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Evaluating nodal metastases in low-grade serous ovarian cancer (LGSOC) patients.Women with LGSOC who had undergone primary cytoreductive surgery comprising systematic pelvic-paraaortic lymphadenectomy were included. Data were obtained retrospectively from 12 oncology centers.One hundred and forty-eight women with LGSOC who had undergone comprehensive surgical staging were included. Seventy-one (48.0%) patients had metastatic lymph nodes. Preoperative serum CA-125 levels of ≥170 U/ml (odds ratio [OR]: 3.84; 95% confidence interval [CI]: 1.22-12.07; p = 0.021) and presence of lymphovascular space invasion (LVSI) (OR: 13.72; 95% CI: 3.36-55.93; p 0.001) were independent predictors of nodal metastasis in LGSOC. Sixty (40.5%) patients were classified to have apparently limited disease to the ovary/ovaries. Twenty (33.3%) of them were upstaged after surgical staging. Twelve (20.0%) had metastatic lymph nodes. Presence of LVSI (OR: 12.96; 95% CI: 1.14-146.43; p = 0.038) and preoperative serum CA-125 of ≥180 U/ml (OR: 7.19; 95% CI: 1.35-38.12; p = 0.02) were independent predictors of lymph node metastases in apparent Stage Ⅰ disease.Clinicians may consider to perform a reoperation comprising systematic lymphadenectomy in patients who had apparently limited disease to the ovary/ovaries and had not undergone lymphadenectomy initially. Reoperation may be considered particularly in patients whose preoperative serum CA-125 is ≥180 U/ml and/or whose pathological assessment reported the presence of LVSI.

AIM To evaluate if the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) could be used to diagnose adnexal torsion. METHODS A retrospective study reviewed medical records of women who underwent surgery due to an adnexal mass between January 2012 and December 2017 at a tertiary referral center in Turkey. According to the surgical findings, the women were divided into a torsion group and a control group. NLR and PLR were compared between women who had adnexal torsion and those who did not. RESULTS A total of 201 women were included in the study: 67 in the torsion group and 134 in the control group. Mean WBC count (9584.0 ± 3080.8 vs. 6678.2 ± 1886.1 h/mm3 ), mean NLR (5.9 ± 4.3 vs. 2.1 ± 0.8), and mean PLR (210.5 ± 132.7 vs. 147.9 ± 48.7) were higher in the torsion group than in the control group (p

Demonstrate survival outcomes of stage 3B/3C ovarian–tubal–peritoneal epithelial cancer patients who had metastases on diaphragm. 141 patients who had undergone diaphragm surgery as a part of primary cytoreductive surgery procedures performed for stage 3B and 3C ovarian–tubal–peritoneal epithelial cancers were reviewed retrospectively. Patients who were administered neoadjuvant chemotherapy and patients who were suboptimally cytoreduced were not included to the study. Median follow-up time was 42 months. Median overall survival of the patients who underwent diaphragm full-thickness resection (n = 18) because of tumors infiltrating diaphragm muscle was 40 months. Median overall survival of the patients who did not have a transdiaphragmatic thoracotomy (n = 113) was 77 months. Patients who underwent a willful full-thickness diaphragm resection because of tumors invading diaphragm muscle had significantly shorter survival compared with patients who did not have a transdiaphragmatic thoracotomy (p = 0.033). Seven (38.9%) of the 18 patients who underwent diaphragm full-thickness resection developed a recurrence in thorax. Twelve (9.8%) of the remaining 123 patients developed a recurrence in thorax. Patients who underwent full-thickness diaphragm resection because of tumors infiltrating diaphragm muscle developed recurrence in the thorax more frequently (p = 0.001). Diaphragm muscle involvement is a predictor of thorax recurrences and worse survival outcomes in stage 3B and 3C ovarian–tubal–peritoneal epithelial cancers. Thus, this should be considered when selecting appropriate adjuvant treatment and route of administration (intravenous/intraperitoneal) in patients who had diaphragm implants infiltrating diaphragm muscle.

