Awareness and Knowledge Levels of Turkish College Students about Human Papilloma Virus Infection and Vaccine Acceptance.

Awareness of HPV by the target population is an important determinant of vaccine acceptance. The aim of this study is to evaluate the awareness of HPV infection and acceptability of the HPV vaccines among Turkish college students. College students aged 18-30 who were attending a large public university in Ankara participated in this study. The participants were asked to complete a questionnaire to elicit demographic characteristics, awareness level of HPV and HPV vaccine, and willingness to be vaccinated. One thousand one hundred sixty students responded to the invitation email and completed the questionnaire. The mean scores of female students about HPV and HPV vaccine were 7.1/15 and 3.6/9, respectively, while these scores were 7.9/15 and 3.4/9 among male students, respectively. While 51 % percent of female and 33.5 % of male students had heard of HPV and 32.8 % and 18 % of them had heard of HPV vaccine, respectively, only 1.5 % of female and 0.4 % of male students had been vaccinated against HPV. A total of 507 students (43.7 %) had previously heard of HPV. Only 309 (26.6 %) of the participants had previously heard of the HPV vaccine, and 45.1 % of the students were willing to receive HPV vaccination. The main predictors for willingness to be vaccinated were the following: sexual experience, sexual behavior, past history of sexually transmitted infection (STI), and knowledge about HPV and HPV vaccine. Higher awareness levels of HPV and HPV vaccine are significantly related to greater willingness to be vaccinated, and the main reasons for rejecting the vaccine were insufficient information about the vaccine and possible unknown side effects.

Evaluation of Probably Benign Adnexal Masses in Postmenopausal Women / Avaliação de massas anexiais benignas em mulheres pós-menopáusicas

Abstract Background Preoperatively identification of malignancy potential of a postmenopausal adnexal masses is important. Aim To evaluate the effectiveness of the Risk of Malignancy Index-2 in presumably benign adnexal masses in postmenopausal women. Study Design Retrospective, observational study. Methods 119 women with postmenopausal adnexal masses with a preliminary diagnosis of benign tumors according to the Risk of Malignancy Index-2 were included. Age, duration of menopause, ultrasonographic findings, and serum CA-125 levels were recorded preoperatively. The definitive diagnosis was based on postoperative histopathological examination. Results Of 119 adnexal mass, 10 were malignant and 109 were benign. There was no statistically significant difference with regard to age and tumor size between the groups. The two significant ultrasonographic parameter between groups were the presence of solid area in the mass and bilaterality. Moreover, if the cut off point for serum CA-125 was adjusted to 14.75 IU/mL according to ROC curve, a sensitivity value of 80% and a specificity value of 72% could be achieved to discriminate benign and malign cysts. Conclusion In the differential diagnosis of benign and malignant adnexal masses in postmenopausal women, the presence of a solid component, bilaterallity based on ultrasonography and high CA-125 values may be used as discriminative criteria. There is no direct relation between the size of the adnexal mass and malignancy potential. Therefore, in the malignancy indexes of postmenopausal women, we recommend lower cut-off values of CA-125 to increase the sensitivity of preoperative evaluation tests without having a great impact on negative predictive values.

