Surgical Anatomy and Intrapelvic Course of Obturator Nerve.

STUDY OBJECTIVE: The aim of this study is to reveal the anatomy of the obturator nerve (ON) and its important relationship in pelvic surgery with the surrounding anatomical structures. DESIGN: Prospective observational study. INTERVENTIONS: Parameters from the left and right ON's to relevant anatomical landmarks were measured and statistical analysis was performed. SETTING: The current study was planned in Department of Anatomy Ankara University School of Medicine and then conducted at the Forensic Medicine Institute, Ankara Group Presidency after receiving the approval of the Institute for Forensic Medicine. PARTICIPANTS: The study was performed in forty fresh or fresh-frozen and female cadavers bilaterally. MEASUREMENTS AND MAIN RESULTS: The mean distances of the midpoint of the left ON to the highest point of the fundus of uterus and isthmus of the uterus, cervico-uterine junction, and highest point of the promontory were 55.1±10.4, 52.9±12.4, 54.8±11.3, and 58.5±15.2 mm, respectively, and 58.7±8.1, 52.5±13.1, 61.4±17.8, and 62.2±19.7 mm on the right side, respectively (p>0.05 for all values). The mean distance between the nerve root of the left ON and highest point of the promontory was 59.1±28.4 mm, it was 59.7±26.2 mm on the right side (p>0.05). There were significant positive correlations between the distance between the left and right anterior superior iliac spines and the distances between the midpoint of the ON to the isthmus of the uterus on both the left and right sides of the pelvis (r=0.546, p=0.019, r=0.896, p<0.001, respectively). CONCLUSIONS: Intraoperative ON injury in gynecological procedures is a complication that may be minimized with good anatomical knowledge. Careful dissection should be performed to decrease the ON injury. The safe surgical zone was established for pelvic procedures by creating a topographical map of the ON. This research may improve pelvic surgery precision, aiding the development of better treatments and reducing ON-related complications.

Sarcopenia, dysphagia, and frailty in community-dwelling older adults: An analysis of mediation and moderated mediation models.

Sarcopenia, dysphagia, and frailty are geriatric syndromes that commonly occur with age and are associated with various adverse health consequences. Nevertheless, the complex associations among them require further study to be clarified. The objectives of this study were to investigate (1) the potential role of dysphagia as a mediator in the association between sarcopenia and frailty and (2) the potential role of taste and smell dysfunction as a moderator of this mediator effect in community-dwelling older adults. A total of 352 older adults (mean age = 70.48 ± 5.31 years; 57.67% female) enrolled in this cross-sectional study. The SARC-F, Eating Assessment Tool-10 (EAT-10), and Edmonton Frailty Scale (EFS) were used to assess sarcopenia, dysphagia, and frailty, respectively. The Taste and Smell Dysfunction Questionnaire (TSDQ) was employed to assess taste and smell dysfunction. Frailty was present in 21.86%, sarcopenia risk in 39.77%, and dysphagia in 26.99% of the participants. The mediation analysis showed that the SARC-F had a significant effect on the EAT-10 (B = 1.001; p < 0.001), which in turn had a significant effect on the EFS (B = 0.129; p < 0.001). The direct (B = 0.659; p < 0.001), indirect (B = 0.129), and total (B = 0.778; p < 0.001) effects of SARC-F on EFS were significant. Of the association between sarcopenia and frailty, 16.6% was explained by dysphagia. The moderated mediation analysis showed that the TSDQ (B = 0.127; p < 0.001) moderated the association between SARC-F and EAT-10 and that the EAT-10 mediated the association between SARC-F and EFS only in older adults who scored moderate and high on the TSDQ (B = 0.049 and B = 0.114, respectively). The EAT-10 partially mediates the association between the SARC-F and the EFS, implying that sarcopenia affects frailty indirectly via dysphagia. Furthermore, taste and smell dysfunction moderates this mediator effect, with sarcopenia functioning as a mediator in older adults who scored moderate and high on the TSDQ. Therefore, it is plausible to anticipate that if someone has taste and smell dysfunction in addition to sarcopenia, they are more likely to have dysphagia and, ultimately, frailty. These findings emphasize the importance of addressing sarcopenia, taste and smell dysfunction, and dysphagia concurrently in frailty management in older adults.

