Immediate colposcopic evaluation in postmenopausal women with low-grade squamous intraepithelial lesion cytology.

OBJECTIVE: To compare the final diagnosis among pre- and postmenopausal women with low-grade squamous intraepithelial lesion (LGSIL) cervical smear results. DESIGN: Retrospective, comparative study. SETTING: Departments of obstetrics and gynecology in two teaching and research hospitals. POPULATION: Data were evaluated on 712 women with LGSIL between April 2005 and April 2011. METHODS: Results from 129 postmenopausal women with LGSIL were compared with 583 premenopausal women with a similar LGSIL result with respect to sociodemographic data and histopathology. MAIN OUTCOME MEASURES: Final clinicopathological diagnosis. RESULTS: The mean age of the pre- and postmenopausal women was 37.2 and 52.5 years, respectively, and lesions of cervical intraepithelial neoplasia grade 2 or worse were detected by biopsy and/or endocervical curettage in 13.6 and 9.3%, respectively. There was no significant difference between the final diagnosis among pre- and postmenopausal women with LGSIL cytology (relative risk 1.43; 95% confidence interval 0.82-2.48; p= 0.19). Invasive cervical cancer was detected in three premenopausal (0.5%) and two postmenopausal women (1.6%). CONCLUSIONS: Cervical pre-invasive and invasive disease rates were similar in pre- and postmenopausal women with LGSIL cytology. For this reason, LGSIL in postmenopausal women should be considered more seriously, and colposcopic evaluation may be as acceptable an option in the management of LGSIL in this group of patients as it is with premenopausal women.

Benign cystic mesothelioma: a case series with one case complicated by pregnancy.

Benign cystic mesothelioma (BCM) is a rare tumor of unknown origin, most frequently encountered in women of reproductive age and with unknown etiology. Most patients have a history of previous pelvic operation, endometriosis, or pelvic inflammatory disease. Preoperative diagnosis is difficult. We report the cases of three patients, with one case complicated by pregnancy, and discuss the diagnostic evaluation and treatment of this rare disease. Complete surgical resection is recommended if feasible. However, recurrent disease is not uncommon. Clinical positive effects of different adjuvant medical treatments are also discussed.

Successful treatment of a very rare case: locally treated cervical rhabdomyosarcoma.

AIM: To study the local treatment of uterine cervical rhabdomyosarcoma in which fertility-sparing surgery is done. METHODS: We report an embryonal rhabdomyosarcoma of the uterine cervix which presented as a cervical polyp in a 22-year-old nulliparous woman. RESULTS: The tumor was composed of rhabdomyoblasts of varying differentiation dispersed within a loose, myxoid stroma, and formed a distinct cambium layer beneath the epithelium. The patient was successfully treated with fertility-sparing surgery and adjuvant chemotherapy. CONCLUSION: The treatment modality should be done according to the patients individually. Treatment has recently inclined toward conservative therapy. Patients with favorable prognostic factors such as localized disease, single polyp and embryonal histologic subtype and without deep invasion can be treated with minimal invasive surgery.

Cesarean scar pregnancy: a rare cause of uterine arteriovenous malformation.

A 38-year-old gravida 4, para 2 woman with a history of two Cesarean sections and one curettage was referred to our hospital, because of painless vaginal bleeding and 6 weeks + 2 days of amenorrhea. The first diagnosis was Cesarean scar pregnancy, managed with methotrexate. Subsequently, an arteriovenous malformation developed, which was diagnosed with color Doppler imaging. The diagnosis was confirmed with angiography. Successful bilateral uterine artery embolization was performed with ethylene vinyl alcohol copolymer (Onyx), n-butyl-2-cyanoacrylate (Histoacryl), and gelfoam.

Incidental adnexal masses at cesarean section and review of the literature.

AIM: To study the outcome of cases of incidental adnexal masses detected during cesarean section. METHODS: A total of 126 093 live births and 39 115 cesarean deliveries performed between 2002 and 2008 were retrospectively evaluated and cases with additional adnexal masses and surgical interventions were included in the study. Histopathologic assessment and related outcomes were examined. RESULTS: One hundred and nineteen patients had incidental adnexal masses at the time of cesarean delivery; the incidence of adnexal masses was 1/329. The most common histopathologic diagnoses were mature cystic teratoma (32%) and functional cysts (26%). Six cases (5%) were bilateral. The mean cyst size was 6.4 cm; two of the masses were malignant. CONCLUSION: Incidental masses detected at the time of cesarean section should be extirpated in order to exclude the possibility of malignancy and to avoid additional surgical procedures following cesarean section.

Angiokeratoma of the clitoris with evident vulvar varicosity.

