Uterine extra gastrointestinal stromal tumor presenting as intramural leiomyoma.

Extra gastrointestinal stromal tumors (EGIST) are reported in different sites and organs. This tumors are rare in gynecologic apparatus. Here the authors report an uterine unique tumor represented as intramural leiomyoma. Because of different treatment options, clinicians should be aware of this rare tumor which may be located in uterus and confused with a smooth muscle tumor.

Vulval pruritus: the experience of gynaecologists revealed by biopsy.

Pruritus of the vulva is a common symptom among patients attending to outpatient clinics. In the present study, we aimed to assess pathologies causing vulval pruritus in the reliability of biopsy in a tertiary referral centre. A total of 137 patients undergoing vulval colposcopy because of vulval pruritus were reviewed from the hospital records retrospectively. The mean age of the patients was 47.61 ± 11.88 years and 36.5% of the patients were postmenopausal. In 101 (73.7%) of the patients, macroscopic lesions were present. In 88 (64.2%) of the patients, tolidine-positive stained areas were determined under colposcopy. In total, 68 (49.6%) of the lesions were plain, whereas 51 (37.2%) of them were depigmented. Lichen simplex chronicus, lichen sclerosis and chronic inflammation were the major pathologies associated with vulval pruritus (25.5%, n = 35; 20.4%, n = 28; 14.6%, n = 20). In conclusion, several pathologies out of vulvovaginal candidiasis may lead to vulval pruritus and clinicians should be aware of the importance of biopsy in determining the underlying pathology.

Borderline ovarian tumors: outcomes of fertility sparing surgery.

AIM: Borderline ovarian tumors(BOT) account for ten to 20 percent of all epitelial ovarian carcinomas and often occur in reproductive ages. The aim of this study was to evaluate the clinical and reproductive outcomes of patients who were diagnosed with BOT and underwent fertility sparing surgery. MATERIALS AND METHODS: Patients younger than 40 years who underwent fertility sparing surgery for BOT from 2004 to 2012 were reviewed retrospectively and were evaluated according to the reproductive and clinical outcomes. RESULTS: Twenty-eight patients younger than 40 years with BOT underwent fertility sparing surgery. Median follow up time was 42 +/- 28.1 months. During the follow up period, two patients (7.1%) developed recurrence at 35 and 36 months, respectively. Five (17.9%) out of 28 patients became pregnant during the follow up period. CONCLUSION: Fertility sparing surgery should be the first choice for the treatment of BOT in patients who wish to preserve fertility.

Beta irradiation-induced thermoluminescence: Glow curve analysis and kinetic parameters in combustion-synthesized undoped Ca4YO(BO3)3.

This study examines the thermoluminescent (TL) properties of undoped Ca4YO(BO3)3 phosphor, focusing on how it behaves under a variety of experimental conditions. The IRSL-TL 565 nm was chosen as the appropriate detection filter among various optical detection filter combinations. During the preheating trials conducted at a rate of 2 °C/s, the TL peak exhibited increased intensity, particularly around 200 °C. The experimental outcomes demonstrated a reliable linear relationship (R2 = 0.996 and b = 1.015) in the dose response of undoped preheated Ca4YO(BO3)3 within the range of 1-200 Gy. The investigation encompasses a range of techniques, including the TM-Tstop method, computerized glow curve deconvolution (CGCD) analysis, and theoretical modelling. The application of the TM-Tstop method to samples irradiated with a 5 Gy dose revealed distinct zones on the TM versus Tstop diagram, signifying the presence of at least two discernible components within the TL glow curve, specifically, a single general order kinetics peak and a continuous distribution. The analysis of activation energy versus preheated temperature exhibited a stepwise curve, indicating five trap levels with depths ranging between 1.13 eV and 1.40 eV. The CGCD method also revealed the superposition of at least five distinct TL glow peaks. It was observed that their activation energies were consistent with the Tm-Tstop experiment. Furthermore, the low Figure of Merit (FOM) value of 1.18% indicates high reliability in the goodness-of-fit measure. These findings affirm the reliability and effectiveness of the employed methods in characterizing the TL properties of the Ca4YO(BO3)3 phosphor under investigation. Theoretical models, including the semi-localized transition model, were introduced to explain anomalous observations in TL glow peak intensities and heating rate patterns. While providing a conceptual framework, these models may require adjustments to accurately capture the specific characteristics uncovered through CGCD analysis. As a potential application, the study suggests that the characterized TL properties of Ca4YO(BO3)3 phosphor could be utilized in dosimetric applications, such as radiation dose measurements, owing to its reliable linear response within a broad dose range.