Resumo Introdução É fundamental identificar o potencial maligno de massas anexiais pósmenopáusicas no período pré-operatório. Objetivo Avaliar a efetividade do risco de malignidade (risk of malignancy index-2, RMI2) em massas anexiais benignas presumíveis em mulheres na pós-menopausa. Desenho do Estudo Estudo observacional retrospectivo. Métodos Este estudo foi conduzido em nossa clínica de cirurgia de endoscopia e endoscopia de nosso hospital entre janeiro de 2013 e setembro de 2015. Um total de 119 mulheres com massas anexiais pós-menopausa com diagnóstico preliminar de tumores benignos de acordo com o RMI-2. A idade, a duração da menopausa, os achados ultrassonográficos e os níveis séricos de CA-125 foram registados no préoperatório. O diagnóstico definitivo foi baseado no exame histopatológico pósoperatório. Resultados A média de idade dos pacientes foi de 55,4 6,71 anos. O exame histopatológico revelou que 8,4% das massas anexiais eram tumores malignos ou limítrofes, enquanto 91,6% eram benignos. Não houve diferença estatisticamente significante quanto ao tamanho do tumor e do tamanho das lesões entre patologias malignas e benignas. Não houve diferença estatisticamente significativa entre pacientes benignos e malignos quanto à idade e tamanho do tumor. Os dois parâmetros ultrasonográficos estatisticamente significativos entre os grupos foram a presença de área sólida na massa e bilateralidade. Além disso, se o ponto de corte para CA-125 sérico fosse ajustado para 14,75 UI/mL de acordo com a curva receiver operating characteristic (ROC), um valor de sensibilidade de 80% e um valor de especificidade de 72% poderiam ser conseguidos para discriminar cistos benignos e malignos (área sob a curva [ASC]: 0,89). Conclusão No diagnóstico diferencial de massas anexiais benignas e malignas em mulheres pós-menopáusicas, a presença de um componente sólido, bilaterais com base na ultra-sonografia e valores elevados de CA-125 podem ser utilizados como critério discriminatório. Parece que não há relação direta entre o tamanho da massa anexial eo potencial maligno. Portanto, nos índices de malignidade de mulheres pósmenopáusicas, recomendamos valores de corte mais baixos de CA-125 para aumentar a sensibilidade dos testes de avaliação pré-operatória sem ter grande impacto em valores preditivos negativos.

Evaluation of Probably Benign Adnexal Masses in Postmenopausal Women.

Background Preoperatively identification of malignancy potential of a postmenopausal adnexal masses is important. Aim To evaluate the effectiveness of the Risk of Malignancy Index-2 in presumably benign adnexal masses in postmenopausal women. Study Design Retrospective, observational study. Methods 119 women with postmenopausal adnexal masses with a preliminary diagnosis of benign tumors according to the Risk of Malignancy Index-2 were included. Age, duration of menopause, ultrasonographic findings, and serum CA-125 levels were recorded preoperatively. The definitive diagnosis was based on postoperative histopathological examination. Results Of 119 adnexal mass, 10 were malignant and 109 were benign. There was no statistically significant difference with regard to age and tumor size between the groups. The two significant ultrasonographic parameter between groups were the presence of solid area in the mass and bilaterality. Moreover, if the cut off point for serum CA-125 was adjusted to 14.75 IU/mL according to ROC curve, a sensitivity value of 80% and a specificity value of 72% could be achieved to discriminate benign and malign cysts. Conclusion In the differential diagnosis of benign and malignant adnexal masses in postmenopausal women, the presence of a solid component, bilaterallity based on ultrasonography and high CA-125 values may be used as discriminative criteria. There is no direct relation between the size of the adnexal mass and malignancy potential. Therefore, in the malignancy indexes of postmenopausal women, we recommend lower cut-off values of CA-125 to increase the sensitivity of preoperative evaluation tests without having a great impact on negative predictive values.

Introdução É fundamental identificar o potencial maligno de massas anexiais pós-menopáusicas no período pré-operatório. Objetivo Avaliar a efetividade do risco de malignidade (risk of malignancy index-2, RMI2) em massas anexiais benignas presumíveis em mulheres na pós-menopausa. Desenho do Estudo Estudo observacional retrospectivo. Métodos Este estudo foi conduzido em nossa clínica de cirurgia de endoscopia e endoscopia de nosso hospital entre janeiro de 2013 e setembro de 2015. Um total de 119 mulheres com massas anexiais pós-menopausa com diagnóstico preliminar de tumores benignos de acordo com o RMI-2. A idade, a duração da menopausa, os achados ultrassonográficos e os níveis séricos de CA-125 foram registados no pré-operatório. O diagnóstico definitivo foi baseado no exame histopatológico pós-operatório. Resultados A média de idade dos pacientes foi de 55,4 ± 6,71 anos. O exame histopatológico revelou que 8,4% das massas anexiais eram tumores malignos ou limítrofes, enquanto 91,6% eram benignos. Não houve diferença estatisticamente significante quanto ao tamanho do tumor e do tamanho das lesões entre patologias malignas e benignas. Não houve diferença estatisticamente significativa entre pacientes benignos e malignos quanto à idade e tamanho do tumor. Os dois parâmetros ultra-sonográficos estatisticamente significativos entre os grupos foram a presença de área sólida na massa e bilateralidade. Além disso, se o ponto de corte para CA-125 sérico fosse ajustado para 14,75 UI/mL de acordo com a curva receiver operating characteristic (ROC), um valor de sensibilidade de 80% e um valor de especificidade de 72% poderiam ser conseguidos para discriminar cistos benignos e malignos (área sob a curva [ASC]: 0,89). Conclusão No diagnóstico diferencial de massas anexiais benignas e malignas em mulheres pós-menopáusicas, a presença de um componente sólido, bilaterais com base na ultra-sonografia e valores elevados de CA-125 podem ser utilizados como critério discriminatório. Parece que não há relação direta entre o tamanho da massa anexial eo potencial maligno. Portanto, nos índices de malignidade de mulheres pós-menopáusicas, recomendamos valores de corte mais baixos de CA-125 para aumentar a sensibilidade dos testes de avaliação pré-operatória sem ter grande impacto em valores preditivos negativos.

