RESUMEN
Vulvar neoplasias are rarely encountered lesions at female genital tract, regardless if they are primary or metastatic. Presence of signet ring cells in a tumour at female genito-urinary tract is highly suggestive of a metastatic lesion particularly from a gastrointestinal tumour. Here the authors present a case of vulvar carcinoma with signet ring cells with an undetermined primary site possibly originating from embryonic cloaca.
Asunto(s)
Cloaca/patología , Cistadenocarcinoma Mucinoso/patología , Neoplasias de la Vulva/patología , Carcinoma de Células en Anillo de Sello/patología , Femenino , Humanos , Persona de Mediana Edad , VulvaRESUMEN
Atypical squamous cells 'cannot exclude high-grade squamous epithelial lesion' (ASC-H) cytology represents clear risk and has been a controversial issue in clinical practice. The objective of this study is to investigate the diagnostic performance of p16(INK4A) immunohistochemistry (IHC) among ASC-H Pap smears in predicting high-grade cervical intraepithelial lesions. Decolourisation and staining process with p16(INK4A) is applied to 27 ASC-H diagnosed conventional Pap smears, which were all managed with colposcopy-directed cervical biopsy priorly. Staining characteristics of ASC-H Pap smears were compared with histopathological data and sensitivity-specificity values of p16 triage to detect CIN2 + histopathology were determined. The sensitivity and specificity of positive p16(INK4A) immune staining to detect CIN2 + histopathology were as 87.5% and 68%, respectively. The positive predictive value of p16 triage is found as 53.8% and negative predictive value was as 92.8%. p16(INK4A) IHC seems applicable for conventional Pap smears and may provide an alternative triage option in ASC-H category.
Asunto(s)
Cuello del Útero/patología , Inhibidor p16 de la Quinasa Dependiente de Ciclina/análisis , Displasia del Cuello del Útero/patología , Neoplasias del Cuello Uterino/patología , Adulto , Cuello del Útero/química , Femenino , Humanos , Persona de Mediana Edad , Prueba de Papanicolaou , Estudios Retrospectivos , Neoplasias del Cuello Uterino/química , Frotis Vaginal , Displasia del Cuello del Útero/químicaRESUMEN
The objective of this study was to assess the feasibility of laparoscopy (LS) in endometrial carcinoma staging. Clinical early stage endometrial cancer patients (n = 153) staged by LS or laparotomy (LT) were compared. A total of 40 (26.1%) patients were treated by LS and 113 (73.9%) by LT. All patients underwent pelvic lymphadenectomy. Lymphadenectomy has been extended to para-aortic space in 55% of the LS group and 70% of the LT group. The majority of patients had stage I-II disease. The median numbers of removed pelvic and para- aortic lymph nodes were similar in two groups (p values 0.213 and 0.199, respectively). Body mass index (BMI) (kg/m(2)) was higher in the LT group (31.2 vs 27.4, p < 0.05). Operation time, age, tumour histology, para-aortic lymphadenectomy and complication rates were similar in the two groups. Four (10%) patients in the LS group and 12 (10.6%) in the LT group had recurrence of disease (p = 1.0). There was no statistical difference for overall survival between the two groups. In conclusion, these findings showed that in endometrial carcinoma cases, laparoscopy has provided adequate staging and similar survival rates with laparotomy.
Asunto(s)
Neoplasias Endometriales/patología , Neoplasias Endometriales/cirugía , Laparoscopía , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Endometriales/mortalidad , Femenino , Humanos , Laparotomía , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Metástasis Linfática , Persona de Mediana Edad , Recurrencia Local de Neoplasia/epidemiología , Estadificación de Neoplasias , Pelvis , Tasa de SupervivenciaRESUMEN
PURPOSE OF INVESTIGATION: To estimate the value of ultrasonographic screening and symptom-based triage for the detection of endometrial pathologies in breast cancer patients using tamoxifen. METHOD(S): A total of 292 breast cancer patients using tamoxifen were analyzed retrospectively. A total of 115 endometrial biopsies were performed on the basis of ultrasonographic examination and symptomatic status of both premenopausal and postmenopausal patients. Endometrial thickness and symptomatic status were then correlated with histopathologic data to figure out the clinical implications of ultrasonographic screening and symptom-based triage. RESULT(S): The cut-off value of endometrial thickness was 8 mm for asymptomatic postmenopausal patients and the positive predictive value of transvaginal ultrasound for endometrial pathologies was 59%. The positive predictive values of symptom-based triage alone for premenopausal and postmenopausal patients were 37.5% and 48.2%, respectively. CONCLUSION: Transvaginal ultrasound may be a useful method for the detection of pathological endometrial changes in asymptomatic postmenopausal breast cancer patients administered adjuvant tamoxifen. In premenopausal patients, symptom-based triage alone does not seem to be an effective diagnostic tool for endometrial pathologies.
