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Aim: The aim of this study is evaluating the predictive value of preoperative inflammatory blood parameters for differential of serous cystadenoma, serous borderline ovarian tumor (BOT) and high-grade serous ovarian (HGSOC) carcinoma. Materials and Method: In this single-center study, we retrospectively enrolled 370 patients with ovarian tumors were divided into three groups. The groups were classified as serous cystadenoma, serous BOT and HGSOC. The potential association of preoperative hemoglobin (Hb), red cell distribution width (RDW), Hb/RDW ratio, ratio of neutrophils to lymphocytes (N/L) and ratio of platelets to lymphocytes (P/L) were analyzed. Results: P/L and N/L were significantly lower in benign serous cystadenoma or serous BOT than HGSOC (p

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.

Amaç: Çalışmanın amacı Kanser Erken Tanı ve Tarama Merkezlerinden Jinekolojik Onkoloji polikliniğine sevk edilen, yetersiz servikal sitolojili ve yüksek riskli insan papilloma virüsü (HPV) pozitifliği olan kadınların kolposkopik biyopsi sonuçlarının incelemektir.Gereç ve Yöntemler: Bu retrospektif çalışmada Mart 2015-Ekim 2017 tarihleri arasında kliniğimize yönlendirilen yetersiz servikal sitoloji ve yüksek riskli HPV pozitifliği olan kadınlara kolposkopi eşliğinde servikal biyopsi ve endoservikal küretaj yapıldı. Hastalar HPV tiplerine göre gruplandırıldı. Endoservikal küretaj, servikal biyopsi ve servikal konizasyon sonuçları analiz edildi.Bulgular: Yetersiz servikal sitolojisi ve yüksek riskli HPV pozitifliği olan 46 hasta 30 aylık dönemde bu çalışmaya dahil edildi. Yirmi bir hastada (% 45,7) HPV 16 ve/veya HPV 18 ve 25 hastada (% 54,3) “16 olmayan 18 olmayan” HPV yüksek risk alt tipi mevcuttu. Servikal biyopsi sonuçları 20 hastada (% 43.5) normal histopatoloji, dört hastada (% 8.7) "HPV etkisi", 17 hastada (% 37) düşük dereceli skuamöz intraepitelyal lezyon (L-SIL) ve 5 hastada (% 10.9) yüksek dereceli skuamöz intraepitelyal lezyon (H-SIL) olarak bildirildi. Endoservikal küretaj incelemesinde üç hastada H-SIL (% 6.5) ve yedi hastada L-SIL (% 15.2) tespit edildi. Yedi (% 15.2) hastaya H-SIL nedeniyle konizasyon yapıldı ve konizasyon materyelinde üç cerrahi sınırları negatif H-SIL ve dört L-SIL bildirildi.Sonuç: Yetersiz servikal sitolojisi ve yüksek riskli HPV pozitifliği olan kadınlar için HPV alt tiplerinden bağımsız olarak H-SIL riski arttığından kolposkopi yapmak çok önemli görünmektedir., Aim: We aimed to analyze the colposcopic directed biopsy results of women with unsatisfactory cervical cytology and high-risk human papilloma virus (HPV) positivity, who were referred to the Gynecologic Oncology outpatient clinic from Cancer Early Diagnosis and Screening Centers.Materials and Methods: In this retrospective study, women with high-risk HPV subtypes who applied to our clinic between March 2015 and October 2017 with an inadequate cervical cytology underwent colposcopy-directed biopsy. Patients were grouped according to HPV types. The results of endocervical curettage, cervical biopsy, and cervical conization were analyzed.Results: Forty-six patients with unsatisfactory cervical cytology and high-risk HPV were included in this study during the 30-month period. Twenty-five (54.3%) of the patients had “non-16 non-18” HPV subtypes, while 21 (45.7%) had HPV 16 and/or HPV 18. Cervical biopsy results revealed high-grade squamous intraepithelial lesion (H-SIL) in 5 (10.9%) patients, low-grade squamous intraepithelial lesion (L-SIL) in 17 (37%), “HPV effect” in 4 (8.7%) and normal histopathology in 20 (43.5%) patients. The endocervical curettage revealed three (6.5%) women with H-SIL and seven (15.2%) with L-SIL. Seven (15.2%) patients underwent conization due to H-SIL and there were three H-SIL with negative margins and four L-SIL in the final histopathology report.Conclusion: Performing colposcopy seems to be crucial for women with inadequate cervical cytology and high-risk HPV regardless of HPV subtypes as there is an increased risk of H-SIL in this patient population.

