Evaluation of the height of the corpus callosum body region in fetal meningomyelocele malformation.

PURPOSE: To investigate height of the corpus callosum (CC) in order to describe the corpus callosum anomalies in fetuses with meningomyelocele (MMC) and compare these findings with the corpus callosum of healthy fetuses. METHODS: In this study, fetal MRI examinations were performed on 44 fetal MMC malformation cases. As the control group, 34 fetal MRI examinations, which were anatomically normal, were evaluated retrospectively. In the study group, lateral ventricle diameter, the level and diameter of the MMC defect, and CC height were measured. In the control group, CC height and lateral ventricular diameter were measured. RESULTS: The mean CC body height was 1.36 mm in the study group, and 2.48 mm in the control group. The height of the CC body region of the study population was inclined to be thinner compared with the control population (p<0.001). CONCLUSIONS: The fact that the height of the CC body region was found to be thinner in fetal MRI in cases of MMC compared with normal fetuses suggests that various callosal anomalies are uncertain, investigation of additional callosal anomalies may be beneficial in the decision for the continuation of pregnancy, and termination or intrauterine surgery in cases with MMC. Further large case group studies are needed.

Appendix and uterus metastasis of squamous cell carcinoma arising from mature cystic teratoma of the ovary.

Mature cystic teratoma of the ovary rarely undergoes malignant transformation. There is no consensus for a treatment modality because of the rarity of the disease. Herein we present a case of squamous cell carcinoma (SCC) arising in a mature cystic teratoma (MCT) in a 66-year-old patient. The patient underwent total hysterectomy and bilateral salpingo-oophorectomy, omentectomy, appendectomy, and bilateral pelvic + paraaortic lymph node dissection. The histopathological examination revealed malignant invasion of the appendix and uterus. The patient, who refused the continuation of treatment initiated with the administration of a single dose of cisplatin, died 5 months later because of the disease. It is imperative that gynecologists consider appendectomy in SCC arising from MCT cases.

Can serum oestradiol be a predictor of quality of oocytes and embryos, maturation of oocytes and pregnancy rate in ICSI cycles?

Our aim was to assess the influence of ratios of oestradiol (E2) to either number of follicles ≥ 14 mm on the day of human chorionic gonadotropin administration (E2/fol) or the number of oocytes retrieved (E2/o) during oocyte pick up and total serum E2 levels on the day of embryo transfer (ETE2) on the outcome of ICSI cycles. The assessed outcomes were number of oocytes retrieved (NRO), number of mature oocytes (NMO), number of fertilised oocytes (NFO), number of transferred embryos (NTE), qualities of oocytes (OQS), qualities of embryos (EQS) and pregnancy rates (PR). Two hundred and twenty-seven ICSI-ET cycles admitted to our IVF clinic during a 2-year period with normal ovarian reserve receiving long luteal GnRH agonist protocol were included. The E2/fol levels correlated positively with NRO (r = 0.202, p = 0.002), NMO (r = 0.199, p = 0.003) and NFO (r = 0.159, p = 0.018). However, we observed negative correlations between E2/o and NMO (r = -0.329, p <0.001), NFO (r = -0.219, p = 0.001), EQ5 (r = -0.203, p = 0.040). Oocyte quality scores were not affected from either E2/fol or E2/o levels. Implantation, clinical and ongoing PRs were comparable between groups categorised due to E2/fol, E2/o and ETE2. It seems that high E2/fol ratio may have beneficial effects on NRO, NMO and NFO while E2/o may adversely affect these parameters. Neither of the E2 levels is associated with pregnancy rates in women with normal ovarian reserve.

Serum IL-6 level may have role in the pathophysiology of unexplained infertility.

PROBLEM: The aim of this study was to compare the serum levels of interleukin (IL)-6 of women with unexplained infertility with fertile subjects. METHOD OF STUDY: Serum IL-6, and tumor necrosis factor-alpha (TNF-alpha) levels of 45 infertile and 44 fertile women on day 3 of menstrual cycle were assessed and compared for this prospective controlled study. RESULTS: The mean serum IL-6 level was significantly higher in women with unexplained infertility, compared with fertile women (5.71 +/- 1.81 and 4.31 +/- 1.79, P < 0.001, Student's t-test). There was no significant difference in TNF-alpha level among the groups. CONCLUSION: Significant difference in serum IL-6 levels between unexplained infertile and fertile women suggests that this cytokine may be involved in pathophysiology of unexplained infertility.

Testosterone versus clobetasol for maintenance of vulvar lichen sclerosus associated with variable degrees of squamous cell hyperplasia.

OBJECTIVE: To evaluate the therapeutic regimens and symptomatic response rates in patients with vulvar lichen sclerosus associated with variable degrees of squamous cell hyperplasia (mixed disease). MATERIAL AND METHODS: Eighty-three women with biopsy-proven vulvar mixed disease were evaluated for this retrospective study. All patients were initially treated with topical fluorinated corticosteroids, and then 2% testosterone propionate in petrolatum or 0.05% clobetasol 17-propionate (44 (53%) versus 39 (47%)). RESULTS: The remission rates were 82 and 93% in the testosterone and clobetasol subgroups at the end of 6 months (p=0.112), respectively. The disease recurred in 8% of the patients. The recurrence rates in the testosterone and clobetasol arms were 13 and 5%, respectively (p=0.163). The histopathological review of the repeat vulvar biopsies of the patients without symptomatic relief revealed 6 (60%) patients with persistent disease, 2 (20%) with lichen sclerosus, 1 (10%) with atypical squamous hyperplasia, and 1 (10%) with VIN1. Two patients with recurrent disease and 2 patients with vulvar intraepithelial neoplasia I-II or atypical squamous hyperplasia were treated with skinning vulvectomy. CONCLUSIONS: Clobetasol resulted in higher remission and lower recurrence rates than those in testosterone therapy, although statistically significant differences were not obtained. In the evaluation of patients without symptomatic relief, the first step should be a vulvar biopsy to exclude the presence of atypical components.