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Antineoplásicos Hormonales/efectos adversos , Neoplasias de la Mama/tratamiento farmacológico , Endometrio/efectos de los fármacos , Antagonistas de Estrógenos/efectos adversos , Tamoxifeno/efectos adversos , Triaje , Adulto , Anciano , Endometrio/diagnóstico por imagen , Endometrio/patología , Femenino , Humanos , Persona de Mediana Edad , Posmenopausia , UltrasonografíaRESUMEN
In this study we aimed to investigate high-risk human papilloma virus (hrHPV) prevalence among Turkish women. Cervical samples were collected from 501 women for cytological screening and hrHPV testing by Digene Hybrid Capture 2. hrHPV prevalence and its relation with cytological results and epidemiologic data were analysed by SPSS. The prevalence of hrHPV was 4.2% (21 of the 501 women). Women with abnormal cytological screening results have significantly higher risk of hrHPV positivity compared with women with normal cytological results (19% vs 3.5%) (p ≤ 0.01). The incidence of HPV infection was only associated with the number of sexual partners, but there was no association with age, contraception methods or age at the first sexual intercourse. The prevalence of hrHPV among histological-confirmed cervical intraepithelial neoplasia (CIN) 1, CIN 2 and normal cases were found as 37.5%, 25% and 25%, respectively. The prevalence of cervical hrHPV infection is 4.2% in our population and this rate seems lower than reported rates from other regions. According to further studies with a larger sample size, reflex cytology based on hrHPV positivity should be considered for our national cervical cancer screening programme.
Asunto(s)
Cuello del Útero/patología , Papillomaviridae/aislamiento & purificación , Infecciones por Papillomavirus/patología , Enfermedades del Cuello del Útero/virología , Adolescente , Adulto , Femenino , Humanos , Persona de Mediana Edad , Papillomaviridae/genética , Infecciones por Papillomavirus/epidemiología , Parejas Sexuales , Turquía/epidemiología , Enfermedades del Cuello del Útero/patología , Neoplasias del Cuello Uterino/patología , Neoplasias del Cuello Uterino/virología , Frotis Vaginal , Displasia del Cuello del Útero/patología , Displasia del Cuello del Útero/virologíaRESUMEN
OBJECTIVE: The aim of this study was to evaluate the prevalence and spectrum of a known founder mutation, 5382insC and large genomic rearrangements (LGRs) in BRCA1 in ovarian cancer patients in Turkey. The additional aim was to determine the genetic testing strategy in Turkish breast/ovarian cancer family. METHODS: Six hundred and sixty-seven ovarian cancer patients from five large geographical regions in Turkey, 61 of which had family history of breast/ovarian cancer, were tested for the mutation 5382insC by mutagenically separated polymerase chain reaction and direct sequencing of the entire coding sequence and the splicing sites. Additionally, multiplex ligation-dependent probe amplification (MLPA) was performed for large mutational scanning of BRCA1 gene in unselected ovarian cancer. RESULTS: In this study, BRCA1 point mutations were observed in 1% of all patients and 9.8% of familial cases: 5382insC, unique novel missense variant-G1748S and unclassified splice site variant IVS20+5A>T. 5382insC was observed in two patients. However, G1748S, previously unreported, was found in four patients and thus led to the conclusion that this mutation may be unique to Turkey. A splice site variant, IVS20+5A>T, was detected in three patients, with two of them including G1748S and IVS20+5A>T, together. Using MLPA, six different distinct LGRs in BRCA1 were observed: the deletion of E1A-1B-2, E11, E17-19, E18 and E18-19 and duplication of E5-9. The prevalence of LGRs in this study was 40.9% among patients with family history. The deletion of E1A-1B-2 was the common mutation, and patients with this deletion were referred to us from four different geographical regions in Turkey. Therefore, it was hypothesized that this deletion covering E1-2 is common in Turkey. CONCLUSION: LGRs in BRCA1 were strongly associated with positive family history among the Turkish population. On the basis of these findings, it can be recommended that a low-cost screening for LGRs in BRCA1 may be the first-line mutation detection method in families with strong breast/ovarian cancer history in Turkey.
