC endometrium kanserinde paraaortik lenf nodu metastazı varlığında derin miyometrial invazyon ve malign peritoneal sitoloji görülme olasılığı artmaktadır.

AIM We aimed to compare weekly methotrexate (MTX) regimen and methotrexate-folinic acid (MTX-FA) 8-day regimen in the first line treatment of low-risk gestational trophoblastic neoplasia (GTN). METHODS The study included 73 patients with low-risk GTN according to FIGO risk score (FIGO risk score

Aim This study aims to determine the frequency of germline BRCA 1/2 mutations in Turkish women with epithelial ovarian cancer (EOC) and evaluate its relationship with clinicopathological characteristics. Methods In this cross-sectional study, all women with recently diagnosed EOC presenting to Zekai Tahir Burak Women's Health Training and Research Hospital Medical Oncology Clinic between 2016 and 2019 were referred for BRCA testing. Peripheral blood samples were obtained from 76 patients applying to Medical Genetics and BRCA1/2 genes were sequenced using next-generation sequencing. The American College of Medical Genetics and Genomics 2015 criteria were followed for classification of genetic variants. Results Twenty-four women (31.6%) had pathogenic germline BRCA1/2 mutations. Of these, 17 patients (22.4%) harbored germline BRCA1 mutations and 7 (9.2%) had BRCA2 mutations. When we compared the patients with and without BRCA mutations, there was significant difference in terms of family history (41.7% vs 9.6%, respectively, P = .001). Among all patients, 15 (19.7%) had history of breast or ovarian cancer in first- or second-degree relatives. Germline BRCA1/2 mutations were detected in 66.7% of patients with family history, while these mutations were found in 22.9% of patients without family history (P = .001). Conclusion In this sample 31.6% of Turkish women with EOC harbored germline BRCA1/2 mutations, which seems higher compared to other ethnic groups except for the Ashkenazi Jews population. All women with EOC should be referred for BRCA testing regardless of family history, age at diagnosis, and histological subtype.

Introduction/Background During excision of bulky lymph nodes, there is an increased risk of operative vessel injury. Methodology 59 years old woman with a preoperative endometrial biopsy result of Grade 3 endometrioid endometrial cancer admitted to the Gynecologic Oncology clinic with the abdominal computed tomography result which indicates bulky lymph nodes at the paraaortic retrocaval region. Results Entering the retroperitoneal paraaortic area by cutting the peritoneum with an incision beginning below the cecum and extending along the base of small bowel mesentery up to the level of ligament of Treitz (suspensory muscle of duodenum). Small bowels are kept outside the surgical field; right lateral traction of ascending colon and right ureter, cranial traction of duodenum and left lateral traction of mesentery of sigmoid colon. At the level of L3-L4 vertebra; inferior vena cava is isolated and retracted over the bulky lymph node. Tape traction of inferior vena cava from the superior and inferior part of bulky lymph node facilitates the surgery and provides a hemostatic control. A cleavage is developed on the right border of inferior vena cava and the bulky lymph node is excised from the retrocaval and inter aortocaval space. Conclusion Meticulous dissection with proper surgical and anatomic landmarks is extremely important in resection of bulky lymph nodes especially if they are located on the retrocaval or retroaortic region. Disclosure Nothing to disclose

Prognostic value of accompanying adenomyosis in endometrial cancer is the subject of interest due to their common etiology and co-occurrence frequency. However, it is still unclear whether adenomyosis has a role in the prognosis of endometrial cancer. The aim of this study was to determine the effects of adenomyosis on the prognosis of patients with endometrial cancer. In this study, medical records of 552 patients with endometrioid endometrial cancer who underwent surgery between 2007 and 2017 were retrospectively reviewed. The patients were divided into two groups based on the presence or absence of adenomyosis, and these two groups were compared in terms of the clinicopathological factors and survival outcomes of patients. Of these patients, 103 (18.7%) had adenomyosis, and the remaining 449 (81.3%) did not. The endometrial cancer patients with adenomyosis exhibited earlier stages (p

