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The study aims to evaluate the effect of parametrial dimensions on the prognosis of cases who underwent type 3 radical hysterectomy or radical trachelectomy in early-stage cervical cancer (stage I - IIa).Medical reports of patients with early-stage cervical cancer who have undergone surgery between 1998 and 2020 in Akdeniz University Faculty of Medicine Gynecological Oncology Clinic were reviewed retrospectively. A total of 292 cases were identified and included in the study. Demographic characteristics, preoperative examination findings, operation records, and pathology results of the cases were reviewed.Parametrial involvement was found histopathologically negative in 244 out of 292 patients included in our study, the remaining 48 (16.4%) patients were found to be positive. The mean length of the right and left parametrium in the group with negative parametrium invasion, who had an average follow-up of 131.2 (0.57 - 268.2) months, was 3 cm, while the mean volume of the right and left parametrium was 7.2 (0.52 - 32) cmRadical surgical approach is necessary to obtain a tumor-free surgical margin in the surgical treatment of early cervical cancer, but the complications leading to morbidity and mortality are also increasing with this radicality. For this reason, we consider that it is important to adapt the dimensions of the removed parametrium according to the factors affecting recurrence in cervical cancer to obtain more appropriate surgical margins with the least complications.

Depending on the developing laparoscopic technique and experience, the treatment of cesarean scar choriocarcinoma can be safely performed laparoscopically by experts.

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–intermediateand 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., NA

BACKGROUND Uterine cervical cancer rates also increase with aging. Especially, the primary treatments of patients with cervical cancer include surgery, chemotherapy, and radiotherapy. AIM Our aim is to discuss the effect of clinical and histopathological risk factors on survival in patients over 65 years old with invasive cervical cancer in the light of the literature. METHODS AND RESULTS The files of 60 patients aged 65 and over who were diagnosed, examined, and treated for invasive cervical uteri cancer between 2004 and 2021 by the gynecological oncology clinic of Akdeniz University were analyzed retrospectively after obtaining approval from the Akdeniz University ethics committee with the number KAEK-110. Detailed written consent was obtained from all patients and their relatives for data analysis. Patients aged 65 and over who were diagnosed with invasive cervical uteri cancer at all stages who accepted treatment were included in the study. The patients who were not included in the study were those who did not accept treatment, did not continue their follow-up regularly, were under 65 years of age, had preinvasive cervical lesion, had a second primary cancer, had an unknown stage, and died due to accidents or similar reasons. When the demographic data of 60 cases were examined, the mean age was 70.5, the youngest age was 65, and the oldest age was 84. When we divided them into two groups by age groups, 76.7% were between 65 and 75 years old and 23.3% were over 75 years old. When the data of 60 patients who were referred to our hospital, which was a tertiary center in the 15 years duration, were examined, the mean disease-progression free survival (PFS) of patients with locally advanced stage was 45 months, however, it was 4 months for metastatic patients, this difference was significant and a statistically significant difference was found between the two groups (p: .001). When the total survival was examined, the mean was 108.7 months in the locally advanced stage group, while it was 2.9 months in metastatic cases, and this difference was also statistically significant between the two groups (p: .001). When we divide the cases into two groups as between 65 and 75 and over 75 years of age, the mean age of disease-free survival is 76.9 months in the 65-75 years old group, while 16 months in the 76-85 years old group, however, the p value of this difference in PFS between the two groups was not significant (p: 0.154). However, when the total survival was examined, it was seen that the mean was 140.4 in the 65-75 years old group, while it was 56 months in the 76-85 years old group and this difference was significant between the two groups (p: .046). CONCLUSION In parallel with the increased population worldwide, advanced age cancer rates are increasing. In parallel with the population growth, it should be remembered that the patients over 65 years of age who were diagnosed with invasive uterine cervical cancer had difficulty in accessing screening tests, late diagnosis and inadequate treatment regimens due to concomitant diseases, resulting in recurrence in a short time and poor clinical symptoms due to short total survival.

Because of the accessory polar renal artery (APRA) is functional, it is extremely important to be careful with vascular injuries, to prevent ischemic damage and not to cause kidney failure complications.

The cost-effectiveness of bevacizumab has been the subject of debate, and we aimed to present our own retrospective data on its effect on survival in recurrent epithelial ovarian cancer.Patients with recurrent ovarian, tubal and primary peritoneal cancer between October 2007 and June 2018 were grouped according to the platinum-free interval. The progression-free and overall survivals of the patients who had received chemotherapy only and chemotherapy with bevacizumab were calculated.Eighty patients had received chemotherapy (CT) only, and 65 had received CT+BV. In platinum-sensitive recurrent epithelial ovarian cancer (PSREOC) patients, the median progression-free survival (PFS) months was 7 months (95% CI; 5.5-8.4) in the group who had received CT only and 13 months (95% CI; 5.8-20.1) in the group who had received CT+BV (p=0.001) and for CT+BV HR (Hazard Ratio):0.39 (95% CI; 0.24-0.64) (p=0.001). The median PFS of platinum-resistant recurrent epithelial ovarian cancer (PRREOC) patients who had received CT only was determined as 2 (95% CI; 1.4-2.5) and as 10 (95% CI; 6.8-13.1) months for patients who had received CT+BV (p=0.001), for patients who had received CT+BV HR: 0.31 (95% CI; 0.17-0.58) (p=0.001). In both PSREOC and PRREOC patients, there was no difference between CT + BV and CT group in terms of overall survival (p=0.978 and p=0.738, respectively).A significant effect of bevacizumab on the progression-free survival of both platinum-sensitive and platinum resistant recurrent ovarian cancers has been demonstrated; however, this effect failed to impact overall survival. Therefore, it could be recommended to use bevacizumab, considering the cost-effectiveness in undeveloped and developing countries.

