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.

The relationship between urogenital symptoms and climacteric complaints.

OBJECTIVE: To evaluate the relationship between urogenital symptoms and climacteric complaints, including anxiety, depression, somatic, vasomotor and sexual subscores according to the Greene Climacteric Scale (GCS). METHODS: We retrospectively reviewed the records of 1278 patients and the 908 patients who fulfilled the inclusion criteria were included in the study. The relationships were evaluated between GCS and vaginal symptoms, including vaginal pain, dyspareunia, itching, discharge, burning, dryness, and postcoital bleeding, and urinary symptoms, including dysuria, frequency, nocturia and incontinence, by using univariate and multivariate analyses. RESULTS: Among vaginal symptoms, somatic and sexual scores and, among urinary symptoms, anxiety and somatic scores were found to be the most associated factors. Of the vaginal symptoms, the highest odds ratios for somatic score and sexual score were found to be 2.21 (95% confidence interval (CI) 1.69-2.88, p < 0.001) and 2.08 (95% CI 1.70-2.56, p = 0.029), respectively. Multivariate logistic regression analyses for urinary symptoms revealed that the highest odds ratios for anxiety, somatic, depression and sexual scores were 1.53 (95% CI 1.20-1.95, p = 0.001), 1.92 (95% CI 1.38-2.66, p = 0.01), 1.47 (95% CI 1.11-1.94, p = 0.007), and 1.28 (95% CI 1.06-1.55, p < 0.001), respectively. CONCLUSIONS: There is a strong relationship between urogenital symptoms and GCS subscores. Therefore, clinicians should be aware of urogenital problems in the presence of severe climacteric symptoms and this may provide earlier treatment for urogenital complaints.

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.

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.

Prognostic significance of fascin expression in endometrioid carcinoma.

PURPOSE OF INVESTIGATION: Actin bundling protein fascin has been previously associated with tumor progression in human cancers. We evaluated whether fascin also plays a role in endometrioid carcinomas. METHODS: Cases of 28 proliferative and hyperplastic endometrium and 43 endometrioid carcinomas were examined by immunohistochemistry using antihuman fascin antibody. RESULTS: Weak fascin expression in glandular epithelium was observed in 39% of non-neoplastic samples and various degrees of fascin expression were observed in 74% of neoplastic samples. The number of positively stained samples and intensity of epithelial staining were significantly higher in endometrioid carcinoma compared to the non-neoplastic group (p < 0.001). The number of positively stained samples and total fascin scores of stroma were significantly higher in proliferative and hyperplastic endometrium biopsies compared to the endometrioid carcinoma (p < 0.001). Higher grade endometrioid carcinoma cases had significantly increased total epithelial fascin scores (.042, p < 0.05). There was also a significant difference between tumor grade and patient survival (.040, p < 0.05). There was a significant correlation between microvessel count and disease-free survival (r = .412, p = .006). In the proliferative and hyperplastic endometrial biopsies microvessels stained homogeneously in all cases (28/28), but in the endometrioid carcinoma group eight out of 43 cases showed heterogeneous fascin staining of microvessels. The difference was significant (.019, p < 0.05). CONCLUSIONS: Our study supported the dynamic role of actin bundling protein fascin in generating and maintaining endometrial neoplasms. It also showed that in the development of neoplasia, stromal fascin expression decreases but epithelial fascin expression up-regulates.

Actin bundling protein fascin expression in ovarian neoplasms: comparison of histopathologic features of tumors obtained by the first and secondary cytoreduction surgeries.