Examination of the Relationship Between Sensory Processing Skills, Kinesiophobia and Fear of Falling in Older Adults with Hypertension and Normotension.

OBJECTIVES: The aim of the study was to investigate fear of falling, kinesiophobia, and sensory processing in older adults with hypertension and normotension. METHODS: Older adults, 62 with hypertension and 62 with normotension, aged 65-84 years were included in the study. The assessment of fear of falling was conducted using the Tinetti Falls Efficacy Scale, kinesiophobia was evaluated with the Tampa Kinesiophobia Scale, and sensory processing skills were analyzed with the Adolescent/Adult Sensory Profile. RESULTS: Significant differences were found between the groups in terms of vestibular processing, visual processing and activity level, fear of falling and kinesiophobia (p < .05). No significant differences were found between the groups with respect to taste/smell, tactile, and auditory processing skills. The findings revealed that older adults with hypertension exhibited diminished vestibular and visual processing abilities, reduced activity levels, and heightened concerns about falling and a tendency to experience kinesiophobia. Fear of falling and kinesiophobia were found to increase with decreasing vestibular processing skills and activity levels in both groups (p < .05). Regression analysis revealed that age, kinesiophobia, vestibular processing, and activity levels were significant determinants of fear of falling (p < .05). CONCLUSION: It is recommended that older adults with hypertension be assessed in terms of sensory, functional, and mental health, with the objective of planning appropriate intervention approaches.

Psychometric and edumetric properties of the Turkish version of the assessment of physiotherapy practice.

BACKGROUND: Clinical education is a crucial process in which students learn how to use theoretical knowledge in clinical settings. However, there is no standardized assessment tool routinely used to evaluate the clinical performance of physiotherapy students in Turkey. This study aimed to examine the psychometric (validity and reliability) and edumetric (acceptability, feasibility, and educational impact) properties of the Turkish version of the Assessment of Physiotherapy Practices (APP-T). METHODS: This methodological study included 7 clinical educators and 174 4th-grade physiotherapy students at three universities in Turkey. Students were assessed with the APP-T on completion of 4-week clinical placements. The construct validity was examined using the exploratory factor analysis. The internal consistency was determined using Cronbach's α-coefficient. The test-retest and inter-rater reliability were evaluated with the intra-class correlation coefficient (ICC). For the measurement error of the APP-T, standard error of measurement (SEM) and minimum detectable change (MDC) values were calculated. After the administration of the APP-T was completed, clinical educators were requested to provide feedback on the acceptability, applicability, and educational impact of the APP-T. RESULTS: Exploratory factor analysis demonstrated the 20 items of the APP-T represent a single dominant dimension explaining 76.28% of the variance. Excellent test-retest and inter-rater reliability was detected by ICC = 0.94 and ICC = 0.77, respectively, and good internal consistency was detected by Cronbach's α = 0.935. The MDC90 values for test-retest and inter-rater reliability were 3.11 and 6.86, respectively. Clinical educators provided generally positive feedback on the acceptability, feasibility, and educational impact of the APP-T. CONCLUSIONS: The current findings provided evidence for universities and clinical educators that the APP-T has sufficient psychometric and educational properties for evaluating the clinical performance of physiotherapy students in Turkey.

Maintaining Physical Health in Individuals with Duchenne Muscular Dystrophy Through Telerehabilitation.

