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1.
Cytopathology ; 35(6): 757-760, 2024 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-38989556

RESUMO

OBJECTIVE: We aimed to investigate differences between HPV-16 mono- and HPV-16/18 co-infections in terms of cervical dysplasia and invasive cancer. METHODS: This multicentre, retrospective study spanned from December 2017 to December 2020, involving women who visited gynaecological oncology clinics for colposcopy with either HPV-16 or HPV-16/18 positivity. A total of 736 patients, 670 in Group 1 (HPV-16 positivity) and 66 in Group 2 (HPV-16/18 positivity), were compared for the presence of CIN2+ lesions detected by colposcopic biopsy or endocervical curettage (ECC). Exclusions included hysterectomized patients, those with prior gynaecological cancers, and patients with HPV positivity other than types 16 and 18. RESULTS: Among the included patients, 42.4% had a diagnosis of CIN2+ lesions. The cytology results demonstrated abnormal findings in 45.3% in Group 1 and 42.2% in Group 2, with no significant difference between the groups. ECC revealed CIN2+ lesion in 49 (8.7%) patients in group 1, while only 1 (1.7%) patient had CIN2+ lesion in group 2. There was no difference between 2 groups in terms of ECC result (p = 0.052). In group 1, 289 (43.1%) patients had CIN2+ lesion, while 23 (34.8%) patients had CIN2+ lesions in group 2. There was no difference between group 1 and 2 in terms of diagnosis of CIN2+ lesions (p = 0.19). CONCLUSION: This multicentre retrospective study found no significant differences between HPV-16 mono- and HPV-16/18 co-infections regarding cervical pathologies. Larger studies are needed to validate and further explore these findings.


Assuntos
Coinfecção , Papillomavirus Humano 16 , Papillomavirus Humano 18 , Infecções por Papillomavirus , Displasia do Colo do Útero , Neoplasias do Colo do Útero , Humanos , Feminino , Papillomavirus Humano 16/isolamento & purificação , Papillomavirus Humano 16/patogenicidade , Infecções por Papillomavirus/patologia , Infecções por Papillomavirus/virologia , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/complicações , Papillomavirus Humano 18/isolamento & purificação , Papillomavirus Humano 18/patogenicidade , Estudos Retrospectivos , Adulto , Coinfecção/patologia , Coinfecção/virologia , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/virologia , Neoplasias do Colo do Útero/diagnóstico , Pessoa de Meia-Idade , Displasia do Colo do Útero/patologia , Displasia do Colo do Útero/virologia , Displasia do Colo do Útero/diagnóstico , Colposcopia , Colo do Útero/patologia , Colo do Útero/virologia
2.
J Turk Ger Gynecol Assoc ; 25(2): 90-95, 2024 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-38868461

RESUMO

Objective: To determine whether patients with atypical squamous cells, cannot exclude high grade squamous intraepithelial neoplasia (ASC-H) cytology have a correlation between high-risk human papillomavirus (HPV) type and CIN 2+1 lesion in final pathology. Material and Methods: The study was conducted retrospectively, using data from three tertiary gynecologic oncology centers located in various regions of Turkey. Data from 5,271 patients who had colposcopy between January 2003 and January 2021 were analyzed. Results: A total of 163 patients who had ASC-H cervical cytology test results, based on the Bethesda 2014 classification were eligible, and of these 83 (50.9%) who tested positive for HPV were included in the study. There was no correlation between the occurrence of CIN 2+ lesions and age (p=0.053). If there was any HPV 16 positivity (only HPV 16, HPV 16 and 18, HPV 16 and others) the presence of CIN 2+ lesions in the final pathology increased significantly. In HPV 16 positive ASC-H patients, the probability of CIN 2+ lesions in the final pathology were 72.5% while this rate was 48.1% in HPV 16 negative group (p=0.033). Conclusion: The guidelines do not provide a comprehensive definition of the role of the HPV test in managing ASC-H. Positive high-risk HPV types, especially HPV 16, together with an ASC-H smear result should bring to mind the possibility of high-grade dysplasia.