Endometrial carcinoma is the most common genital malignancy in women. Endometrioid type is the most common variant of endometrial carcinoma described in literature. Giant cell carcinoma is a rare, and infrequently reported variant of endometrial carcinoma. We present a 75-year-old patient admitted with vaginal bleeding. Transvaginal ultrasound revealed a 26x28 mm hypodense lesion without any adnexal pathology. The patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic, and paraaortic lymph node dissection. The final histopathology report indicated a 3.8x2x9 cm giant cell carcinoma variant of endometrial carcinoma and one positive external iliac lymph node metastasis. Administration of adjuvant carboplatin and paclitaxel chemotherapy was given. As far as we know, this is the fifteenth case reported in the English literature.

Objective: To compare the clinicopathologic features of patients with endometrial cancer (EC) with recurrent disease with a primary surgery, stage, grade, and tumor histotype-matched cohort of patients without recurrence. Materials and Methods: Patients with EC who were surgically treated at a single tertiary care institution between 2005 and 2015 were enrolled in this study. The dataset included 381 consecutive patients with EC, of which 31 (8.1%) had disease recurrence. Data consisting of age at surgery, CA- 125 concentration at diagnosis, number of lymph nodes harvested, growth pattern of the primary tumor, location of the primary tumor within the endometrium, tumor histotype, tumor grade, disease stage, adjuvant therapy, disease recurrence, time to recurrence, CA-125 concentration at recurrence, clinical and imaging findings at recurrence, and treatment modalities used for recurrent disease were extracted from the institutional database. Results: After 1-to-1 propensity-score matching of patients with and without recurrence, the clinicopathologic features of 26 patients from each group were compared. Patients with recurrent disease were found to have a significantly higher CA-125 concentration at initial diagnosis (p

Endometrial cancer is the sixth most common neoplasm in women worldwide, with a rising incidence largely attributed to the ongoing obesity epidemic. TNF-Related Apoptosis-Inducing Ligand (TRAIL) and TRAIL receptors have been tested for their predictive, diagnostic, and prognostic values in various cancers, as well as for possible use in combination therapies. The roles of TRAIL and its receptors in endometrial tissue biology has not yet been cleared, and the potential of these molecules as biomarkers in endometrial cancer is yet to be defined. We investigated the expression profiles of TRAIL and its transmembrane receptors during endometrial carcinogenesis to evaluate their potential as prognostic markers. Paraffin-embedded normal endometrium (n=18), endometrial hyperplasia (n=27), and endometrioid endometrial adenocarcinoma tissues (n=100) were analysed for TRAIL and receptor expression profiles via immunohistochemical staining. Apoptotic indexes in the corresponding tissues were defined by TUNEL assay. Endometrial carcinoma displayed decreased TRAIL and DR4 expressions compared to the normal endometrium, while increased DR5 and decoy receptor (DcR1 and DcR2) expressions were evident. The complex atypical hyperplasia displayed the most similar expression profiles to the endometrial carcinoma, in accordance with the greatest risk of progression to endometrial carcinoma attributed to this tissue type. TRAIL/TRAIL receptor expression levels did not correlate with the prognostic factors of tumor stage or grade, or depth of myometrial invasion. Overall, distinct profiles of TRAIL and its receptor expressions were evident in progression from normal endometrium to hyperplasia and cancer, which may indicate significance of TRAIL signaling in the course of endo metrial carcinoma development. © 2019, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.

It should be kept in mind that non‐Hodgkin lymphoma may involve uterine cervix and a multidisciplinary approach should be adopted.

Objectives: In this study, we aimed to evaluate the effect of systemic lymphadenectomy on overall and progression free survival in advanced stage of ovarian cancer. Material and methods: The data of ovarian cancer patients who had been admitted to our clinic between March 2008 and December 2019 were collected retrospectively. The patients who had received neo-adjuvant chemotherapy (NACT), those having undergone interval surgery, those who had non-epithelial ovarian cancer, those with residual tumour larger than 1 cm and those with stage I-IIA were excluded from the study. Results: A total of 241 patients with inclusion criteria were included in the study. While 169 patients (70.1%) had undergone systemic lymphadenectomy (SLND), 72 (29.9%) had not. Lymph node involvement was present in 105 out of 169 patients (62.1%) who had undergone SLND. There was no statistically significant difference between the groups in terms of SLND and lymph node involvement for both progression free survival (PFS) and overall survival (OS) (p = 0.577, p = 0.493, p = 0.481, p = 0.849 respectively). When subgroup analysis was performed according to the residual tumor amount, we could not find any statistically significant difference in both PFS and OS in terms of SLND and lymph node involvement in R0 (complete resection) group (p = 0.057, p = 0.917, p = 0.106 and p = 0.980 respectively). We found similar results for patients in the R1 (optimal resection) group. Conclusions: It was found that performing systemic lymphadenectomy had no effect on both progressive and overal survival. It should be kept in mind that the increasing number of malignant lymph nodes removed could have a therapeutic effect in OS. Large numbers of randomized clinical trials are required to enlighten this debatable issue that has been continuing, particularly in the recent two decades.