Sonographically guided core biopsy: a minimally invasive procedure for managing adnexal masses.

OBJECTIVES: We hypothesized that sonographically guided core biopsy is an effective method for the differential diagnosis of adnexal masses and evaluated patients who underwent core biopsies in our gynecologic oncology department. METHODS: We reviewed the medical records of 55 patients who underwent sonographically guided core biopsies in our gynecologic oncology department between 2010 and 2013. Patients with suspected ovarian malignancies who were unsuitable for optimal debulking surgery and patients at risk for higher morbidity and mortality because of a poor performance status, suspected nongynecologic tumors, and peritoneal tuberculosis were indicated for sonographically guided biopsy. RESULTS: The indications for sonographically guided core biopsy were candidacy for suboptimal cytoreduction (n = 32 [58.2%]), a poor performance status (n = 11 [20.0%]), and suspected nongynecologic tumors (n = 12 [21.8%]). Histopathologic evaluations revealed primary ovarian tumors in 36 patients (65.5%). Tuberculosis was found to be the second most common disease (n = 8 [14.5%]) among the patients who underwent core biopsies. In 2 patients (3.6%), histologic examination revealed metastatic colorectal cancer. CONCLUSIONS: Sonographically guided core biopsy may be preferred as a minimally invasive procedure for managing adnexal masses, particularly in patients with advanced ovarian cancer and high comorbidities who might benefit from neoadjuvant chemotherapy and in cases of suspected nongynecologic tumors, including pelvic tuberculosis.

Gestational trophoblastic diseases in Turkey.

OBJECTIVE: To evaluate epidemiological data, staging, prognostic scoring system and immunohistochemical reports as well as the management and outcome of hydatidiform mole (HM) in Turkey. STUDY DESIGN: All published data in the Turkish literature from 1932-2011 were evaluated retrospectively. RESULTS: The incidence of HM was 0.3-16 per 1,000 pregnancies and 1.0-24.5 per 1,000 deliveries. Of a total number of 929,323 pregnancies during a 68-year period, 2,227 HM cases were encountered, to give an average incidence of 2.39 per 1,000 pregnancies and 1.87 per 1,000 deliveries. Although there were big differences in reported incidences, the overall incidence is also very high, and the main reason for the differences was thought to be related to the origin of the studies: all were hospital based. An epidemiological field study of HM in the rural part of Turkey identified 4 HM cases and 6,274 pregnancies in 2,032 women aged 15-49. The frequency of HM per 1,000 live births and per 1,000 pregnancies was 0.8 and 0.6, respectively. CONCLUSION: Multicenter, community-based studies are needed to present the real incidence, and it is vital that women with gestational trophoblastic disease be followed by a multidisciplinary team, and ideally in trophoblastic disease centers and national case registry systems for gestational trophoblastic disease.

Platelet volume as a parameter for platelet activation in patients with endometrial cancer.

The objective of this study was to use mean platelet volume (MPV) as a measure of platelet activation in patients with endometrial adenocarcinoma and healthy controls. There was a total of 310 patients with endometrial adenocarcinoma retrospectively evaluated and 250 healthy controls. Preoperative haemoglobin, platelet counts and mean platelet volume were evaluated and statistical tests were conducted to determine the differences among early and advanced disease groups and controls. Median haemoglobin (13.0 vs 13.3 g/dl) and platelet count (282,000 vs 280,000/µl) values were similar in patients with endometrial adenocarcinoma and healthy controls (p > 0.05). Subjects with endometrial cancer exhibited slightly higher MPV than the control group (8.4 fl vs 8.2 fl) (p = 0.048). In patients with advanced-stage endometrial cancer, haemoglobin was significantly lower (p < 0.05) and MPV was significantly higher (p < 0.05) than in either patients with early-stage endometrial cancer or the control group. It was concluded that MPV was found to be a marker for predicting advanced-stage endometrial cancers.

Hydatidiform mole in Turkey: results from six centers.

