Oncocytic and tall columnar type papillary thyroid carcinoma arising on a mature cystic teratoma: A case report and literature review.

Mature cystic teratoma (MCT) is the most common germ cell ovarian tumour, which accounts for 15-20% of all ovarian neoplasms. The frequency of MCT cases undergoing malignant transformation ranges from 0.17% to 2%. Our aim for presenting this case is to contribute to formation of an algorithm in the literature for the treatment and follow-up of MCT undergoing malignant transformation. A 38-year-old female patient presented to the emergency service with acute abdomen. The patient underwent salpingo-oophorectomy due to a prediagnosis of ovarian torsion with a dermoid cyst. Postoperative pathological examination reported oncocytic and tall columnar type papillary thyroid carcinoma arising on a mature cystic teratoma. During the follow up no local recurrences or metastases were identified in one-year. The rarity of MCT cases undergoing papillary type thyroid carcinoma transformation hinders the establishment of an algorithm for treatment and follow-up in literature.

Emergency peripartum hysterectomy: A retrospective study in a tertiary care hospital in Turkey from 2007 to 2015.

Postpartum haemorrhage is the most important cause of maternal morbidity and mortality, especially when all conservative measures, including syntometrine oxytocin and Bakri balloons have failed to accomplish haemostasis and expeditious surgical procedures, such as uterine artery ligation and emergency peripartum hysterectomy (EPH) are required. This retrospective study analysed 31 cases of EPH performed between January 2007 and January 2016 in the Department of Gynecology and Obstetrics of Izmir Ataturk Teaching and Research Hospital. All hysterectomies performed for bleeding not responding to other treatments within 24 h of vaginal delivery or caesarean section (CS) were included. Twenty-nine patients who underwent EPH (93.6%) had at least one previous CS (p<0.05). Two EPHs (6.4%) were performed after vaginal delivery (p<0.05). The most frequent indications were placenta previa with accreta (70.9%, p<0.05). There were no cases of maternal mortality. Previous CS and abnormal placental invasion were the most common indications for EPH.

An interesting prenatal diagnosis: double aneuploidy.

Double aneuploidy, the existence of two chromosomal abnormalities in the same individual, is a rare condition. Early diagnosis of this condition is important to offer termination of pregnancy in genetic counselling. Cytogenetic analysis with amniocentesis and ultrasound examination is valuable for diagnosis of double aneuploidy. In this report we present a case with the karyotype of 48XXY+21 diagnosed prenatally.

A giant cystic leiomyoma mimicking an ovarian malignancy.

INTRODUCTION: Leiomyoma of the uterus is the most common type of tumor affecting the female pelvis and arises from uterine smooth muscle. The size of leiomyomas varies from microscopic to giant; giant myomas are exceedingly rare. We report an unusual case of a large, cystic, pedunculated uterine leiomyoma mimicking a primary malignant ovarian tumor on sonography and CT. PRESENTATION OF CASE: A 58-year-old postmenopausal nulliparous woman presented with a history of lower abdominal pain and distension for a period of approximately 12 months. The patient's personal history revealed difficulty in walking, tiredness and recent weight gain of approximately 25kg. Sonography and CT examination showed a large mass that filled the abdomen. A preoperative diagnosis of a primary malignant ovarian tumor was made. The patient underwent laparotomy, total hysterectomy and bilateral salpingo-ooferectomy. The histology revealed a leiomyoma with extensive cystic degeneration. DISCUSSION: The current established management of uterine fibroids may involve expectant, surgical, or medical management or uterine artery embolization or a combination of these treatments. A surgical approach is preferred for management of giant leiomyomas. CONCLUSION: Pedunculated leiomyomas should be considered in the differential diagnosis of a multilocular and predominantly cystic adnexal mass.

Preoperative serum CA 125 level in the prediction of the stage of disease in endometrial carcinoma.

OBJECTIVE: To evaluate whether a preoperative serum CA-125 level in patients with endometrial carcinoma can provide additional information in determining the stage of disease, and which cutoff value is optimal in this respect. STUDY DESIGN: Retrospective chart review of 147 women with pathologically proven endometrial carcinoma who were treated between January 1999 and May 2009. The associations of preoperative CA-125 levels with the tumor stage, histologic type and grade, and the lymph node positivity were examined. To determine the values of cutoff point levels for serum tumor marker CA-125, the levels of 20 IU/ml and 35 IU/ml were compared. RESULTS: High CA-125 levels significantly correlated with advanced stage and lymph node metastases. The ROC curve determined that the best cutoff value was 20 U/ml. The sensitivity and specificity of a CA-125 cutoff level of 20 U/ml were 75% and 69.51%, respectively, with a positive predictive value of 80.6% and negative predictive value of 84.9%. CONCLUSION: The current study suggests that measurement of preoperative CA-125 is a clinically useful test in endometrial carcinoma patients. CA-125 appears to be a significant independent predictor of the advanced stage of the disease as well as lymph node metastases. The results complement a growing body of literature that supports the relationship between CA-125 level and stage of disease but more studies are needed to establish the appropriate cutoff level for serum CA-125 in this respect.