Aim. To evaluate the clinicopathological features affecting the recurrence and survival of 9 cases of neuroendocrine cancer of the cervix. Method. We retrospectively analyzed 9 cervical neuroendocrine cancer cases identified among 453 cervical cancer patients between 2004 and 2021 at Akdeniz University Gynecological Oncology Outpatient Clinic. Kaplan–Meier survival analysis was used for progression-free survival (PFS) and overall survival (OS). Mathematical functions of mean, standard deviation, median, Min–Max values, and frequencies were used for descriptive statistics. The categorical data were expressed in numbers and percentages (%). Results. Nine patients with neuroendocrine histological subtype were selected out of 453 patients diagnosed with cervical cancer (1.98%). The average overall survival time of the patients was 26 months. The 5-year survival rate was 53.3%, while the PFS was 62.5%. The most common subtype was small cell neuroendocrine cancer. Tumours were mostly locally advanced at the time of diagnosis. 3 patients’ stage was 1b2, while 4 patients were 2b, 1 patient was 3c2r, and 1 patient was 4b. All tumours showed the immunohistochemical staining properties of neuroendocrine cancer. The main treatment modality applied to our patients was surgery + adjuvant CRT. The most used chemotherapeutic agents were cisplatin/carboplatin and etoposide. Recurrence was found in 3 cases, including 5 deaths. Conclusion. Neuroendocrine tumour of the cervix is a rare subtype with a poor prognosis. Unfortunately, there is not yet a standard treatment protocol due to the limited number of comparative studies of surgery, chemotherapy, and radiotherapy based treatment schemes.

TPS5623 Background: Carboplatin-paclitaxel chemotherapy (with trastuzumab for HER2+ uterine serous carcinoma) is the standard of care first-line systemic treatment for recurrent or metastatic endometrial carcinoma (EC), which has a 5-year relative survival rate of only 17%. Worse survival outcomes have been shown for the mismatch repair deficient (dMMR) subtype of EC. Pembrolizumab (pembro), an anti-PD-1 antibody, showed compelling antitumor activity in previously treated, advanced MSI-H/dMMR EC in the phase 2 KEYNOTE-158 study (ORR, 48%; median duration of response [DOR], not reached; O’Malley JCO 2022). KEYNOTE-C93/GOG-3064/ENGOT-en15 (NCT05173987) is a phase 3, randomized, open-label study evaluating first-line pembro versus carboplatin-paclitaxel chemotherapy in patients with dMMR advanced or recurrent EC. Methods: Patients aged ≥18 years with histologically confirmed stage III/IV recurrent EC including carcinosarcoma (mixed Mullerian tumor), radiographically evaluable disease (measurable or nonmeasurable per RECIST v1.1), no prior systemic therapy (prior radiation with or without radiosensitizing chemotherapy > 2 weeks before first dose or prior hormonal therapy ≥1 week before randomization is permitted), and an ECOG PS ≤1 are eligible. Patients must have central confirmation of dMMR status. Approximately 350 patients will be randomized 1:1 to receive pembro 400 mg IV Q6W for 18 cycles (̃2 years) or carboplatin AUC 5 or 6 mg/mL/min IV Q3W and paclitaxel 175 mg/m2 IV Q3W for 6 cycles (with option for > 6 cycles). Trastuzumab is permitted for patients in the chemotherapy arm with HER2+ serous EC. Randomization is stratified by disease status (newly diagnosed advanced EC vs recurrent EC) and histology (endometrioid vs nonendometrioid). Treatment will continue for the specified number of cycles or until PD or unacceptable toxicity. Patients in the chemotherapy arm have the option to receive pembro following confirmed PD by blinded independent central review (BICR). Tumor imaging will be performed Q9W from randomization to week 54 and Q12W thereafter. AEs will be assessed from randomization to 30 days (90 days for serious AEs) after treatment discontinuation and graded per NCI CTCAE version 5.0. Dual primary endpoints are PFS per RECIST v1.1 by BICR and OS. Secondary endpoints are ORR, disease control rate, and DOR per RECIST v1.1 by BICR; PFS per RECIST v1.1 by investigator review; PFS2 (ie, time from randomization to PD per investigator assessment or death from any cause after start of subsequent anticancer therapy); safety; and patient-reported outcomes. PFS and OS will be estimated by the Kaplan-Meier method, with treatment differences assessed by the stratified log-rank test and HRs with 95% CIs determined using a Cox proportional hazard model. Enrollment is ongoing. Clinical trial information: NCT05173987.

