The importance of immediate verification of a cervical cytological abnormality with histology.

BACKGROUND: A serious proportion of the patients with invasive cervical cancer can be women who have had abnormal smear findings known for at least 6 months. AIMS: The aims of the study were to evaluate the cervical cytohistopathologic correlation in the population studied, and to discuss the acceptability of immediate histological verification for minor Papanicolaou smear abnormalities. MATERIALS AND METHODS: A total of 443 patients who were admitted with abnormal smear results and had undergone immediate colposcopy, cervical biopsy and endocervical curretage in the gynecologic oncology clinic between the years of 2003-2009 were enrolled into the present retrospective study. One-way analysis of variance and independent t-tests were used to study the results. RESULTS: The distribution of abnormal smear results were documented as 46.27%, 29.57%, 13.76%, 7.67%, 1.58%, 0.67%, and 0.45% for atypical squamous cells of undetermined significance (ASC-US), low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H), squamous cell carcinoma (SCC), atypical glandular cell (AGC), and adenocarcinoma, respectively. The percentages of cervical intraepithelial neoplasia grade 2-3 (CIN 2-3) and greater lesions were 70.49%, 35.29%, 15.26%, and 9.75% for HSIL, ASC-H, LSIL, and ASC-US, respectively. Moreover, 38.36% of all the CIN 2-3 or cancer (n = 104) cases originated from those with low grade referral diagnosis (ASC-US and LSIL). CONCLUSIONS: The majority of cases in the study were predominantly ASC-US and LSIL and approximately 40% of all the high grade lesions came from those with low grade referral diagnosis. This shows poor cytohistopathological correlation and calls the triage of minor cytological abnormalities into question.

Radical abdominal trachelectomy is a safe and fertility preserving option for women with early stage cervical cancer.

PURPOSE OF INVESTIGATION: To present the surgical, oncological and obstetrical outcomes gained from patients who underwent radical abdominal trachelectomy (RAT) in Zeynep Kamil Women and Children Diseases Education and Research Hospital and radical Yeditepe University Hospital. METHODS: A total of eight RATs were performed between 2003-2010. Data were obtained from medical and pathological records of the patients. RESULTS: The mean age of the patients was 27.37 +/- 6.39 years. The mean follow-up time of the patients was 33.62 +/- 27.47 months. Three (37.5%) patients had a tumor size smaller than 2 cm, and five (62.5%) patients had a tumor size larger than 2 cm. Seven (87.5%) patients had stage IB1 and one (12.5%) patient had stage IIA tumor. Three (37.5%) patients had late postoperative complications: uterotubal abscess, severe lymphedema and lymphocyst. There were no recurrences. Three patients became pregnant which resulted in two live births and one abortus. The spontaneous pregnancy rate was 50%. CONCLUSION: We think that RAT is a reliable surgical option for a patient with early stage cervical cancer who wants to preserve fertility.

Peritoneal tuberculosis simulating advanced ovarian carcinoma: is clinical impression sufficient to administer neoadjuvant chemotherapy for advanced ovarian cancer?

Peritoneal tuberculosis mimics advanced ovarian cancer because of the similarities in clinical signs and symptoms such as ascites, pelvic and abdominal pain and mass, and elevation of serum CA125 level. We have presented four cases of peritoneal tuberculosis that underwent exploratory laparotomy for suspected advanced ovarian cancer during a 3-year period. Definitive diagnosis of tuberculosis was performed at laparotomy in all the cases. The frozen-section analysis seems to be the gold standard in the differential diagnosis. In view of these data, clinical diagnosis of advanced ovarian cancer is not sufficient for administering neoadjuvant chemotherapy. Cytologic or pathologic findings must be consistent with ovarian cancer for candidates who are being considered for neoadjuvant chemotherapy.

Metastatic ovarian carcinoma one year after surgical removal of colon carcinoma during pregnancy: a case report.

Colorectal carcinoma during pregnancy is a very rare event. We presented a woman with metachronous metastatic ovarian tumor existing 1 year after surgical removal of perforated sigmoid colon carcinoma encountered during cesarean section of woman of 36-week gestation for fetal distress. Pregnant women with suspicious abdominal mass should be evaluated for a possible colorectal carcinoma even in the absence of any other gastrointestinal symptoms associated with it and undergo rectal examination and sigmoidoscopy. In addition, as synchronous and metachronous ovarian metastases are common in these patients, ovaries must be evaluated carefully by bisection during operation for possible metastasis, and in women who do not have a desire for fertility, prophylactic oophorectomy seems an appropriate treatment modality for resecting synchronous metastasis and preventing future metastasis.