Background: Endometrial clear cell carcinoma (ECCC) is a rare variant of endometrial cancer with an unfavorable prognosis. The aim of this study was to determine the relationships, if any, between preoperative serum cancer antigen 125 (CA-125) levels, the last Papanicolaou (Pap) smear, the results of endometrial biopsy and tumor histology, and disease-stage according to permanent histopathology. Materials and Methods: The data of 26 women with ECCC were collected from their medical records to compare demographics, preoperative serum CA-125 levels, Pap test results, histological diagnosis of the endometrial biopsy, and tumor histology, as well as the disease stage according to permanent histopathology. Results: The mean age at diagnosis was 64.0 years. There were 17 (65.3%) women with pure ECCC and 8 (30.7%) women with a mixed histology. Stage III-IV disease was diagnosed in 12 (46.2%) women and occurred more frequently in pure ECCC (n = 11, 91.7%). CA-125 values were significantly higher in advanced stage disease. Cytological evaluation indicated the presence of 71.4% (10/14) cytological abnormalities in pure ECCC. The overall sensitivity of endometrial sampling for the detection of malignancy was 92.3% (24/26), whereas the accurate diagnosis of ECCC was only 34.7% (8/23) with the Pipelle sampler. Conclusion: Pap test abnormalities are frequent in ECCC. Although it is less accurate in the diagnosis of ECCC than in the detection of malignancy, endometrial sampling is still the main procedure for the diagnosis of ECCC. Higher preoperative CA-125 concentrations imply the presence of advanced stage ECCC.

Mucoepidermoid carcinoma of uterine cervix is a rare tumor that has some individual features. Defining risk factors after surgery shape the postoperative treatment modality on cervical cancer patients. Although there is not a well-known strategy for the postoperative follow-up of mucoepidermoid carcinoma, the aggressive behaviour of this tumor makes the gynecological oncologists choose liberal therapies on these patients.

OBJECTIVE To compare the effectiveness of topical lidocaine spray compared to a placebo for relieving pain during colposcopic cervical biopsies and endocervical curettage. METHODS This randomized, placebo-controlled, double-blind study included patients with abnormal cervical cytologic results requiring colposcopy and directed cervical punch biopsy with or without endocervical curettage (ECC). The patients were randomly assigned to either the 10% lidocaine spray or the placebo group. The patients were asked to rate the pain level immediately after the cervical biopsy and ECC, and mean pain scores of the 2 groups were compared. RESULTS A total of 214 women were included in the study: 104 in the lidocaine group and 110 in the control group. Age, parity, and history of previous vaginal delivery and cesarean section were similar in both groups. Mean ± SD age was 41.5 ± 10.6 years in the lidocaine group and 43 ± 11.3 years in the control group. Pain scores after cervical biopsy and ECC were also similar between the 2 groups. Mean ± SD pain scores associated with cervical biopsy were 2.18 ± 1.7 in the lidocaine group and 2.31 ± 1.6 in the control group. DISCUSSION AND CONCLUSION In our population, there is no evidence to recommend the use of routine locally sprayed lidocaine anesthesia before cervical punch biopsy or ECC.

INTRODUCTION Malignant peripheral nerve sheath tumors (MPNSTs) are rare, up to one half of the MPNSTs occur in patients with neurofibromatosis type-1 (NF-1), while the rest are sporadic. Here, we present a 52-year-old woman with MPNST of the vulva without NF-1. We will discuss basics of the disease, treatment options and follow-up strategies. PRESENTATION OF CASE 52-year-old female admitted to our hospital with complaint of abnormal uterine bleeding and rapidly growing vulvar mass. Excisional biopsy of the mass showed MPNST of the vulva. Afterwards, the patient underwent radical vulvectomy with inguinofemoral lymph node dissection. Short after the surgery, multiple lung metastasis were shown and responded to chemotherapy, but rapid local recurrence occurred short after the completion of the chemotherapy. DISCUSSION The primary treatment option in MPNSTs is surgical excision with or without adjuvant therapy. There is not enough data about the role of systemic chemotherapy in the management of MPNSTs and it still remains controversial. CONCLUSION In general, radiation therapy has not been demonstrated to improve overall survival. Complete surgical resection of the primary tumor is the mainstay of the treatment.