In an automated cervical cancer test, the prediction of the location of the cervical os from 2D images is required. Cervical os is the reference point to determine the lesion's location by either using cervical four-quadrant location or by 12 o’clock locations. Precise detection of the cervical os point ensures correct addressing of the lesions. This study used a 6-layer convolutional neural network to predict the center of the cervical os’ coordinates (x,y) on 2D grayscale images. We used a holistic approach without masking any visual element to predict the location of the cervical os. The 2D images were obtained using a telecentric lens and a CCD camera with light wavelengths of 500 550 nanometers. Because of the limited number of image samples (145 images), we used augmentation techniques to increase the training set size by rotating each original image in 1-degree increments from -30 degrees to +30 degrees relative to the center of the image. The 6-layer convolutional neural network was tested on 21 unseen cervix images using augmentation data. The outcomes showed that the image center-based augmentation technique improves the prediction performance. We obtained 2.4 RMSE in predicting the location of the cervical os., Otomatik bir rahim ağzı kanseri testinde, 2 boyutlu görüntülerden rahim ağzının yerinin tahmin edilmesi gerekir. Servikal os, dört kadran konumu gösteriminde veya 12 saatlik dilimler halindeki gösterimde her bir konumun yerini belirlemek için referans noktası olarak kullanılmaktadır. Servikal os noktasının hassas tespiti lezyonların doğru adreslenmesini sağlar. Bu çalışmada, 2 boyutlu gri tonlamalı görüntülerde servikal os koordinatının (x, y) merkezini tahmin etmek için 6 katmanlı bir evrişimli sinir ağı kullanılmıştır. Servikal os'un yerini tahmin etmek için herhangi bir görsel unsuru maskelemeden bütünsel bir yaklaşım kullandık. Çalışmada kullanılan iki boyutlu görüntüler, bir telesentrik lens ve 500-550 nanometre ışık dalga boylarına sahip bir CCD kamera kullanılarak elde edildi. Sınırlı sayıda örnek görüntü (145 görüntü) nedeniyle veri, büyütme tekniklerinden faydalanılarak her bir orijinal görüntü, görüntünün merkez noktasına göre -30 dereceden +30 dereceye kadar 1 derecelik artan açılar ile döndürüldü. Bu veriler üzerinden öğrenme yapan 6 katmanlı evrişimli sinir ağı, daha önce görülmeyen 21 serviks görüntüsü üzerinde test edildi. Sonuçlar, kullanılan görüntü merkezi tabanlı büyütme tekniğinin tahmin performansını iyileştirdiğini gösterdi. Servikal os lokasyonunun tahmininde 2.4 RMSE değeri elde edildi.

Objective To investigate factors associated with refractory disease, recurrence, or death as well as disease-free survival (DFS) and overall survival (OS) in low-grade endometrial sarcoma (LGESS). Methods A multi-institutional, retrospective study was conducted in a total of 124 patients, who received a curative-intent surgery. The exclusion criteria were as follows: i) history of any other invasive disease; ii) neoadjuvant therapy; iii) fertility sparing surgery; iv) a different diagnosis after review of the slides. Results All patients underwent hysterectomy, 96% had bilateral salpingo-oophorectomy, and 65% had lymphadenectomy. Twelve (14.8%) of 81 patients undergoing lymphadenectomy had lymph node (LN) metastasis. Of those, 8 (9.8%) had pelvic LN metastasis whereas 4 (5.6%) had isolated paraaortic LN metastasis. Six of 8 (75%) patients with positive pelvic LNs had concurrent paraaortic LN metastasis. Among 124 patients, 3 patients (2.4%) had refractory disease following primary therapy. During a median follow-up of 45.5 months, 27 (22.3%) of 121 patients who achieved complete remission after primary therapy developed recurrence, and 10 patients (8.1%) died of disease. The 3-year DFS and OS were 76.9% and 93.8%, respectively. Stage was the sole independent prognostic factor in the whole cohort. When analyzing factors within subgroups of stage I and stage ≥II, there was no significant prognostic factor for stage I; however, lymphadenectomy and adjuvant chemotherapy were significantly associated with disease outcomes for stage ≥II. While lymphadenectomy was related with improved DFS, chemotherapy was associated with poor DFS and OS. Conclusion The risk of LN metastasis at pelvic as well as paraaortic lymphatic basins is not negligible to omit lymphadenectomy in stage ≥II LGESS. Moreover, lymphadenectomy provides significant DFS advantage in patients with extrauterine disease.

Non-Hodgkin's lymphoma of the female genital system is extremely rare. It may be confused with cervix uteri malignancies when being diagnosed.

To assess the clinicopathological features, prognostic factors, and survival rates associated with uterine leiomyosarcoma (uLMS). Databases from 15 participating gynecological oncology centers in Turkey were searched retrospectively for women who had been treated for stage I-IV uLMS between 1996 and 2018. Of 302 consecutive women with uLMS, there were 234 patients with Federation of Gynecology and Obstetrics (FIGO) stage I disease and 68 with FIGO stage II-IV disease. All patients underwent total hysterectomy. Lymphadenectomy was performed in 161 (54.5%) cases. A total of 195 patients received adjuvant treatment. The 5-year disease-free survival (DFS) and overall survival (OS) rates were 42% and 54%, respectively. Presence of lymphovascular space invasion (LVSI), higher degree of nuclear atypia, and absence of lymphadenectomy were negatively correlated with DFS, while LVSI, mitotic count, higher degree of nuclear atypia, FIGO stage II-IV disease, and suboptimal surgery significantly decreased OS. LVSI and higher degree of nuclear atypia appear to be prognostic indicators for uLMS. Lymphadenectomy seems to have a significant effect on DFS but not on OS.