3.
Asia Pac J Clin Oncol ; 20(2): 292-298, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36823769

RESUMO

OBJECTIVE: To investigate the clinicopathological features, prognostic factors, treatment, clinical response, and outcome of gestational choriocarcinoma (GCC). MATERIALS AND METHODS: A retrospective review was made of the clinicopathological and survival data of 13 patients who were diagnosed and treated for GCC in two referral centers in Turkey between 1992 and 2020. RESULTS: The median age of patients was 36 years (range, 27-54 years), and seven were ≤39 years. The antecedent pregnancy was a term in nine (69.2%) cases, and the risk score was ≥7 in 11 (84.6%). According to the International Federation of Gynecology and Obstetrics 2009 staging, eight cases were in stage I, two in stage III, and three in stage IV. With the exception of one patient, all the others received combination chemotherapy (CT), and two of those were also treated with radiotherapy. Chemoresistance developed in 50% (6/12), and second-line CT was given to four of these. The overall complete response rate was 69.2%. Four patients died of chemoresistance and disease progression, all of them were with antecedent-term pregnancy, had high scores ≥7, and had metastases. CONCLUSION: GCC is a unique subtype of gestational trophoblastic neoplasia, which differs from others in terms of poor prognosis, a frequent tendency to early metastasis, and resistance to treatment. To be able to achieve the most efficient therapy and prognosis, histopathology-based risk models should be developed.


Assuntos
Coriocarcinoma , Doença Trofoblástica Gestacional , Gravidez , Feminino , Humanos , Adulto , Pessoa de Meia-Idade , Estudos Retrospectivos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Doença Trofoblástica Gestacional/tratamento farmacológico , Doença Trofoblástica Gestacional/patologia , Coriocarcinoma/tratamento farmacológico , Prognóstico
4.
J Gynecol Oncol ; 35(3): e39, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38156722

RESUMO

OBJECTIVE: To define the clinical, histopathological features and the prognostic factors affecting survival in patients with adult granulosa cell tumors of the ovary (AGCT). METHODS: A 322 patients whose final pathologic outcome was AGCT treated at nine tertiary oncology centers between 1988 and 2021 participated in the study. RESULTS: The mean age of the patients was 51.3±11.8 years and ranged from 21 to 82 years. According to the International Federation of Gynecology and Obstetrics 2014, 250 (77.6%) patients were stage I, 24 (7.5%) patients were stage II, 20 (6.2%) patients were stage III, and 3 (7.8%) were stage IV. Lymphadenectomy was added to the surgical procedure in 210 (65.2%) patients. Lymph node involvement was noted in seven (3.3%) patients. Peritoneal cytology was positive in 19 (5.9%) patients, and 13 (4%) had metastases in the omentum. Of 285 patients who underwent hysterectomy, 19 (6.7%) had complex hyperplasia with atypia/endometrial intraepithelial neoplasia, and 8 (2.8%) had grade 1 endometrioid endometrial carcinoma. It was found that 93 (28.9%) patients in the study group received adjuvant treatment. Bleomycin, etoposide, cisplatin was the most commonly used chemotherapy protocol. The median follow-up time of the study group was 41 months (range, 1-276 months). It was noted that 34 (10.6%) patients relapsed during this period, and 9 (2.8%) patients died because of the disease. The entire cohort had a 5-year disease-free survival (DFS) of 86% and a 5-year disease-specific survival of 98%. Recurrences were observed only in the pelvis in 13 patients and the extra-abdominal region in 7 patients. The recurrence rate increased 6.168-fold in patients with positive peritoneal cytology (95% confidence interval [CI]=1.914-19.878; p=0.002), 3.755-fold in stage II-IV (95% CI=1.275-11.063; p=0.016), and 2.517-fold in postmenopausal women (95% CI=1.017-6.233; p=0.046) increased. CONCLUSION: In this study, lymph node involvement was detected in 3.3% of patients with AGCT. Therefore, it was concluded that lymphadenectomy can be avoided in primary surgical treatment. Positive peritoneal cytology, stage, and menopausal status were independent prognostic predictors of DFS.


Assuntos
Tumor de Células da Granulosa , Neoplasias Ovarianas , Humanos , Feminino , Pessoa de Meia-Idade , Tumor de Células da Granulosa/patologia , Tumor de Células da Granulosa/terapia , Tumor de Células da Granulosa/mortalidade , Adulto , Estudos Retrospectivos , Idoso , Prognóstico , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/mortalidade , Neoplasias Ovarianas/terapia , Turquia/epidemiologia , Idoso de 80 Anos ou mais , Adulto Jovem , Excisão de Linfonodo , Estadiamento de Neoplasias , Histerectomia , Quimioterapia Adjuvante , Metástase Linfática
5.
Artigo em Inglês | MEDLINE | ID: mdl-38063009

RESUMO

Objective: To determine factors affecting obstetric outcomes in pregnancies after conization by loop electrosurgical excision procedure (LEEP) or cold-knife conization (CKC) due to cervical intraepithelial neoplasia (CIN). Material and Methods: The maternal and clinical characteristics and obstetric outcomes of CKC, LEEP and control groups were evaluated and compared. Risk factors for adverse pregnancy outcomes were evaluated using multiple logistic regression analyses. Results: The incidence of preterm delivery, PPROM, low APGAR scores, fetal mortality, and late-period spontaneous abortus was highest in patients who underwent CKC (p<0.05). Cone depth of CKC was longer than LEEP (p=0.025). Cervical length (CL) at pregnancy was CKC