Summary Objective The purpose of this study was to examine the influence of leptin in women with uterine myoma. Materials and Methods In this study, 38 women with myoma uteri and 30 normal women who applied to the Dr Zekai Tahir Burak Woman Health Research and Education Hospital's gynecology clinic were enrolled. Uterine leiomyomas were proved by pathology postoperatively. In all subjects, FSH, LH, E2, prolactin, hemoglobin, hematocrit, blood urea nitrogen, creatinine, fasting glucose, CA125, and leptin were examined, and body mass index (BMI) was calculated. Data were analyzed by Student's t test and Mann-Whitney U test. Results Although leptin level was higher in the myomatic women (5.73 ± 4.08 ng/mL) than in the normal women, there was no statistically significant difference ( p = 0.303). Also, no statistical difference in the ratios of leptin/BMI was found in both groups. A significant correlation was found between high E2 level and myoma uteri ( p = 0.021). Hemoglobin levels were significantly lower in the myomatic women ( p = 0.044). When we compared the leptin levels according to BMI, leptin levels were higher in patients who had BMI > 30 ( p = 0.02). Conclusion We did not find any significant difference in serum leptin levels between the two groups. But leptin may have an indirect role in the pathogenesis of uterine leiomyoma. So further research is needed to reveal the role of leptin in myoma uteri pathogenesis.

Ozgu, Emre/0000-0002-8444-9694; Gungor, Tayfun/0000-0002-7869-9662 WOS: 000343832900049 PubMed: 25169520 Background: There are limited data in the literature related to concomitant genital or extra-genital organ pathologies in patients with borderline ovarian tumors (BOTs). The aim of this study was to evaluate our experience with 183 patients to draw attention to the accompanying organ pathologies with BOTs. Materials and Methods: One hundred eighty-three patients with BOTs, diagnosed and/or treated in our center between January of 2000 and March of 2013 were evaluated retrospectively. Data related to age, tumor histology, lesion side, disease stage, accompanying incidental ipsilateral and/or contralateral ovarian pathologies, treatment approaches, and follow-up periods were investigated. Incidental gynecologic and non-gynecologic concomitant organ pathologies were also recorded. Results: The mean age at diagnosis was 40.6 years (range: 17-78). Ninety-five patients (51%) were

Granulosa cell tumors (GCTs) of the ovary are rare tumors and they are generally detected in early stages with a favorable prognosis. However, the controversies over the extend of surgery are still judging the surgical management. We retrospectively evaluated demographic and clinical variables of granulosa cell tumors of the ovary with probable prognostic factors to identify the clinicopathological features. Women with adult type granulosa cell tumor pathology result between March 2007 and April 2013 were evaluated retrospectively using computerized database of the institution. Age, stage, menopausal status, parity, clinical presentation, surgical procedures, histopathologic results, preoperative tumor markers, tumor diameter and laterality were the reviewed parameters. Patients were staged according to the International Federation of Gynecology and Obstetrics (FIGO) staging system for ovarian tumors that was revised in 2014. A total of 40 patients were retrospectively evaluated. We further categorized patients as stage 1A and more advanced stage disease. Twenty-seven patients (67.5%) were within Stage 1A disease and 13 (32.5%) patients had more advanced stage of disease. Only one patient had retroperitoneal lymph node involvement and recurred 2 years after the completion of the chemotherapy, and died of disease after 2 years from recurrence. Since the risk of unintended complications and morbidity, which is related with lymph node dissection, the rare incidence of lymph node involvement should be kept on mind. So that omitting lymphadenectomy could be an option for GCTs if a low mitotic index ( [Med-Science 2016; 5(2.000): 496-504]