Prognostic factors associated with high-grade endometrial stromal sarcoma (HGESS) and undifferentiated uterine sarcoma (UUS) have not been distinctly determined due to the repetitive changes in the World Health Organization (WHO) classification. We aimed to compare clinicopathologic features and outcomes of patients with HGESS with those of patients with UUS. A multi-institutional, retrospective, cohort study was conducted including 71 patients, who underwent surgery at 13 centers from 2008 to 2017. An experienced gynecopathologist from each institution re-evaluated the slides of their own cases according to the WHO2014 classification. Factors associated with refractory/progressive disease, recurrence or death were examined using logistic regression analyses. Kaplan–Meier method and log-rank test were used for survival comparisons. The median disease-free survival (DFS) for HGESS and UUS was 12 months and 6 months, respectively. While the median overall survival was not reached in HGESS group, it was 22 months in the UUS group. Kaplan–Meier analyses revealed that patients with UUS had a significantly poorer DFS than those with HGESS (p = 0.016), although OS did not differ between the groups (p = 0.135). Lymphovascular-space involvement (LVSI) was the sole significant factor associated with progression, recurrence or death for HGESS (Hazard ratio: 9.353, 95% confidence interval: 2.539–34.457, p = 0.001), whereas no significant independent factor was found for UUS. UUS has a more aggressive behavior than HGESS. While no significant predictor of prognosis was found for UUS, LVSI is the sole independent prognostic factor for HGESS, with patients 9.3 times more likely to experience refractory/progressive disease, recurrence or death.

Objective ROS1 is an orphan receptor protein tyrosine kinase which is supposed to undergo genetic rearrangement in carcinogenesis. In the current study, we aimed to investigate the frequency and clinicopathologic features associated with ROS1 gene fusion and ROS1 protein expression in patients with ovarian serous carcinoma or serous borderline tumors. Materials and methods Tissue samples of 102 patients with high or low grade serous carcinoma and borderline serous tumors were selected randomly from the archives of Department of Gyneco-pathology, and analyzed for ROS1 gene expression. (Fluorescence in situ hybridization (FISH) method was used to assess ROS1 gene rearrangement, while ROS1 protein expression was analyzed using immunohistochemistry. Results The study consisted of 94 cases of high-grade serous carcinoma (92.1%), 2 cases of low-grade serous carcinoma (%2) and 6 cases of serous borderline tumor (5.9%). ROS1 gene rearrangement analysis revealed that 4 patients (3.9%) were FISH-positive; whereas the immunohistochemical analysis yielded only 1 patient (0.9%) exhibiting faint positive expression of ROS1 protein. Given the low incidences of ROS1 gene rearrangement and protein expression, their relationships with clinicopathologic parameters could not be statistically analyzed. Conclusion Although rare, patients with ovarian serous carcinoma or serous borderline tumor may exhibit ROS1 gene rearrangement and ROS1 protein expression. Further large-scale studies are necessary to explore the clinicopathologic significance of ROS1 gene expression in ovarian serous carcinoma.

Objective: Low grade cervical intraepithelialneoplasia (CIN) is a relatively common disorder. The course of diseaseincluding recurrence, persistence, andprogression in untreated women is not well-known. The aim of the present study was todetermine the natural history of CIN 1 during a follow-up periodof 3 years.Method: Thisretrospective study involved data extracted from the medical files of 545patients diagnosed with CIN 1 between 2009 and 2015 in the obstetrics andgynecology department of a tertiary care center. Initial cervical smear resultswere compared to those on the follow-upvisits at 1st, 2nd and 3rd years.Results: Comparison of initial smear results with follow-upsamples yielded significant improvements on1st, 2nd, and 3rd years (p, Amaç: Düşük dereceli servikal intraepitelyal neoplazi (CIN)oldukça yaygın bir bozukluktur. Tedavi edilmemiş kadınlarda rekürrens,persistans ve progresyonu içeren hastalığın seyri iyi bilinmemektedir. Buçalışmanın amacı 3 yıllık takip sürecinde CIN1in doğal gidişatınıbelirlemektir.Yöntem: Bu retrospektif çalışma, 2009 ve 2015 yıllarıarasında, üçüncü basamak bakım merkezimizdeki jinekolojik onkoloji bölümünde CIN1 tanısı almış 545hastanın tıbbi verilerini içermektedir. İlk servikal smear sonuçları; 1., 2. ve3. yıl takiplerdeki sonuçlarla karşılaştırıldı.Bulgular: İlk smear sonuçları takip örneklerlekarşılaştırıldığında 1., 2. ve 3. yıllara kıyasla anlamlı iyileşme göstermiştir(p

Derinin invaziv ve agresif kanseri olan malign melanoma diger kanserlere gore daha fazla mortalite ve morbiditeye neden olmaktadir. Jinekolojik sistem primer melanomlari, genital mukoza epitelindeki melanositlerden gelisen bir grup bozuklugu icermektedir. Melanom, cildin kutanoz kisminin yanisira mukozal alanlari (vulva gibi) da etkiler. Vulva hem kutanoz hem de mukozal cildi icerir; klitoris, labium minor/major, mons pubis ve uretra ve vajina acikliklarini icermektedir. Burada biz, vulvar malign melanomun iki farkli uc prezentasyonlarini ve tedavilerini sunmayi amacladik.

