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A model for predicting extrauterine tumor spread in patients with endometrial cancer Abstract Background: The factors predicting extrauterine spread in patients undergoing staging surgery with the diagnosis of endometrial cancer were investigated. Aims: The study aimed to create a model using demographic, surgical, and pathological factors to predict extrauterine spread. Methods: Included in the study were 355 patients with a final diagnosis of endometrial cancer who underwent surgery for staging purposes. The effect of surgical-prognostic factors on extrauterine spread was analyzed using univariate analysis and multivariate logistic regression analysis. Results: Extrauterine spread was detected in 97 patients. A multivariate logistic regression model that was created to determine the factors affecting extrauterine spread identified the presence of lymphovascular invasion, cervical invasion, peritoneal cytology positivity and tumor type as independent factors. A model was created using these four independent risk factors. According to this model, the rate of extrauterine spread was 6.4% in patients who did not have the risk factors and 100% in patients who had all the risk factors (p

FACTORS PREDICTING INACCURACY BETWEEN FROZEN SECTION ANALYSIS AND POSTOPERATIVE PATHOLOGY RESULTS: A TERTIARY CENTER EXPERIENCE ABSTRACT Objective: To evaluate the diagnostic accuracy and to identify the factors determining the inaccuracy between FS analysis and postoperative pathology results in our hospital. Materials and Methods: This study included 1435 patients with pelvic masses who underwent surgical intervention and FS consultation. Results: On univariate analysis, menopausal state, abnormal uterine bleeding, preoperative serum Ca125 level, preoperative leukocyte value, preoperative neutrophil value, tumor size, presence of cystic component, pathological findings in Doppler USG, ascites and cell type were found to have statistical significance for benign / borderline / malign discrimination. Menopausal state (p lt;0.0001), preoperative serum Ca125 level (p lt;0.0001) and tumor size (p lt;0.0001) were identified as independent predictors for determining inaccuracy between intraoperative and postoperative pathological evaluation. Inconsistency increased 2.5 times with a serum Ca125 gt; 35 IU/ml, 3.8 times with tumor size gt; 79 mm and 5 times in postmenopausal patients. For the discrimination of benign / borderline / malign definitions, FS results and final pathology results were compatible in 1250 (87%) patients while it was not in 185 (13%) patients. Conclusions: Increased preoperative serum Ca125 level was a predictor for inaccuracy between FS examination and postoperative pathology results. Also, tumor size ≥80 mm and menopausal state were related to misdiagnosis in FS results. Maximal effort should be done to minimize preventable errors during intraoperative FS analysis. Keywords: Frozen section, Pelvic mass, Inaccuracy, Borderline tumors

Background: Uterine carcinosarcoma is rare neoplasm that mostly presents as metastatic disease. Stage is one of the most important prognostic factor, however, the management of the early stage uterine carcinosarcoma is still controversial. Aims: To evaluate prognostic factors, treatment options, and survival outcomes in patients with surgically approved stage I uterine carcinosarcoma. Study Design: Cross-sectional study. Methods: Data of 278 patients with uterine carcinosarcoma obtained from four gynecologic oncology centers were reviewed, and 70 patients with approved stage I uterine carcinosarcoma after comprehensive staging surgery were studied. Results: The median age of the entire cohort was 65 years (range; 39-82). All patients underwent both pelvic and paraaortic lymphadenectomy. Forty-one patients received adjuvant therapy. The median follow-up time was 24 months (range; 1-129). Nineteen (27.1%) patients had disease failure. The 3-year disease-free survival and cancer-specific survival of the entire cohort was 67% and 86%, respectively. In the univariate analysis, only age was significantly associated with disease-free survival (p=0.022). There was no statistical significance for disease-free survival between observation and receiving any type of adjuvant therapy following staging surgery. Advanced age (

