The predictive value of the first trimester combined test for gestational diabetes mellitus.

OBJECTIVES: To investigate the predictive importance of first trimester combined test markers pregnancy-associated plasma protein-A (PAPP-A), human chorionic gonadotropin ß (ß-hCG) and nuchal translucency (NT) for gestational diabetes mellitus (GDM). MATERIAL AND METHODS: Pregnant women which both first trimester combined test and GDM screening were performed during antenatal follow-up were included in this retrospective case-control study. The cases were divided into two groups as GDM screening positive and negative. Demographic, clinical and laboratory data of both groups were compared. Predictive tests were applied to the first trimester combined test data for the detection of GDM. RESULTS: A total of 378 patients, 171 (45.2%) in the control group and 207 (54.8%) in the GDM group. The age (control: 30.9 ± 5.2; GDM: 30.5 ± 5.1; p = 0.844) and NT (control: 1.254 ± 0.289; GDM: 1.319 ± 0.299; p = 0.074) data of the groups were statistically similar. MoM PAPP-A (GDM:0.967 ± 0.685; ontrol:1.191 ± 0.624; p < 0.001) and MoM f-ßhCG (GDM: 0.9 ± 0.602; control: 1.103 ± 0.746; p = 0.001) levels of the GDM group were lower than the control group. In the binary logistic regression model, MoM PAPP-A and MoM f-ßhCG variables were found to be effective on GDM. In the ROC analysis of these variables, the MoM PAPP-A (0.654) had the highest area under the curve. According to the optimum cut-off point (≤ 0.885) of the MoM PAPP-A, we found a sensitivity of 66.7% and a specificity of 65.50% for predicting GDM. CONCLUSIONS: Our study showed that serum PAPP-A and f-ßhCG MoM values, which are among the first trimester combined test parameters, can be used in the early pregnancy period for the prediction of GDM.

Effect of coexisting adenomyosis on patients with endometrioid adenocarcinoma: Determination of intraoperative risk factors for tumor metastasis and estimation of prognosis.

Context: We sought to clarify the impact of adenomyosis on the clinical and pathological prognosis of endometrial cancer to aid the selection of appropriate surgical intervention based on the diagnosis of adenomyosis. Aims: Our study aimed to report the frequency of adenomyosis in patients with endometrioid cancer and correlate its incidence rate with the survival and prognostic factors. Materials and Methods: This retrospective study included 357 patients. Patients with endometrioid adenocarcinoma were divided into two groups based on the presence of adenomyosis. The groups were compared in terms of tumor diameter, lymphovascular space invasion (LVSI), low-high risk pathologic status, stage of the disease, and survival outcome. Statistical Analysis Used: Continuous variables were analyzed using the Student's t or Mann-Whitney U-test. Survival data were analyzed using the Kaplan-Meier test. Results: The average age was similar between the two groups. In total, 47 (13.2%) of 357 patients had adenomyosis. A total of 43 (91.4%) cases with adenomyosis and 258 (83.2%) cases without adenomyosis had Stage I endometrioid adenocarcinoma (n = 301, 84.3%). Moreover, 32 (68.1%) cases with adenomyosis and 187 (60.3%) cases without adenomyosis were in the low-risk group. There was no statistically significant correlation between the risk groups (P = 0.309) and overall survival between the two groups (P = 0.416). Conclusion: No correlation was seen between the characteristics of endometrioid type endometrial cancer and survival rates in patients with or without adenomyosis. The impact of adenomyosis as a factor in evaluating the perioperative prognosis and planning postoperative adjuvant therapy for endometrial cancer should be assessed by further studies.

The effect of fetal gender on the biochemical markers of the first-trimester screening.

OBJECTIVES: To determine the effects of fetal gender on the maternal levels of first-trimester screening biochemical markers, such pregnancy-related plasma protein A (PAPP-A) and beta-human chorionic gonadotropin (ß-hCG). METHODS: In this retrospective study, we assessed 267 cases of singleton pregnancies, who underwent first trimester screening tests and delivered between January 2016 and January 2019 at our hospital. Multiple of median (MoM) levels of PAPP-A and free ß-hCG, and the neonatal genders according to the birth records were compared and analyzed. Additionally, patients with small for gestational age (SGA) newborns, preeclampsia, and placental ablation, called ischemic placental diseases, were classified into a separate group and their PAPP-A and free ß-hCG MoM values and fetal genders were compared. RESULTS: There was no significant relationship between the mean values of PAPP-A (1.07±0.6) and free ß-hCG (1.23±1.14) and the fetal gender (males: 137, 51.3%; females: 130, 48.7%), respectively (p=0.833; p=0.075). In 41 cases (15.4%) with ischemic placental disease, free ß-hCG values was significantly higher in the fetal females (19 cases; 46.3%) than males (22 cases; 53.7%), (1.53±1.02 and 0.77±0.53, respectively), (p=0.004). CONCLUSION: Pregnancy-related plasma protein A and free ß-hCG values were not affected by the fetal gender. However, the significant relationship observed between free ß-hCG MoM levels and fetal gender in patients with ischemic placental diseases suggests the need for larger studies on this topic.

Lower uterine segment involvement in lymphovascular space invasion and lymph node metastasis in endometrioid endometrial cancer.

OBJECTIVES: To evaluate the correlation between lymphovascular space invasion (LVSI) indicating lower uterine segment involvement (LUSI) in endometrioid endometrial cancer and lymph node metastasis based on the lymphatic drainage difference between the uterine corpus and the lower segment. MATERIAL AND METHODS: Patients who underwent staging surgery for endometrioid endometrial cancer between January 2010 and January 2019 at our institution were reviewed. The clinicopathologic findings and LUSI status of the patients were compared with their LVSI and lymph node metastasis status. RESULTS: Of the 253 patients included in this study, 49 (19.4%) had LUSI. Among these patients, none of the 31 LVSI-negative patients had metastatic lymph node involvement. However, of the 18 LVSI-positive patients, half had metastatic lymph node involvement; this difference was significant (p < 0.05). CONCLUSIONS: The significant correlation between LVSI and lymph node metastasis in LUSI-positive cases indicates that pathologists should also focus on LVSI findings in the frozen examination required for the decision of staging surgery in patients with endometrioid endometrial cancer limited to the uterus. This is especially important in patients with a lower uterine segment involvement.

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.