AIMS: To investigate the effects of a telerehabilitation program on walking performance, lower and upper extremity function, fall frequency, respiratory function, and satisfaction in individuals with Duchenne muscular dystrophy (DMD). METHODS: Thirty children (mean age 8.8 ± 4.2 years) were ambulant (Group 1), and 12 youth (18.5 ± 4.7 years) were non-ambulant (Group 2). The telerehabilitation program was applied by physiotherapists for 24 sessions (3 days/week). The 10-meter walking test, stand up from the supine position test, the modified upper extremity performance test, repetition of Lower and upper extremity movements, and the single breath count (SBC) test were administered. Fall frequency and satisfaction level were also recorded. RESULTS: Significant improvement was found after telerehabilitation in upper extremity performance, repetition of lower and upper extremity movements, fall frequency, and SBC scores in Group 1. Changes in the 10-minute Walk and Stand Up from the Supine Position tests were not significant. There was a significant improvement in SBC scores in Group 2. Satisfaction with the service was 88%. CONCLUSIONS: The 8-week telerehabilitation program was effective in improving aspects of upper and lower extremity function, fall frequency, pulmonary function, and satisfaction levels in individuals with DMD.

Skew Constacyclic Codes over a Non-Chain Ring.

In this paper, we investigate the algebraic structure of the non-local ring Rq=Fq[v]/⟨v2+1⟩ and identify the automorphisms of this ring to study the algebraic structure of the skew constacyclic codes and their duals over this ring. Furthermore, we give a necessary and sufficient condition for the skew constacyclic codes over Rq to be linear complementary dual (LCD). We present some examples of Euclidean LCD codes over Rq and tabulate the parameters of Euclidean LCD codes over finite fields as the Φ-images of these codes over Rq, which are almost maximum distance separable (MDS) and near MDS. Eventually, by making use of Hermitian linear complementary duals of skew constacyclic codes over Rq and the map Φ, we give a class of entanglement-assisted quantum error correcting codes (EAQECCs) with maximal entanglement and tabulate parameters of some EAQECCs with maximal entanglement over finite fields.

Prognostic significance of lymphovascular space invasion in low-risk endometrial cancer.

OBJECTIVE: The purpose of this study was to assess the prognostic significance of lymphovascular space invasion in women with low-risk endometrial cancer. METHODS: A dual-institutional, retrospective department database review was performed to identify patients with 'low-risk endometrial cancer' (patients having <50% myometrial invasion with grade 1 or 2 endometrioid endometrial cancer according to their final pathology reports) at two gynecologic oncology centers in Ankara, Turkey. Demographic, clinicopathological and survival data were collected. RESULTS: We identified 912 women with low-risk endometrial cancer; 53 patients (5.8%) had lymphovascular space invasion. When compared with lymphovascular space invasion-negative patients, lymphovascular space invasion-positive patients were more likely to have post-operative grade 2 disease (p<0.001), deeper myometrial invasion (p=0.003), and larger tumor size (p=0.005). Patients with lymphovascular space invasion were more likely to receive adjuvant therapy when compared with lymphovascular space invasion-negative women (11/53 vs 12/859, respectively; p<0.001). The 5-year recurrence-free survival rate for lymphovascular space invasion-positive women was 85.5% compared with 97.0% for lymphovascular space invasion-negative women (p<0.001). The 5-year overall survival rate for lymphovascular space invasion-positive women was significantly lower than that of lymphovascular space invasion-negative women (88.2% vs 98.5%, respectively; p<0.001). Age ≥60 years (HR 3.13, 95% CI 1.13 to 8.63; p=0.02) and positive lymphovascular space invasion status (HR 6.68, 95% CI 1.60 to 27.88; p=0.009) were identified as independent prognostic factors for decreased overall survival. CONCLUSIONS: Age ≥60 years and positive lymphovascular space invasion status appear to be important prognostic parameters in patients with low-risk endometrial cancer who have undergone complete surgical staging procedures including pelvic and para-aortic lymphadenectomy. Lymphovascular space invasion seems to be associated with an adverse prognosis in women with low-risk endometrial cancer; this merits further assessment on a larger scale with standardization of the lymphovascular space invasion in terms of presence/absence and quantity.

