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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 (

Background: In women with endometrial hyperplasia, there is a risk for co-existent endometrial cancer when patients are subjected to immediate surgical treatment. Aims: The aim of this study was to investigate the frequency of endometrial cancer and the accuracy of frozen section analysis at the time of hysterectomy among patients with endometrial hyperplasia, to reveal whether or not a preoperative diagnosis of endometrial hyperplasia necessitates frozen section consultation. Study Design: Retrospective cross-sectional study. Methods: A department database review was performed to identify patients who were subjected to hysterectomy with a preoperative diagnosis of endometrial hyperplasia, during the period from 2007 to 2014. Results: The study group included 189 cases. The final pathological examination revealed endometrial cancer in 16 women (8.4%). The risk of cancer in patients with endometrial hyperplasia was 1 of 125 (0.8%) in simple hyperplasia without atypia, 1 of 21 (4.8%) in complex hyperplasia without atypia and 14 of 43 (32.5%) in atypical hyperplasia. Of women with cancer, 2 of 16 (12.5%) had high-risk features. Frozen section analysis was requested in 46 cases. Frozen sections helped to identify six out of 11 cases of endometrial cancer (54.5%). The sensitivity, specificity and positive and negative predictive values of frozen section analysis for the detection of endometrial cancer among women with endometrial hyperplasia were 54.4%, 97.2%, 85.7% and 87.5%, respectively. Conclusion: Although a significant proportion of patients with atypical endometrial hyperplasia are diagnosed with endometrial cancer following hysterectomy, most of these cases have low-risk features and do not require surgical staging. Additionally, intraoperative frozen section analysis if not helpful for diagnosing concurrent endometrial cancer in patients with endometrial hyperplasia. Therefore, it seems that patients with endometrial hyperplasia can be operated upon in settings with no available method for obtaining frozen sections intraoperatively

OBJECTIVE: Emesis is significant side effect of chemotherapy. In this study we aimed to compare prophylactic effect of ondansetron (OND), granisetron (GRA) and tropisetron (TRO) on acute emesis induced by cisplatin/paclitaxel combine chemotherapy. STUDY DESIGN: Between years 1993 and 2005, 172 patients have been operated for gynecologic malignancy and who had first-line chemotherapy (cisplatin-paclitaxel) were evaluated retrospectively. Chemotherapy was started with paclitaxel (175 mg/m2, 3 hours infusion) followed by cisplatin (75 mg/m2, 2 hours infusion). Dexamethasone (24 mg) was given 60 min before chemotherapy and infused until chemotherapy. 5 HT3 antagonist (OND=8 mg/TRO = 5 mg/GRA=3 mg) is started 1 hour before chemotherapy and given in 30 minutes. The second dose of OND also was given before cisplatin (8 mg, 30 min infusion). Chemotherapy toxicity was assessed according to WHO criteria. According to this, grade 0 was accepted as a complete response while grade 1 and more toxicity were accepted as nonresponse. RESULTS: 172 patients received 968 chemotherapy courses. OND, TRO, GRA were given 23.8% of patients and 23.3% of courses, 16.7% of patients and 15.7% of courses, 60.5% of patients and 59.9% of courses, respectively. Grade 3 toxicity was developed in 3.5% of patients and 0.8% of courses. None of the patients developed grade 4 toxicity. Complete response occurred in 28.5% of patients and 63% of courses. If it has been evaluated only for courses GRA is more effectiv e than TRO. Other than there was no significant difference in antiemetic potency between the drugs for courses and patients. CONCLUSION: Although this study is not prospective, it is homogenous for treatment modalities and patient selection. Complete response was observed in 63% of courses; however this antiemetic affect is not found to be satisfactory. In order to develope better protocols there is need for prospective studies on homogenous group. Antiemetic efficiency has to associate for chemotherapy protocols.