To determine the prognostic impact of the lymph node ratio (LNR) in node-positive low-grade serous ovarian cancer (LGSOC).We retrospectively reviewed women with LGSOC who had undergone maximal cytoreduction followed by standard chemotherapy in 11 centers from Turkey during a study period of 20 years. Sixty two women with node-positive LGSOC were identified. LNR was defined as the number of metastatic lymph nodes (LNs) divided by the number of total LNs removed. We grouped patients pursuant to the LNR as LNR ≤ 0.09 and LNR 0.09. The prognostic value of LNR was investigated by employing the univariate log-rank test and multivariate Cox-regression model.With a median follow-up of 45 months, the 5-year progression-free survival (PFS) rates were 61.7% for women with LNR ≤ 0.09 and 32.0% for those with LNR 0.09 (p = 0.046) whereas, the 5-year overall survival (OS) rates were 72.8% for LNR ≤ 0.09 and 54.7% for LNR 0.09 (p = 0.043). On multivariate analyses, lymphovascular space invasion (LVSI) (Hazard Ratio [HR] 4.18, 95% confidence interval [CI] 1.88-9.27; p 0.001), omental involvement (HR 3.48, 95% CI 1.36-8.84; p = 0.009) and LNR 0.09 (HR 3.51, 95% CI 1.54-8.03; p = 0.003) were adverse prognostic factors for PFS. Additionally, LVSI (HR 6.56, 95% CI 2.33-18.41; p 0.001), omental involvement (HR 6.34, 95% CI 1.86-21.57; p = 0.003) and LNR 0.09 (HR 7.20, 95% CI 2.33-22.26; p = 0.001) were independent prognostic factors for decreased OS.LNR 0.09 seems to be an independent prognosticator for decreased survival outcomes in LGSOC patients who received maximal cytoreduction followed by standard adjuvant chemotherapy.

Objective: To evaluate the histopathological findings of cystic endometrial morphology based on ultrasonographic imaging in premenopausal women.Study Design: The medical records of 3607 premenopausal women that underwent ultrasonographic examination at a tertiary care center were reviewed, as were endometrial biopsy findings in 816 of the women. These 816 women were divided in 2 groups according to ultrasonographic endometrial findings: the cystic group and the non-cystic group. Clinical and histopathological findings in the 2 groups were compared. Statistical analysis was performed using independent samples t test, chi-square test, and binary logistic regression analysis.Results: Three hundred and eighty one (46.7%) of the women that underwent endometrial biopsy had cystic endometrium, whereas 435 (53.3%) had non-cystic endometrium. The most common histopathological finding in the cystic group was endometrial hyperplasia without atypia (44.6%). Cystic morphology was nearly 8-fold more common in the women with endometrial hyperplasia without atypia (95% CI: 5.43-11.67). The premalignant and malignant pathology rates in the cystic group and non-cystic group were similar (1.1% vs. 0.5% [p=0.426] and 0.8% vs. 0.5% [p=0.669], respectively). Secretory endometrium was less common in the cystic group than in the non-cystic group (5.0% vs. 37.9% [p< 0.001])Conclusion: Cystic endometrial morphology based on ultrasonographic imaging was more common in women with endometrial hyperplasia without atypia. There wasn’t an association between cystic endometrium and other endometrial pathologies or functional endometrium. Keywords: Cystic endometrium, Endometrium, Endometrial hyperplasia, Premenopausal, Ultrasonography

To determine the rate of high-grade cervical intraepithelial lesion and cancer (HSIL+) diagnosis as a result of colposcopic histopathology in patients aged ≥50 years and to investigate the role of cytology, Human Papillomavirus (HPV) test positivity and HPV genotyping in predicting HSIL+.The study included 1102 patients aged ≥50 as study group and 2723 patients aged50 as control group who were admitted to our colposcopy unit between January 1, 2015 and December 31, 2019 and underwent colposcopy for the first time. The patients with HSIL+ were compared as Cytology group and HPV group in the study group. To evaluate the impact of genotyping HPV positive group was compared in terms of HSIL+ results in subgroups with HPV16/18 and HPV other types positivity. Patients diagnosed with cancer in the same period were compared in terms of age, stage and histology as screening cancer group and symptomatic cancer groups.The rate of cervical cancer in the study group was 2.2% and 1.2 % in the control group. In patients diagnosed with cancer, Federation of Gynecology and Obstetrics stage was ≥ stage IB2 in 57.4% of cases in the symptomatic cancer group and in 18.9% of cases in the screening cancer group. The HPV 16/18 positivity rate in HSIL+ patients were 75.0% and 79.5% in the study and control group, respectively.Cervical cancer rates were found to be high in the group aged ≥ 50 years. HPV genotyping is as effective in patients ≥50 years of age as in those aged50 years. Patients diagnosed as a result of screening are caught in the early stages and therefore with increased general life expectancy, the age at which screening is discontinued should be re-evaluated.

Objective To evaluate surgical outcomes and survival outcomes of cervical cancer patients who underwent complementary surgery after an extrafacial hysterectomy Methods Patients with cervical cancer, who underwent extrafacial hysterectomy initially and thereafter underwent complementary surgery were reviewed retrospectively. Complementary surgery consisted of radical parametrectomy, proximal vaginectomy and pelvic lymphadenectomy. Results Twenty patients were evaluated. Histopathologic subtype was squamous cell carcinoma in twelve patients, adenocarcinoma in six patients and adenosquamous carcinoma in two patients. Route of surgery was laparotomy in 19 patients and laparoscopy in one patient. Two patients were staged as stage 1A2, nine were staged as stage 1B1, four were staged as stage 1B2, one was staged as stage 2A1, one was staged as stage 2B and three were staged as stage 3C1. The median tumor size was 16.5 (Range, 4–40) mm. Grade ≥ 3 complications related to surgery occured in 8 (40%) patients. Four of them were managed intraoperatively and recovered problem free. Remaining four (20%) needed reoperation. Pathology reports revealed involvement of parametrium in one (5%) patient, involvement of the proximal vagina in one (5%) patient, matastasis to pelvic lymph nodes in 3 (15%) patients. Five (25%) patients received adjuvant radiotherapy. Consequently, 5-year and 10-year cumulative survival was calculated as 94%. Conclusion Complementary surgery and radiotherapy show similar oncologic outcomes in patients with early-stage cervical cancer who had undergone simple hysterectomy initially. Complementary surgery is associated with slightly higher rate of morbidity compared with radiotherapy, however significant proportion of complications can be noticed and repaired intraoperatively.

