Assessment of CA-125 area under the curve as a prognostic factor in patients with ovarian cancer.

The goal of this study was to evaluate the efficacy of CA-125 area under the curve (CA-125 AUC) as a prognostic factor following surgical treatment for ovarian cancer patients. A retrospective analysis was conducted on ninety-five patients with ovarian cancer who had primary treatment in a tertiary center between 2000 and 2010. After either optimal or cytoreductive surgery, all patients underwent adjuvant chemotherapy. CA-125 AUC was calculated for each patient that had a minimum of three CA-125 serum measurements during the treatment period. The mean age at diagnosis and mean survival were 53.9 years (range, 16-75 years) and 35.6 ± 22.9 months (range, 3.1-95.4 months), respectively. The mean (and median) CA-125 AUC of patients of FIGO stages I, II, III, and IV was 53.0 (42.5), 58.06 (58.06), 97.8 (54.6), and 405.2 (149.3) IU/ml day, respectively (p = 0.004). The mean CA-125 AUC was 57.7, 410.1, and 636.3 IU/ml day for patients with a complete response, partial response, and no response/progressive disease to first-line chemotherapy, respectively (p < 0.001). The CA-125 AUC cut-off level for an overall survival of ≥5 years was 99.75 IU/ml day with a sensitivity of 90.9 % (95 % CI, 70.8-98.6) with 1.27 as positive likelihood ratio. Patients who suffer from ovarian cancer, with a lower CA125 AUC, have a better overall survival than those with a higher CA125 AUC. CA-125 AUC could be used as an independent factor for evaluating the treatment efficacy and chemotherapy response.

The investigation of tumoral angiogenesis with HIF-1 alpha and microvessel density in women with endometrium cancer.

OBJECTIVE: Hypoxia inducible factor 1 alpha (HIF-1α) is a nuclear protein upregulated in response to reduced cellular oxygen concentration which therefore acts as a marker for hypoxia. The aim of this study was to determine tumoral angiogenesis with immunohistochemical markers in endometrium cancer and its relation with stage, grade, survival rates and other prognostic factors. MATERIAL AND METHODS: Using the database in our Gynecologic Oncology clinic, we selected 94 patients who were diagnosed with endometrial cancer and underwent primary surgery at our institution between 2001 and 2010. Tissue microarrays believed to demonstrate the optimum part of the tumor were reprepared from the paraffin blocks. Angiogenesis and microvessel density (MVD) were investigated with the aid of HIF-1α and CD34 antibodies. RESULTS: High expression of HIF-1α was significantly more frequent in advanced grade endometrial cancers (p=0.044). HIF-1α expression was highly correlated with CD34 expression in the tumor cells (p<0.001). However lack of relation among stage, overall survival rates and histological types were analyzed with HIF-1α. When we compared HIF-1α positive and negative cases with cervical, adnexial, lymphovascular and myometrial invasion, there was no difference between these groups. MVD was evaluated with CD34 and it was remarkable and significantly different on advanced grade tumors (r=0.268; p=0.009). A similar significant difference was observed between the high expression of CD34 and type II endometrial cancer histology (p<0.001). However, there was no relationship between the MVD and stage or survival rates. CONCLUSION: High expression of HIF-1α is associated with tumoral angiogenesis in endometrial adenocarcinomas. Further studies targeting HIF-1α for disrupting mechanisms essential for tumor growth in endometrium cancer will be significant investigations in the future.

Delayed-interval delivery of an in vitro-fertilized triplet pregnancy with premature rupture of membranes in the second trimester.

BACKGROUND: The incidence of multiple pregnancies is increasing with the availability of assisted reproductive techniques. Preterm labor and preterm rupture of membranes are major complications in such pregnancies. Preterm delivery of the first fetus is often followed by delivery of the remaining fetuses. However, conservative management in such circumstances might allow for fetal lung maturity in the remaining fetuses. CASE: We present a case of conservative management of an in vitro-fertilized triplet pregnancy with early loss of the leading triplet. A 33-year-old woman in the 21st week of a triplet pregnancy delivered her one of the fetuses, 4 days after the preterm rupture of membranes. To save the surviving fetuses, ligation of the umbilical cord at the cervical level was performed. Patient received antibiotics, tocolytics and corticosteroids after then. The second and the third fetuses were successfully delivered by cesarean section in the 28th week of pregnancy, 43 days after the first fetus was born. CONCLUSION: We can improve the life expectancy of the retained fetuses by conservative management using tocolytics, antenatal steroids to stimulate lung maturation and antibiotics following the delivery of the first fetus.

Neuromuscular morphometry of the vaginal wall in women with anterior vaginal wall prolapse.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to compare the changes in hystomorphometry and innervation of the anterior vaginal wall in women with and without anterior vaginal wall prolapse. METHODS: Eighty-nine biopsy specimens were obtained from the anterior vaginal wall of women having a cystocele repaired (stage >or=II; prolapse group, 49) and the same location in patients with no prolapse (stage

Huge solitary primary pelvic hydatid cyst presenting as an ovarian malignancy: case report.