6.
Complement Ther Clin Pract ; 52: 101748, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37054616

RESUMO

BACKGROUND: and purpose: To date, there has been very limited experimental research on the impact of ylang ylang oil and lemon oil inhalation labor pain. This study was conducted to investigate the effects of aromatherapy, one of the non-pharmacological pain methods, on anxiety and labor pain in the active phase in primiparous pregnant women. METHODS: A randomized controlled trial design was used in the study, which was conducted with 45 primiparous pregnant women. Volunteers were randomized into the lemon oil group (n = 15), ylang-ylang oil group (n = 15), and control group (n = 15) by using the sealed envelope method. The visual analog scale (VAS) and the state anxiety inventory were applied to the intervention and control groups before the application. After the application, the VAS and the state anxiety inventory were applied at 5-7 cm dilatation and the VAS was applied alone at 8-10 cm dilatation. The trait anxiety inventory was applied to the volunteers after delivery. RESULTS: The mean pain scores at 5-7 cm dilatation in the intervention groups (lemon oil 6.90, ylang ylang oil, 7.30) were significantly lower than in the control group (9.20) (p = 0.005). There was no significant difference between the groups in terms of their mean pre-intervention and 5-7-cm-dilatation anxiety scores (p = 0.750; p = 0.663), mean trait anxiety scores (p = 0.094), and mean first-and fifth-minute Apgar scores (p = 0.051; p = 0.051). CONCLUSION: It was found that aromatherapy applied by inhalation at labor reduced the perception of labor pain but had no effect on anxiety.


Assuntos
Aromaterapia , Dor do Parto , Humanos , Feminino , Gravidez , Dor do Parto/tratamento farmacológico , Gestantes , Ansiedade/tratamento farmacológico , Óleos de Plantas/uso terapêutico , Aromaterapia/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto
7.
Cytopathology ; 34(2): 130-137, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36571109

RESUMO

OBJECTIVE: The Papanicolaou (Pap) smear test is a standard screening test that detects cervical lesions and cancers. In this multicentric study, we performed a retrospective analysis of cytological results associated with atypical glandular cells, not otherwise specified (AGC-NOS). METHODS: We retrospectively reviewed Pap smear tests that resulted as AGC-NOS. A total of 254 women who underwent colposcopy due to a Pap smear result of AGC-NOS were included the study between 2003 and 2021. The ages, Pap smear results, HPV results if any, colposcopic biopsy results, endocervical and endometrial pathology results, and management of these patients were analysed. RESULTS: Two hundred fifty-four patients with AGC-NOS Pap smear results were included in the study. A total of 70 (27.6%) patients had cervical and endometrial premalignant or malignant lesions. Malignancy was observed in 17 (6.7%) patients (endometrium, n = 11 [4.3%]; cervix, n = 6 [2.4%]). Isolated premalignant or malignant lesions of the cervix and endometrium were detected in 57 (22.4%) and 12 (4.7%) patients, respectively. CONCLUSIONS: Patients diagnosed with AGC-NOS should undergo a careful evaluation with all clinicopathological features. Because cancer of the cervix and endometrium is not rare in patients diagnosed with AGC-NOS, colposcopic examination with endocervical sampling should be a priority based on a cervicovaginal smear. Endometrial sampling is also required according to the patient's clinic, age, and examination characteristics.


Assuntos
Lesões Pré-Cancerosas , Displasia do Colo do Útero , Neoplasias do Colo do Útero , Humanos , Feminino , Teste de Papanicolaou , Esfregaço Vaginal/métodos , Estudos Retrospectivos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/patologia , Colo do Útero/patologia , Lesões Pré-Cancerosas/patologia , Displasia do Colo do Útero/patologia
8.
Arch Gynecol Obstet ; 308(1): 193-200, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-36543966

RESUMO

PURPOSE: To investigate the role of partial human papillomavirus (HPV) genotyping tests in predicting the diagnosis of high-grade cervical intraepithelial lesion and cancer (HSIL +) as a result of colposcopic histopathology. MATERIALS AND METHODS: The study included 2872 patients who presented at our colposcopy unit between January 1, 2015 and December 31, 2019 and underwent colposcopy for the first time. The patients were compared in terms of HSIL + results as HPV 16/18 and HPV other type positive groups. RESULTS: HSIL + was determined at the rate of 22.3% in the HPV 16/18 group and at 7.0% in the HPV Other group, and the difference was statistically significant (p = 0.000). HPV 16/18 types were found to be responsible for 84.8% of cervical cancers and 83.5% of HSIL and worse cases. CONCLUSION: Partial HPV 16/18 genotyping is an effective strategy in the triage of HPV-positive women. HPV type identification consistent with the epidemiology of HPV types in HSIL + cases in the screened population, and the age-appropriate use of primary HPV tests will determine the sensitivity and cost effectiveness of screening.