SATEN III-Splitting Adjuvant Treatment of stage III ENdometrial cancers: an international, multicenter study.

INTRODUCTION: The purposes of this study were to compare adjuvant treatment modalities and to determine prognostic factors in stage III endometrioid endometrial cancer (EC). METHODS: SATEN III was a retrospective study involving 13 centers from 10 countries. Patients who had been operated on between 1998 and 2018 and diagnosed with stage III endometrioid EC were analyzed. RESULTS: A total of 990 women were identified; 317 with stage IIIA, 18 with stage IIIB, and 655 with stage IIIC diseases. The median follow-up was 42 months. The 5-year disease-free survival (DFS) of patients with stage III EC by adjuvant treatment modality was 68.5% for radiotherapy (RT), 54.6% for chemotherapy (CT), and 69.4% for chemoradiation (CRT) (p=0.11). The 5-year overall survival (OS) for those patients was 75.6% for RT, 75% for CT, and 80.7% for CRT (p=0.48). For patients with stage IIIA disease treated by RT versus CT versus CRT, the 5-year OS rates were 75.6%, 75.0%, and 80.7%, respectively (p=0.48). Negative peritoneal cytology (HR: 0.45, 95% CI: 0.23 to 0.86; p=0.02) and performance of lymphadenectomy (HR: 0.33, 95% CI: 0.16 to 0.77, p=0.001) were independent predictors for improved OS for stage IIIA EC. For women with stage IIIC EC treated by RT, CT, and CRT, the 5-year OS rates were 78.9%, 67.0%, and 69.8%, respectively (p=0.08). Independent prognostic factors for better OS for stage IIIC disease were age <60 (HR: 0.50, 95%CI: 0.36 to 0.69, p<0.001), grade 1 or 2 disease (HR: 0.59, 95% CI: 0.37 to 0.94, p=0.014; and HR: 0.65, 95%CI: 0.46 to 0.91, p=0.014, respectively), absence of cervical stromal involvement (HR: 063, 95% CI: 0.46 to 0.86, p=0.004) and performance of para-aortic lymphadenectomy (HR: 0.52, 95% CI: 0.35 to 0.72, p<0.001). DISCUSSION: Although not statistically significant, CRT seemed to be a better adjuvant treatment option for stage IIIA endometrioid EC. Systematic lymphadenectomy seemed to improve survival outcomes in stage III endometrioid EC.

The Relationship between Z-Protein Level and other Parameters in Pregnant Women with Intrauterine Growth Retardation in Third Trimester.

BACKGROUND: Protein Z is a glycoprotein which acts as an anticoagulant factor. A deficiency of protein Z is associated with thrombotic events and adverse obstetric outcomes. The association between protein Z deficiency and adverse obstetric outcomes has previously been demonstrated in several studies. However, none of them have investigated each complication independently. The aim of this study was to evaluate serum levels of protein Z in pregnancies complicated by intrauterine growth restriction (IUGR). METHODS: Pregnant and nonpregnant healthy women between the ages of 18 and 40 years were included in the study. There were three groups: One: Study group: pregnant women with IUGR fetuses; Two: Control group 1: pregnant women with normal fetuses; Three: Control group 2: nonpregnant, healthy women. Plasma protein levels of protein Z, protein S, and protein C were measured for each group. RESULTS: Women with IUGR had significantly higher mean plasma concentrations of protein Z compared to women with normal pregnancies. This is in contrast to previous studies. CONCLUSIONS: The results of this study indicate that the association between protein Z levels and IUGR is still controversial.

Risk factors for failure of sentinel lymph node mapping using indocyanine green/near-infrared fluorescent imaging in endometrial cancer.