Uterine smooth muscle tumors of uncertain malignant potential (STUMP) belong to a subcategory of uterine smooth muscle tumors. The clinical behavior of these tumors is also not clarified. It is hard to state which histological features of STUMPs might represent high recurrence rates. The follow up period also has not been mentioned. For clinicians, STUMPs are difficult tumors to manage since they clinically present as ordinary fibroids. For pathologists, diagnosis of these tumors could be difficult because these tumors are rare and a certain level of expertise in gynecological pathology is required to make a correct diagnosis. Here we report a patient with STUMP that subsequently recurred as a leiomyosarcoma, aiming to remind the disease and its recurrence risk even if followed strictly.

Purpose:To investigate the effects of information acquired by KETEM’s staff on the diagnosis and treatment of breast cancer.Patients and Methods:Between 2007-2010, BSE was first taught and performed in all women. USG was performed for those ≤40, and MG for those ≥40; also, USG and MRI were ordered, if necessary. For patients with BIRADS 4-5 lesions via USG, MG and MRI and those whose lesions were diagnosed with USG, tru-cut biopsy and USG were performed. While different treatments were administered for those diagnosed with cancer within first 2-year period, their treatments were planned and performed in second 2-year period under decisions by breast council. Information for patients was obtained from the data in hospital, and that concerning staff’s training from personal files.Results:Between 2007-2010, 17768 women applied to Konya KETEM [mean age rate 51 (18-19)]. Of these, 10595(60%), 10492(59%) and 119(0.6%) were administered with MG, USG, respectively. Performing biopsy from suspected malignant 378(2%) breast lesions, 104(0.6%) were diagnosed with cancer. Meetings of Breast Council started on 3rd February, 2009. A surgeon was sent to Breast Unit of Istanbul Medical School, Istanbul University for 3 months. All staff in Konya KETEM were trained. While excisional biopsy was performed for 52% of patients with suspected cancers, and modified radical mastectomy was done before 2007-2008, diagnoses were conducted via tru-cut biopsy between(2009-2010), and rate of breast conserving surgery was 24%.Conclusion:In-service training for all staff in KETEMs contributes to modern and accurate procedures in diagnostic and therapeutic stages of breast cancer.

OBJECTIVE: To evaluate the effectiveness of routine Pap smear screening in postmenopausal women. STUDY DESIGN: 2060 women applied to menopause outpatient clinic were reviewed retrospectively. Demographic characteristics, the use of hormone therapy, and the history of previous Pap smear were analyzed. RESULTS: The Pap smear results were as; normal in 1320, inflammation in 591, atrophy in 121, metaplasia in 22, ASCUS in 4, HGSIL in 1, and carcinoma in 1. While two of the ASCUS patients had two previous cervical smears which were normal; the other two HGSIL and carcinoma patient had not previous Pap smear. The patients who had ASCUS, colposcopy was applied and three of them were normal. The histopathological analysis of the cervical biopsy in the HGSIL case was squamous cell carcinoma. CONCLUSION: Pap smear screening should be done to postmenopausal women in spite of low efficiency or false positive results.

OBJECTIVE: It is expected that neoadjuvant chemotherapy (NACT) decrease tumor size, increase the operability and improve surgical-pathologic risk factors so that improve the survival. In this study we evaluated the effect of NACT on surgical-pathologic risk factors and survival. STUDY DESIGN: Between 1993 and 2007, the data of patients with stage IB2 cervical cancer were reviewed. Twenty-four patients who were treated with NACT followed by radical surgery (RS) were compared with 15 patients underwent primary RS. After two or three courses of chemotherapy patients were reassessed and RS was performed to patients whose tumor size was less than 40mm. In both groups all patients underwent type III radical hysterectomy + bilateral salpingo-oophorectomy + systematic paraaortic and bilateral pelvic lymphadenectomy. RESULTS: The mean size of the tumor mass was 50.1mm. Nine patients were acccepted as responder (complete clinical response + partial clinical response) and 15 patients as unresponder (stabile disease) after NACT. The surgical-pathologic risk factors didn’t improve with NACT except for stromal invasion. The median follow-up was 48 months. Overall survival and disease free survival was 86.7% in RS group, this ratio was 80% in NACT unresponder group and 66.7% in NACT responder group (p=0.501). CONCLUSION: NACT didn’t improve either the surgical-pathologic risk factors expect for stromal invasion or survival in patients with stage IB2 cervical carcinoma. It appears that we have disappointment with this treatment modality.