Objective To examine correlations among nuclear, architectural, and International Federation of Gynecology and Obstetrics (FIGO) grading systems, and their relationships with lymph node (LN) involvement in endometrioid endometrial cancer. Material and methods Histopathology slides of 135 consecutive patients were reviewed with respect to tumor grade and LN metastasis. Notable nuclear atypia was defined as grade 3 nuclei. FIGO grade was established by raising the architectural grade (AG) by one grade when the tumor was composed of cells with nuclear grade (NG) 3. Correlations between the grading systems were analyzed using Spearman's rank correlation coefficients, and relationships of grading systems with LN involvement were assessed using logistic regression analysis. Results Correlation analysis revealed a significant and strongly positive relationship between FIGO and architectural grading systems (r=0.885, p=0.001); however, correlations of nuclear grading with the architectural (r=0.535, p=0.165) and FIGO grading systems (r=0.589, p=0.082) were moderate and statistically non-significant. Twenty-five (18.5%) patients had LN metastasis. LN involvement rates differed significantly between tumors with AG 1 and those with AG 2, and tumors with FIGO grade 1 and those with FIGO grade 2. In contrast, although the difference in LN involvement rates failed to reach statistical significance between tumors with NG 1 and those with NG 2, it was significant between NG 2 and NG 3 (p=0.042). Although all three grading systems were associated with LN involvement in univariate analyses, an independent relationship could not be established after adjustment for other confounders in multivariate analysis. Conclusion Nuclear grading is significantly correlated with neither architectural nor FIGO grading systems. The differences in LN involvement rates in the nuclear grading system reach significance only in the setting of tumor cells with NG 3; however, none of the grading systems was an independent predictor of LN involvement.

Purpose: Despite the common occurrence of adenomyosis in endometrial cancer (EC), there is a paucity and conflict in the literature regarding its impact on outcomes of patients. We sought to compare outcomes of patients with endometrioid type EC with or without adenomyosis. Methods: A total of 314 patients were included in the analysis. Patients were divided into 2 groups according to the presence or absence of adenomyosis. Adenomyosis was identified in 79 patients (25.1%). A propensity score-matched comparison (1:1) was carried out to minimize selection biases. The propensity score was developed through multivariable logistic regression model including age, stage, and tumor grade as covariates. After performing propensity score matching, 70 patients from each group were successfully matched. Primary outcome of the study was disease-free survival (DFS), and the secondary outcomes were overall survival (OS) and disease-specific survival (DSS). Results: Median follow-up time was 61 months for the adenomyosis positive group and 76 months for the adenomyosis negative group. There were no statistically significant differences in 3- and 5-year DFS, OS, and DSS rates between the 2 groups. Five-year DFS was 92% vs 88% (hazard ratio [HR] 1.54 [0.56-4.27]; p = 0.404), 5-year OS was 94% vs 92% (HR 1.60 [0.49-5.26]; p = 0.441), and 5-year DSS was 94% vs 96% (HR 2.51 [0.46-13.71]; p = 0.290) for patients with and without adenomyosis, respectively. Conclusions: Coexistent adenomyosis in EC is not a prognostic factor and does not impact survival outcomes.

Aims: To investigate whether the presence of serous tubal intraepithelial carcinoma (STIC) is associated with clinical outcomes in a nonselected (unknown BRCA status) cohort of patients with a high-grade serous carcinoma (HGSC) of the ovary, fallopian tube, and peritoneum. Settings and Design: A prospective case-series with planned data collection. Subjects and Methods: The study was conducted in a total of 131 patients, who underwent primary cytoreductive surgery between 2007 and 2012. Histological examination of the fallopian tubes included the “sectioning and extensively examining the fimbriated end” protocol. The diagnosis of STIC was based on the combination of morphology and immunohistochemistry. The patients were divided into two groups according to the absence or presence of STIC and compared clinicopathologically. Statistical Analysis Used: Analyses were performed using PASW 18 (SPSS/IBM, Chicago, IL, USA) software. The primary outcome was progression-free survival (PFS), and the secondary outcome was overall survival (OS). Results: STIC was identified in 20.6% of patients. Median follow-up time was 49.5 months for the STIC-positive group and 38.0 months for the STIC-negative group. Study groups were comparable in terms of clinicopathological characteristics with the exception that patients with STIC had less lymph node involvement (55.0% vs. 65.4%, P = 0.001), and more diagnosis of primary tubal carcinoma (29.6% vs. 3.8%, P = 0.001) compared to those without STIC. No statistically significant differences in terms of PFS (P = 0.462) and OS (P = 0.501) were observed between the groups. Conclusions: The absolute identification of the origin of tumor cell does not seem to significantly affect the clinical course of the patients with HGSC.

Objective: We aimed to analyze variables affecting lymph node (LN) involvement and to assess the need for systematic lymphadenectomy in patients with endometrial cancer (EC). Materials and Methods: A single centre retrospective analysis was conducted in a total of 128 consecutive patients with EC who underwent systematic pelvic or combined pelvic and paraaortic lymphadenectomy between 2009 and 2012. Mann-Whitney U, chi-square, and Fisher’s exact test were used for univariate analyses when appropriate. Variables with a p value 30) were found associated with LN involvement. However, the number of total LNs removed (>30) was the only independent variable that predict LN involvement in multivariate analysis [OR: 15.08; 95% CI: (1.28-177.59); p=0.03]. Conclusion: This study demonstrates that the more LNs removed during staging of EC, the greater the probability of finding LN metastasis.