OBJECTIVE: To evaluate the clinical profile of gestational trophoblastic disease and to determine the incidence of hydatidiform mole (HM) from six centers in Turkey. STUDY DESIGN: A retrospective analysis of patients diagnosed with HM in six medical centers in Turkey from 2000 to 2010 was undertaken. Patients' age, gravidity, parity and abortion, presenting signs, histopathological results and their follow-up were recorded. RESULTS: From 2000 to 2010, 351,650 deliveries were recorded in six centers in Turkey, and 263 cases were diagnosed as HMs. Of the 263 patients the mean age was 28.2 years. The mean numbers of gravidity, parity and abortion were 2.6, 1.3 and 0.3, respectively. According to the medical histories, 3 (1.1%) patients had molar pregnancy previously and the presenting symptom was vaginal bleeding in symptomatic cases. After evacuation, histopathologic examination revealed complete mole in 175 (66.5%) patients and partial mole in 86 (32.6%) patients, and methotrexate was given as a prophylactic chemotherapy in 17 patients (6.4%) while 6 (2.2%) patients underwent hysterectomy procedure. CONCLUSION: According to the results the incidence of molar pregnancy is 0.7/1,000 deliveries. Because of its rarity, multicenter, community-based studies are needed to determine the real incidence.

Synthesis and beta particle excited thermoluminescence of BaSiF6 phosphor.

BaSiF6 phosphor was synthesized by a gel combustion method. The crystalline size was found to be 54.17 ± 4.36 nm using Williamson-Hall (W-H) approximation. The TL data collected by means of a combination of a commercial BG39 and HC575/25 filters was studied to evaluate basic kinetic parameters. Three TL glow peaks of BaSiF6 phosphors are centered at around 84, 190 and 322 °C. Tm-Tstop, various heating rate (VHR) and computerized glow-curve deconvolution (CGCD) method were utilized to analyse collected data. Our findings indicate that luminescence process in scrutinized material may obey second order kinetics. The TL dose response of the TL glow peaks exhibits a linear characteristic up to 100 Gy. Deconvolution of the glow curve reveals that the number of the component TL glow peaks in the complex glow curve is composed of well-isolated six overlapping glow peaks. The FOM value is 2.32.

Differential expression of P16 and P21 in benign and malignant uterine smooth muscle tumors.

PURPOSE: The diagnosis of benign and malignant uterine smooth muscle tumors depends on morphologic criteria such as nuclear atypia, coagulative tumor cell necrosis and mitotic activity. Most of these tumors are readily classifiable into benign or malignant categories using these criteria. However, the distinction between leiomyomas and leiomyosarcomas may at times be problematic. Hence, it would be useful to have additional markers which could help to distinguish these tumors. The aim of the study was to evaluate p16 and p21 expressions in uterine smooth muscle tumors and determine whether p16 and p21 have a potential value in the differential diagnosis of problematic cases. In addition, we evaluated whether the differential expression of p16 and p21 in uterine leiomyosarcomas correlated with tumor recurrence and patient survival. METHODS: p16 and p21 expressions were investigated by immunohistochemistry from paraffin-embedded tissues in 53 cases of uterine smooth muscle tumors consisting of 15 cases of leiomyoma, 14 cases of atypical leiomyoma (leiomyoma with bizarre nuclei), 3 cases of smooth muscle tumor of uncertain malignant potential (STUMP) and 21 cases of leiomyosarcoma. Cases were evaluated with respect to both staining percentage and intensity. RESULTS: There was a statistically significant difference in p16 and p21 staining percentage and intensity between leiomyosarcomas and the other groups. There was no difference in p16 and p21 expressions between leiomyomas, atypical leiomyomas (leiomyoma with bizarre nuclei) and STUMPs. Multivariate analysis showed that the tumor stage was the only independent significant prognostic factor for overall survival in leiomyosarcomas. Neither p16 nor p21 was correlated with disease-free or overall survival. CONCLUSIONS: Our findings suggested that p16 and p21 may be of value as an adjunct to conventional morphologic criteria in the assessment of problematic uterine smooth muscle tumors.

Identification of 13 novel NLRP7 mutations in 20 families with recurrent hydatidiform mole; missense mutations cluster in the leucine-rich region.