Identification of extraovarian sites with primary tumors similar to ovarian tumors like that renal clear cell adenocarcinoma is difficult. Ovarian metastasis from renal clear cell adenocarcinoma is quite rare and such entity presented in this article. Primary site was right kidney and tumor spread to bilateral ovaries. Immunohistochemical study was necessitated for diagnosis of primary site. Patient died on the 58th day after the operation due to pulmonary emboli. Ovarian metastasis in pelvic masses must be kept in mind. Identification of primary focus is important regard with planning of treatment and determining the prognosis. The presented case is distinctive with the primary focus being in the right kidney, the ovary metastasis being bilateral and development of pulmonary emboli. Special care must be attributed regarding the risk of pulmonary emboli, especially in patients diagnosed as renal clear cell.

OBJECTIVE: The divergence of surgical pathologic risk factors and adjuvant radiotherapy (RT) according to the stage were examined in patients whit early stage cervical carcinoma. STUDY DESIGN: 250 patients with adequate pathologic data who had been operated with type III radical hysterectomy were reviewed. Adjuvant RT was given in high-risk patients (tumor positive surgical margin, tumor invasion of parametrium and lymph node metastasis) after RH. Patients were staged according to the 1988 FIGO criteria. Impact of stage on surgical pathologic risk factors and possibility of adjuvant RT was evaluated. RESULTS: The mean age was 53.9 years and tumor size was 30mm. 68.4% of patients was in stage IB1, 12% in IB2 and 19.6% in IIA. Pathological diagnosis was squamous cell carcinoma in 83.2% of patients. A positive correlation was identified between the stage and vaginal metastasis and stromal invasion. However stage didn’t effect invasion of parametrium, lymph node metastasis, lymphovascular space invasion, tumor positive surgical margin and ratio of adjuvant RT. CONCLUSION: Stage did not clearly predict surgical pathologic risk factors, a result of uncertainty of clinical staging. Without surgery, it is impossible to determine the actual limits of the disease with the tests available at this time.

OBJECTIVE: The scoring system of GTN determines the treatment modalities. Scoring system was first improved by Bagshawe et al. in 1976. World Health Organisation (WHO) had modified this scoring system in 1983. FIGO reviewed and rev ised the WHO scoring system in 2000. In this study, the change in scores and risk groups of patients scored according to WHO, were analy zed when the patients were re-evaluated according to FIGO STUDY DESIGN: The records of 71 patients with GTN were reviewed between 1994 and 2002. The f irst scoring system that determines the treatment modality was WHO scoring system in all patients. All patients were rescored by the FIGO’s modif ied scoring system retrospectively. RESULTS: In this study, 35.2% of 71 patients’ score wasn’t changed, while increased in 14.1% and decreased in 50.7%. In high-risk group (n=29) by the WHO scoring system the risk score was same in 31% of patients, increased in 27.6% and decreased in 41.4%. In the intermediate-risk group (n=15) risk score was same in 33.3% and decreased in 66.7%. In the low-risk group (n=27) the risk score was same in 40.7%, increased in 7.4% and decreased in 51.9% of patients. CONCLUSION: Today the uncertainty of the scoring systems still remains. The univariant and the multivariant analyses of the studies about the effect of prognostic factors that are used in scoring systems on the treatment success declare different results. The new studies will show the validity of the last scoring system.