Androgenic adult granulosa cell tumor in a teenager: a case report and review of the literature.

The clinicopathologic findings of the third case of androgenic adult granulosa cell tumor in patients younger than 15 years was presented and discussed in the light of the literature. A patient complaining of secondary amenorrhea and hirsutism with elevated levels of plasma total testosterone, dehydroepiandrosterone sulfate, free androgen index and serum inhibin A, and a left ovarian septated, cystic mass was admitted to the hospital. The inhibin A level was within normal levels in the first month postoperatively. Inhibin A could be a tumor marker of utmost importance particularly in patients with androgenic or hyperestrogenic symptoms, especially in cases where benign criteria are abundant such as young age, nonincreased levels of classic tumor markers, and ultrasonographic appearance without any suspicion of malignancy.

Mucoepidermoid variant of adenosquamous carcinoma arising in ovarian dermoid cyst: a case report and review of the literature.

A 40-year-old woman with mucoepidermoid variant of adenosquamous carcinoma arising in dermoid cyst in left ovary is presented. The patient was staged as IC. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and pelvic and para-aortic lymph node sampling were carried out. The disease recurred in postoperative 12th month. To our best knowledge, this is 12th case of adenosquamous carcinoma in dermoid cyst and third case of mucoepidermoid variant of adenosquamous carcinoma in the literature.

Uterine liposarcoma in a young woman: a case report.

Liposarcoma of uterus is a very rare neoplasm encountered generally in the sixth or seventh decade of life. We reported the eighth case of uterine liposarcoma with extension to broad ligament in a 23-year-old woman who presented with pelvic pain, dysuria, and rapidly enlarging pelvic mass. During laparotomy, the mass was detected to be originated from the uterine cervix. In frozen section, no definitive diagnosis was established, and for preservation of fertility, extirpation of the mass was performed. The histopathologic examination of the specimen revealed liposarcoma. The tumor cells were diffusely and intensively immune reactive for vimentin and S-100, and negative for smooth muscle actin, desmin, h-caldesmon, pan cytokeratin, and CD10. Staining with periodic acid and Schiff, alcian blue, mucicarmine, and epithelial membrane antigen (EMA) were negative. No recurrence was detected in the postoperative seventh month. Present case is the youngest patient with uterine liposarcoma and also the first case detected in reproductive period.

A case of cotyledonoid leiomyoma and review of the literature.

We report a case of a rare, unusual benign tumor, the cotyledonoid leiomyoma or Sternberg tumor, detected incidentally in a 67-year-old woman who underwent total hysterectomy and bilateral salpingo-oophorectomy because of a persisting left ovarian cyst of 5 cm. This is the 14th case of cotyledonoid leiomyoma and 2nd case which had no intrauterine portion but had extrauterine extensions. At laparotomy, it was detected that a deep red nodular papillary tumor had been dissecting the posterior leaf of the left broad ligament, projecting into the abdominal cavity just near the left cornu of the uterus, and extending in downward direction. The remaining portion was lying between the layers of the left broad ligament and arose from the subserosa of the left side of the uterine isthmus. Although the bizarre and unusual shape was in favor of malignity, the frozen-section examination revealed a benign histology. Although the cotyledonoid leiomyoma is a benign entity, it may suggest a malignant disease owing to its unusual sarcomatoid appearance and its rarity. Therefore, awareness of obstetricians and gynecologists regarding this rare entity will prevent unnecessary anxiety and interventions.

Atypical glandular cells: improvement in cytohistologic correlation by the 2001 Bethesda system.

The objective of this article was to evaluate clinical significance of glandular atypia on Papanicolaou smear, to compare the Bethesda system (TBS) 2001 with the 1991 revision, and to determine whether there is any improvement in the cytohistologic correlation by the new system. Cytology files of 18,955 patients were reviewed for diagnosis of atypical glandular cells of undetermined significance (AGUS), and histopathology files were searched. Cervical smears of these patients were reclassified according to TBS 2001. Of the 18,955 specimens, 89 (0.46%) were diagnosed as AGUS. Of these 89 women, 76 (85.3%) accepted the follow-up protocol of our hospital. In reevaluation according to TBS 2001, 31 specimens were reevaluated as atypical glandular cells (AGC) and 3 were reevaluated as adenocarcinoma in situ, 8 as AGC with concomitant squamous cell abnormalities, 1 as atypical squamous cells that cannot exclude high-grade squamous intraepithelial lesions, and 33 as negative. Thirty-one (93.9%) of these 33 negative cases were in the AGUS-reactive category in the initial examination. The difference between the rates of the malignant pathologies in the AGUS (25%, 19/76) and in the AGC (42.8%, 18/42) categories was significant (chi(2)= 4.0, P= 0.04). The new terminology of AGC is more likely to suggest a clinically significant lesion than TBS 1991. Repeated cytologic testing during follow-up seems to be unacceptable.