Objective: The purpose of this study is to evaluate the impact of loop electrosurgical excision procedure (LEEP) and cold-knife conization (CKC) active training model on the surgical education and confidence levels of gynecologists. Materials and Methods: The LEEP and CKC hands-on training model consists of sausage, which is 2.5 cm in diameter, as cervix; plastic cup as vagina; foam rubber as posterior and anterior fornices; and cotton plate as the leukoplakia area. In total, 34 participants performed LEEP and CKC procedures on the training model under the guidance of mentors after theoretical lessons about the transformation zone, indications, and surgical techniques of LEEP and CKC. Afterward, a web-based survey was conducted to measure the effectiveness of this surgical model, and participants graded their learning and confidence levels on the same. Results: We evaluated the educational levels of the course, which were based on the basic surgical steps of LEEP and CKC procedures, and the confidence levels of the participants with regard to the previous practice or expertise of LEEP and CKC. Importantly, participants in each group had similar learning gains irrespective of previous practice or expertise. Despite a significantly higher pre-course confidence level of participants who had previously performed LEEP (p

Amaç: Bu çalışmada konizasyon cerrahisi sonrası servikal intraepitelyal neoplazi nüksünü öngörmede preoperatif nötrofil-lenfosit oranının prediktif değerinin araştırılması amaçlanmıştır.Gereç ve Yöntem: Bu retrospektif çalışmada, servikal intraepitelyal neoplazi patolojisine bağlı konizasyon uygulanan hastalar analiz edildi. Çalışmaya konizasyon materyalinde servikal intraepitelyal neoplazi saptanıp cerrahi sınırları negatif olan ve klinik veri tabanımızda en az 12 aylık takip süresi olan hastalar dahil edildi. Hastaların demografik, klinik, patolojik verileri ve preoperatif tam kan sayımı bulguları tıbbi dosyalardan çıkarıldı.Bulgular: Toplamda mevcut olan 105 hasta iki gruba ayrıldı: rekürrens grubu (n = 30) ve kontrol grubu (n = 85). İki grup arasında servikal intraepitelyal neoplazi patoloji dereceleri açısından istatistiksel olarak anlamlı fark yoktu. Rekürrens grubunda kontrol grubuna göre endoservikal küretaj pozitif sonuç sayısı artmıştı. Nüks grubunda rekürrenssiz sağkalım ortalaması 10.5 aydı. İki grup arasında preoperatif nötrofil-lenfosit oranı ve diğer hematolojik parametreler açısından istatistiksel olarak anlamlı fark yoktu. Lojistik regresyon analizinde rekürrens tahmininde sadece endoservikal küretaj pozitifliği belirleyici idi (p = 0.002,% 95 CI 0.084-0.365). Sonuç: Preoperatif nötrofil-lenfosit oranı ve diğer inflamatuar belirteçler cerrahi sınırları temiz konizasyon olgularında nüksü öngörmede etkin bulunmamıştır. Pozitif postkonizasyon endoservikal küretaj, eksizyonel tedaviden sonra nüks ile ilişkili tek prognostik faktör olarak bulunmuştur., Objective: This study aimed to evaluate the predictive value of preoperative neutrophil-lymphocyte ratio in cervical intraepithelial neoplasia recurrence after conization surgery.Materials and Methods: In this retrospective study, patients who underwent conization due to cervical intraepithelial neoplasia were analyzed. Inclusion criteria were cervical intraepithelial neoplasia in the conization specimen with negative surgical margins and at least 12 months follow-up period at our clinical database. Demographic, clinical, pathological data, and preoperative complete blood count findings of the patients were extracted from medical files. Results: There were a total of 105 patients divided into two groups: the recurrence group (n = 30) and the control group (n =85). There were no statistically significant differences between the two groups in terms of cervical intraepithelial neoplasia pathology grades. There was statistically increased number of postconization endocervical positive results in the recurrence group. In the recurrence group, the mean of recurrence free survival was 10.5 months. There were no statistically significant differences in the preoperative neutrophil-lymphocyte ratio and in other hematologic parameters between the groups. In logistic regression analysis, only endocervical curettage positivity was predictive in estimating recurrence (p=0.002, %95 CI 0.084-0.365). Conclusion: Preoperative neutrophil-lymphocyte ratio and other inflammatory markers were not predictive of recurrence after conization in women with negative surgical margins. Positive postconization endocervical curettage was the only prognostic factor associated with recurrence after excisional therapy.