Hydatid disease is a zoonotic parasitic infection caused by Echinococcus granulosus. Echinococcus cysts are found mostly in the liver (60%) and lung (15%), but they can be located in any part of the body. However pelvic echinococcosis as the primary site is rarely seen. We report the case of a large echinococcal cyst localized in the lower pelvis. A 76-year-old woman was admitted to an emergency department with urinary retention for ten days. Ultrasonography and other imaging modalities revealed a mass with solid and cystic components in pelvic localization. This unusual presentation in an elderly postmenopausal woman was initially considered as an ovarian malignancy until surgical exploration and microscopic studies confirmed the diagnosis of echinococcosis. Antihelminthics were administered postoperatively and the patient is now being closely followed up. Gynecologists should be aware of the possibility of a primary hydatid cyst of the pelvic cavity and should be considered in the differential diagnosis of cystic pelvic masses, especially in areas where the disease is endemic.

Typical pulmonary carcinoid tumors: presentation and outcome of 24 cases.

BACKGROUND: The aim of the study was to determine the presenting clinical-radiological features and outcomes of typical pulmonary carcinoid tumors in our center. MATERIAL/METHODS: The medical records of 24 patients with typical pulmonary carcinoid tumor diagnosed between January 1995 and December 2003 were retrospectively reviewed. Follow-up information on patients was obtained from direct patient contact in February 2004. RESULTS: There were 17 female and 7 male patients with a mean age of 40.3 years (range: 17-69 years). Sixteen patients (66.7%) were nonsmokers. The most frequent presenting symptom was cough, followed by hemoptysis. Twenty-three patients had an abnormal chest X-ray, showing atelectasis in seven. Bronchoscopy revealed mass lesion in all cases. In 13 cases, tumor was located in the lobar bronchi. Diagnosis of carcinoid tumor was established with bronchoscopy in 19 patients and with thoracotomy in five cases. While surgery was the treatment modality in 23 patients, one patient refused treatment. Lobectomy was performed in 15 cases and six of them were sleeve lobectomy. One patient died two days after operation due to ischemic heart disease, two were lost to follow-up, and 21 patients were still alive. Survival for the 21 patients was between 5 and 96 months. Eight patients had survival of more than five years. CONCLUSIONS: Our data suggest that typical pulmonary carcinoids are different from major lung cancer types with respect to sex, age predilection, and smoking history. Surgery is the treatment of choice for pulmonary carcinoid tumors. These patients had excellent prognosis after surgical treatment.

[Diagnostic approach to solitary pulmonary nodule]. / Soliter pulmoner nodüle tanisal yaklasim.

The solitary pulmonary nodule is a common radiologic abnormality that is often detected incidentally. Many malignant and benign diseases can present as a solitary pulmonary nodule on a chest roentgenogram. It is important to differentiate malignant nodules from benign nodules in the least invasive way and to make as specific and an accurate diagnosis as possible. In this paper, a diagnostic approach to the solitary pulmonary nodule was discussed.

[Adenosquamous carcinoma of the lung (an analysis of 13 cases)]. / Akcigerin adenoskuamöz karsinomu (13 olgu nedeniyle).

Adenosquamous carcinoma of the lung is a rare disease. The biological behavior and clinicopathologic characteristics of this tumor have not been well described. In this study, we retrospectively evaluated 13 patients with adenosquamous carcinoma of the lung diagnosed at our center between January 2001 and May 2004. There were 12 males and 1 female whose ages ranged from 45 to 69 years, with a mean age of 55.9 years. Ten patients were smoker. The most frequent symptoms were chest pain and cough. Bronchoscopic examination detected that tumor was centrally located in four cases and was peripherally located in nine cases. Preoperative pathological diagnosis was squamous cell carcinoma in eight patients, non-small cell lung carcinoma in four patients and adenocarcinoma in one patient. One patient was in pathological stage IA, three patients in stage IB, one patient in stage IIA, two patients in stage IIB, five patients in stage IIIA, and one patient in stage IIIB. Twelve patients underwent resection (six, lobectomy; five, pneumonectomy; one, bilobectomy). Five of 12 patients received adjuvant therapy. Five patients died of disease within 3 and 21 months. Seven patients have had survival time between 9 and 31 months.

Coexisting bronchial carcinoid tumor and pulmonary tuberculosis in the same lobe: a case report.

The synchronous occurrence of pulmonary tuberculosis and bronchial carcinoid tumor is unusual. Although pulmonary tuberculosis can coexist with all histological types of lung cancer, few coexisting cases of bronchial carcinoid tumor and pulmonary tuberculosis have been reported. We present coexistent bronchial carcinoid tumor and pulmonary tuberculosis in the same lobe. A 39-year-old woman was admitted to our clinic with chest pain for two months. Chest radiograph showed consolidation in the right lower field. Computed tomography of the thorax demonstrated multiple mediastinal lymphadenopathies, infiltration and atelectasis in the right lower lobe. Fiberoptic bronchoscopy showed a mass lesion totally obstructing the proximal right lower lobe bronchus. The pathological diagnosis was typical carcinoid tumor. Right lower lobectomy with mediastinal lymph node dissection was performed. The pathological examination of resected material revealed coexistent tuberculosis and carcinoid tumor in the same lobe and mediastinal tuberculous lymphadenitis.