Efficacy of electrosurgical bipolar vessel sealing for abdominal hysterectomy with uterine myomas more than 14 weeks in size: a randomized controlled trial.

OBJECTIVE: To compare electrosurgical bipolar vessel sealing with conventional suturing during abdominal hysterectomy. METHODS: This was a randomized controlled prospective study. A total of 88 patients with myoma uteri larger than 14 weeks in size were divided into two groups: group A (44 patients who were administered the LigaSure vessel sealing system during surgery) and group B (44 patients who were administered conventional sutures during surgery). Total abdominal hysterectomy was performed in all patients. Hemoglobin reduction, operation time, hospital stay and visual analogue scale parameters of patients in both groups were compared. SPSS 16.0 was utilized in statistical analyses. The outcomes with a 95% confidence interval and a p value of less than 0.05 were regarded as significant. RESULTS: When the two groups were compared, it was observed that the LigaSure device significantly reduced the operation time (p < 0.05). Nevertheless, no statistically significant difference was determined in hemoglobin reduction, hospital stay and visual analogue scale parameters between the two groups. CONCLUSION: In myoma uteri cases larger than 14 weeks in size, LigaSure vessel sealing is a secure and comfortable method for surgeons to achieve shorter operation times in abdominal hysterectomy.

The effect of body mass index value during labor on pregnancy outcomes in Turkish population (obesity and pregnancy outcomes).

PURPOSE: We investigated the relation between body mass index (BMI) value during labor and pregnancy outcomes in a group of Turkish population. METHODS: The data on 9,112 singleton pregnancies were reviewed retrospectively. Patients were classified into three groups according to their BMI values: normal (BMI 20-25 kg/m(2), n = 5,685, 62.4%), overweight (BMI 20-25 kg/m(2), n = 2,214, 24.3%) and obese (BMI >30 kg/m(2), n = 1,213, 33.3%). RESULTS: Gestational diabetes mellitus (P = 0.000), risk of delivering a baby >90th percentile (P = 0.000) and preeclampsia (P = 0.000) were increased in parallel with increased BMI. A statically significant difference was observed between the normal and obese groups in terms of the abdominal cesarean rates (P = 0.020). However, a significant difference was not observed in terms of preterm delivery (P = 0.846), birthweight <10th percentile (P = 0.484), placenta previa (P = 0.880), ablatio placenta (P = 0.499) and intrauterine death (P = 0.175) between the groups. CONCLUSIONS: Regardless of the gestation, BMI is a factor that affects the fetal and maternal outcomes. The obese and overweight women should be followed up carefully during the labor and delivery.

Axillary lymph node metastasis from serous ovarian cancer: a case report and review of the literature.

INTRODUCTION: The symptoms and findings of ovarian cancer are parallel with the degree of intra-abdominal expansion of the tumor. Metastases in the early stage occur by peritoneal fluid's tracking via the circulatory system. Renal and cerebral metastases of ovarian cancer have been previously reported, but axillary lymph node metastasis is quite rare. Axillary lymph node metastasis usually occurs in the advanced stage. MATERIALS AND METHODS: We present a 47-year-old female who had applied adjuvant chemotherapy following cyto-reductive surgery because of stage 3C ovarian cancer. Axillary lymph node metastasis was detected in the postoperative 32 months. CONCLUSION: As tumors in axillary lymph nodes are found in patients with an ovarian carcinoma, the treatment is also so important too. Metastasis to the breast be differentiated accurately from primary breast cancer, because prognosis and treatment differ significantly. Accurate diagnosis of these metastases may allow more appropriate therapy, such as chemotherapy, and prevent the patient from an unnecessary major breast surgery.

Does manual removal of the placenta affect operative blood loss during cesarean section?

OBJECTIVE: To investigate whether manual removal of the placenta is associated with significantly more blood loss compared to spontaneous separation of the placenta during cesarean section. STUDY DESIGN: This was a randomised study of 200 women with normal pregnancies undergoing cesarean section. Patients were randomly assigned to the study group, manual removal (n=100) or the control group, spontaneous separation (n=100). Operative blood loss was measured using a volume and gravimetric method. Patients postoperative complications were recorded and hemoglobin levels measured at 24 and 48 h. RESULTS: The amount of blood loss associated with spontaneous and manual removal of the placenta was 626+/-253 ml and 589+/-272 ml, respectively. This difference was not significant. There was a decrease in the postoperative hemoglobin levels in both groups which was not significantly different. The incidence of endometritis, wound infection, and the need for blood transfusion was similar in the two groups. CONCLUSION: Manual delivery of the placenta is not associated with a significantly greater risk of operative blood loss, decreased postoperative hemoglobin levels or increased incidence of endometritis compared with spontaneous placental separation.