Uterine adenosarcomas: A dual-institution experience.

There has been limited literature about treatment and follow-up strategies of uterine adenosarcomas because of their rare nature. For this study we retrospectively investigated the medical database of the two major womens' health hospitals in Turkey. A total of 15 patients were identified from the hospital's database. Median follow-up was 86.43 months for all patients. Seven out of 15 patients had recurrences during their follow-up. Among these 7 patients, 4 of them had stage IA disease. Median Disease Free Survival (DFS) and Overall Survival (OS) were calculated as 41.47 and 57.21 months, respectively. According to our study, polypoid tumours confined to the uterus with superficial myometrial invasion can be treated without comprehensive surgical staging. We believe that, publishing all the data in an organised manner even though they are small in size, gives us an opportunity to design meta-analysis for the development of more appropriate treatment strategies.

Evaluation of Breast Cancer Knowledge and Awareness Among Hospital Staff in a Women Heath Hospital in Turkey.

The purpose of this study was to examine breast cancer prevention knowledge, beliefs, and information sources among people which are employed in healthcare system including nurses and hospital staff. A cross-sectional survey was conducted among hospital staff of the largest women health hospital in Turkey. Self-administered questionnaires were delivered to participants. A total of 200 hospital staff participated to the study with a response rate of 80.5 %. One-way ANOVA with post-hoc Tukey test was used for multiple comparisons. The results showed that the overall knowledge of hospital staff about breast cancer is inadequate. The mean total knowledge score of the participants was approximately 60 %. The overall mean score of the survey for all participants was 16.69 (SD, 3.12) out of 27. Significant difference was detected in mean total score among educational levels. Education and increasing awareness about the disease can be identified as the major determinants for improving the percentages of early diagnosis and decreasing the mortality rates. Hospital staff education should be the key target for increasing the awareness of whole population especially for developing countries.

Prognostic value of 18F-FDG PET/CT for identifying high- and low-risk endometrial cancer patients.

OBJECTIVES: To assess the usefulness of adding PET/CT as a preoperative test for determining the extent of endometrial cancer and discriminating low- and high-risk patients to identify candidates for surgical staging. MATERIAL AND METHODS: We retrospectively reviewed 86 patients with pathologically proven endometrial cancer who had undergone preoperative ¹8F-FDG PET/CT. The prognostic relationships between PET/CT parameters and pathology reports were assessed. RESULTS: The SUVmax was significantly higher in patients with FIGO stage IB or higher compared with those with stage IA; for stage III-IV compared with stage I-II; and for patients with lymph node metastasis compared with those without lymph node metastasis. Using 6.70 as a cut-off for SUVmax, low-risk patients can be identified with a sensitivity of 92.9%. CONCLUSIONS: PET/CT imaging can be used not only for determining malignancy and lymph node involvement but also for determining candidates for surgical staging with high sensitivity.

A randomized controlled experimental study of the efficacy of platelet-rich plasma and hyaluronic acid for the prevention of adhesion formation in a rat uterine horn model.