To explore the correlation of the primary tumor's maximum standardized uptake value (SUVA total of 45 patients who had undergone staging surgery after a preoperative evaluation withThe mean ADCAmong clinicopathologic features, only MI was independently correlated with SUVAmaç: Endometrium kanserinde (EK) primer tümörün maksimum standardize tutulum değeri (SUVmaks) ve minimum görünen difüzyon katsayısının (ADCmin) klinikopatolojik özellikler ile olan ilişkisini araştırmak ve bunların öngörü gücünü belirlemektir. Yöntem: 18F-fluorodeoksiglukoz (FDG) pozitron emisyon tomografisi/bilgisayarlı tomografi (PET/BT) ve difüzyon ağırlıklı-manyetik rezonans görüntüleme (DA-MRG) ile preoperatif değerlendirmeyi takiben evreleme cerrahisi yapılan toplamda 45 hasta, planlı veri toplama yapılan prospektif bir olgu serisine dahil edildiler. Çalışma verileri arasındaki ilişkiler çoklu doğrusal regresyon analizi ile araştırıldı. Bulgular: Ortalama ADCmin ve SUVmaks sırasıyla 0,72±0,22 ve 16,54±8,73 olarak bulundu. Tek değişkenli analizde yaş, myometriyal invazyon (Mİ) ve lenfovasküler alan tutulumu (LVAT) ADCmin ile ilişkili potansiyel faktörler olarak bulunurken, yaş, evre, tümör büyüklüğü, LVAT ve metastatik lenf düğümlerinin sayısı SUVmaks ile ilişkili potansiyel değişkenler olarak tespit edildiler. Diğer taraftan, çok değişkenli analizde Mİ, ADCmin (p=0,007) ve SUVmaks (p=0,024) ile ilişkili tek anlamlı değişkendi. Derin Mİ en iyi, ≤0,77’lik [%93,7 duyarlılık, %48,2 özgüllük ve %93,0 negatif öngörü değeri (NPD)] bir ADCmin kesim değeri ve20,5’lik (%62,5 duyarlılık, %86,2 özgüllük ve %81,0 NPD) bir SUVmaks kesim değeri ile öngörülebiliyordu. Ne var ki, her iki tanısal test birbirlerinden anlamlı şekilde farklı değildi (p=0,266). Sonuç: Klinikopatolojik özelliklerden yalnızca Mİ bağımsız ve anlamlı şekilde SUVmaks ve ADCmin ile ilişkiliydi. Ne var ki, her iki parametrenin ideal olmayan öngörü performansları nedeniyle 18F-FDG PET/BT veya DA-MRG’nin rutin kullanımı şu noktada önerilemez.

In this study, we aimed to evaluate the effects of pregnancy on the serum level of HE4. Forty-six singleton pregnant women in the study group and 40 premenopausal women in the control group were included. HE4 and Ca125 levels were measured longitudinally at each trimester of pregnancy in the study group and once in the control group at the recruitment. In total 46, 38 and 33 pregnant patients blood samples were analysed in the first, second and third trimester of pregnancy, respectively. The analysis was performed in 31 of the pregnant patients (31/46, 67.4%) in each trimester of pregnancy. A comparison of the median HE4 levels of control and study group revealed that the first and second trimester levels were significantly lower than the control group (

PurposeTo investigate the clinico-pathological prognostic factors and treatment outcomes in patients with ovarian yolk sac tumors (YST).MethodsA multicenter, retrospective department database review was performed to identify patients with ovarian YST who underwent surgery between 2000 and 2017 at seven Gynecologic Oncology Centers in Turkey.ResultsThe study group consisted of 99 consecutive patients with a mean age of 23.9years. While 52 patients had early stage (stage I-II) disease, the remaining 47 patients had advanced stage (stage III-IV) disease. Theuterus was preserved in 74 (74.8%) of the cases. The absence of gross residual disease following surgery was achieved in 76.8% of the cases. Of the 54 patients with lymph node dissection (LND), lymph node metastasis was detected in 10 (18.5%) patients. Of the 99 patients, only 3 patients did not receive adjuvant therapy, and most of the patients (91.9%) received BEP (bleomycin, etoposide, cisplatin) chemotherapy. Disease recurred in 21 (21.2%) patients. The 5-year disease-free survival (DFS) and overall survival (OS) in the entire cohort were 79.2% and 81.3%, respectively. In multivariate analysis, only residual disease following initial surgery was found to be significantly associated with DFS and OS in patients with ovarian YST (p=0.026 and p=0.001, respectively).ConclusionsOur results demonstrate the significance of achieving no visible residual disease in patients with ovarian YST. Fertility-sparing approach for patients with no visible residual disease affected neither DFS nor OS. Although high lymphatic involvement rate was detected, the benefit of LND could not be demonstrated.

Endometrial carcinoma is the most commonly encountered gynecological cancer in women worldwide and is also one of the popular models of the hormone-dependent carcinomas. This study was aimed to evaluate and compare the concentrations of five paraben molecules (methylparaben, ethylparaben, N-propylparaben, benzylparaben, isobutylparaben + N-butylparaben) in the endometrial and myometrial tissue samples of patients diagnosed with endometrial carcinoma and benign gynecologic diseases. A total of 88 patients were included in the study and chemical analysis was performed on 176 tissue samples. The study group comprised of 33 patients with endometrial carcinoma and 6 patients with endometrial intraepithelial neoplasia. The control group comprised of 49 patients. One endometrial and one myometrial tissue samples were collected from each patient. The analyses were performed using ultrahigh-performance liquid chromatography and tandem mass spectrometry (UHPLC-MS/MS). At least one type of paraben molecule was detected in 23.07% (9/39) of the patients in the study group, and in 2.04% (1/49) of the patients in the control group; this difference between the groups was statistically significant (p = .002). N-Propylparaben and isobutyl + N-butylparaben were the most frequently detected (in 7/10 of the samples) paraben molecules in the study. Tumor characteristics (tumor diameter, myometrial invasion, architectural grade, nuclear grade, lymphovascular space invasion, and tumor stage) were comparable between the two groups of endometrial carcinoma (paraben-detected and paraben-undetected groups). In conclusion, paraben molecules were more frequently detected in the endometrial carcinoma tissue samples than in the normal endometrium.