PURPOSE: Side-specific systematic lymphadenectomy is suggested if sentinel lymph node (SLN) mapping failed in early stages endometrial cancer. This study aimed to evaluate the risk factors associated with failed mapping which may lead to modify SLN mapping technique, increase the success of SLN mapping and reduce the necessity of systematic lymphadenectomy. METHODS: Patients with early stage endometrial cancer were included in this study. All patients underwent SLN mapping with indocyanine green/near-infrared compatible surgical platforms. Indocyanine green was injected intracervical. "Bilateral mapping" and "failed bilateral SLN mapping (unilateral or bilateral failed mapping)" groups were compared for demographic, clinical, surgical, and pathological features. RESULTS: 101 cases were analyzed. The overall, unilateral, and bilateral SLN detection rates were 94.1%, 19.8%, and 74.3%, respectively. The failed (unilateral or no mapping) bilateral detection rate was 25.7%. Failed bilateral mapping rates were higher in patients with longer cervical and uterine longitudinal lengths, deep myometrial invasion and larger tumor size without statistical significance. Body mass index and operation type were not related with failed mapping. Increasing number of operations or injection of larger volume of indocyanine green (4 mL vs. 2 mL) did not improve mapping rate significantly. CONCLUSION: Cervical indocyanine green injection may overcome the negative effect of obesity on bilateral mapping. Although there was a negative correlation trend between the longitudinal cervical and uterine lengths and bilateral mapping, this possible relation needs to be confirmed in further studies.

Carcinosarcoma of the ovary compared to ovarian high-grade serous carcinoma: impact of optimal cytoreduction and standard adjuvant treatment.

OBJECTIVE: The purpose of this retrospective study was to compare the prognoses of women with ovarian carcinosarcoma (OCS) who had optimal cytoreductive surgery followed by platinum plus taxane combination chemotherapy to those of women with ovarian high-grade serous carcinoma (HGSC) treated in the same manner. METHODS: A multicenter, retrospective department database review was performed to identify patients with OCS at eight gynecologic oncology centers in Turkey. A total of 54 women with OCS who had undergone optimal cytoreductive surgery followed by platinum plus taxane combination chemotherapy between 1999 and 2017 were included in this case-control study. Each case was matched to two women with ovarian HGSC who had undergone optimal cytoreductive surgery followed by platinum plus taxane combination chemotherapy. The Kaplan-Meier method was used to generate survival data. Factors predictive of outcome were analysed using Cox proportional hazards models. RESULTS: Median disease-free survival (DFS) was 29 months [95% confidence interval (CI) 0-59, standard error (SE) 15.35] versus 27 months (95% CI 22.6-31.3, SE 2.22; p = 0.765) and median overall survival (OS) was 62 versus 82 months (p = 0.53) for cases and controls, respectively. For the entire cohort, the presence of ascites [hazard ratio (HR) 2.32; 95% CI 1.02-5.25, p = 0.04] and platinum resistance [HR 5.05; 95% CI 2.32-11, p < 0.001] were found to be independent risk factors for decreased OS. CONCLUSION: DFS and OS rates of patients with OCS and HGSC seem to be similar whenever optimal cytoreduction is achieved and followed by platinum plus taxane combination chemotherapy.

Prognostic factors for maximally or optimally cytoreduced stage III nonserous epithelial ovarian carcinoma treated with carboplatin/paclitaxel chemotherapy.

