Risk factors for omental metastasis and the effect of omentectomy on survival in type 2 endometrial cancer patients.

To investigate the risk factors for occult omental metastasis and the effect of omentectomy on the survival of type 2 endometrial cancer (EC) patients. This study enrolled patients who were diagnosed with high-risk (grade 3, serous, clear cell, undifferentiated, carcinosarcoma, or mixed type) EC between 2000 and 2021 and underwent surgery in our center. Data from 482 patients were analyzed retrospectively. Omentectomy was performed in 405 (84.0%) patients. Omental metastases were detected in 61 (12.7%) patients. Eighteen (29.5%) of these metastases were occult. Adnexal involvement, malignant cytology, and peritoneal spread were independent risk factors for omental metastasis. The 5-year overall survival (OS) rate was 59.5% in patients who underwent omentectomy and 64.7% in those who did not (P = 0.558). In patients with and without omental metastases, the overall 5-year OS rates were 34.9% and 63.5%, respectively (P < 0.001). The 5-year OS rates of patients with a normal omentum, gross tumors, and occult metastases were 63.5%, 26.9%, and 52.5%, respectively (P < 0.001). Omental metastases is not uncommon in type II endometrial cancer; approximately one third of patients have occult metastases. Factors - positive cytology, adnexal involvement, and peritoneal involvement are associated with higher probability of omental metastases.

The Relationship between Serum Ischemia-Modified Albumin Levels and Uterine Artery Doppler Parameters in Patients with Primary Dysmenorrhea.

OBJECTIVE: Primary dysmenorrhea occurs due to abnormal levels of prostanoids, uterine contractions, and uterine blood flow. However, the reasons for pain in primary dysmenorrhea have not yet been clarified. We examined the blood flow alterations in patients with primary dysmenorrhea and determined the relationship between ischemia-modified albumin (IMA) levels, as an ischemia indicator, and primary dysmenorrhea. METHODS: In the present study, 37 patients who had primary dysmenorrhea and were in their luteal and menstrual phase of their menstrual cycles were included. Thirty individuals who had similar demographic characteristics, who were between 18 and 30 years old and did not have gynecologic disease were included as control individuals. Their uterine artery Doppler indices and serum IMA levels were measured. RESULTS: Menstrual phase plasma IMA levels were significantly higher than luteal phase IMA levels, both in the patient and in the control groups (p < 0.001). Although the menstrual phase IMA levels of patients were significantly higher than those of controls, luteal phase IMA levels were not significantly different between the two groups. Menstrual uterine artery pulsatility index (PI) and resistance index (RI) of primary dysmenorrhea patients were significantly different when compared with luteal uterine artery PI and RI levels. There was a positive correlation between menstrual phase IMA and uterine artery PI and RI in the primary dysmenorrhea. CONCLUSION: Ischemia plays an important role in the etiology of the pain, which is frequently observed in patients with primary dysmenorrhea. Ischemia-modified albumin levels are considered as an efficient marker to determine the severity of pain and to indicate ischemia in primary dysmenorrhea.

The relationship between serum ischemia-modified albumin levels and uterine artery doppler parameters in patients with primary dysmenorrhea

Abstract Objective Primary dysmenorrhea occurs due to abnormal levels of prostanoids, uterine contractions, and uterine blood flow. However, the reasons for pain in primary dysmenorrhea have not yet been clarified. We examined the blood flow alterations in patients with primary dysmenorrhea and determined the relationship between ischemia-modified albumin (IMA) levels, as an ischemia indicator, and primary dysmenorrhea. Methods In the present study, 37 patients who had primary dysmenorrhea and were in their luteal and menstrual phase of their menstrual cycles were included. Thirty individuals who had similar demographic characteristics, who were between 18 and 30 years old and did not have gynecologic disease were included as control individuals. Their uterine artery Doppler indices and serum IMA levels were measured. Results Menstrual phase plasma IMA levels were significantly higher than luteal phase IMA levels, both in the patient and in the control groups (p < 0.001). Although the menstrual phase IMA levels of patients were significantly higher than those of controls, luteal phase IMA levels were not significantly different between the two groups. Menstrual uterine artery pulsatility index (PI) and resistance index (RI) of primary dysmenorrhea patients were significantly different when compared with luteal uterine artery PI and RI levels. There was a positive correlation between menstrual phase IMA and uterine artery PI and RI in the primary dysmenorrhea. Conclusion Ischemia plays an important role in the etiology of the pain, which is frequently observed in patients with primary dysmenorrhea. Ischemia-modified albumin levels are considered as an efficient marker to determine the severity of pain and to indicate ischemia in primary dysmenorrhea.

Primary ovarian fibrosarcoma: a case report and review of the literature.