PURPOSE: Platelet-rich plasma (PRP) has been known to possess an efficacy in tissue regeneration. The aim of this study was to determine the role of PRP on post-operative adhesion formation in an experimental rat study. METHODS: Thirty Sprague-Dawley rats were randomly divided into control, hyaluronic acid, and PRP treatment groups and operated on for uterine horn adhesion modeling. Blood was collected to produce a PRP with platelet counts of 688 × 10(3)/µL, and 1 ml of either hyaluronic acid gel or PRP was administered over the standard lesions, while the control group received no medication. The evaluation of post-operative adhesions was done on the 30th post-operative day. The location, extent, type, and tenacity of adhesions as well as total adhesion scores, tissue inflammation, fibrosis and transforming growth factor-1beta (TGF-1ß) expressions were evaluated. RESULTS: The total adhesion score was significantly lower in the PRP group (3.2 ± 1.5) compared with the hyaluronic acid (5.0 ± 1.3) and control (8.1 ± 1.7) groups. The extent of the adhesions was significantly lower in the PRP group. There was no significant difference in the type and tenacity of adhesions between the hyaluronic acid and the PRP group. The level of inflammation was significantly higher in the control group than the others, while there was no difference between the PRP and hyaluronic acid groups. TGF-1ß expression was significantly lesser in the PRP group than the control and hyaluronic acid groups. CONCLUSIONS: PRP is more effective than hyaluronic acid treatment in preventing post-operative adhesion formation in an experimental rat uterine horn adhesion model.

Could 25-OH vitamin D deficiency be a reason for HPV infection persistence in cervical premalignant lesions?

Vitamin D is an essential precursor to the steroid hormone calcitriol which mainly regulates calcium homeostasis. Moreover anti- proliferative, pro- apoptotic, anti- angiogenic effects of Vitamin D support the ideas of preventive role in various cancer. This study aimed to determine if there is a relationship between HPVDNA infection and cervical intraepithelial neoplasia and Vitamin D deficiency. As a result of the study the difference of 25-OH Vitamin D3 levels between HPVDNA positive group and the control group were statistically significant (p=0,009). According to results of our study, with the proven anti-inflammatory functions of Vitamin D, the deficiency of these molecule and its metabolites can be a possible reason for HPVDNA persistence and related cervical intraepithelial neoplasia.

Efficacy of a real time optoelectronic device (TruScreen™) in detecting cervical intraepithelial pathologies: a prospective observational study.

OBJECTIVE: To assess the effect of TruScreen™ (an objective optoelectronic cervical screening device) in improving the sensitivity of cervical screening programs either alone or in combination with Papanicolaou (PAP) smear or human papilloma virus (HPV) DNA screening. MATERIAL AND METHODS: Our study was performed in 285 patients with abnormal Pap test results. TruScreen™ and HPV screening methods were performed in all participants. Consistency and differences between the tests were compared with cervical biopsy results. RESULTS: TruScreen™ was found to be an approach method in the determination of cervical pathologies (ROC curve area underlined=0.606) and with an 89.5% negative predictive value. HPV screening remains a counterpart to TruScreen™ with a 0.620 area underlined in the ROC curve and an 83% negative predictive value. CONCLUSION: As determined in our study, TruScreen™ with a sensitivity of 86.1% can be used as a screening test with instant and not professional dependent results for cervical cancer screening. Avoiding from subjectivity in interpretation of Pap smears and requirement for pathologists, TruScreen™ can be a used for cervical cancer screening especially in countries with a low socio-economic status. The combination of TruScreen™ and HPV screening was not able to demonstrate a significant rise of effectiveness in screening.

Is mucinous adenocarcinoma of the endometrium a risk factor for lymph node involvement? A multicenter case-control study.

PURPOSE: The purpose of this multicenter case-control study was to compare the demographic and clinical characteristics of patients with mucinous adenocarcinoma of the endometrium (MAE) and endometrioid endometrial carcinoma (EEC). METHODS: A retrospective review of two cancer registry databases in Turkey was conducted to identify patients diagnosed with MAE between January 1996 and December 2012. Each patient was matched with a control EEC patient by age and tumor grade. Cases and controls were compared in terms of known risk factors for lymph node metastasis, disease-free survival (DFS), and overall survival (OS). RESULTS: The analysis included 112 patients with MAE and 112 with EEC. No significant difference in baseline characteristics was evident between the two groups. Lymphovascular space invasion, deep myometrial invasion, cervical involvement, and tumor diameter did not differ significantly between the mucinous and endometrioid cases. Multivariate analysis confirmed that only mucinous histology (OR 2.2, 95 % CI 1.1-4.5; P = 0.02) was an independent predictor of lymph node involvement. Although the median DFS and OS tended to be better in the endometrioid group, the differences were not statistically significant. Routine appendectomy was performed in 52 (46.2 %) patients with MAE. No mucinous tumor of the appendix was identified. CONCLUSION: Routine appendectomy is not necessary when the appendix is grossly normal at the time of surgery for MAE. Although the DFS and OS of EEC and MAE patients were similar, the risk of nodal metastasis in MAE patients was greater than that in ECC patients, and we thus suggest to perform retroperitoneal lymphadenectomy (both pelvic and para-aortic) for patients with MAE during the initial operation.