OBJECTIVE: To identify factors predictive of poor prognosis in women with stage III nonserous epithelial ovarian cancer (EOC) who had undergone maximal or optimal primary cytoreductive surgery (CRS) followed by six cycles of intravenous carboplatin/paclitaxel chemotherapy. METHODS: A multicenter, retrospective department database review was performed to identify patients with stage III nonserous EOC who had undergone maximal or optimal primary CRS followed by six cycles of carboplatin/paclitaxel chemotherapy at seven gynecological oncology centers in Turkey. Demographic, clinicopathological and survival data were collected. RESULTS: A total of 218 women met the inclusion criteria. Of these, 64 (29.4%) patients had endometrioid, 61 (28%) had mucinous, 54 (24.8%) had clear-cell and 39 (17.9%) had mixed epithelial tumors. Fifty-five (25.2%) patients underwent maximal CRS, whereas 163 (74.8%) had optimal debulking. With a median follow-up of 31.5 months, the 5-year progression-free survival (PFS) and overall survival (OS) rates were 34.8% and 44.2%, respectively. Bilaterality (hazard ratio [HR] 1.44, 95% CI 1.01-2.056; P = 0.04), age (HR 2.25, 95% CI 1.176-4.323; P = 0.014) and maximal cytoreduction (HR 0.34, 95% CI 0.202-0.58; P < 0.001) were found to be independent prognostic factors for PFS. However, age (HR 2.6, 95% CI 1.215-5.591; P = 0.014) and maximal cytoreduction (HR 0.31, 95% CI 0.166-0.615; P < 0.001) were defined as independent prognostic factors for OS. CONCLUSION: The extent of CRS seems to be the only modifiable prognostic factor associated with stage III nonserous EOC. Complete cytoreduction to no gross residual disease should be the main goal of management in these women.

Is the presence of endometriosis associated with a survival benefit in pure ovarian clear cell carcinoma?

BACKGROUND: The purpose of this study was to compare the prognoses of women with pure ovarian clear cell carcinoma (OCCC) arising from endometriosis to those of women with pure OCCC not arising from endometriosis treated in the same manner. METHODS: A dual-institutional, retrospective database review was performed to identify patients with pure OCCC who were treated with maximal or optimal cytoreductive surgery (CRS) followed by paclitaxel/carboplatin chemotherapy between January 2006 and December 2016. Patients were divided into two groups according to the detection of cancer arising in endometriosis or not, on the basis of pathological findings. Demographic, clinicopathological, and survival data were collected, and prognosis was compared between the two groups. RESULTS: Ninety-three women who met the inclusion criteria were included. Of these patients, 48 (51.6%) were diagnosed with OCCC arising in endometriosis, while 45 (48.4%) had no concomitant endometriosis. OCCC arising in endometriosis was found more frequently in younger women and had a higher incidence of early stage disease when compared to OCCC patients without endometriosis. The 5-year overall survival (OS) rate of the patients with OCCC arising in endometriosis was found to be significantly longer than that of women who had OCCC without endometriosis (74.1 vs. 46.4%; p = 0.003). Although univariate analysis revealed the absence of endometriosis (p = 0.003) as a prognostic factor for decreased OS, the extent of CRS was identified as an independent prognostic factor for both recurrence-free survival (hazard ratio (HR) 8.7, 95% confidence interval (CI) 3.15-24.38; p < 0.001) and OS (HR 11.7, 95% CI 3.68-33.71; p < 0.001) on multivariate analysis. CONCLUSION: Our results suggest that endometriosis per se does not seem to affect the prognosis of pure OCCC.

Lipoma of round ligament on the intraperitoneal portion (abdominal site): a case report.

OBJECTIVE: Primary tumors of round ligament are rare, and when found are typically leiomyomas. Endometrioma, and mesothelial cysts are the benign lesions recognized as involving the round ligament. We report a case of lipoma of the round ligament in a 48-year-old premenopausal woman. Round ligament lipoma on the intraperitoneal portion (abdominal site) is very rare and it should be kept in the differential diagnosis of ovarian and abdominal masses.

Cystic lymphangioma of the lesser omentum in a pregnant woman: a case report and review of the literature.

OBJECTIVE: Lymphangiomas are rare benign tumors which are generally seen in pediatric population and the etiopathogenesis has not yet been understood. They occasionally occur in the head and neck or axillary region with only 5% of them being located in the abdominal or mediastinal cavity. These tumors may be asymptomatic or may cause acute abdominal symptoms due to the location and extention. In the English literature, only 4 cases of lymphangioma were reported to have occurred in the pregnancy period. Herein, we report a case of cystic lymphangioma of the lesser omentum detected incidentally on the ultrasonogram of a 21 year-old, 26-week pregnant woman. The patient was followed up uneventfully during pregnancy. Caesarean section was performed due to transverse presentation of the fetus, and the tumor was completely resected during the same session. The patient is recurrence-free after 1 year of postoperative follow-up.