Abstract Objective To evaluate colposcopy performance following the human papillomavirus (HPV) DNA screening program in Turkey. Methods Women aged 30–65 years are screened for cervical cancer every 5 years, with individuals positive for HPV 16 and/or 18 or other high‐risk HPV types with abnormal cytology referred for colposcopy. Both HPV test and cytology are obtained at the same visit. If HPV is negative, cytology will not be assessed. However, if HPV is positive, both cytology and HPV genotyping will be performed. Colposcopy‐require was defined as HPV 16/18 positivity or abnormal smear results with any hrHPV positivity, and the remaining patients (normal smear with hrHPV positivity other than HPV 16/18) were grouped as colposcopy non‐required. National data on colposcopy outcomes and unnecessary performance rates in February 2018–2019 were evaluated via a questionnaire. Results A total of 9808 patients were included, divided based on colposcopy requirement: 5751 (58.6%) patients required colposcopy and 4057 (41.4%) did not. Unnecessary colposcopy was performed on 90.1% of the non‐required group (3657 of 4057 patients). In the colposcopy‐required group, 4455 patients (79.9%) underwent punch biopsy; 3194 (57.1%), endocervical curettage (ECC); and 421 (7.5%), “see and treat” in the non‐required group, the results were 2790 (76.3%), 1957 (53.2%), and 211 (5.7%), respectively. A total of 746 cervical intraepithelial neoplasia (CIN)‐3 isolates were detected, including 702 using existing screening and triage with 94.1% sensitivity (702/746). Multiple biopsies were taken in 69.8% (n = 3110) of patients from the colposcopy‐required group and 63.7% (n = 1777) from the non‐required group. The ECC samples included 19 cervical cancers and 212 ≥CIN‐3 lesions in the colposcopy‐required group, and four cancers and 41 ≥CIN‐3 lesions in the non‐required group. The proportion of ≥CIN‐3 lesions detected by ECC only was 4.7% (35 of 746 ≥CIN‐3 lesions). Conclusion Our results showed high rates of unnecessary colposcopies, and a high percentage of multiple and random punch biopsies and ECC.

This study was conducted to compare the long-term oncological outcomes of laparotomy and laparoscopic surgeries in endometrial cancer under the light of the 2016 ESMO-ESGO-ESTRO risk classification system, with particular focus on the high–intermediate- and high-risk categories. Using multicentric databases between January 2005 and January 2016, disease-free and overall survivals of 2745 endometrial cancer cases were compared according to the surgery route (laparotomy vs. laparoscopy). The high–intermediate- and high-risk patients were defined with respect to the 2016 ESMO-ESGO-ESTRO risk classification system, and they were analyzed with respect to differences in survival rates. Of the 2745 patients, 1743 (63.5%) were operated by laparotomy, and the remaining were operated with laparoscopy. The total numbers of high–intermediate- and high-risk endometrial cancer cases were 734 (45%) patients in the laparotomy group and 307 (30.7%) patients in the laparoscopy group. Disease-free and overall survivals were not statistically different when compared between laparoscopy and laparotomy groups in terms of low-, intermediate-, high–intermediate- and high-risk endometrial cancer. In conclusion, regardless of the endometrial cancer risk category, long-term oncological outcomes of the laparoscopic approach were found to be comparable to those treated with laparotomy. Our results are encouraging to consider laparoscopic surgery for high–intermediate- and high-risk endometrial cancer cases.

Objective: Complex procedures such as distal pancreatectomy and splenectomy (DPS) may be required for R0 resection in patients with ovarian cancer (OC). These procedures can increase survival and cause serious morbidity. We aimed to present our experience in this field. Materials and methods: Thirteen patients who underwent DPS for OC between January 2004 and July 2018 in two centers (Hacettepe University Hospital, Etlik Hospital) were evaluated. Statistical analysis was performed using SPSS. Results: The mean operative time was 310 min (220–570 min). None of the patients required transfusion. No perioperative mortality was observed. The mean postoperative hospital stay was 12 days (ranging from 8 to 33 days). The number of patients with early postoperative complications was four (30.7%). One of these patients was complicated by intestinal perforation, one with pancreatic fistula, one with pneumonia and the other with atelectasis. Other complications were observed conservatively. Ten patients underwent 6 cycles of platinum-based chemotherapy postoperatively. The median value of the postoperative chemotherapy period was 20 days (range 11–47 days). The median follow-up period was 46 months (2–144 months). Ten patients had recurrence. Eleven patients died of disease. Two patients are stil alive. Disease-free (DFS) and overall (OS) survival were 16 and 63 months, respectively. Conclusion: DPS for cytoreductive surgery is a procedure that increases morbidity, but most of the complications can be treated conservatively. Considering the increase in survival, it is considered to be a valuable procedure in upper abdominal disease.