Retrospective evaluation of borderline ovarian tumors: single center experience of 183 cases.

PURPOSE: Borderline ovarian tumors (BOTs) constitute about a quarter of epithelial ovarian malignancies and require different treatment approaches. The present study aims to document the experience of a single center on the treatment outcome of women who had conservative or comprehensive surgery for BOTs. METHODS: One hundred eighty-three patients with BOTs, diagnosed and/or treated in our center between January of 2000 and March of 2013, were reviewed retrospectively. RESULTS: The mean age at diagnosis was 40.6 years old (range 17-78). Ninety-five patients (51 %) were ≤40 years. Comprehensive surgical staging and fertility sparing surgery were performed in 49 % (n = 91) and 48 % of patients (n = 89) respectively. A hundred and forty-seven patients had stage IA disease (80 %). The most common type of BOT was serous in histology with 18 % bilateralism. CA-125 and CA-199 levels were increased in 29 (19 %) and 15 (10 %) patients with stage IA disease. Non-invasive tumor implants were diagnosed in 9 patients (4 %) and uterine involvement was 2 % among BOT patients that underwent hysterectomies. The mean post-operative follow-up period was 20.4 months (range 6-78 months). Disease recurrence was seen in 5 patients indicating overall recurrence rate of 2.7 %. CONCLUSIONS: In our study, we evaluated a large data pool of 183 patients diagnosed with borderline epithelial ovarian tumors. BOTs have a relatively better prognosis than invasive epithelial ovarian cancer. Surgery with proper staging is the cornerstone of treatment. Patients with BOTs at the early stage can undergo fertility sparing surgery with close follow-up.

Addition of parity to the risk of malignancy index score in evaluating adnexal masses.

OBJECTIVE: The aim of our study was to evaluate the individual contribution of parity when incorporated as another parameter into the four risk of malignancy indices (RMI 1-4) to differentiate noninvasive benign lesions from invasive malignant ovarian lesions. MATERIALS AND METHODS: After calculating RMI 1-4 for each patient included in this study, the resulting RMI scores were further multiplied by the parity score (P) of each patient to calculate the RMI parity (RMIP) score. RESULTS: A cutoff value of 300 for RMIP 1 yielded 95.0% specificity, 97.4% negative predictive value (NPV), 88.5% sensitivity, and 79.3% positive predictive value (PPV) and performed better than RMI 1 in the preoperative diagnosis of invasive malignant lesions. RMIP 2 with a cutoff value of 400 yielded 95.0% specificity, 97.4% NPV, 88.5% sensitivity, and 79.3% PPV, and it also performed better than RMI 2. A cutoff value of 400 for RMIP 3 provided 97.5% specificity, 97.5% NPV, 88.5% sensitivity, and 88.5% PPV and performed better than RMI 3. However, a cutoff value of 400 for RMIP 4 provided 90.0% specificity, 97.3% NPV, 88.5% sensitivity, and 65.7% PPV but did not perform better than RMI 4 in the preoperative diagnosis of invasive malignant lesions. CONCLUSION: RMIP 1-3 scales were more reliable tools for the preoperative diagnosis of invasive adnexal masses compared with the traditional RMI 1-3 scales.

Role of a risk of malignancy index in clinical approaches to adnexal masses.