Is Tumor Size Really Important for Prediction of Lymphatic Dissemination in Grade 1 Endometrial Carcinoma With Superficial Myometrial Invasion?

OBJECTIVES: Selection of patients with endometrioid endometrial cancer (EEC), in whom systematic lymph node dissection (LND) is indicated, is an important part of management to maintain optimal oncological outcomes, while avoiding unnecessary morbidities. According to the current approach, LND is recommended for the patients with International Federation of Gynecology and Obstetrics (FIGO) grade 1 to 2 tumors and a primary tumor diameter (PTD) greater than 2 cm, even with myometrial invasion (MMI) of less than 50%. We aimed to determine incidence of LN metastasis in this particular group of patients with grade 1 tumors, superficial MMI, and a PTD greater than 2 cm. MATERIALS AND METHODS: This study only focused on women with FIGO grade 1 EEC having less than 50% MMI. Therefore, women with grade 2 or 3 tumors were excluded, as well as patients with 50% or greater MMI. We also excluded women with macroscopic extrauterine disease, as well as patients with cervical stromal involvement. Patients were divided into subgroups with regard to PTD; group 1 was composed of patients with PTD of 20 mm or less, whereas group 2 was composed of patients with PTD greater than 20 mm. All clinical and pathological variables were compared between the groups. RESULTS: Final pathology reports of 484 women with EEC who underwent surgical staging were analyzed. Among these women, there were 123 women in group 1 (PTD ≤ 20 mm) and 120 women in group 2 (PTD > 20 mm), with FIGO grade 1 tumors and superficial MMI. The median number of total LNs removed was 54 (range, 20-151). There were no women with pelvic and/or para-aortic LN metastasis in group 2, as well as in group 1. CONCLUSIONS: Our results suggest that lymphadenectomy may be omitted in women with FIGO grade 1 EEC having superficial MMI regardless of PTD. Deferral of systematic LND in this subgroup of patients may lead to reductions in costs and surgical morbidity.

Risk factors for paraaortic lymph node metastasis in endometrial cancer.

OBJECTIVE: The purpose of this study was to determine the risk factors for paraaortic lymph node (LN) metastasis in endometrial cancer (EC) patients who underwent comprehensive surgical staging. METHODS: A total of 641 women with EC (endometrioid, non-endometrioid, or mixed histology) who underwent comprehensive surgical staging including pelvic and paraaortic LN dissection between 2008 and 2016 were included in this retrospective study. Patient data were analyzed with respect to paraaortic LN involvement, and predictive factors for paraaortic LN metastasis were investigated. RESULTS: Lymph node metastasis was detected in 90 (14%) patients, isolated pelvic LN metastasis in 28 (4.3%), isolated paraaortic LN metastasis in 15 (2.3%), and both pelvic and paraaortic LN metastasis in 47 (7.3%) women, respectively. Univariate analysis showed that the risk of paraaortic LN metastasis significantly increased in patients with non-endometrioid histology, age greater than 60 years, grade 3 tumor, deep myometrial invasion, lymphovascular space invasion (LVSI), primary tumor diameter (≥2 cm), cervical stromal invasion, adnexal involvement, serosal invasion, pelvic LN involvement, two or more positive pelvic LNs, and positive peritoneal cytology (p < 0.05). At the end of multivariate analysis, the presence of LVSI [odds ratio (OR), 4.8; 95% confidence interval (CI), 1.25-18.2; p = 0.022] and pelvic LN metastasis (OR, 18.8; 95% CI, 5.7-61.6; p < 0.001) remained as independent risk factors for paraaortic LN involvement in women with EC. CONCLUSION: The presence of LVSI and pelvic LN involvement appear to be independent risk factors for paraaortic LN metastasis in patients with EC. LVSI may be considered as a routine pathological parameter during frozen section analysis in women with EC undergoing surgery.