Asunto(s)
Reordenamiento Génico , Genes BRCA1 , Neoplasias Ováricas/genética , Mutación Puntual , Estudios de Casos y Controles , ADN de Neoplasias/sangre , ADN de Neoplasias/genética , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Ováricas/sangre , TurquíaRESUMEN
PURPOSE OF INVESTIGATION: To investigate the value of telomerase activity (TA) in the detection of early recurrence in primary epithelial ovarian cancer (EOC). METHOD(S): In this study, TA was studied in 30 patients with Stage III EOC and 50 control patients with benign gynecological disease. All enrolled EOC patients had had primary cytoreductive surgery and six cycles of platinum-based first-line chemotherapy previously. Semi-quantative TA measurements were done by TRAP assay in ascites, taken at second-look surgery, of cancer patients and in peritoneal washings, taken during planned surgery, of the control group. RESULT(S): Early recurrence was diagnosed in ten EOC patients (33.3%). Mean TA was statistically higher in EOC patients than in patients with benign disease. However, the mean TA was insignificantly lower in early recurrent EOC patients than in disease-free EOC patients. CONCLUSION(S): The value of TA is limited in the detection of early recurrence in primary EOC.
Asunto(s)
Biomarcadores de Tumor/análisis , Recurrencia Local de Neoplasia/diagnóstico , Neoplasias Ováricas/diagnóstico , Telomerasa/análisis , Adulto , Terapia Combinada , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Ováricas/metabolismo , Neoplasias Ováricas/patología , Neoplasias Ováricas/terapiaRESUMEN
PURPOSE: The aim of this study was to determine the role of p53, Bcl-2 and Ki-67 expression in the carcinogenesis of cervical carcinoma and aggressiveness of cervical intraepithelial neoplasia (CIN). METHODS: The pathology specimens of 63 patients with a diagnosis of normal squamous epithelium (22 cases), CIN I (14), CIN II (5), CIN III (8) and squamous cell carcinoma (14) were evaluated immunohistochemically for the expression of p53, Bcl-2 and Ki-67 in paraffin sections. RESULTS: The expression of p53 and Ki-67 increased proportionally to the grade of CIN and cervical cancer, but only the increase of p53 expression was statistically significant (p = 0.002). There was no significant correlation between Bcl-2 expression and premalignant and malignant cervical lesions. CONCLUSION: p53 expression may have a role in the carcinogenesis of squamous cell cervical carcinoma whereas Bcl-2 expression has no role. Ki-67 expression can not be used in determining the aggressiveness of CIN lesions.
Asunto(s)
Antígeno Ki-67/metabolismo , Proteínas Proto-Oncogénicas c-bcl-2/metabolismo , Proteína p53 Supresora de Tumor/metabolismo , Displasia del Cuello del Útero/patología , Neoplasias del Cuello Uterino/patología , Femenino , Humanos , Inmunohistoquímica , Pronóstico , Neoplasias del Cuello Uterino/clasificación , Displasia del Cuello del Útero/clasificaciónRESUMEN
We report a 34-year-old woman with intrathyroid metastasis of choriocarcinoma associated with pulmonary and brain metastasis. The patient presented with a solitary thyroid nodule. Needle biopsy showed anaplastic malignant cells. Pathologic evaluation after thyroidectomy showed choriocarcinoma in the thyroid gland and the patient subsequently underwent combined chemotherapy and radiotherapy with satisfactory response. This is only the third reported case of metastatic choriocarcinoma in the thyroid gland and emphasizes this rare clinical presentation of choriocarcinoma.
Asunto(s)
Coriocarcinoma/secundario , Neoplasias de la Tiroides/secundario , Adulto , Neoplasias Encefálicas/patología , Coriocarcinoma/diagnóstico por imagen , Coriocarcinoma/patología , Femenino , Humanos , Neoplasias Pulmonares/patología , Cintigrafía , Glándula Tiroides/patología , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/patología , Tiroidectomía , Neoplasias Uterinas/diagnóstico por imagen , Neoplasias Uterinas/patologíaRESUMEN
A woman of 88 years old with primary carcinoma of the fallopian tube, the oldest patient reported in the English literature according to the best of our knowledge, was presented. After debulking surgery four courses of chemotherapy including paclitaxel and carboplatin was performed. The patient was free of disease during two years follow-up.