BACKGROUND: NLRP7 (NALP7) has recently been identified as the causative gene for familial recurrent hydatidiform mole (FRHM), a rare autosomal recessive condition in which affected women have recurrent molar pregnancies of diploid biparental origin. To date only a small number of affected families have been described. Our objectives were to investigate the diversity of mutations and their localisation to one or both isoforms of NLRP7, by screening a large series of women with FRHM and to examine the normal expression of NLRP7 in ovarian tissue. METHODS: Fluorescent microsatellite genotyping of molar tissue was used to establish a diagnosis of FRHM. Twenty families were subsequently screened for mutations in NLRP7 using DNA sequencing. Expression of NLRP7 in the ovary was examined by immunohistochemical staining. RESULTS: 16 different mutations were identified in the study, 13 of which were novel. Missense mutations were found to be present in transcript variant 2 of NLRP7 and cluster in the leucine-rich region (LRR). A man with two affected sisters and homozygous for the p.R693P mutation had normal reproductive outcomes. In the normal human ovary, NLRP7 expression is confined to the oocytes and present at all stages from primordial to tertiary follicles. CONCLUSION: 13 novel mutations in NLRP7 were identified. We confirm that mutations in NLRP7 affect female but not male reproduction, and provide evidence that transcript variant 2 of NLRP7 is the important isoform in this condition. The mutation clustering seen confirms that the LRR is critical for normal functioning of NLRP7.

Comparison of histopathologic classification and surgical stage by cytokeratin 8 and cytokeratin 18 in endometrial cancer.

PURPOSE OF INVESTIGATION: The aim of the study was to show the role of the cytoskeletal proteins CK8 and CK18 in endometrial cancer invasion and to histopathologically classify endometrial cancer patients. METHODS: This study was a prospective analysis of 49 histologic samples of consecutively surgically operated endometrial cancer patients. After histopathologic classification the most invasive tumor area was selected for immunohistochemistry. Monoclonal antihuman keratin Ab-4 and keratin Ab-1 were applied. RESULTS: CK8 and CK18 stained tumoral tissue and tumoral cell debris in the lymphovascular space were significantly correlated with stage (p < or = 0.005). CONCLUSIONS: To understand the causes of early treatment failure in endometrial cancer patients, further studies are needed to show the role of enhancing factors of endometrial cancer invasion.

Prediction of suboptimal cytoreduction of epithelial ovarian carcinoma by preoperative computed tomography.

In an aim to evaluate the diagnostic efficacy of preoperative abdominal-pelvic CT for the prediction of suboptimal cytoreduction of epithelial ovarian carcinoma (EOC) at primary surgery, CT scans of 48 patients who underwent primary surgery for EOC were retrospectively analyzed. The presence of at least one of the following CT findings: multiple implants > 1 cm in maximum diameter in the mesenteria of the small or large intestines, porta hepatis or intersegmental fissure or on the hepatic surface, diaphragmatic peritoneum, gastrohepatic or gastrosplenic ligaments or the extension of tumor infiltration > 2 cm on the omentum towards the spleen or stomach or the intestines encased by the tumor > 2 cm, diffuse peritoneal thickening or invasion of the lateral pelvic wall > 1 cm or multiple lymph nodes > 1 cm at the cardiophrenic and suprarenal levels were accepted as the critical markers for predicting suboptimal cytoreduction. Suboptimal surgery, defined as leaving a residual tumor mass > 1 cm, was determined in 18 (37.5%) patients. CT predicted suboptimal cytoreduction with 83.3% (15/18) sensitivity, 90% (27/30) specificity and 87.5% (42/48) accuracy. PPV and NPV values were 83.3% (15/18) and 90% (27/30), respectively. These results suggested that preoperative CT could successfully predict suboptimal surgery in patients with EOC.

Regional perspectives on gestational trophoblastic disease in Turkey.

Studies in Turkey are hospital based, and there is a wide variation in reported incidences that necessitate population based-studies to determine the real incidence of gestational trophoblastic diseases (GTDs). According to hospital-based studies, the frequency of GTD is generally very high and there are also regional differences. Epidemiologic study was performed to determine the frequency of hydatidiform mole (HM) in a rural part of Turkey. According to this study, the frequency of HM was lower than the frequencies reported by most of the hospital-based studies. In a national study, an inquiry form related to the approach to GTD was sent to obstetrics and gynecology departments. According to this study, a clinical classification system was used for gestational trophoblastic neoplasia by 60% of the hospitals. Methotrexate was the single-agent chemotherapy used most frequently. With regard to first-line combined chemotherapy, MAC (methotrexate, actinomycin, chlorambucil) was the preferred combination. EMA-CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, Oncovin) was the most commonly used second-line chemotherapeutic regimen. From more recent studies, EMA-CO is the first-line combination chemotherapy. There is no national registry system for GTD in Turkey. There appears to be a need to conduct properly designed community-based studies with well-established case registry system in Turkey.