PURPOSE OF INVESTIGATION: The aim of the study was to compare the fascin expression pattern and histopathologic features of malign epithelial ovarian tumors obtained by the primary and secondary surgeries. METHODS: The samples of 94 epithelial ovarian carcinomas, 35 secondary surgeries for ovarian carcinomas, 13 borderline epithelial ovarian tumors, 25 cystadenomas and four normal ovarian tissues were stained by means of fascin immunohistochemistry. Secondary surgeries included in the study were secondary cytoreduction at the time of second-look laparotomy (SLL), interval debulking surgery after neoadjuvant chemotherapy or secondary cytoreductive surgery in patients with recurrent epithelial ovarian carcinoma. RESULTS: Mean rank value of the stromal fascin score was higher in 94 cases of malign epithelial ovarian carcinomas than borderline epithelial tumors, cystadenomas and normal ovaries (.000, p < 0.001). There was no significant difference in terms of total epithelial fascin score (.685, p > 0.05) and total stromal fascin score (.572, p > 0.05) between the primary and the secondary surgeries of epithelial ovarian carcinomas. CONCLUSIONS: Regarding the results of stromal fascin expression in 94 epithelial ovarian carcinomas, we hypothesized that cell-matrix interaction was an important step in the progression of malign epithelial ovarian neoplasms. Our study showed that the initial tumorigenic phenotype did not change with time and use of cisplatinum-based combination chemotherapy. Further studies with close follow-up of patients are necessary to reveal the role of fascin on matrix degradation mechanisms which might be the cause of the recurrences in ovarian neoplasms.

The role of actin bundling protein fascin in the progression of ovarian neoplasms.

PURPOSE OF INVESTIGATION: The aim of the study was to investigate the role of fascin in tumor progression and to investigate the role of fascin on endothelial cell migration and angiogenesis in ovarian neoplasms. METHODS: In the study, 94 malign epithelial ovarian neoplasms, 13 borderline epithelial ovarian neoplasms, 25 serous and mucinous cystadenomas and four normal ovarian tissues were examined by means of immunohistochemistry, using monoclonal antihuman fascin antibody, clone IM20. RESULTS: Total stromal fascin score in cases of borderline and malign epithelial ovarian tumors was significantly higher compared to normal ovaries and benign epithelial ovarian tumors (.000, p < 0.001). There was no statistically significant difference in terms of total epithelial fascin scores of samples between groups (.080, p > 0.05). Presence of vascular invasion (.000, p < 0.001), psammomatous calcifications (.001, p = 0.001), and lymphocytic infiltration (.000, p < 0.001) were significantly higher in malign neoplasms. There was no significant difference in terms of mean microvessel count and homogeneous or heterogeneous fascin expression of microvessels between the benign and malign groups (respectively p = .228 and p = .143). CONCLUSIONS: This study suggests that up-regulation of fascin in tumoral tissue may promote invasion of ovarian carcinoma by cell-matrix adhesion.

Genetic imbalances in endometrial hyperplasia and endometrioid carcinoma detected by comparative genomic hybridization.

OBJECTIVE: To evaluate the sequential genomic copy alterations related to the development of precursor lesions and endometrioid-type endometrial carcinomas, and its association with cellular atypia. STUDY DESIGN: Paraffin-embedded tissue specimens from 32 cases of endometrial hyperplasia, 15 of endometrial carcinoma, and 20 of normal endometrial tissue were retrospectively evaluated by the comparative genomic hybridization (CGH) technique. The average number of copy alterations (ANCA) index was used to define the incidence of genomic imbalances in each tissue group. Identified sequential genetic abnormalities were compared with the final histopathological diagnosis and the cellular atypia. RESULTS: Detectable and consistent chromosomal imbalances were found in 13 hyperplasia and 9 carcinoma specimens. There was a significant correlation between ANCA value and degree of cellular atypia and tumor grade. While 1p36-pter, 20q deletions, and 4q overrepresentation were the most prevalent imbalances detected in both complex hyperplasia and complex atypical hyperplasia, 17q22-qter deletion and amplification of 2p34 were only seen in hyperplasia with atypical cells. Overrepresentations of chromosomes 8q, 1q, and 3q are the most frequent aberrations in endometrial carcinomas, but were absent from all the precursor lesions except one. Underrepresentations of chromosomes 1p36-pter and 10q are the other commonly seen aberrations in carcinomas, the latter being more frequent in moderately differentiated than in poorly differentiated lesions. CONCLUSIONS: Different patterns of chromosomal aberrations are seen in precursor lesions than in endometrial carcinomas, except for the loss of 1p36-pter. The presence of 1p deletion in both endometrial hyperplasia and cancer specimens suggests that this is an early event in the development of carcinoma. These results support a stepwise mode of tumorigenesis with accumulation of a series of genomic copy alterations in endometrial carcinogenesis.

Mixed serous and endometrioid carcinoma of the fallopian tube: a case report with literature review.