OBJECTIVE: The aim of this study was to evaluate predictive role of risk of malignancy index in discriminating between benign and malignant adnexal masses preoperatively. METHODS: This retrospective study was conducted with a total of 569 patients with adnexal masses/ovarian cysts managed surgically at our clinic between January 2006 and January 2012. Obtained data from patient files were age, gravidity, parity, menopause status, ultrasound findings and CA125 levels. For all patients ultrasound scans were performed. For the assessment of risk of malignancy index (RMI) Jacobs' model was used. Histopathologic results of all patients were recorded postoperatively. Malignancy status of the surgically removed adnexal mass was the gold standard. RESULTS: Of the total masses, 245 (43.1%) were malignant, 316 (55.5%) were benign and 8 (1.4%) were borderline. The mean age of benign cases was lower than malign cases (35.2±10.9 versus 50.8±13.4, p<0.001). Four hundred and five of them (71.2%) were in premenopausal period. Malignant tumors were more frequent in postmenopausal women (81% versus 29%, p<0.001). All ultrasound parameters of RMI were statistically significantly favorable for malignant masses. In our study ROC curve analysis for RMI provided maximum Youden index at level of 163.85. When we based on cutoff level for RMI as 163.85 sensitivity, specificity , PPV, NPV was calculated 74.7%, 96.2%, 94% and 82.6%, respectively. CONCLUSIONS: RMI was found to be a significant marker in preoperative evaluation and management of patients with an adnexal mass, and was useful for referring patients to tertiary care centers. Although utilization of RMI provides increased diagnostic accuracy in preoperative evaluation of patient with an adnexal mass, new diagnostic tools with higher sensitivity and specificity are needed to discriminate ovarian cancer from benign masses.

Persistent ascites due to sclerosing encapsulating peritonitis mimicking ovarian carcinoma: A case report.

Sclerosing encapsulating peritonitis, also known as 'Cocoon Syndrome', is a rare cause of bowel obstruction. The condition might be congenital or acquired and has non-specific symptomatology. Abdominal pain occurs due to the limitation of intestinal motility or segment obstruction by a thick homogenous fibrotic mantle covering the intra-peritoneal organs. Altered peritoneal fluid dynamics result in persistent ascites. Leading pathogenic theories are not well defined, but genetic factors, retrograde trans-tubal flow of causative agents, peritoneal infections, medications and peritoneal invasive procedures are all thought to play a role. There are no specific diagnostic criteria and exact diagnosis is only confirmed during surgery when the investing thick fibrous folds covering the bowel loops are visualised. We present here a case that had been suspected to have an ovarian malignancy due to a huge abdominal heterogeneous mass and ascites on preoperative diagnostic workup, but had a final diagnosis of abdominal Cocoon Syndrome made during surgery.

Clinical significance of atypical squamous cells of undetermined significance in detecting preinvasive cervical lesions in post- menopausal Turkish women.

BACKGROUND: To evaluate the clinical significance of atypical squamous cells of undetermined significance (ASCUS) in PAP test in post-menopausal women and compare with reproductive age women. MATERIALS AND METHODS: A total of 367 patients who referred to our gynecologic oncology clinic were included to the study between September 2012 and August 2013. Data for 164 post-menopausal (group 1) and 203 pre-menopausal (group 2) women with ASCUS cytology were evaluated retrospectively. Immediate colposcopy and endocervical curettage was performed for both groups and conization for all women with a result suggestive of CIN2-3. Histopathological results and demographic features of patients were compared between the two groups. RESULTS: Mean age of the patients was 54.6±6.5 years in group 1 and 38±6.6 years in group 2. Some 14 (8.5%) of post- menopausal women and 36 (17.7%) of pre-menopausal women were current smokers (p=011). Totals of 38 (23.2%) post-menopausal and 64 (31.5%) pre-menopausal women were assessed for HPV-DNA. High risk HPV was detected in 7 (4.3%) and 21 (10.3%), respectively (p=0.029). Final histopathological results recorded were normal cervix, low grade cervical intra-epithelial neoplasia (CIN 1), and high grade cervical intra-epithelial neoplasia (CIN2-3). In group 1 results were 84.8%, 12.2% and 1.8%, respectively, and in group 2 were 71.9%, 23.2% and 4.9%. There were no cases of micro invasive or invasive cervical carcinoma in either group. Two cases were detected as endometrial carcinoma in the menopausal group (1.2%). CONCLUSIONS: In current study we found that preinvasive lesions were statistically significantly higher in pre-menopausal women than post- menopausal women with ASCUS. Cervicitis was more common in menopausal women. Therefore, we think that in case of ASCUS in a post-menopausal woman there is no need for radical management.

Utility of frozen section pathology with endometrial pre-malignant lesions.