Squamous cell carcinoma arising in a mature cystic teratoma of the ovary in young patient with elevated carbohydrate antigen 19-9.

Squamous cell carcinoma is the most common type of malignant transformation in mature cystic teratomas. It mainly effects postmenopausal women but is rarely seen in young patients. Carbohydrate antigen 19-9 (CA19-9) tumor marker is a high-molecular-weight glycoprotein, frequently elevated in gastrointestinal adenocarcinomas. CA19-9 levels can increase in both dermoid cysts and in malignant transformation of dermoid cysts. Herein we report a case of squamous cell carcinoma originating from a dermoid cyst in a 31-year-old, gravida 0, para 0, single woman with high levels of CA19-9 and normal levels of CEA. Preoperative CA19-9 was 1000 U/ml (normal range below 27 U/ml). The patient underwent unilateral salpingo-oophorectomy, omentectomy, appendectomy, pelvic and paraaortic lymphadenectomy. After the pathologic analysis of the material, the patient was categorized as FIGO Stage IIa due to metastasis to the left tube. She received six cycles of cisplatin and paclitaxel at 21-day intervals. The postoperative first day, second month, and sixth month CA19-9 values were 602 U/ml, 33.5 U/ml and 22.3 U/ml, respectively. She is now doing well without recurrence of disease six months after the surgery. Squamous cell carcinomas originating from dermoid cysts are rare tumors especially seen in elderly patients with high levels of tumor markers (like CEA, SCCA). Every case may not have the same characteristics and management should be individualized.

CD105 (endoglin) expression as a prognostic marker of angiogenesis in squamous cell cervical cancer treated with radical radiotherapy.

INTRODUCTION: Increased levels of endoglin may represent a new reagent of active neovascularization and angiogenesis process in various cancer types. The prognostic value of tumor CD105 (endoglin) expression in cervical squamous cell cancer (CSCC) patients treated with radical radiotherapy (RT) ± chemotherapy was investigated. MATERIALS AND METHODS: CD105 (endoglin) expression was assessed by immunohistochemical methods in seventy patients, who were treated with radical RT ± chemotherapy for CSCC. The prognostic effects of CD105 on patient and treatment characteristics, local-regional control, and survival were assessed. RESULTS: The median follow-up was 24 (5-99) months for the whole cohort. The median CD105 microvessel density was 55.5 (range; 12-136). Age (≤61 vs. >61 years; P = 0.015), lymph node metastasis status (absent vs. present; P = 0.028), International Federation of Gynecology and Obstetrics stage (Ib-IIa vs. IIb-IVa; P = 0.036), cycles of concurrent chemotherapy (1-3 vs. 4-6 cycles; P = 0.001), and hemoglobin levels (≤10 g/dL vs. >10 g/dL; P = 0.006) appeared to associate significantly with overall survival on univariate analysis. DISCUSSION: No correlation was identified between the tumor CD105 (endoglin) expression and survival in CSCC patients treated with radical RT ± chemotherapy.

Benign clear cell adenofibroma of the ovary. A case report with literature review.

Most clear cell neoplasms of the ovaries are carcinomas; benign and borderline clear cell tumors are uncommon. To date, only 12 cases of benign clear cell adenofibroma have been reported in the literature. Here we report a case of benign clear cell adenofibroma of the left ovary in a 51-year-old postmenopausal woman. Histological examination revealed widely spaced simple glands embedded in a dense fibrous stroma. The glands were lined by one to two layers of cells with abundant clear cytoplasm. The nuclei were bland and uniform in size and shape. There was minimal cytologic atypia in some areas. In this article we discussed the criteria for the diagnosis of benign and borderline clear cell adenofibromas and reviewed the literature.

Pulmonary hemosiderosis with normocomplementemic urticarial vasculitis in a child.