Malignant neoplasms of the fallopian tube are the rarest of the gynecologic cancers. The frequency of histologic subtypes has been difficult to ascertain from the literature because most authors have not classified these tumors according to their cell types. Papillary serous adenocarcinoma appears to be the most common histologic type. On the contrary, mixed cell types of fallopian tube carcinoma have rarely been reported in the literature. A case of mixed serous and endometrioid carcinoma of the fallopian tube is presented and the related literature is reviewed.

Fascin, an actin-bundling protein expression in cervical neoplasms.

PURPOSE OF INVESTIGATION: Our objectives were (1) to examine expression of fascin in cervical tissues with chronic inflammation, intraepithelial neoplasms and invasive carcinomas, and (2) to investigate the role of fascin on endothelial migration and angiogenesis in cervical neoplasms. METHODS: In this study we investigated by means of immunohistochemistry fascin expression in 92 cervical biopsy samples representative of chronic inflammation (n=13), squamous intraepithelial lesions (SILs, n = 33) and invasive carcinomas (n = 46). RESULTS: Various degrees of fascin expression were observed in 94% of the samples of SILs, in 67% of the samples of invasive cervical carcinoma and in 69% of the samples of chronic inflammation. Total epithelial fascin scores of samples were significantly higher in high-grade (H)SILs compared to low-grade (L)SILs, invasive carcinoma and chronic inflammation of the cervix (p < 0.05). Mean microvessel count was 55.00 +/- 5.17 in HSILs, 40.76 +/- 3.57 in LSILs, 37.11 +/- 2.91 in carcinoma and 25.69 +/- 3.98 in chronic inflammation. We found a significantly higher microvessel count in HSILs compared to invasive carcinoma and chronic inflammation (respectively, p = .004, p = .000). CONCLUSION: Epithelial fascin expression up-regulated when the malignant tumor cell phenotype had occurred in the cervix. Similarly, microvessel count increased with the beginning of cervical tumorigenesis.

Isolated torsion of fallopian tube during pregnancy; report of two cases.

Isolated torsion of fallopian tube is very uncommon during pregnancy. Predisposing factors for torsion are hydrosalpinx, prior tubal operation, pelvic congestion, ovarian and paraovarian masses and trauma. Although the most important clinical symptom is abdominal pain in lower quadrants, the diagnosis is usually established during the operation performed for acute abdomen and salpingectomy is almost always necessary. Two cases of torsion of fallopian tube during pregnancy, one with hydrosalpinx, the other with paratubal cyst are presented and symptoms and predisposing factors are discussed.

Synchronous primary malignancies of the female genital tract.

This study includes 29 patients with synchronous primary malignancies of the female genital tract. These patients constituted 1.7% of all genital malignancies. The most frequently observed synchronous neoplasms were those of the ovary together with the endometrium (51.7%). Most patients had early-stage and low-grade disease. Stage I disease was observed in 68.1% of patients with ovarian cancer. Patients with synchronous ovarian and endometrial cancer had a 73.3% 5-year survival rate, suggesting a favorable prognosis.

Short-term intravaginal maximal electrical stimulation for refractive detrusor instability.

OBJECTIVES: To determine the efficacy of intravaginal maximal electrical stimulation for the treatment of refractive detrusor instability. METHODS: Thirty-five consecutive patients, treated by maximal electrical stimulation for pure refractive detrusor instability were evaluated subjectively by patient's questionnaires and 24-h urinary diary and objectively by 1-h standardized pad test and subtracted cystometry before and 1 week after the treatment. Paired-t and chi(2)-tests were used for the statistical analysis of the data. RESULTS: Thirty-one (88.6%) of the 35 patients were found to be either cured or improved, subjectively. The overall objective success rates based on the 1-h pad test and subtracted cystometry were 80.0% and 74.3%, respectively. The results of all subjective and objective assessment tests, except postvoiding residual urine volume, improved significantly after the treatment (P<0.01). No significant adverse effect related to the treatment was observed, except vaginal irritation noted only by 5 (14.3%) patients. CONCLUSION: Maximal electrical stimulation could offer a safe, non-invasive and effective treatment for patients with detrusor instability who respond poorly to other conservative therapies.