Angiokeratomas of the vulva are uncommon, benign vascular lesions that are generally located on the labia. However, the clitoris is an extremely rare location, with only three published cases. We report a case of clitoral angiokeratoma in a 22-year-old nulligravida with a history of surgery to remove a clitoral mass at 6 years of age. The case described herein is distinguished from the other case reports by an accompanying varicose structure involving the vulva.

Mucinous adenocarcinoma arising in ovarian mature cystic teratoma in pregnancy.

We report a case of mucinous adenocarcinoma arising from mature cystic teratoma (MCT) of the ovary ascertained incidentally during pregnancy. An ovarian adnexal mass was seen in a 38-year-old pregnant woman during cesarean section. Oophorectomy revealed a mucinous adenocarcinoma arising from MCT with additional capsule invasion. Following this, staging procedures were applied. The patient was staged as IC and adjuvant chemotherapy was applied. She has remained disease-free for over 24 months. To our knowledge, this is a case of mucinous adenocarcinoma arising from MCT and the third case of malignant transformation from MCT in pregnancy in English literature.

First trimester diagnosis of sirenomelia: a case report and review of the literature.

Sirenomelia sequence is a rare lethal pattern of congenital anomalies characterized by a number of hallmark skeletal anomalies, including fusion of the lower extremities or a single lower limb, bilateral renal agenesis or dysgenesis with absent or hypoplastic renal arteries, oligohydramnios, and the presence of aberrant vasculature. The etiology is still controversial. Prognosis is very poor, with the babies being stillborn or succumbing soon after birth. In the second trimester, oligohydramnios due to renal agenesis makes the diagnosis of sirenomelia difficult. Conversely, in the first trimester, the amniotic fluid volume is usually normal, unrelated to the fetal urine production. Therefore, a first-trimester or early second trimester anatomic survey of the fetus is proposed as preferable and more accurate for the diagnosis of this rare anomaly. In this article, we report a case of sirenomelia detected by two- and three-dimensional ultrasound in the 11th week of gestation and the associated literature is discussed.

Perinatal and neonatal outcomes of growth restricted fetuses with positive end diastolic and absent or reversed umbilical artery doppler waveforms.

OBJECTIVE: To evaluate the outcome of intrauterine growth restriction fetuses with absent or reversed end-diastolic flow in the umbilical artery. METHODS: This was a retrospective study conducted at the Department of Maternal Fetal Medicine of the Bakirkoy Women and Children's Teaching Hospital, Istanbul, Turkey between 2002 and 2006. Three hundred and ten pregnant women with growth-restricted fetuses confirmed by ultrasound were followed up with Doppler studies of the umbilical artery. The population was subdivided into 2 groups. Group 1, intrauterine growth restriction with positive end diastolic flow velocity waveforms, (n=137) and group 2, intrauterine growth restriction with absent or reversed end diastolic velocities, (n=163). Perinatal and neonatal outcomes of the 2 groups were recorded. RESULTS: Group 1 was associated with a higher perinatal mortality and morbidity rate than group 2 (p=0.02), odds ratio [OR]: 1.09, 95% confidence interval [CI] 1-3.5, (p=0.03, OR: 2, 95% CI 1.2-3.2). In group 1, significantly more neonates were admitted to the neonatal intensive care unit, but no difference was seen in neonatal intensive care unit stay. The frequency of respiratory distress syndrome, septicemia, and necrotizing enterocolitis increased in group 1. There was no significant difference in need for ventilation of respiratory distress syndrome. CONCLUSION: Our data suggest that pregnancies with absent or reversed end-diastolic flow in the umbilical arteries have high perinatal mortality and morbidity.

Can CA-125 predict lymph node metastasis in epithelial ovarian cancers in Turkish population?

OBJECTIVE: The role of single preoperative serum CA-125 levels in predicting pelvic or paraaortic lymph node metastasis in patients operated for epithelial ovarian cancer has been investigated. METHODS: 176 patients diagnosed with epithelial ovarian carcinoma after staging laparotomy between January 2002 and May 2010 were evaluated retrospectively. RESULTS: The mean, geometric mean, and median of preoperative serum CA-125 levels were 632,6, 200,29, and 191,5 U/mL, respectively. The cut-off value predicting lymph node metastases in the ROC curve was 71,92 U/mL, which is significant in logistic regression analysis (P = 0.005). The preoperative log CA-125 levels were also statistically significant in predicting lymph node metastasis in logistic regression analysis (P = 0.008). CONCLUSIONS: The tumor marker CA-125, which increases with grade independent of the effect of stage in EOC, is predictive of lymph node metastasis with a high rate of false positivity in Turkish population. The high false positive rate may obscure the predictive value of CA-125.

