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Background/aim To investigate the risk factors for evisceration in a gynecological-oncology population. The secondary aim was to evaluate the impact of evisceration on survival. Materials and methods Inclusion criteria were having had an elective surgery performed by a xiphoidopubic incision in our institution and having a gynecological malignancy based on pathology. A total of 198 patients were evaluated, 54 with evisceration and 144 without evisceration. Due to the widely varied prognosis of female genital cancers, the survival was analyzed on a homogenized group, including only 62 patients with primary advanced stage epithelial ovarian-tubal-peritoneal cancer. Results The preoperative factors associated with evisceration in the univariate analysis were old age, high body mass index (BMI), hypertension, smoking, comorbidities, high American Society of Anesthesiologist (ASA) score (3 and 4), and low preoperative albumin level. The associated intraoperative factors were bleeding volume, receiving more than two units of erythrocyte suspension or fresh frozen plasma, and having had a major operation. The associated postoperative factors were the albumin transfusion and the antibiotic use in the early postoperative period. In the multivariate analysis, smoking, low levels of preoperative albumin, high BMIs, and high ASA scores (3 and 4) were independent prognostic factors for evisceration. Evisceration was not associated with recurrence and survival in the patients with primary advanced stage epithelial ovarian-tubal-peritoneal cancer patients. Conclusion Smoking, preoperative hypoalbuminemia, obesity, and high ASA scores (3 and 4) were the prognostic factors for evisceration. Short-term modifiable factors such as smoking cessation and improved nutritional status should be considered in elective gynecological-oncology surgeries. Evisceration had no impact on survival and recurrence in the patients with primary advanced stage epithelial ovarian-tubal-peritoneal cancer patients. Key words: Evisceration, hypoalbuminemia, obesity, smoking, survival, wound dehiscence.

research Background/aim: The vanishing cancer phenomenon was first reported in radical prostatectomy specimens in the absence of neoadjuvant treatment. Reported cases are mostly well-differentiated and low-volume tumors. A similar entity was described for hysterectomy specimens of patients with biopsy proven endometrial cancer (EC). In this study, we discuss the probable reasons for vanishing EC and long-term follow-up results of EC patients without residual tumors in hysterectomy specimens. Materials and methods: This study was carried at two institutions in Ankara, Turkey, in a retrospective design. The computerized databases of both institutions were searched for endometrioid type EC patients whose final pathological specimens failed to show any residual tumor. Results: We evaluated 38 endometrial biopsy confirmed EC patients with no residual tumor detected in the hysterectomy specimens among a total of 224 women (17%) with the disease confined to the endometrium. During the follow-up period, no recurrences were noted among the patients. Conclusion: It can be suggested that premenopausal women with FIGO grade 1 endometrioid type EC with MRI proven “absent myometrial invasion” would have a significant probability of having no residual tumor after endometrial biopsy without any further medical treatment. Background/aim: The vanishing cancer phenomenon was first reported in radical prostatectomy specimens in the absence of neoadjuvant treatment. Reported cases are mostly well-differentiated and low-volume tumors. A similar entity was described for hysterectomy specimens of patients with biopsy proven endometrial cancer (EC). In this study, we discuss the probable reasons for vanishing EC and long-term follow-up results of EC patients without residual tumors in hysterectomy specimens. Materials and methods: This study was carried at two institutions in Ankara, Turkey, in a retrospective design. The computerized databases of both institutions were searched for endometrioid type EC patients whose final pathological specimens failed to show any residual tumor. Results: We evaluated 38 endometrial biopsy confirmed EC patients with no residual tumor detected in the hysterectomy specimens among a total of 224 women (17%) with the disease confined to the endometrium. During the follow-up period, no recurrences were noted among the patients. Conclusion: It can be suggested that premenopausal women with FIGO grade 1 endometrioid type EC with MRI proven “absent myometrial invasion” would have a significant probability of having no residual tumor after endometrial biopsy without any further medical treatment.

Synchronous primary cancers of the endometrium and ovary (SEOC) occur in approximately 10% of all women with ovarian cancer and 5% of all women with endometrial cancer. Diagnosis of these tumors as independent primaries or metastases is necessary for appropriate staging and treatment. We aimed to demonstrate the clinic-pathological characteristics and prognosis of patients diagnosed as SEOC. Clinico-pathological data of cases with SEOC were retrieved from the computerized database of Etlik Zubeyde Hanim Women’s Health and Research Hospital. Twenty-six patients with SEOC who underwent comprehensive surgical staging between 1998 and 2014 were included in study. Mean age at diagnosis of women with primary SEOC in our study was 50.9. Median follow up was 86.5 months and the 10 year overall survival (OS) rates were 86.0% for patients with SEOC. Among the variables only omental involvement independently affected OS (p= 0.008). Most of the tumors were well-differentiated, early stage and of endometrioid cell type. In this study we showed that women with SEOC was often young and mostly have an excellent prognosis.