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

Aim: Target in cervical cancer screenings is to use easy applying, cheap and diagnostic-assisted screening tests together. The most important thing is to do HPV-DNA analysis with Pap smear. The aim in this study is to perform a detailed follow-up program according to the results of patients who had been diagnosed with cervical intraepithelial lesion (SIL) who applied to the hospital for 2 years and to find out whether being used HPV-DNA results affected the SIL lesions without applying a smear test (pap test) in the menopausal patients with negative HPV-DNA analysis by performing only HPVDNA analysis. Materials and Methods: A smear test was requested for 11,850 patients aged 50 ± 3.2 in the Zekai Tahir Burak Women’s Health Training and Research Hospital between the years 2015-2016 for a 2-year period. 5180 patients are menopausal. HPV-DNA genotyping analyzes were performed for HPV 16,18,31,33,35,3 9,45,51,56,58,66 and 68 types while 1102 of these patients were followed by pap test for Low grade SIL, and colposcopies were performed and biopsies were taken by the same gynecologist. In this study, Chi-square test, Mann Whitney U test were used for the statistical analysis and Spearman Rho test was used for correlation analysis with IBM SPSS statistical program version 21.0. Values of p ≤ 0.001 were considered significant. Non-significant analyzes were not used in this study. In the result of histopathological examination, cases were compared with smear findings. For colposcopy, Barcelona 2002 colposcopy terminology was used. In the histopathologic analysis of colposcopic biopsies, Bethesda System 2014 version and also HPV ascia LAST in ano-genital lesion coexistence were used for classification. Findings: Patients were selected among 11,850 patients who applied to the hospital between 2015 and 2016 and were received cervical cytology specimens. 5180 patients were in menopausal period. 1102 of these patients have LSIL. 278 of the LSIL 1102 patients were reported as HPV (+) CIN I neoplasia and the remaining 824 patients as HPV (-) non-neoplastic lesion. CIN I lesion in 270 patients and CIN II lesion in 8 were determined with colposcopic biopsy performed in HPV-DNA (+) group (n=278). CIN I lesion in 670 patients and CIN II in 14 patients were also found with colposcopic biopsy performed in HPV-DNA (-) group (n=840); in 140 patients dysplasia was not observed. We think that only HPV-DNA analysis is not appropriate for menopausal HPV (+), pap smear negative patients with negative

Background: Cold knife conization is a surgical procedure that allows both diagnosis and treatment of cervical lesions at the same time. It is mainly performed for indications of high-grade cervical intraepithelial neoplasia (CIN). In this study, we aimed to investigate the clinical outcome of cases without CIN in cold knife conization specimen, following a high-grade lesion (CIN2/3) in cervical biopsy. Materials and Methods: We performed a retrospective cohort study at a tertiary referral hospital between January 1 st 2008 and August 1 st 2012. Cases that underwent cold knife conization for CIN2/3 within the study period were included. Cone-negative (Group 1) and cone-positive (Group 2) cases were analyzed for various clinical parameters, and were compared in the 1-year post-conization period for histological recurrence and human papillomavirus (HPV) DNA status. Results: A total of 173 women underwent cold knife conization for CIN2/3 within the study period. Twenty-two cases (12.7%)

Serous borderline ovarian tumors (SBOT) generally occur in young women, present at early stages and are associated with an excellent prognosis. However, there are rare subtypes of SBOT which may exhibit a more aggressive course. In contrast with other types of SBOT, the micropapillary variant SBOT (SBOT-MP) tends to present at advanced stages. Herein, we present a rare case of a SBOT-MP that occurred in a 66-year-old woman, who had tumoral involvement on bilateral ovaries, sigmoid serosa and a positive peritoneal cytology. The currently recommended treatment options for these cases are also discussed.Seröz borderline over tümörleri (SBOT) genellikle genç kadınlarda ortaya çıkmakta, erken evrede tanı almakta ve çok iyi bir prognoza sahip olmaktadır. Ancak, SBOT’nin daha agresif bir seyir gösterebilen nadir alt tipleri mevcuttur. Diğer SBOT’lerin aksine, SBOT’nin mikropapiller varyantı (SBOT-MP) ileri evrelerde ortaya çıkma eğilimindedir. Bu yazıda, 66 yaşındaki postmenopozal bir kadında ortaya çıkan, bilateral overlerde ve sigmoid kolon serozasında tutuluma ve pozitif peritoneal sitolojiye sahip nadir bir SBOT-MP olgusu sunulmaktadır. Ayrıca, bu tip olgular için güncel tedavi önerileri de tartışılmaktadır.