Assuntos
Infecções por Papillomavirus , Displasia do Colo do Útero , Neoplasias do Colo do Útero , Gravidez , Humanos , Feminino , Colposcopia , Genótipo , Papillomavirus Humano 16/genética , Papillomavirus Humano 18 , Neoplasias do Colo do Útero/patologia , Papillomaviridae/genética , Detecção Precoce de Câncer/métodos , Displasia do Colo do Útero/patologia
9.
J Turk Ger Gynecol Assoc ; 23(1): 22-27, 2022 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-35000896

RESUMO

OBJECTIVE: The purpose of the present study was to evaluate the clinical and pathological features and oncological outcomes of Brenner tumors (BT). MATERIAL AND METHODS: Evaluation was performed on the data of 46 patients with BTs retrieved from the oncology clinic database and pathology reports between 2005 and 2020. RESULTS: The median (range) age of the patients was 52 (22-75) years. Median (range) tumor size was 52.5 (5.0-300) mm. The tumor was benign in 37 (80.4%), borderline in one (2.2%), and malignant in the remaining eight (17.4%). Ten (21.7%) of the tumors were detected incidentally. Mixed tumor, BT plus another ovarian pathology, was found in 13 (28.2%). Recurrence developed in 2/8 (25%) with malignant BT (MBT). The stage of these patients was 3C, and both received chemotherapy after surgery. CONCLUSION: BTs are rare and generally detected incidentally. MBTs are treated in the same way as epithelial tumors. Due to the rarity of these tumors, lymphadenectomy and optimal chemotherapy regimens are controversial issues.

10.
J Obstet Gynaecol ; 42(2): 281-288, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33938363

RESUMO

We aimed to evaluate clinicopathological data in high-risk early-stage cervical cancer and to define the prognostic factors determining the oncological outcomes. This retrospective study included 158 patients with stage IB-IIA cervical cancer who underwent radical hysterectomy plus lymph node dissection. Each patient had at least one high-risk factor. The median tumour diameter of the study group was 30 mm (range, 6-80). Seventy-five (47.5%) patients had parametrial invasion, 32 (20.3%) had positive surgical margins, and 108 (68.4%) had lymph node metastasis. The median duration of follow-up was 42 months (range, 1-228). During this period, 28 patients developed recurrence, and the recurrent disease occurred in a distant area in 18 patients. Five-year disease-free survival was 77.5%, and five-year disease-specific survival was 85%. In multivariate analysis, adjuvant radiotherapy was identified as an independent prognostic factor for recurrence and death. The recurrence (Odds ratio: 10.139, 95% CI: 1.477-69.590, p = .018) and mortality rates (Odds ratio: 16.485, 95% CI: 2.484-109.408, p =.004) were higher in patients who did not receive adjuvant therapy.IMPACT STATEMENTWhat is already known on this subject? The decision to proceed with adjuvant therapy in the patients with early-stage disease treated with surgery depends on the presence of risk factors in pathological examination. Various prognostic factors have been identified in cervical cancer (CC). However, there is a limited number of studies describing the prognostic factors in early-stage CC with high-risk factors.What do the results of this study add? In current study, the recurrence and mortality rates were higher in patients who did not receive adjuvant therapy. No relationship was found between the survival outcomes and the number of high-risk factors. Most of the patients who developed recurrence had the recurrence in the distant localisation. This result questioned the adequacy of adjuvant therapy.What are the implications of these findings for clinical practice and/or further research? There is still a debate over the prognostic factors and the adjuvant treatment options in the patients with early-stage cervical cancer who possess high-risk factors. Adjuvant RT or adjuvant concomitant chemoradiotherapy must definitely be used in this patients. However, adjuvant therapy fails approximately 14-32%, thus multimodal treatment modalities must be developed to improve the recurrence rates and the survival.