Objective: The aim of this study was to evaluate the prognostic factors of recurrence in uterine tumors resembling ovarian sex-cord tumors (UTROSCT) and to determine clinical-pathological characteristics, treatment options and outcome. Material and Method: An electronic literature search was conducted from 1976 to 2018. After the comprehensive evaluation and conjunction with our case, the study included 79 cases. Results: The median age at initial diagnosis was 49 years (range; 16-86 years). The age was under 40 years in 21 (26.6%) patients. Whereas 68 patients underwent at least hysterectomy, 9 patients had organ sparing surgery. There was necrosis in 4 (5.1%) patients, atypia in 16 (20.3%) patients, and infiltrative tumor border in 34 (43%) patients. At least one mitosis per 10 high power fields was determined in 36 (45.5%) patients. The tumor involved at least part of the myometrium in 54 (68.3%) patients. Median follow-up time was 30 months (range; 3-296 months). Recurrence was determined in 5 (6.3%) patients. The disease free survival (DFS) was significantly related only to surgery type. None of the pathologic features were associated with DFS. The 5-year DFS was 86% and 96% in patients who underwent organ sparing surgery or not, respectively (p=0.038). Conclusion: The accurate pathologic diagnosis of UTROSCT has great value in shaping surgical management and management during the follow-up period. Organ sparing surgery was related to poor DFS. Although recurrence is rare, it should be kept in mind for patients with UTROSCT.

Abstract Background This study aimed to determine the effect of neoadjuvant chemotherapy (NACT) on the complex surgical procedures required in addition to staging surgery for the need to achieve a residual tumor 1 cm or less in a population of stage IIIC–IV epithelial ovarian cancer patients. Methods Patients were referred for NACT if preoperative imaging and/or intraoperative evaluation confirmed that it was not possible to achieve a residual tumor size of 1 cm or less with cytoreductive surgery or if the patient had a poor performance status and a high American Society of Anesthesiologists (ASA) score. Surgical complexity was defined as complex or non-complex. Results One hundred and twenty-six patients with stage IIIC–IV ovarian cancer were included in the study. Primary cytoreductive surgery was performed in 67 patients, and interval cytoreductive surgery was performed in 59 patients after NACT. At least one complex surgery was performed in 74.6% of the patients in the primary cytoreductive surgery group and in 61% of the patients in the NACT group, with no statistically significant difference between the groups. However, the NACT group showed significantly decreased rates of low-rectal resection, diaphragmatic peritoneal stripping, and peritonectomy. Conclusions The analyses showed no reduction in the requirement for at least one complex surgical procedure in the group of patients who underwent NACT. Nevertheless, this group exhibited a significant decrease in low-rectal resection, diaphragmatic peritoneal stripping, and peritonectomy due to their effectiveness in reducing peritoneal disease.

Abstract Background This study aimed to evaluate the outcomes of patients diagnosed with stage IB2/IIA2 cervical squamous cell carcinoma who underwent neoadjuvant chemotherapy (NACT) prior to radical hysterectomy compared to those who did not receive NACT before surgery. Materials and methods This is a multicenter study including data of 6 gynecological oncology departments. The study is approved from one of the institution’s local ethics committee. Patients were stratified into two cohorts based on the receipt of NACT preceding their surgical intervention. Clinico-pathological factors and progression-free survival were analyzed. Results Totally 87 patients were included. Lymphovascular space invasion (LVSI) was observed as 40% in the group receiving NACT, while it was 66.1% in the group not receiving NACT (p = 0.036). Deep stromal invasion (> 50%) was 56% in the group receiving NACT and 84.8% in the group not receiving NACT (p = 0.001). In the univariate analysis, application of NACT is statistically significant among the factors that would be associated with disease-free survival. Consequently, a multivariate analysis was conducted for progression-free survival, incorporating factors such as the depth of stromal invasion, the presence of LVSI, and the administration of NACT. Of these, only the administration of NACT emerged as an independent predictor associated with decreased progression-free survival. (RR:5.88; 95% CI: 1.63–21.25; p = 0.07). Conclusions NACT shouldn’t be used routinely in patients with stage IB2/IIA2 cervical cancer before radical surgery. Presented as oral presentation at National Congress of Gynaecological Oncology & National Congress of Cervical Pathologies and Colposcopy (2022/ TURKEY).