The effects of the natural and synthetic estrogens have been studied for a long time but the data regarding estrogen related chemicals (endocrine disrupting chemicals, EDCs) and their effects on reproductive system are scarce. EDCs are hormone like agents that are readily present in the environment, which may alter the endocrine system of humans and animals. Approximately 800 chemicals are known or suspected to have the potential to function as EDC. Potential role of EDCs on reproductive disease has gained attention in medical literature in recent years. We hypothesize that exposure to low doses of EDCs in a chronic manner could cause hormone dependent genital cancers including ovarian and endometrial cancer. Long term exposure to low concentrations of EDCs may exert potentiation effect with each other and even with endogenous estrogens and could inhibit enzymes responsible for estrogen metabolism. Exposure time to these EDCs is essential as we have seen from Diethylstilbestrol experience. Dose-response curves of EDCs are also unpredictable. Hence mode of action of EDCs are more complex than previously thought. In the light of these controversies lower doses of EDCs in long term exposure is not harmless. Possibility of this relationship and this hypothesis merit further investigation especially through in vivo studies that could better show the realistic environmental exposure. With the confirmation of our hypothesis, possible EDCs could be identified and eliminated from general use as a public health measure.

Predictive factors for survival following liver metastasis in endometrial cancer (EC) have not been studied to date. It is expected that patients who initially presented with liver metastasis or developed liver metastasis as the subsequent metastatic site of progressive disease are likely to have poor outcomes. However, patients developing liver metastasis as the first site of recurrence may have a chance of benefiting from the salvage therapies. Therefore, we aimed to determine factors influencing postrecurrence survival in EC patients who developed liver metastasis as the first site of recurrence. Patients with EC who underwent primary surgery at three centers between 1993 and 2013 were reviewed. Liver recurrence was defined as documentation of parenchymal liver metastasis either by radiologically or biopsy, after a disease-free interval of ≥3 months. Patients with liver metastasis at presentation, or liver metastasis as the subsequent metastatic site of progressive disease were excluded. Forty-six patients were identified. Median time to liver recurrence was 12 months, with 91.3 % of recurrences detected within 3 years. Most patients (73.9 %) had liver recurrence concomitant with extra–hepatic disease. Median survival after the diagnosis of liver recurrence was 9 months. While in univariate analysis, time to liver recurrence (p

After the first introduction of laparascopy into gynecology practice in the late 1980s, minimal invasive techniques have been used in both simple and complex procedures. The development of robotic surgery has also opened a new era in minimal invasive surgery. In this review article we aimed to investigate the role of robotic surgery in benign and malign gynecologic disease and on surgical outcomes., Laparaskopinin jinekolojide ilk kez kullanıldığı 1980’lerin sonlarından bu güne, jinekolojide minimal invaziv yaklaşımlar, tanısal amaçlı kullanımdan geniş çaplı karmaşık cerrahilerin yapılabildiği bir döneme girmiştir. Robotik cerrahinin de devreye girmesiyle minimal invaziv cerrahide yeni bir dönem başlamıştır. Bu derleme makalede, robotik cerrahinin çeşitli benign ve malign jinekolojik patolojilerdeki yeri ve bu operasyonların cerrahi sonuçlarından bahsedilmesi amaçlanmıştı

Extrauterine tumor spread is one of the essential determinants of disease outcome in endometrial cancer. However; more than 30% of patients still undergo incomplete surgery at the initial attempt. Strategies regarding the management of patients with incompletely staged early-stage disease or patients with undebulked advanced-stage disease remain controversial. Depending on postoperative uterine features and findings on imaging, patients may be put on observation or receive adjuvant therapy or undergo re-staging or debulking surgery followed by adjuvant therapy. To identify patients who would most benefit from a completion surgery, either for restaging or for cytoreduction, we developed a nomogram for estimation of extrauterine disease based on findings of final hysterectomy specimen. Data of 336 patients whose extrauterine disease status was known were analyzed. A nomogram was constructed using patient characteristics including age, grade, myometrial invasion, lymphovascular space involvement, cervical involvement, and peritoneal cytology. The nomogram was internally validated in terms of discrimination, calibration and overall performance. The nomogram showed good performance accuracy with an area under the receiver operating characteristic curve of 0.870, a specificity of 95.5%, and a positive predictive value of 73.9%. Decision curve analysis revealed that the use of the nomogram in decision-making for completion surgery leads to the equivalent of a net 18 true-positive results per 100 patients without an increase in the number of false-positive results. Estimation of extrauterine disease from final hysterectomy specimen is possible with high predictive performance using the nomogram developed. The nomogram may help clinicians in decision-making for management of incomplete surgeries.