Assuntos
Neoplasias do Colo do Útero , Quimiorradioterapia Adjuvante , Feminino , Humanos , Histerectomia , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Prognóstico , Radioterapia Adjuvante , Estudos Retrospectivos , Neoplasias do Colo do Útero/patologia
11.
J Matern Fetal Neonatal Med ; 35(12): 2241-2246, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32586147

RESUMO

OBJECTIVE: The aim of the study was to evaluate whether maternal obesity increases the risk of intra-abdominal adhesion formation at cesarean delivery. METHODS: Two hundred and two pregnant women of at least 37 weeks' gestation and who had undergone only one prior cesarean delivery were included in this prospective observational study. The study population was divided into two groups according to body mass index (BMI) upon cesarean delivery (<30 kg/m2 and ≥30 kg/m2). The intra-abdominal adhesion incidence and the scar characteristics of the groups were compared. RESULTS: Intra-abdominal adhesions were more common in women ≥30 kg/m2 than in those <30 kg/m2 (OR 2.0, 95% CI 1.1-3.6). BMI upon cesarean delivery (32.6 ± 6.2 kg/m2 vs. 30.5 ± 4.8 kg/m2, p = .018) and pre-pregnancy BMI (27.9 ± 6.8 kg/m2 vs. 25.7 ± 5.2 kg/m2, p = .026) were higher in women with dense adhesions than in those with either filmy or no adhesions. The omentum was the most adherent tissue, and the omental adhesion rate was also higher in women ≥30 kg/m2 than in those <30 kg/m2 (39.6% vs. 23.7%, p = .016). When the scar characteristics were compared, it was observed that the hyperpigmented scar rate was significantly lower (17.8% vs. 39.6%, p = .001) in women ≥30 kg/m2 with intra-abdominal adhesions (16.7% vs. 35.4%, p = .005). CONCLUSION: Intra-abdominal adhesion formation following cesarean delivery is more common in obese women.


Assuntos
Cicatriz , Obesidade Materna , Índice de Massa Corporal , Cesárea/efeitos adversos , Cicatriz/complicações , Feminino , Humanos , Gravidez , Estudos Prospectivos , Aderências Teciduais/complicações , Aderências Teciduais/epidemiologia
12.
Curr Probl Cancer ; 46(1): 100764, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34275530

RESUMO

BACKGROUND: To determine the rate of high-grade cervical intraepithelial lesion and cancer (HSIL+) diagnosis as a result of colposcopic histopathology in patients aged ≥50 years and to investigate the role of cytology, Human Papillomavirus (HPV) test positivity and HPV genotyping in predicting HSIL+. MATERIAL AND METHOD: The study included 1102 patients aged ≥50 as study group and 2723 patients aged <50 as control group who were admitted to our colposcopy unit between January 1, 2015 and December 31, 2019 and underwent colposcopy for the first time. The patients with HSIL+ were compared as Cytology group and HPV group in the study group. To evaluate the impact of genotyping HPV positive group was compared in terms of HSIL+ results in subgroups with HPV16/18 and HPV other types positivity. Patients diagnosed with cancer in the same period were compared in terms of age, stage and histology as screening cancer group and symptomatic cancer groups. RESULTS: The rate of cervical cancer in the study group was 2.2% and 1.2 % in the control group. In patients diagnosed with cancer, Federation of Gynecology and Obstetrics stage was ≥ stage IB2 in 57.4% of cases in the symptomatic cancer group and in 18.9% of cases in the screening cancer group. The HPV 16/18 positivity rate in HSIL+ patients were 75.0% and 79.5% in the study and control group, respectively. CONCLUSION: Cervical cancer rates were found to be high in the group aged ≥ 50 years. HPV genotyping is as effective in patients ≥50 years of age as in those aged < 50 years. Patients diagnosed as a result of screening are caught in the early stages and therefore with increased general life expectancy, the age at which screening is discontinued should be re-evaluated.


Assuntos
Infecções por Papillomavirus , Neoplasias do Colo do Útero , Detecção Precoce de Câncer/métodos , Feminino , Genótipo , Papillomavirus Humano 16 , Papillomavirus Humano 18/genética , Humanos , Pessoa de Meia-Idade , Papillomaviridae/genética , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/diagnóstico , Gravidez , Neoplasias do Colo do Útero/patologia
13.
Turk J Obstet Gynecol ; 18(3): 190-202, 2021 09 27.
Artigo em Inglês | MEDLINE | ID: mdl-34580469