Pulmonary hemosiderosis is rarely associated with urticarial vaculitis especially if normocomplementemic. An eigth year old girl presented with relapsing and remitting chronic and persistent urticarial lesions, conjunctival injection, recurrent cough and hemoptysis. Respiratory findings started at seven years of age. Physical examination revealed diffuse skin lesions mainly settled on the extremities, non-purulent conjunctival injection, rare ronchi and fine crackles in bilateral lower zones of the lungs. Biopsy of the urticaria like skin lesions demonstrated leukocytoclastic vasculitis. Rheumatological markers were negative. Levels of complement fractions 3 and 4 were normal. Chest x-ray demonstrated diffuse alveolar infiltrative images. High Resolution Computed Tomography of the chest revealed diffuse ground-glass appearance, increased interstitial density. Diagnostic flexible fiberoptic bronchoscopy was performed and bronchoalveolar lavage fluid revealed hemosiderin laden alveolar macrophages. She was started on systemic corticosteroid treatment. During follow up, pulmonary symptoms disappeared, however skin lesions and conjunctival symptoms persisted and exacerbated four times in two years. CT of lungs after two years of treatment revealed rare patchy areas of ground glass appearance in bilateral lower lobes and right upper lobe as well as a few of millimetric pleural nodules. This patient is still followed up under low dose steroids and pulmonary findings regressed but low grade inflammation due to vasculitis is thought to continue as supported by the persistence of tomographic findings in the lungs despite the absence of any symptoms. This case demonstrates association of urticarial vasculitis and pulmonary hemosiderosis in the setting of normocomplementemia.

In vitro evaluation of combination of EGCG and Erlotinib with classical chemotherapeutics on JAR cells.

Gestational Trophoblastic Neoplasia (GTN) is a term used for a group of malignant gynecological tumors including choriocarcinoma. Low-risk neoplasias can be cured using single agents Methotrexate (MTX) and actinomycin-D (ACD), but in certain cases, decreased responsiveness and serious side effects occur. Therefore, researchers have been attempting to find new treatment modalities. One of the most popular way for increasing cancer patient survival rates is supporting treatment with adjuvant molecules or chemosensitizers. For this purpose, we investigated epigallocatechin-3-gallate (EGCG), a green tea cathecin, and Erlotinib, an EGFR tyrosine kinase inhibitor, as single agents and combined with MTX or ACD. In accordance with this, JAR (human placenta choriocarcinoma) cell line was used as an in vitro model and MTT, LDH, caspase-3 activation, RT-PCR, and Western Blot analyses were performed to investigate the effects of the test materials. Our studies demonstrate that combination of Erlotinib and EGCG with MTX and ACD decreases JAR cell proliferation and metastatic HER2 protein synthesis and increases caspase-3 activation compared to ACD or MTX alone. In addition, significant increase was observed in the apoptotic Bax gene, but no notable protein synthesis occurred in the Western Blot analysis, which suggests that combination of Erlotinib and EGCG with classical chemotherapeutics ACD or MTX may lead the JAR cells to apoptosis, but not by a mitochondrial pathway. All the results indicate that the synergetic effect of Erlotinib and EGCG with classical chemotherapeutics may help to increase patient survival rates of choriocarcinoma, but the detailed mechanism needs further investigation.

Gynecologic problems among elderly women in comparison with women aged between 45-64 years.

BACKGROUND: As women age, they face a variety of co-morbid medical problems as well as gynecologic problems that may differ from those of younger women. Clinicians should know how to screen and manage those problems among elderly women. OBJECTIVE: With this background, the study was designed to assess the gynecologic problems on admission among elderly women and women aged between 45-64 years. METHODS: A retrospective analysis of symptom distribution of 200 women aged over 65 years and 200 women aged between 45-64 years from January 1999 to December 2003 was performed in an university clinic. PARTICIPANTS: Geriatric women and women aged between 45-64 years with gynecologic complaints on admission to outpatient clinics between January 1999 and December 2003. Analyses of demographic data and data related to symptom distribution, using appropriate parametric and non-paramertic statistical tests, were performed. RESULTS: Geriatric women had a higher number of pregnancies (p < 0.01) but lower percentage of hormone replacement therapy use (p < 0.1) compared to women aged 45-64 years. No significant difference was observed in terms of the age at menopause. Vaginal fullness was felt most commonly by elderly women (p < 0.01) in contrast to menopausal vasomotor symptoms which were relevant in the younger age group (p < 0.01). As a clinical diagnosis, pelvic relaxation with uterine prolapse and genital malignancies were the common two diagnoses among geriatric women (p < 0.05). Postmenopausal vaginal bleeeding was observed more often among geriatric women compared to women aged 45-64 years (19.5% vs 12%, p = 0.03). Endometrial and ovarian cancer distribution did not differ among the two groups when the initial complaint was postmenopausal bleeding. CONCLUSION: Type and management of gynecologic problems in women aged over 65 can be challenging and differ from those for younger women. Thus, caring for these women in their reproductive years as well as in later life should be an aim for all obstetrician-gynecologists.