The aim of this study was to evaluate the prognostic factors for and determine the effect of neoadjuvant chemotherapy (NACT) on oncologic outcome in stage IVB pure serous endometrial carcinoma patients who received taxane and platinum. Forty-two patients with 2009 International Federation of Gynecology and Obstetrics (FIGO) stage IVB uterine serous carcinoma were enrolled from six gynecologic oncology centers and a study group was created. The study group had a 2-year disease-free survival (DFS) of 32% and 2-year disease-specific survival (DSS) of 73%. On univariate analysis; lymphadenectomy (not performed vs. performed), paraaortic lymph node metastasis (positive vs. negative) and number of metastatic lymph node count (≤5 vs. >5) were found to have statistical significance for DFS (p

Objective: To define the factors that determine survival after extrapelvic recurrence in patients with endometrioid type endometrial cancer (EC).objective Materials and methods: Clinicopathological and survival data of surgically treated endometrioid type EC patients who recurred outside pelvis were reviewed. Patients who had non-endometrioid tumor, sarcomatous component in the final pathology and synchronous tumor were excluded. The period from surgery to recurrence was defined as time to recurrence (TTR) and the period from recurrence to death or last visit was defined as post-recurrence survival (PRS). Results: Sixty-six patients with extrapelvic recurrence were included in the study. No residual disease was achieved in all patients at initial surgery. Median TTR was 18 months (range, 2–84). Recurrence developed within 1 year in 24 (36.4%) patients and between 13 and 24 months in 22 (33.3%) patients. Fifty-three of 66 patients (80.3%) had extraabdominal recurrence. The 2-year PRS of the all cohort with extrapelvic recurrence was 56%. In the univariate analysis, advanced FIGO stage, lymph node metastasis, adnexal metastasis and short TTR were associated with diminished PRS (p

Heparin-induced thrombocytopenia is a rare and life-threatening condition of exposure to heparin. A case of heparin-induced thrombocytopenia due to the low molecular weight heparin was presented. Pulmonary emboli and progressively decreased number of thrombocytes developed during the low molecular weight heparin treatment. For that reason, the heparin-induced thrombocytopenia was diagnosed. The heparin was ceased and fondaparinux treatment initiated. Platelet levels returned to normal limits within six days. The delaying in diagnosis of heparin-induced thrombocytopenia causes serious outcomes. The physician must be careful and keep in mind be developed of this clinical condition in patient under heparin treatment.

Objective: To define recurrence pattern of endometrioid type endometrium cancer performed adjuvant radiotherapy. Study Design: 351 patients who underwent at least total abdominal hysterectomy with bilateral salpingo-oophorectomy and followed by adjuvant radiotherapy (vaginal brachytherapy or pelvic radiotherapy or both) for endometrioid type endometrium carcinoma were included. The patients who received systemic adjuvant treatment after surgery were excluded from the study except for 18 patients who received concomitant chemo-radiotherapy. Recurrence was categorized as pelvic recurrence included areas distal to the pelvic inlet, as abdominal recurrence included areas between pelvic inlet and diaphragm and findings such as ascites and peritonitis carcinomatosa, and the rest of recurrences including lung, cutaneous, liver parenchyma and bone as extra-abdominal recurrence. Results: The median age was 57 years (range; 29-82). 236 patients had stage I, 25 had stage II, 63 had stage III and 14 had stage IV disease (by FIGO 2009). Lymph node metastasis was determined in 21.8% of patients who underwent lymphadenectomy (n: 289). The median follow-up time was 46 months (range; 1-190). Throughout follow-up, recurrence was developed in 55 (15.7%) patients. Only pelvic recurrence was determined in 11 (3.1%) patients. There was recurrence beyond the pelvis in 44 (80%) of the recurrent patients. Thirty-five (%63.6) of recurrent patients had extra-abdominal recurrence. Twenty-three (41.8%) of recurrent patients had stage IB disease. The recurrence developed in 10% of patients with stage I&II, whereas it was occurred in 31% of patients with stage III&IV (p