Does vaginal preparation with povidone-iodine prior to caesarean delivery reduce the risk of endometritis? A randomized controlled trial.

OBJECTIVE: The purpose of the present study was to determine whether the vaginal preparation with povidone-iodine prior to caesarean delivery decreased the incidence of postpartum endometritis. METHODS: The present study was a prospective randomized controlled trial in which subjects received a vaginal preparation with povidone-iodine solution immediately prior to caesarean delivery or received no vaginal preparation. The primary outcome measure was the rate of postpartum endometritis. RESULTS: A significant decrease in post-caesarean endometritis was noted in the group that received the povidone-iodine vaginal preparation (n = 334) compared with the control group (n = 336) [6.9 vs. 11.6%; RR = 1.69; 95% CI = 1.03-2.76]. No statistically significant differences in the incidence of endometritis were noted between the experimental and control groups among women who were not in labor at the time of the caesarean delivery [9.2 vs. 8.6%; RR = 1.05; 95% CI = 0.58-1.90], and no differences were found between groups when women with ruptured membranes were excluded from the analysis [9.6 vs. 6.7%; RR = 1.39; 95% CI = 0.78-2.47]. CONCLUSIONS: Vaginal preparation with povidone-iodine solution immediately prior to a caesarean delivery reduces the risk of post-operative endometritis. This preemptive measure was only found to be beneficial in women whose membranes had ruptured and those who were in labor prior to caesarean surgery.

Uterine adenosarcoma with ovarian sex cord-like differentiation: a case report and review of the literature.

OBJECTIVES: To determine the prognosis of uterine adenosarcoma with ovarian sex cord like-differentiation after treatment and to review the literature. CASE REPORT: A 47-year-old premenopausal unmarried woman presented with irregular menstrual bleeding and uterine mass. Sonographic examination, suggested two uterine fibroids located in the uterine fundus and cervix measuring 4 × 3 cm and 3 × 3 cm, respectively. Total abdominal hysterectomy with bilateral salpingo-oopherectomy was performed and the histopathology report confirmed the diagnosis of uterine adenosarcoma with ovarian sex cord like-differentiation. The patient received neither chemotherapy nor other adjuvant therapy because the tumor had low malignant potential, and the extent of myometrial invasion was less than half of the whole myometrium. The patient had an uneventful recovery, and no recurrence was detected for 2 years in the follow-up period. CONCLUSION: Uterine adenosarcomas mostly have relatively low malignant potential. Surgery is the optimal standard treatment for patients. Although there is not enough data in the present literature, benign epithelial differentiations, such as sex cord-like elements may reflect the behaviour of the tumour and shows the tendency to have a benign course in most of cases.

Primary primitive neuroectodermal tumor of the uterus: a case report.

Neuroendocrine carcinomas primitive neuroectodermal tumor (PNET) arise from Kulchitsky cells and are frequently seen in gastrointestinal tract and lungs. But they are unusual in gynecology practice. We presented a case of PNET arising in the uterine corpus of a 22-year-old woman. To our knowledge, this is the first description of small-cell carcinoma of the uterine corpus with a pseudocyst formation within the myometrium without endometrial invasion.

Complete surgical resection of retroperitoneal leiomyosarcoma in pregnancy: a case report.

Retroperitoneal soft tissue sarcoma (RPS) is extremely rare in pregnancy, so there has been little experience in dialing with this condition. We report our experience of a pregnant patient with a retroperitoneal soft tissue sarcoma, which was treated by complete surgical resection at 17 weeks gestation. After regular follow-up, the patient admitted to our hospital in labor, in the 38th gestational week and vaginally delivered a male fetus weighing 3,200 g with Apgar score of 8 and 10 at 1 and 5 min respectively. Adjuvant radiotherapy and chemotherapy is controversial in RPS and due to postoperative continuation of pregnancy in our case, the adjuvant therapy was not practiced. The patient had an uneventful recovery, and no recurrence was detected for 20 months in the follow-up period.

Successful treatment of primary vaginal diffuse large B-cell lymphoma using chemotherapy.

OBJECTIVE: Non-Hodgkins lymphomas (NHL) rarely affect the vagina. As a result, a standard treatment has not been defined. CASE REPORT: A 34-year-old female virgin patient with a primary vaginal NHL stage IEA, diffuse large cell B lineage, showed an excellent response to cytotoxic chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisone) without surgery or radiotherapy. She had experienced no recurrence after 40 months. CONCLUSION: In young patients who wish to preserve their fertility, chemotherapy alone may be the treatment of choice for primary diffuse large B-cell NHL of the lower female genital tract.