Stevens-Johnson syndrome (SJS) is a rare and acute life-threatening condition which is almost always precipitated by drugs. Genital mucositis in female patients may also be an important cause of long-term morbidity secondary to mucosal scarring. We present the case of a 33-year-old nulligravid woman with distal vaginal synechiae necessitating a surgical approach, which occurred after an episode of SJS. Also, we aimed to review the literature to reveal cases which required surgical management for long-term genital sequelae as well as discuss preventive measures.

Context: Atypical glandular cells (AGCs) result in the Papanicolaou (Pap) smear may be associated with significant genital and nongenital neoplastic processes. Aims: To evaluate the underlying histopathology in women who had AGCs on Pap smears. Settings and Design: Retrospective cross-sectional study. Patients and Methods: Clinicopathological data of patients who had AGC on Pap smears and underwent histological workup between January 2004 and December 2014 were retrieved from the computerized database of a tertiary care center. Patients with a prior history of cervical intraepithelial neoplasia or gynecological cancer were excluded. Statistical Analysis Used: Chi-square test or Fisher's exact tests were used as appropriate. Results: Cytological examination of the uterine cervix was carried out in 117,560 patients. We identified 107 patients (0.09%) with AGC and 80 of those with histological follow-up were included in the study. The median age at diagnosis was 47 years (range, 18–79), and 32 women (40%) were postmenopausal, while 56 (70%) had gynecological symptoms. Significant preinvasive or invasive lesions on pathological examination were detected in 27 (33.8%) patients, including 12 endometrial adenocarcinomas (15%), 8 cervical carcinomas (10%), 3 cervical intraepithelial neoplasia II/III (3.75%), 2 ovarian adenocarcinomas (2.5%), and 2 metastatic tumors (2.5%). Univariate analysis showed that postmenopausal status (P < 0.001), age >50 years old (P < 0.001), having symptoms at the time of admission (P = 0.041), and AGC “favor neoplasia” smear results (P = 0.041) were the clinical factors associated with significant pathological outcome. Conclusions: Patients with AGC on Pap smears should be evaluated vigilantly with histological workup, especially if they are postmenopausal or symptomatic.

Aim. To assess the results of the treatment of rectovaginal fistulas with incontinence and impaired anal tonus. Materials and Methods. This study comprised three rectovaginal fistula groups that were treated using sphincteroplasty and fistulectomy: group 1: eight women with simple rectovaginal fistula due to birth trauma; group 2: six rectovaginal fistula cases that were associated with chronic inflammatory diseases; and group 3: five cases with at least one failed repair attempt. In the second step, operations that took place before the year 2000 were compared to the operations that took place after the year 2000 in terms of demographic and clinical characteristics. Results. All of the simple rectovaginal fistula cases healed after the operation. Five of the group 2 patients healed after the operation. However, 1 patient with Crohn’s disease needed to undergo reoperation, but successfully healed after 6 months. On the contrary, 3 patients in group 3 healed (60%) whereas 2 of them failed to heal. Clinical characteristics of the patients were different between the groups (before and after the year 2000). Conclusion. The choice of operation must be done according to the patient’s underlying pathology. Proper management of associated inflammatory diseases and systemic disorders is recommended for necessary complex cases.

Cervical cancer is the third most common female cancer worldwide and the use of routine screening resulted in earlier stage and younger age at diagnosis. Fertility preservation via radical trachelectomy comes up as an option in such patients. Recent literature reviews confirm the safety of this operation with excellent oncologic outcomes in appropriately chosen patients. However, recurrent disease is likely and a strict follow-up is recommended to detect recurrences at an early stage following radical trachelectomy. In this report, a case who underwent radical trachelectomy and developed widespread recurrences 7 years after initial surgery possibly due to the lack of oncologic follow-up is discussed.