Ozgu, Emre/0000-0002-8444-9694; Gungor, Tayfun/0000-0002-7869-9662; Uygur, Dilek/0000-0001-8567-9048 WOS: 000347289600020 PubMed: 25047273 Borderline ovarian tumors (BOTs) constitute about a quarter of epithelial ovarian malignancies and require different treatment approaches. The present study aims to document the experience of a single center on the treatment outcome of women who had conservative or comprehensive surgery for BOTs. One hundred eighty-three patients with BOTs, diagnosed and/or treated in our center between January of 2000 and March of 2013, were reviewed retrospectively. The mean age at diagnosis was 40.6 years old (range 17-78). Ninety-five patients (51 %) were a parts per thousand currency sign40 years. Comprehensive surgical staging and fertility sparing surgery were performed in 49 % (n = 91) and 48 % of patients (n = 89) respectively. A hundred and forty-seven patients had stage IA disease (80 %). The most common type of BOT was serous in histology with 18 % bilateralism. CA-125 and CA-199 levels were increased in 29 (19 %) and 15 (10 %) patients with stage IA disease. Non-invasive tumor implants were diagnosed in 9 patients (4 %) and uterine involvement was 2 % among BOT patients that underwent hysterectomies. The mean post-operative follow-up period was 20.4 months (range 6-78 months). Disease recurrence was seen in 5 patients indicating overall recurrence rate of 2.7 %. In our study, we evaluated a large data pool of 183 patients diagnosed with borderline epithelial ovarian tumors. BOTs have a relatively better prognosis than invasive epithelial ovarian cancer. Surgery with proper staging is the cornerstone of treatment. Patients with BOTs at the early stage can undergo fertility sparing surgery with close follow-up.

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

Objective The aim of this study was to investigate the clinical and laboratory features of patients with the incidental diagnosis of endometrial adenocarcinoma (EC) during infertility work-up, with special attention given to treatment approaches, recurrence rate, and fertility outcome. Material and Methods The medical records of 577 patients who were diagnosed with EC and treated between 2007 and 2013 were included in the study. Out of 577 EC patients, 5.1% (n = 30) were ≤ 40 years of age. However, 10 patients had a history of infertility and had been diagnosed during evaluation for infertility. Patients' clinical and laboratory data were reviewed retrospectively. Results The mean age at diagnosis was 34.3 ± 4.5 years and the mean duration of infertility was 5.1 ± 4.7 years. Immediate staging surgery was performed on three patients. The others were treated with oral megestrol acetate and/or a levonorgestrel-containing intrauterine device (IUD) for 6 months. The mean duration of postoperative or postdiagnostic follow-up was 44.7 ± 25.9 months. The disease persistence and recurrence rates were 11.1% and 22.2%, respectively. Two patients achieved pregnancy naturally or by assisted reproductive technology (ART) trial. Conclusion The investigation of patients during infertility work-up provides an opportunity to evaluate the endometrium and its malignancies in young women, when the disease is in its early stage and symptom free. The standard surgical treatment for early-stage EC is total hysterectomy with bilateral salpingo-oophorectomy. However, conservative management of early stage EC with progestational drugs, especially in young patients who wish to preserve their fertility, is acceptable with the possibility of future pregnancies.

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.

There has been limited literature about treatment and follow-up strategies of uterine adenosarcomas because of their rare nature. For this study we retrospectively investigated the medical database of the two major womens’ health hospitals in Turkey. A total of 15 patients were identified from the hospital’s database. Median follow-up was 86.43 months for all patients. Seven out of 15 patients had recurrences during their follow-up. Among these 7 patients, 4 of them had stage IA disease. Median Disease Free Survival (DFS) and Overall Survival (OS) were calculated as 41.47 and 57.21 months, respectively. According to our study, polypoid tumours confined to the uterus with superficial myometrial invasion can be treated without comprehensive surgical staging. We believe that, publishing all the data in an organised manner even though they are small in size, gives us an opportunity to design meta-analysis for the development of more appropriate treatment strategies. © 2016 Informa UK Limited, trading as Taylor & Francis Group.