Asunto(s)
Adenocarcinoma/patología , Neoplasias de las Trompas Uterinas/patología , Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/cirugía , Anciano , Anciano de 80 o más Años , Antineoplásicos Fitogénicos/uso terapéutico , Antígeno Ca-125/sangre , Diagnóstico Diferencial , Neoplasias de las Trompas Uterinas/tratamiento farmacológico , Neoplasias de las Trompas Uterinas/cirugía , Femenino , Humanos , Histerectomía , Paclitaxel/uso terapéuticoRESUMEN
Women presenting symptoms and/or signs of lower genital tract infection were examined mycologically and to increase the sensitivity of the culture methods and to estimate the aberrant forms of fungi, hypertonic media was used. 47 yeast species were isolated from 86 patients. On the other hand 8 Candida albicans strains were isolated by using hypertonic culture media in which no growth was observed in any of the media used for routine culture. In relation with this study 8 cases were evaluated and the culture methods that have been used were discussed.
Asunto(s)
Candida albicans/aislamiento & purificación , Candidiasis Vulvovaginal/microbiología , Medios de Cultivo , Enfermedades de los Genitales Femeninos/microbiología , Adulto , Femenino , Humanos , Soluciones Hipertónicas , Sensibilidad y Especificidad , Cervicitis Uterina/microbiología , Vaginitis/microbiologíaRESUMEN
We aimed to evaluate the prognostic significance of microvessel density (MVD), vascular endothelial growth factor (VEGF), and transforming growth factor beta (TGFbeta), as well as to find out the relationship between MVD, and VEGF and TGFbeta in epithelial ovarian cancer (EOC). Surgical specimens of 47 patients with stage I-IV primary EOC, who underwent extended surgical staging according to FIGO, were investigated. Five- micro m thick tissue sections were immunostained with antibody to factor VIII-related antigen, and MVD was assessed at three separate areas of x200 magnification. Expressions for VEGF and TGFbeta were evaluated by immunohistochemical staining using related monoclonal antibodies. Results were correlated with clinicopathologic factors and survival. We did not find any correlation between MVD and clinicopathologic factors, or patient survival. Similarly, there was no association between the degree of VEGF staining and survival or clinicopathologic factors, except preoperative ascites volume, which was higher in patients showing moderate and intense VEGF staining than those with weak VEGF staining (P = 0.052). The expression of TGFbeta was inversely correlated with preoperative CA-125 levels (P < 0.05). Furthermore, there was no correlation between MVD and the staining intensity of VEGF or TGFbeta. In conclusion, angiogenesis does not appear as a prognostic factor in EOC. We suggest that VEGF is an important mediator of ascites formation, and that TGFbeta, which is supposed to have tissue-specific actions in tumorigenesis, may have growth-inhibitory functions in EOC.
Asunto(s)
Carcinoma/metabolismo , Neoplasias Ováricas/metabolismo , Factor de Crecimiento Transformador beta/metabolismo , Factor A de Crecimiento Endotelial Vascular/metabolismo , Adolescente , Adulto , Anciano , Carcinoma/mortalidad , Carcinoma/patología , Femenino , Humanos , Inmunohistoquímica , Persona de Mediana Edad , Estadificación de Neoplasias , Neovascularización Patológica/metabolismo , Neoplasias Ováricas/mortalidad , Neoplasias Ováricas/patología , Valor Predictivo de las Pruebas , Pronóstico , Análisis de Supervivencia , TurquíaRESUMEN
Women who grew up in Turkey, where undercooked meat is part of the usual diet, have an increased risk of toxoplasmosis. This study covers treatment and prognosis of 33 cases with chronic toxoplasmosis. The study group was selected among the patients with a history of repeated abortions, recurrent preterm labor, stillbirths and babies with congenital anomaly after all other causative reasons were ruled out. IgG and IgM antibody titers were detected by Sabin-Feldman's dye test and indirect fluorescence antibody test. 33 patients, who had negative IgM and IgG antibody titers above 1/64, were accepted as having chronic toxoplasmosis and were included in our study group. These patients were treated with our pyrimethamine treatment protocol (Dinçer Formula) for 36 days before their pregnancies. IgG antibody titers were repeated in the 8th and the 20th week of pregnancy. With the exception of 7 cases, 24 patients (72.7%) still had IgG antibody titers of more than 1/64 and were given the same treatment protocol in the 8th week of pregnancy. Very early abortions occurred in 2 cases. Of 24 patients, 8 had antibody titers still above 1/64 and were treated with spiramycine. While 28 cases (84.8%) had healthy and living infants, pregnancies of 3 cases are still continuing. No teratogenic effects of pyrimethamine on the fetuses were seen. As a result, we can say that a patient who presents with complaints of repeated abortions, recurrent preterm labor or stillbirth should be investigated for toxoplasmosis during pregnancy; even if the IgG antibody test is normal before pregnancy, she should be treated with the protocol mentioned above before pregnancy and in the 8th week of pregnancy when chronic toxoplasmosis is diagnosed.