Is there a correlation between tumor marker panel and tumor size and histopathology in well staged patients with borderline ovarian tumors?

AIMS: To investigate whether there is a correlation between serum tumor markers panel (CA 125, CA 19-9, CA 15-3, and carcinoembryonic antigen (CEA)) and tumor size and histopathology in well staged patients with borderline ovarian tumors (BOTs). METHODS: Four tumor markers (CA 125, CA 19-9, CA 15-3, and CEA) were analysed clinically in 60 well staged patients with borderline ovarian tumor, for this retrospective observational study. RESULTS: Most patients had serous histology and early stage disease, and the mean age at the time of diagnosis was 40.70 years (range: 19-73). Twenty-nine patients (48.3%) had high CA 125 levels (>35 U/l), 15 patients (25%) had high levels of CEA (>4 ng/ml), 12 patients (20%) had high levels of CA 19-9 (>37 U/ml), and 9 patients (15%) had high levels of CA 15-3 (>30 ng/ml) at the time of initial surgery. The positive rate of CA 125, CA 19-9, CA 15-3, and CEA in serous tumor were 57.9, 7.9, 7.9 and 15.8%, respectively. These figures were 31.8, 40.9, 27.3 and 40.9% in mucinous tumor. The positive rate of CA 125 in the serous group was statistically significantly higher than that in the mucinous group, while the positive rates for CA 19-9 and CEA in mucinous histology was significantly higher than those in serous tumors. In case of grouping the tumor size as <4, 4.1-10 and >10 cm, the mean serum levels of tumor markers had significantly increased by increasing tumor size (p<0.05 for CA 125, and CA 19-9, p>0.05 for CA 15-3, and CEA). CONCLUSION: The high levels of tumor markers, especially for CA 125 and CA 19-9, may indicate the larger tumor size. The elevation of serum CA 125 may suggest serous tumors, while the high level of serum CA 19-9 and CEA may indicate mucinous BOTs.

Partial molar pregnancy and coexisting fetus with diploid karyotype.

OBJECTIVES: To evaluate cases of partial hydatidiform mole coexisting with a live fetus, including an observation of our own, and to discuss the proper antenatal management of women wishing to continue with a partial molar pregnancy. METHOD: A PubMed search was then undertaken, extending over the time period from 1975 to 2006, using the keywords 'partial hydratidiform mole', 'hydatidiform mole' and 'coexisting fetus'. RESULTS: At 16 weeks of gestation, an ultrasonographic examination revealed a normal fetus with an extremely large, multicystic placenta. The woman was informed of future risks but wished to continue with the pregnancy. The pregnancy progressed until 28 weeks without any complication but ended spontaneously with a vaginal delivery; the fetus had died in utero. Pathologic examination of the placenta revealed areas of hydropic degeneration and necrosis. Including our own observation, 17 cases of partial hydatidiform mole associated with a fetus of normal karyotype have been documented. CONCLUSION: Although the rate of adverse perinatal outcome is high, we still believe that if amniocentesis or fetal blood sampling reveals a normal karyotype, then continuing the affected pregnancy with close follow-up in tertiary centers is a feasible choice.

Vulvar edema as a rare complication of laparoscopy.

Vulvar edema as a complication of laparoscopy is a rare condition. A 23-year-old woman was admitted with progressive dysmenorrhea and underwent laparoscopic bilateral endometrioma cystectomy. Twenty-seven hours after surgery, unilateral vulvar edema was observed. It resolved with the application of ice packs and insertion of a Foley catheter. We conclude that this is a rare, normally benign condition that is easy to manage.

Two successful spontaneous pregnancies in a patient with a primary primitive neuroectodermal tumor of the ovary.

OBJECTIVE: To describe a patient with primary primitive neuroectodermal tumor of the ovary with two successful spontaneous pregnancies. DESIGN: Case report. SETTING: Tertiary center for gynecologic oncology. PATIENT(S): A 25-year-old woman with two spontaneous pregnancies 5 months after and 2 years after conservative treatment of International Federation of Gynecology and Obstetrics stage IC primary primitive neuroectodermal tumor of the ovary. INTERVENTION(S): Assessment of extraovarian spread with staging laparotomy. Four courses of BEP (bleomysin, etoposide, cisplatin) and, for recurrent disease, six courses of salvage VIP (vinblastin, iphosphamide, mesna, cisplatin) chemotherapy. MAIN OUTCOME MEASURE(S): Two successful deliveries and no residual ovarian cancer. RESULTS(S): A healthy, normal female infant weighing 3600 g was delivered by cesarean section at 38 weeks' gestation. Sixteen months later another infant, a healthy, normal male weighing 3500 g, was delivered by cesarean section at 38 weeks' gestation. No residual cancer was detected at follow-up 12 months after the last delivery. CONCLUSION(S): Conservative fertility-preserving treatment might be considered in patients with primary primitive neuroectodermal tumor of the ovary. Without any assisted reproductive technologies, spontaneous pregnancies might occur.