OBJECTIVES: Primary ovarian fibrosarcomas are extremely rare neoplasms, and only 50 cases have been reported in the English literature. Diagnosis can be difficult because of this condition's rarity, and other similar appearing mesenchymal lesions should be ruled out. METHODS: A 50-year-old postmenopausal woman came to our hospital because of abdominopelvic pain. Ultrasonography revealed a 41x33 mm heterogeneous solid mass in the right ovary. Total blood counts, biochemical parameters, and tumor markers were within normal ranges. Total abdominal hysterectomy, and bilateral salpingo oophorectomy were performed. Examination of a frozen, specimen revealed fibroma; however, the final histopathological diagnosis was low grade fibrosarcoma of the ovary. Microscopic examination demonstrated densely cellular, spindle-shaped tumor cells with increased mitotic activity (5 to 6 mitoses per 10 high-power fields). RESULTS: Immunohistochemical analysis revealed that the tumor cells were positive for vimentin and negative for actin and desmin and that the Ki 67 proliferation index was 30% to 40%. The patient did not receive adjuvant treatment, and remained free of disease after a follow up of 6 months. CONCLUSIONS: Although ovarian fibrosarcomas are unusual causes of solid masses in postmenopausal women, they should be considered when adnexal masses are examined in these patients. Mitotic activity and Ki-67 positivity were identified as important diagnostic factors for ovarian fibrosarcoma.

Sclerosing stromal tumour of the ovary in a postmenopausal woman presenting with virilization.

Sclerosing stromal tumours are rare benign ovarian neoplasms of the sex cord stromal that occur predominantly in the second and third decades of life. To date, fewer than 200 cases have been described in the literature and most patients have menstrual irregularities and pelvic pain. Sclerosing stromal tumours were reported in which the inactive tumours did not represent endocrine clinical symptoms; however, currently according to several reports, it is the active tumour that produce hormones. Only a few cases of virilizing sclerosing stromal tumours of the ovary have been described in the literature and in this report first describes sclerosing stromal tumour of the ovary in a postmenopausal woman presenting with virilization.

Vulvar Syringoma in a Postmenopausal Woman: A Case Report.

BACKGROUND: First described in 1872, syringomas are common intraepidermal sweat gland tumors most often found in women during adolescence. Frequent involvement areas are the lower eyelids and malar areas; vulvar involvement is relatively rare. These lesions often appear as small, separate, yellowish papules of about 1-3 mm in size and are generally associated with increased vulvar discomfort and itching.They typically occur in multiples and are bilateral and symmetrical. CASE: A 52-year-old, postmenopausal woman presented with vulvar pruritis and was diagnosed with syringomas after vulvar biopsy in our polyclinics. CONCLUSION: Vulvar syringoma should be included in the differential diagnosisf or itchy and papular lesions of vulvae in a postmenopausal woman.

Bilateral malignant mixed serous adenocarcinoma and malignant transitional cell carcinoma of the ovaries: An extremely rare neoplasm.

Mixed epithelial ovarian carcinomas are extremely rare and comprise less than 4% of all malignant ovarian tumors. We report a 61-year-old postmenopausal woman with bilateral adnexal masses. In the postoperative histopathological evaluation, mixed epithelial carcinoma with areas of disseminated serous adenocarcinoma and less prevalent areas of malignant transitional cell carcinoma was observed. Up-to-date, there have been only two cases with mixed serous adenocarcinoma and malignant transitional cell carcinoma reported in the English literature, and our case is the first case with bilateral tumors.

Sclerosing stromal tumour of the ovary: A case report and the review of literature.

Sclerosing stromal tumours are rare benign ovarian neoplasms of the sex cord stromal that occur predominantly in the second and third decades of life. To date, 208 cases have been recorded in the literature. Most patients have menstrual irregularities and pelvic pain. Infertility and virilisation have also been described. In this article, histopathological features and differential diagnosis of the benign sclerosing stromal tumour were described together with the literature data. It is imperative to consider the differential diagnosis of a sclerozing stromal tumour of the ovary in a young woman with an ovarian tumour. A combination of morphological, immunohistochemical, radiological and clinical findings is needed in differentiating the tumour from thecoma, fibroma/fibrosarcoma, lipoid tumours and Krukenberg tumour.

Recurrent massive haemoperitoneum associated with ruptured corpus luteum in women with congenital afibrinogenemia; case report.

Massive hemoperitoneum secondary to ruptured corpus luteum is a rare but serious and life-threatening complication for women with congenital bleeding disorders and may lead to surgical interventions and even oophorectomy. Congenital afibrinogenemia is a rare inherited coagulation disorder. As it can be asymptomatic, its clinical manifestations vary from minimal tendency of bleeding to life-threatening bleedings. Intraabdominal bleeding due to ovulation is very rare in these patients and only a few cases of corpus luteum rupture and hemoperitoneum in afibrinogenemic patients have been described. We report on a 28-year-old woman with congenital afibrinogenemia with recurrent massive intraabdominal bleeding due to ovulation as the presenting clinical sign. The first episode was managed with fresh frozen plasma, cryoprecipitate and blood transfusions; exploratory laparotomy and excision of the ruptured follicle was performed at the second episode; the third episode was managed with fresh frozen plasma, cryoprecipitate and blood transfusions; exploratory laparotomy and right salphingooopherectomy was performed at the fourth episode; fifth episode was managed with fresh frozen plasma, cryoprecipitate and blood transfusions. Conservative management is crucial for patients with congenital bleeding disorders. These case demonstrate that preservation of ovarian function is possible with a conservative approach and recurrent episodes may be prevented by suppression of ovulation.