RESUMO

Objective: This study aimed to evaluate neoadjuvant chemotherapy (NACT) for locally advanced stage cervical carcinoma. Materials and Methods: Data of 43 patients with locally advanced cervical carcinoma who had NACT were reviewed. NACT protocols implemented included cisplatin/5-fluorauracil, cisplatin/UFT, and carboplatin/paclitaxel. After NACT, the patients were re-examined, and patients who had a tumor size ≤40 mm underwent Piver-Rutledge type III radical hysterectomy, while other patients received radiotherapy. Following NACT, clinical responses were assessed according to the criteria of the World Health Organization. Results: The mean age of the patients was 49.4 years, and the median follow-up duration was 48 (range, 5-228) months. The median tumor sizes were 50 and 30 mm before and after NACT, respectively. Complete clinical response was observed in 4 (9.3%) patients, partial clinical response in 8 (18.6%), and pathologic complete response in 3 (6.9%). Stable disease was noted in 30 (69.9%) patients and progression in 1 (2.3%) patient. After NACT, 31 patients have undergone radical surgical procedures. The 5-year disease-free survival rate was 72%, and the 5-year disease-specific survival rate was 91%. Age, International Federation of Gynaecology and Obstetrics 2009 stage, histopathologic type, NACT protocol, rate of decrease in tumor size after NACT, clinical response, number of courses, tumor size before NACT, tumor size after NACT, and lymph node metastasis were not associated with disease-free survival. Conclusion: Following NACT, a significant reduction in tumor dimension was observed, and the probability of radical surgery is increased. However, clinical response was not predictive of survival.

14.
Curr Probl Cancer ; 45(5): 100712, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33685725

RESUMO

To assess the clinicopathological features, prognostic factors, and survival rates associated with uterine leiomyosarcoma (uLMS). Databases from 15 participating gynecological oncology centers in Turkey were searched retrospectively for women who had been treated for stage I-IV uLMS between 1996 and 2018. Of 302 consecutive women with uLMS, there were 234 patients with Federation of Gynecology and Obstetrics (FIGO) stage I disease and 68 with FIGO stage II-IV disease. All patients underwent total hysterectomy. Lymphadenectomy was performed in 161 (54.5%) cases. A total of 195 patients received adjuvant treatment. The 5-year disease-free survival (DFS) and overall survival (OS) rates were 42% and 54%, respectively. Presence of lymphovascular space invasion (LVSI), higher degree of nuclear atypia, and absence of lymphadenectomy were negatively correlated with DFS, while LVSI, mitotic count, higher degree of nuclear atypia, FIGO stage II-IV disease, and suboptimal surgery significantly decreased OS. LVSI and higher degree of nuclear atypia appear to be prognostic indicators for uLMS. Lymphadenectomy seems to have a significant effect on DFS but not on OS.


Assuntos
Leiomiossarcoma/epidemiologia , Leiomiossarcoma/patologia , Neoplasias Uterinas/epidemiologia , Neoplasias Uterinas/patologia , Adulto , Idoso , Feminino , Humanos , Leiomiossarcoma/cirurgia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Turquia/epidemiologia , Neoplasias Uterinas/cirurgia , Adulto Jovem
15.
J Adolesc Young Adult Oncol ; 10(3): 303-308, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-32762565

RESUMO

Purpose: The aim of this study is to evaluate the oncologic outcome in patients with pure ovarian dysgerminomas treated and followed-up in our hospital. Methods: This study included 18 ovarian dysgerminoma patients with unilateral and/or bilateral salpingo-oophorectomy (BSO) ± hysterectomy+omentectomy+bilateral pelvic ± para-aortic lymphadenectomy+peritoneal cytologic sampling. Results: Four (22%) patients underwent definitive surgery, including type I hysterectomy and BSO. Only one of the remaining 14 patients underwent BSO because of bilateral streak gonad presence during intraoperative examination. Thirteen patients (72%) had conservative surgeries. In addition, staging surgeries were performed to all patients except for one patient with 16 weeks of pregnancy (patient #3) in the study group. Retroperitoneal lymphadenectomy was part of the staging procedure except for this pregnant patient. Lymph node metastasis was positive in four (22%) patients. Three (16%) patients recurred and none of them died because of disease during follow-up period. Two of the relapsed patients were treated with combination of surgery and chemotherapy, whereas the third patient received only chemotherapy for treatment. Conclusions: Fertility sparing surgery should be the choice of treatment in patients with pure ovarian dysgerminoma. In addition, staging surgery, including retroperitoneal lymph node dissection is obligatory for determining stage IA patients who are exempt from adjuvant chemotherapy. Close surveillance policy enables early detection of patients with recurrences in whom salvage therapy is highly curable.