Factors affecting the contraceptive choice in a developing country.

OBJECTIVES: To evaluate the factors affecting the contraceptive choice of women in a developing country. METHODS: Demographic characteristics, education and income level, previous and current contraceptive choices of the women from a maternity and a university hospital were retrospectively reviewed for 2 years. The data obtained from the two hospitals were analyzed by Student's t- and chi2-tests. RESULTS: Family planning services were offered to 651 and 7427 women in the university and the maternity hospital, respectively. Although the mean ages and income levels of the women in two centers were similar, the women in the university hospital had lower mean gravidity and mean number of living child, while they had higher education level and previous modern contraceptive use (P < 0.05-0.001). The women in the university hospital more frequently preferred combined oral contraceptive and surgical sterilization, while those in the maternity hospital chose condom and intrauterine device (P < 0.01-0.001). CONCLUSIONS: Women with higher education level had a lower number of pregnancies and living children due to more frequent use of previous effective contraception and they chose combined oral contraceptives and irreversible methods more frequently.

Effects of postpartum corticosteroids in patients with HELLP syndrome.

OBJECTIVE: To evaluate the effect of corticosteroid treatment on the postpartum recovery of parturients with HELLP syndrome. METHOD: Thirty cases with HELLP syndrome were randomly assigned to a study or a control group, each including 15 patients. A total dose of 30 mg intravenous dexamethasone was given to the study group during the 36 h following the childbirth, while the control group did not receive any steroid medication. Arterial blood pressure, urine output, hematocrit ratio, platelet count, serum alanine and aspartate aminotransferases and uric acid levels were monitored during the first 48 h postpartum. The data were analyzed by unpaired t-test, chi2 or Fisher's exact tests. RESULT: Before the treatment, no significant difference was observed between the two groups. The study group showed statistically significant improvement in mean arterial blood pressure, mean serum aspartate aminotransferase level, mean urine volume per hour and mean platelet count (P < 0.05). Length of hospitalization was also shorter in the study group (P < 0.01). CONCLUSION: Early postpartum high-dose corticosteroid treatment accelerates the recovery and shortens the hospitalization of the parturients with HELLP syndrome.

A hospital-based multicentric study results on gestational trophoblastic disease management status in a developing country.

OBJECTIVE: To determine the clinical management of gestational trophoblastic disease in Turkey. MATERIAL AND METHODS: An inquiry form was sent to 55 health centers including university hospitals, maternity hospitals with residency programs and maternity hospitals without residency programs in 1997. The inquiry consisted of questions about the type of classification systems in use, distribution of cases according to those classifications, use of prophylactic chemotherapy and its indications, and drug preference for single-agent or combined chemotherapies. RESULTS: The overall response rate to the conducted inquiry was 47.1%. A clinical classification system was identified in 60% of the hospitals in Turkey. Generally, methotrexate was the most used single-agent chemotherapy. With regard to first-line combined chemotherapy, MAC (methotrexate, antinomycin-D, cyclophosphamide) was the preferred combination. EMA-CO (etoposide, methotrexate, actinomycin-D, cyclophosphamide, vincristine) was the most common used second-line chemotherapeutic regimen. CONCLUSION: Due to insufficient data acquisition from all the medical centers and a lack of national population-based studies, it is difficult to draw a conclusion with respect to the interpretation of the data about the management protocols of gestational trophoblastic disease.

Hydatidiform mole at extreme ages of reproductive life in a developing country from 1932 to 2000.

PURPOSE OF INVESTIGATION: To determine the rates of hydatidiform mole (HM) cases at extreme reproductive life in a developing country. METHODS: A descriptive study was performed to assess the number of pregnancies and deliveries in Turkey, from 1932 to 2000, based on nationally or internationally published data from different university and state maternity hospitals. RESULTS: A spectrum of prevalence rates in different hospitals were depicted. Almost all of represented data were hospital-based. Percentages of all HM cases < 19 years old and > 40 years old compared to the total number of HMs in each study were not mentioned. In addition, the number of HM compared to total number of deliveries and pregnancies in those age groups were not provided in those studies. CONCLUSION: There appears to be a need for further descriptive studies on a national basis, in regard to assess total number of HM cases per total pregnancies and deliveries for those age groups.