The present study aims to compare the clinical and reproductive outcomes of women who have undergone lymph node dissection with those who have not and to discuss the indications for retroperitoneal evaluation in the treatment of borderline ovarian tumors. The present study investigated 123 women who were finally diagnosed with borderline epithelial ovarian tumors at the study center between January 1999 and January 2009. A total of 68 patients (55.3%) were found to have a complete surgical staging procedure. The patients who underwent complete lymph node dissection were significantly younger than those who did not have lymphadenectomy. Thus, the ratio of postmenopausal women was significantly higher among those in whom retroperitoneal evaluation was performed. As expected, the intraoperative blood loss was significantly more and the hospital stay was significantly longer in patients who underwent complete lymph node dissection. Also, the non-serous borderline ovarian tumors were significantly more frequent in the latter patient group. However, overall and disease-free survival spans were found to be statistically similar for both study groups as well as the recurrence rate. Retroperitoneal evaluation can be spared in every woman with borderline ovarian tumor unless she is to undergo complete surgical staging procedure because of high recurrence risk, advanced stage disease or personal choice.

We report a rare case of cervical adenocarcinoma diagnosed and treated in a woman with uterine didelphys, obstructive hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome. A 49-year-old multiparous woman applied to our institution with menorrhagia and intermenstrual bleeding since 6 months. On pelvic examination, a grossly normal cervix was noted. A 7-cm firm mass was palpated in the left pelvic region extending to the vaginal level. Also, a 4-cm fluctuant mass was palpated on the left vaginal wall. On pelvic ultrasound, a 40-mm cystic mass with internal echoes resembling an endometrioma was visualized adjacent to the left superior vaginal wall. Upper abdominal ultrasound revealed left unilateral renal dysplasia, which was further confirmed by magnetic resonance imaging (MRI) (Fig. 1). Laboratory, pap-smear and endocervical curettage (ECC) results were normal. Endometrial biopsy taken with a pipelle endometrial sampling cannula was reported as endometrioid adenocarcinoma. Laparotomy was performed and peritoneal washings were obtained for cytology. Upon exploration, uterine didelphys (UD) with normal adnexa on both sides were discovered (Fig. 2). After complete resection of the uterus with bilateral tubes and ovaries, a blind vaginal stump on the left side was visualized. A brown-colored fluid was drained from the left vaginal lumen. There was a small opening between the left and right vaginal lumens. The operation was completed with bilateral pelvic-paraaortic lymph node dissection (LND) and omentectomy. Final pathology was reported as UD with a 10 9 8 mm well-differentiated primary endometrioid adenocarcinoma of the right cervix. Endometrial tissues on both uteruses were free of any tumoral involvement. Retroperitoneal lymph nodes, omentum and peritoneal cytology were negative for any tumoral spread. The patient was informed about the pathology results. Further treatment options including surgical treatment or chemoradiation were discussed. The patient preferred surgical treatment. Radical parametrectomy and proximal vaginectomy were performed. Postoperative follow-up period was uneventful. On pathological examination, bilateral parametria and vaginal tissues were free of tumor. The patient was consulted to the radiation oncology department of an affiliated hospital. Regular follow-up without adjuvant treatment was recommended, and she was discharged from the hospital. Short-term (15 months) follow-up visits were normal without any treatment related complications or signs of recurrence. Obstructive hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome (Herlyn–Werner–Wunderlich syndrome) is a rare type of congenital Mullerian anomaly (CMA), which is frequently associated with UD [1, 2]. This syndrome results from lateral fusion defect of the Mullerian ducts with asymmetric vaginal obstruction. The classical urinary manifestation of OHVIRA syndrome is ipsilateral renal agenesis. However, as in our case, dysplastic or duplicated kidneys have also been reported [3]. Women with CMA are generally diagnosed in adolescence or reproductive period. Symptoms and clinical findings vary greatly, depending on the present anomaly. The woman presented here did not report any symptoms M. Kaba T. Gungor E. Baser (&) B. Ozdal Department of Gynecologic Oncology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Talatpasa Bulvari, Samanpazari, Altindag, Ankara, Turkey e-mail: eralpbaser@gmail.com