Assuntos
Disgerminoma , Neoplasias Ovarianas , Quimioterapia Adjuvante , Disgerminoma/diagnóstico , Disgerminoma/patologia , Disgerminoma/cirurgia , Feminino , Humanos , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Centros de Atenção Terciária
16.
J Obstet Gynaecol ; 40(5): 666-672, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31482755

RESUMO

We designed this study to evaluate any factors associated with positive surgical margin in conisation specimens and to determine the optimal cone size. The medical records of patients who had undergone a loop electrosurgical excision procedure (LEEP), cold-knife conisation (CKC) and needle excision of the transformation zone (NETZ) procedure were reviewed retrospectively. Two hundred and sixty eight women fulfilled the inclusion criteria. Univariate analyses showed that 'postmenopause', 'HSIL on smear', 'previous colposcopic examination revealing HSIL in endocervical curettage (ECC) material and in two or more ectocervical quadrants' and 'managing with LEEP' were significant predictors of surgical margin positivity. Nulliparous patients showed significantly lower rate of surgical margin positivity. 'Postmenopause', 'previous colposcopic examination revealing HSIL in ECC material and in two or more ectocervical quadrants' and 'HSIL on smear' were identified as independent predictors of surgical margin positivity according to multivariate analyses.IMPACT STATEMENTWhat is already known on this subject? Previous studies demonstrated 'menopause', 'Age ≥50', 'managing with LEEP', 'disease involving >2/3 of cervix at visual inspection', 'training level of the surgeon', 'cytology squamous cell carcinoma' and 'mean cone height' as factors associated with positive surgical margin in conisation specimens.What do the results of this study add? In our study, univariate analyses showed that 'postmenopause', 'HSIL on smear', 'previous colposcopic examination revealing HSIL in endocervical curettage material and in two or more ectocervical quadrants' and 'managing with LEEP' were associated with surgical margin positivity. On the other hand, nulliparous women showed significantly lower rate of surgical margin positivity compared with parous women. Multivariate analyses showed that 'postmenopause', 'previous colposcopic examination revealing HSIL in endocervical curettage material and in two or more ectocervical quadrants' and 'HSIL on smear' were independent predictors of surgical margin positivity in conisation specimens.What are the implications of these findings for clinical practice and/or further research? We can predict high-risk patients with regard to surgical margin positivity. Prediction of high-risk patients and management with a tailored approach may help minimise surgical margin positivity rates.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Conização/métodos , Margens de Excisão , Lesões Intraepiteliais Escamosas Cervicais/cirurgia , Neoplasias do Colo do Útero/cirurgia , Adulto , Carcinoma de Células Escamosas/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Lesões Intraepiteliais Escamosas Cervicais/patologia , Neoplasias do Colo do Útero/patologia
17.
Ginekol Pol ; 89(11): 599-606, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30508211

RESUMO

OBJECTIVES: To evaluate the predictive value of preoperative CA125 in extra-uterine disease and its association with poor prognostic factors in endometrioid-type endometrial cancer (EC). MATERIAL AND METHODS: A total of 423 patients with pathologically proven endometrioid-type EC were included in the study. The association between preoperative CA125 level and surgical-pathological factors was evaluated. The conventional cut-off value was defined as 35 IU/mL. RESULTS: A high CA125 level ( > 35 IU/mL) was significantly associated with all of the studied poor prognostic factors, except grade. The risk of lymph node metastasis (LNM) increased from 15.9% to 45.7% when CA125 level was > 35 IU/mL (p < 0.05). The optimal cut-off value for the prediction of LNM in patients aged > 50 years was determined to be 16 IU/mL (sensitivity, specificity, positive predictive value, and negative predictive value were 71%, 60%, 35%, and 87%, respectively.) Conclusions: Preoperative CA125 level was significantly related with the extent of the disease and LNM. The age-dependent cut-off level of CA125 can improve the prediction of LNM in endometrioid-type EC. For older patients, CA125 level of > 16 IU/ml could be used to predict LNM. However, further studies are needed to evaluate the appropriate cut-off level of CA125 for younger patients.


Assuntos
Antígeno Ca-125/sangue , Carcinoma Endometrioide/patologia , Neoplasias do Endométrio/patologia , Linfonodos/patologia , Proteínas de Membrana/sangue , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Carcinoma Endometrioide/sangue , Neoplasias do Endométrio/sangue , Feminino , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos
18.
Saudi Med J ; 37(8): 871-6, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27464864

RESUMO

OBJECTIVES: To determine whether a history of cesarean section was a risk factor for abnormal uterine bleeding in patients with uterine leiomyomas, and to identify other risk factors for this symptom. METHODS: We analyzed retrospectively, the medical records of patients who underwent hysterectomies due to the presence of uterine leiomyomas during a 6-year period (2009 and 2014) at Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey. Uterine leiomyoma was diagnosed based on histopathological examination of hysterectomy specimens. Demographic characteristics, and laboratory and histopathological findings were compared between patients with uterine leiomyoma with and without abnormal uterine bleeding. RESULTS: In total, 501 (57.9%) patients had abnormal uterine bleeding and 364 (42.1%) patients had other symptoms. A history of cesarean section was more common in patients with abnormal uterine bleeding than in those with other symptoms (17.6% versus 9.3%, p=0.001; odds ratio [OR]: 2.1; 95% confidence interval [CI]: 1.4-3.3). The presence of a submucosal leiomyoma (OR: 2.1; 95% CI: 1.5-3.1) and coexistent adenomyosis (OR: 1.6; 95% CI: 1.1-2.4) were also associated with abnormal uterine bleeding. CONCLUSION: A history of cesarean section was an independent risk factor for abnormal uterine bleeding in patients with uterine leiomyomas; submucosal leiomyoma and coexisting adenomyosis were also independent risk factors.