Primary ovarian fibrosarcoma: a case report and review of the literature.

OBJECTIVES: Primary ovarian fibrosarcomas are extremely rare neoplasms, and only 50 cases have been reported in the English literature. Diagnosis can be difficult because of this condition's rarity, and other similar appearing mesenchymal lesions should be ruled out. METHODS: A 50-year-old postmenopausal woman came to our hospital because of abdominopelvic pain. Ultrasonography revealed a 41x33 mm heterogeneous solid mass in the right ovary. Total blood counts, biochemical parameters, and tumor markers were within normal ranges. Total abdominal hysterectomy, and bilateral salpingo oophorectomy were performed. Examination of a frozen, specimen revealed fibroma; however, the final histopathological diagnosis was low grade fibrosarcoma of the ovary. Microscopic examination demonstrated densely cellular, spindle-shaped tumor cells with increased mitotic activity (5 to 6 mitoses per 10 high-power fields). RESULTS: Immunohistochemical analysis revealed that the tumor cells were positive for vimentin and negative for actin and desmin and that the Ki 67 proliferation index was 30% to 40%. The patient did not receive adjuvant treatment, and remained free of disease after a follow up of 6 months. CONCLUSIONS: Although ovarian fibrosarcomas are unusual causes of solid masses in postmenopausal women, they should be considered when adnexal masses are examined in these patients. Mitotic activity and Ki-67 positivity were identified as important diagnostic factors for ovarian fibrosarcoma.

Comprasion of ovarian stromal blood flow measured by color Doppler ultrasonography in polycystic ovary syndrome patients and healthy women with ultrasonographic evidence of polycystic.

OBJECTIVE: To compare ovarian stromal artery blood flows measured by Doppler ultrasonography of polycystic ovary syndrome (PCOS) patients and healthy women with polycystic ovarian image in ultrasonography. METHODS: Forty-two patients diagnosed with PCOS according to the criteria of 2003 Rotterdam Concencus Conferance on PCOS and 38 healthy volunteers with polycystic ovarian image in ultrasonography were included in the study. Ovarian volumes and ovarian stromal artery blood flows were measured by 3-dimensional (3-D) ultrasonography and Doppler ultrasonography in all patients. RESULTS: In patients with PCOS, ovarian stromal artery pulsatility index (PI) and resistivity index (RI) were found significantly different from healthy women with polycystic ovarian image in ultrasonography (p < 0.05). 3-D ovarian volumes were found significantly higher in patients with PCOS (p < 0.05), and a negative correlation was also obtained between ovarian volumes and ovarian stromal artery resistivity indices. CONCLUSION: Ovarian stromal artery Doppler examination could have an importance to explain the pathophysiology of PCOS, but there are few publications in the literature about PCOS and the details of ovarian stromal artery Doppler parameters in patients with polycystic ovarian image only. We conclude that Doppler ultrasonography findings of PCOS patients might be helpful in understanding the clinical follow-up and etiology of the disease.

Vulvar Syringoma in a Postmenopausal Woman: A Case Report.

BACKGROUND: First described in 1872, syringomas are common intraepidermal sweat gland tumors most often found in women during adolescence. Frequent involvement areas are the lower eyelids and malar areas; vulvar involvement is relatively rare. These lesions often appear as small, separate, yellowish papules of about 1-3 mm in size and are generally associated with increased vulvar discomfort and itching.They typically occur in multiples and are bilateral and symmetrical. CASE: A 52-year-old, postmenopausal woman presented with vulvar pruritis and was diagnosed with syringomas after vulvar biopsy in our polyclinics. CONCLUSION: Vulvar syringoma should be included in the differential diagnosisf or itchy and papular lesions of vulvae in a postmenopausal woman.