Objective: To present the clinicopathological features of endometrial cancer (EC) patients with isolated liver or lung metastases and to compare the survival differences after diagnosis of recurrent disease. Material and Methods: The clinical and histopathological data of the patients who were treated with a diagnosis of epithelial EC between January 1993 and May 1993 at Etlik Zubeyde Hanim Teaching and Research Hospital were retrospectively reviewed. Patients with isolated recurrence in liver (ILR) or lung (IPR) were included in the analysis. Results: The clinical data of 162 patients with recurrent EC were available. Of these, 21 had IPR and 9 had ILR. Patients with ILR presented with more advanced stage, and omental and adnexal involvement was more common compared to patients with IPR. On the other hand, patients with IPR had higher grade disease. Fifty-seven percent of patients with IPR had grade 3 compared to 11% of grade 3 disease in ILR (p=0.02). The median time to recurrence (TTR) was 18 months (range 1-54) in the whole study population. While the median TTR of patients with IPR was 19 months, the median TTR of patients with ILR was 16 months (p=0.204). Both study groups have similar survival. The 1-year post-recurrence survival of IPR and ILR was 66% and 56% (p=0.129), respectively. Conclusion: Although , isolated liver and lung metastases are the result of hematogenous spread in EC, clinicopathological features of these two recurrence patterns significantly differ. Clinicians should try to categorize these patients separately to better understand the prognostic outcomes.

To investigate the variations in the recurrence patterns of stage IB cervical cancer according to lymph node involvement. Materials and methods: We reviewed the medical records of 170 patients who had undergone type III radical hysterectomy and systematic lymphadenectomy from 1993 to 2007. Results: Among the patients in the study group, 115 did not have lymph node metastases, whereas 55 did. A total of 27 patients developed recurrences. Twelve were in the lymph node-negative group, and 15 were in the lymph node-positive group. The recurrence rate was higher in lymph node-positive group (27.3% versus 10.4%, P = 0.011). The recurrence pattern was not affected by lymph node involvement. However, distant recurrence was more common in the lymph node-positive group (53.3% versus 25%, P = 0.137). Additionally, distant failure was observed only in the patients in the lymph node-negative group who received adjuvant radiotherapy. In this group, 3 patients who did not receive adjuvant radiotherapy developed recurrences only in the pelvic region. Conclusion: The presence of lymph node involvement in stage IB cervical cancer does not affect the site of recurrence. However, distant recurrence was more frequent in the lymph node-positive group.

To evaluate the effectiveness of the addition of epirubicin to conventional chemotherapy as a first-line therapy for stage III-IV epithelial ovarian cancer.A total of 132 patients who had undergone primary cytoreductive surgery between January 1998 and March 2003 were enrolled in the study. Twenty-four cases were excluded. Out of the remaining 108 subjects, 35 received epirubicin/paclitaxel/ carboplatin (Group EPC) and 73 were treated with paclitaxel/platinum (cisplatin.or carboplatin) (Group PC).The median follow-up period was 66.5 months. The clinical complete response was 94% in the EPC group and 97% in the PC group. The recurrence rate in the first 6 months after treatment was significantly higher in the PC than the EPC group (47% vs. 23%, P = 0.018). Triplet chemotherapy was not found to improve 2- and 5-year disease-free survival (DFS) statistically. No significant difference in overall survival was observed between the 2 groups (80% vs. 83% at 2 years and 56% vs. 57% at 5 years for the PC and the EPC group, respectively). The main toxicity in both groups was hematological, and it was particularly severe in the EPC group.The addition of epirubicin to the standard treatment protocol yielded an improvement in the DFS rate that was not statistically significant and caused a tolerable increase in toxicity.