Introduction/Background The objective of this retrospective, multi-centred study was to determine the incidence of occult uterine sarcoma in women operated for presumed uterine leiomyoma. Methodology We reviewed all myomectomy and hysterectomy operations performed with a pre-operative diagnosis of uterine leiomyoma at four tertiary centres, from January 2013 until December 2017, in Ankara, Turkey. The medical records of occult uterine sarcoma patients were analyzed to determine prognostic factors for disease-free survival (DFS) and overall survival (OS). Results A total 18604 women underwent hysterectomy or myomectomy during the study period. There were 56 cases of occult uterine sarcomas (51 uterine leiomyosarcomas, and five endometrial stromal sarcomas). The incidence of occult uterine sarcoma was 0.30% (56/18604) or approximately 1/332. The median DFS was 31.0 months (95% confidence interval [CI] 9.6–52.3 months). The 3-year and 5-year DFS rates were 44.1% and 34.0%, respectively. The 3-year and 5-year OS rates were 68.8% and 50.0%, respectively. For 5-year DFS, stage of the disease (stage IA vs. more advanced stages; p=0.007), rapidly growing myoma (p=0.01) and complete surgical staging at initial operation (p=0.02) were found to be statistically significant in univariate analysis. However, only stage of the disease (Hazard Ratio: 3.45, 95% Confidence Interval 1.13–10.49; p=0.02) remained as an independent prognostic factor for decreased DFS in multivariate analysis. Conclusion Our results indicated that the incidence of occult uterine sarcoma was 0.3% (1/332) in women operated for presumed uterine leiomyoma. Early and complete surgical resection might offer better DFS for these patients. Disclosure Nothing to disclose.

To evaluate the significance of parenchymal, hilar and capsular involvement of the spleen with regard to survival. All patients who underwent primary cytoreductive surgery for advanced ovarian–tubal–peritoneal (OTP) epithelial cancer were reviewed retrospectively. Stage 3C patients who had an upper abdomen involvement and who were optimally debulked were included. Patients who had abdomen-confined disease, but were upstaged to stage 4B due to splenic parenchymal metastases were also included. Seventy four patients eligible with the inclusion criteria who underwent splenectomy and 69 patients who did not undergo splenectomy were included. The median follow-up time was 39.1 months. The median overall survival of the study group was 61.4 months. Patients who underwent splenectomy were grouped according to the involved site of the spleen: parenchyma subgroup, hilus subgroup, capsule subgroup and benign subgroup. The median overall survival of patients in the hilus subgroup was 41.1 months. The median overall survival of patients who were not in the hilus subgroup was 65.5 months. Patients in the hilus subgroup showed significantly shorter survival (p = 0.035). Hilus subgroup was associated with a statistically significant increase in mortality risk (hazard ratio 1.971; 95% confidence interval 1.1–3.531). Splenic hilus involvement predicts poorer survival outcomes among stage 3C epithelial OTP cancer patients with disease expansion to upper abdomen. According to current study and many published studies, hilar involvement had a higher incidence rate compared to parenchymal involvement. Thus, hilar involvement would be a beneficial clinical predictor of survival for larger number of patients.

Sister chromatid exchange (SCE) frequencies were studied in patients with different types of ovarian malignancies and in healthy volunteers. The level of DNA damage in patients with ovarian malignancy and control subjects has also been studied by alkaline single cell gel electrophoresis (SCGE), also known as the comet assay.Peripheral blood was collected from 30 patients after histological confirmation of malignancy and 20 healthy female volunteers. The cells were evaluated according to their grade of damage.We found that the sister chromatid exchange frequencies of cancer cases were significantly greater than that of controls (P0.001). The frequency of exchange in chromosomal groups A, B, and C, which include chromosomes 1-12, was higher than that of the other chromosomal groups in both groups. Comparison of the results of the alkaline comet assay in patient and control subjects showed a significant difference in the number of damaged cells. The frequency of limited migrated and extensive migrated cells in the women with ovarian malignancies was higher than that of control women (P0.001).SCE and SCGE can be used successfully to monitor DNA damage in women with ovarian cancer.