Assuntos
Cesárea/efeitos adversos , Leiomioma/complicações , Hemorragia Uterina/etiologia , Neoplasias Uterinas/complicações , Estudos de Casos e Controles , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Fatores de Risco
19.
J Chin Med Assoc ; 79(4): 212-20, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26874679

RESUMO

BACKGROUND: In this article, we aimed to define the clinical, pathological, and surgical factors predicting pulmonary recurrence (PR) and determining survival after PR in patients with endometrial cancer. METHODS: Thirty-six (2.7%) patients were analyzed who suffered pulmonary failure in the first recurrence out of 1345 patients who had at least extrafascial hysterectomy plus bilateral salpingo-oophorectomy for endometrial cancer between January 1993 and May 2013. The recurrence was designated as an isolated PR in cases of the presence of recurrence only in the lung, while it was called a synchronized PR if the patient had extrapulmonary recurrence in addition to PR. RESULTS: In the multivariate analysis in the entire cohort, only International Federation of Gynecology and Obstetrics stage was an independent prognostic factor for PR. Two-year overall survival (OS) was 52% in patients with PR. In the univariate analysis, early International Federation of Gynecology and Obstetrics stage, absence of lymphatic metastasis, negative lymphovascular space invasion, absence of cervical invasion, negative adnexal spread, negative peritoneal cytology, negative omental metastasis, adjuvant radiotherapy after initial surgery, isolated PR, and chemotherapy upon recurrence were associated with improved OS after PR. The OS was 54 months for patients with isolated PR, while it was 10 months for patients who had synchronized PR. Furthermore, OS was 43 months and 13 months for the patients who took chemotherapy and radiotherapy, respectively. CONCLUSION: Advanced stage is associated with PR. If recurrence is only in the lung, survival is better. Systemic treatment after PR is associated with improved survival. However, multi-center studies are required to standardize the treatment for PR.


Assuntos
Neoplasias do Endométrio/patologia , Neoplasias Pulmonares/secundário , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Endométrio/mortalidade , Neoplasias do Endométrio/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias
20.
Int J Gynecol Cancer ; 26(4): 619-25, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26825833

RESUMO

OBJECTIVE: In this study, we aimed to demonstrate characteristics, recurrence rates, survival numbers, and factors associated with survival of patients with adult granulosa cell tumor (AGCT) from a single institution. Our secondary goal was to evaluate the necessity of staging surgery and the importance of a comprehensive lymphadenectomy in these patients. METHODS: The data of 158 patients in our institution who were diagnosed with AGCT between 1988 and 2013 were evaluated. The data were obtained from the files of the patients, electronic database of the gynecologic oncology clinic, operation notes, and pathology records. RESULTS: The median (range) age of the patients was 50.3 (22-82) years. The main symptom was postmenopausal bleeding (25.9%). Seventy-six percent of the patients underwent staging surgery including lymphadenectomy. Among these patients, 3 (2.5%) had lymph node metastasis. The median (range) follow-up time was 97 (1-296) months. In the follow-up period, 18 patients (12.5%) had recurrence. Menopausal status (P = 0.016), advanced age (P = 0.024), cyst rupture (P = 0.001), poorly differentiated tumor (P = 0.002), and advanced stage (P < 0.001) were associated with recurrence. Stage was the only independent prognostic factor for the development of recurrence. None of the patients had lymph node failure. CONCLUSIONS: In the present study with a long follow-up period and in which most of the patients had staging surgery including lymphadenectomy (76.6%), lymph node recurrence was not observed and the total recurrence rate (12.5%) was lower than that reported in the literature. The study showed the importance of surgical staging in patients with AGCT.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Tumor de Células da Granulosa/patologia , Excisão de Linfonodo , Recidiva Local de Neoplasia/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante , Terapia Combinada , Feminino , Seguimentos , Tumor de Células da Granulosa/terapia , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Gradação de Tumores , Invasividade Neoplásica , Recidiva Local de Neoplasia/terapia , Prognóstico , Taxa de Sobrevida , Adulto Jovem
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