Amaç: Hormonal olarak aktif ovaryen tümörler sekonder amenorenin nadir nedenlerinden olup tanıda zorluk nedeni ile gözden kaçabilmektedir. Adult granüloza hücreli tümör (AGHT); overin seks-kord stromal tümörleri arasında en yaygın görülen tipidir ve tüm over tümörlerinin %3-5'ini oluşturur. Bu makalede düşük folikül stimulan hormon ile sekonder amenore (hipogonadotropik amenore) gelişen 2 AGHT olgusu sunulmuştur. Olgu: 44 (hasta no #1) ve 41 (hasta no# 2) yaşında iki hasta son 1 yıldır adet görememe nedeniyle polikliniğimize başvurdu. FSH düzeyi iki olguda bazalin altında (sırasıyla; 1.94 IU/L ve 3.32 İU/L saptandı. Beta-human koryonik gonadotropini (β- hCG) negatif; tiroid fonksiyon testleri (tiroksin, triiyodotironin, tiroid stimule edici hormon), prolaktin, lüteinizan hormon, östradiol ve tümör belirteçleri (CA-125, CEA, AFP, CA 15-5, CA19-9) normaldi. İnhibin-B düzeyi iki hastada >900ng/ml'ydi (normal aralık:16-225ng/ml). Transvajinal ultrasonografide kitle sol over kaynaklı olup boyutları 5x3 cm (hasta no #1) ve 8x6 cm (hasta no#2) idi. Laparatomide her iki hastada batında asit saptandı. Sol salpingo-ooforektomi yapılarak patolojiye gönderildi. İntraoperatif patoloji konsültasyonunun AGHT olarak rapor edilmesi üzerine hastalara total abdominal histerektomi+sağ salpingo-ooforektomi+bilateral pelvikparaaortik lenfadenektomi+infrakolik omentektomi yapıldı. Nihai patoloji sonuçları AGHT olarak bildirildi (Evre Ia). Postoperatif 2. haftanın sonunda bakılan FSH düzeyi 2 .hastada 115 IU/L iken 1.hastada postoperatif FSH değeri bakılmamıştı. Hastaların operasyon sonrası takiplerinde (sırasıyla; 16 ay ve 19 ay) nüks saptanmadı. Sonuç: Premenopozal dönemde düşük FSH düzeyiyle seyreden amenore ayırıcı tanısında erken tanı sayesinde kontrol altına alınabilecek olan AGHT gözden kaçırılmamalıdır., Aim: Hormonally active ovarian tumors are rare causes of secondary amenorrhea and can be misdiagnosed. Adult granulosa cell tumor (AGCT) is the most common sex-cord stromal tumor of the ovary and it constitutes 3-5% of all ovarian tumors. We presented here 2 cases of secondary amenorrhea with low serum follicle stimulating hormone (FSH) caused by AGCT. Case: Two patients who were 44 (#patient1) and 41(#patient2) years old applied to our institution with amenorrhea for 1 year. FSH) levels were 1.94 IU/L and 3.32 IU/L, respectively, below the basal level. Beta human chorionic gonadotropin (βhCG) levels were negative and thyroid function tests were normal. Besides high serum inhibin levels (>900 in both patients) tumor markers (CA-125, CEA, AFP, CA 15-5, CA19-9), serum luteinizing hormone, estradiol, and prolactin levels were in the normal ranges. Transvaginal sonography revealed 5x3 cm and 8x6 cm sized left adnexal masses, respectively. During laparotomy, acidic fluid was detected in both patients, left salpingo-oophorectomy was performed and specimens were sent for frozen-section examination. Frozen-section revealed AGCT intraoperatively in both patients and surgical staging procedure was performed (total abdominal hysterectomy + right salpingo-oophorectomy + bilateral pelvic and para-aortic lymphadenectomy and omentectomy). Final pathology confirmed the diagnosis of stage IA AGCT. FSH level was 115IU/L at postoperative second week in #patient 2. No FSH level was obtained for #patient 1 postoperatively. There were no recurrences during the follow-up period (16 and 19 months, respectively). Conclusion: AGCT should be considered as a cause of amenorrhea with low serum FSH levels.

To define a high-risk group for paraaortic (PA) lymph node metastasis among endometrial carcinoma patients. Materials and methods: Prognostic factors determining PA lymph node metastasis were defined. Using these factors in different combinations, 14 risk groups were formed. A patient with at least one of these factors was considered as high-risk for PA lymph node metastasis. Results: This study included 152 patients. Of these patients, 18 had tumors in the PA region. Lymphovascular space invasion (LVSI) and pelvic lymph node metastasis were independent prognostic factors for PA lymph node involvement. In the risk modeling system, pelvic lymph node metastasis was an important factor in predicting PA lymph node status, and in groups where this factor was included for risk modeling, PA lymph node involvement was significantly increased in high-risk patients. Best results were obtained with the risk group model (group 10) involving cell type, LVSI, serosal spread, adnexal metastasis, and pelvic lymph node as prognostic factors. In this group sensitivity was 94%, specificity was 53.7%, and negative and positive predictive values were 98.6% and 21.5%, respectively. According to this model, 52% of all patients were in the high-risk group. Conclusion: Group 10 seemed to include the guiding properties for a decision on paraaortic lymphadenectomy and it was possible to reduce unnecessary paraaortic lymphadenectomies by 50%.

Background/aim We aimed to define the effect of tumor size on recurrence and survival rates in patients with stage I–II endometrioid-type endometrial cancer. Materials and methods A total of 550 patients who had total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic-paraaortic lymphadenectomy were included. Patients with extrauterine spread, sarcomatous components, or synchronized tumor and those who did not undergo lymphadenectomy or did not have data on tumor size were excluded. Results The median tumor size was 35 mm (range: 3–335 mm). According to the 2009 International Federation of Obstetrics and Gynecology (FIGO) criteria, 245 cases were defined as stage IA, 271 as stage IB, and 34 as stage II. The 5-year disease-free survival (DFS) rate was 92% and the 5-year disease-specific survival (DSS) rate was 99%. The effects of prognostic factors on DFS were evaluated. Older age, stage II disease, deep myometrial invasion, and receiving adjuvant radiotherapy were associated with decreased DFS. There was no statistically significant association between tumor size and DFS. The 5-year DFS for patients with a tumor diameter of 35 mm (P = 0.128). Conclusion Tumor size was not a risk factor predicting recurrence in patients with stage I or II endometrioid-type endometrial cancer who had lymphadenectomy.