AIM: To determine utility of the frozen section (FS) in the operative management of endometrial pre-malignant lesions. MATERIALS AND METHODS: We retrospectively analyzed patients who underwent abdominal hysterectomy with preoperative diagnosis of complex atypical endometrial hyperplasia (CAEH) and simple endometrial hyperplasia (SEH) between May 2007 and December 2013. Frozen and paraffin section (PS) results were compared. Sensitivity, specificity, the positive predictive value (PPV), the negative predictive value (NPV) and the accuracy in predicting EC on FS were evaluated with 95% confidence intervals (CIs) for each parameter. The correlation between FS and PS was calculated as an κ coefficient. RESULTS: Among 143 preoperatively diagnosed CAEH cases, 60 (42%) were malignant and 83 (58%) were benign in PS; and among 60 malignant cases diagnosed in PS, 43 (71%) were "malignant" in FS. Sensitivity, specificity, PPV and NPV for FS were 76%, 100%, 100% and 87.5%, respectively. CONCLUSIONS: We found that FS is reliable and applicable in the management of endometrial hyperplasias. It is important that the pathologist should be experienced because FS for endometrial pre-malignant lesions has significant inter-observer variability. The other conclusion is that patients with the diagnosis of EH, especially those who are postmenopausal, should undergo surgery where FS investigation is available.

Is target oriented surgery sufficient with borderline ovarian tumors? - Role of accompanying pathologies.

BACKGROUND: There are limited data in the literature related to concomitant genital or extra-genital organ pathologies in patients with borderline ovarian tumors (BOTs). The aim of this study was to evaluate our experience with 183 patients to draw attention to the accompanying organ pathologies with BOTs. MATERIALS AND METHODS: One hundred eighty-three patients with BOTs, diagnosed and/or treated in our center between January of 2000 and March of 2013 were evaluated retrospectively. Data related to age, tumor histology, lesion side, disease stage, accompanying incidental ipsilateral and/or contralateral ovarian pathologies, treatment approaches, and follow-up periods were investigated. Incidental gynecologic and non-gynecologic concomitant organ pathologies were also recorded. RESULTS: The mean age at diagnosis was 40.6 years (range: 17-78). Ninety- five patients (51%) were ≤40 years. A hundred and forty-seven patients (80%) were at stage IA of the disease. The most common type of BOT was serous in histology. Non-invasive tumor implants were diagnosed in 4% and uterine involvement was found 2% among patients who underwent hysterectomies. There were 12 patients with positive peritoneal washings. Only 17 and 84 patients respectively had concomitant ipsilateral and concomitant contralateral incidental ovarian pathologies. The most common type of uterine, appendicular and omental pathologies were chronic cervicitis, lymphoid hyperplasia and chronic inflammatory reaction. CONCLUSIONS: According to our findings most of accompanying pathologies for BOT are benign in nature. Nevertheless, there were additional malignant diseases necessitating further therapy. We emphasize the importance of the evaluation of all abdominal organs during surgery.

Predictive role of the neutrophil lymphocyte ratio for invasion with gestational trophoblastic disease.

PURPOSE: The objective of this study was to assess the predictive role of the neutrophil/lymphocyte ratio (NLR) for invasion of gestational trophoblastic disease (GTD). MATERIALS AND METHODS: A retrospective analysis was conducted on 127 women who were managed at our clinic for GTD. Of all patients, 8 showed invasion according to histological examination. The clinical parameters of patients with invasive GTD (Group 1; n=8) were compared with patients who showed no invasion (Group 2; n=119). All underwent a prior uterine evacuation and followed up by regular assessment of ß-hCG titers. RESULTS: Demographic and obstetric history and pre-evacuation hCG levels of the patients showed no statistically significantly difference between the groups (p>0.05). The mean gestational weeks (GW), size of the GTD and NLR levels were statistically significantly higher in the invasive GTD group (p<0.05). Correlations between invasion and gestational weeks, size of GTD, post-evacuation chemotherapy and NLR were evident. ROC curve analysis demonstrated that GW, size of GTD and NLR may be discriminative parameters in predicting invasion of GTD. CONCLUSIONS: To the best of our knowledge, this is the first study evaluating the predictive role of NLR in invasion of GTD. In conclusion, we think that pretreatment NLR can be used as a biomarker of invasion in GTD.