Atypical squamous cells: improvement in cytohistological correlation by the 2001 Bethesda System.

PURPOSE OF INVESTIGATION: To evaluate the advantages of the 2001 Bethesda System over the 1991 Bethesda System in the management of atypical squamous cells. METHODS: The cytology files of the 8,748 patients were reviewed for diagnosis of atypical squamous cells of undetermined significance (ASCUS) at Zeynep Kamil Hospital. Seventy-two of the 259 smear specimens with the diagnosis of ASCUS were reviewed and reclassified according to Bethesda 2001. RESULTS: Of the 8,748 specimens, 259 (2.96%) were diagnosed as ASCUS. In re-evaluation of the 72 specimens according to the 2001 Bethesda system, the number of cervical smears with a diagnosis of atypical squamous cells (ASC) decreased to 21 in number. Of the 21 cervical smears with an ASC category, eight patients (38.1%) had high-grade intraepithelial squamous lesions (HSIL) and six (28.6%) had low-grade intraepithelial squamous lesions (LSIL) in histopathological specimens. The detection rates of squamous abnormalities (chi2 = 24.79, p < 0.0001) and high-grade squamous abnormalities (chi2 = 8.31, p = 0.0039) were significantly higher according to Bethesda 2001. CONCLUSION: The 2001 Bethesda System seems to reduce the number of cervical smear diagnoses of ASC, without causing any impairment in the diagnosis of HSIL thus decreasing the number of unneccesary interventions like cervical biopsy and decreasing the cost, inconvenience, anxiety and discomfort.

Sclerosing stromal cell tumor of the ovary in pregnancy: a case report.

A rare case of benign ovarian stromal cell tumor during pregnancy is presented. Because of a rapidly growing solid ovarian mass, 6 x 7 cm in diameter, a 21-year-old woman at 14 weeks of gestation was explored via laparotomy. Histopathological diagnosis was sclerosing stromal tumor of the ovary. She had no complaint of menstrual irregularities before pregnancy and there was no clinical or hormonal evidence of active androgenic hormone secretion. Immunohistochemical staining showed positive vimentin, smooth-muscle actin and desmin reactions. Sclerosing stromal tumor is a very rare condition in pregnancy and our case is only the eighth case detected during pregnancy according to the literature.

Human chorionic gonadotropin assay in cervical secretions for accurate diagnosis of preterm labor.

OBJECTIVES: We planned to determine whether the concentration of human chorionic gonadotropin (hCG) in cervical secretions could be a useful marker for accurate diagnosis of preterm labor, and whether the use of cervical hCG assay in combination with the Bishop score would improve the prediction of delivery within 7 days, and to determine the cut-off values for hCG in prediction of delivery within 100 h, 7 and 14 days, as well as before 35 and 37 weeks of gestation in a group of women at high risk for preterm delivery. METHODS: The study was conducted in the perinatology department of Zeynep Kamil Women and Children Diseases Education and Research Hospital between February 2002 and February 2003. One hundred and two subjects with a diagnosis of threatened preterm labor with intact membranes were included in the study. For hCG measurements, a cotton swab was rolled intracervically for 10 s to absorb fluid. Bishop scores were assessed. The correlation test was employed for the variables influencing hCG values. The ROC curve analysis was used to establish an optimal cut-off concentration for cervical hCG and an optimal cut-off level for Bishop score. The continuous variables were analyzed by the unpaired, independent, two-tailed t-test and categorical data were analyzed by the chi-square test. RESULTS: A significant positive correlation was present between the cervical hCG concentrations and Bishop scores (r=0.72, P<0.0001), and a highly negative correlation between the cervical hCG concentrations and the time interval from sampling time until delivery (r=-0.80, P<0.0001) was detected. The cut-off value for cervical hCG concentration and its sensitivity, specificity, positive and negative predictive values, accuracy, relative risk and likelihood ratio for accurate determination of delivery within 100 h were > or =32 mIU/ml, 98%, 55%, 70%, 96%, 77%, 19.68 and 2.18, respectively. However, these values were > or =32 mIU/ml, 97%, 84%, 89%, 95%, 92%, 17.37 and 6.06, respectively, for prediction of delivery within 7 days; > or =30 mIU/ml, 97%, 79%, 87%, 94%, 89%, 15.15 and 4.62, respectively, for prediction of delivery within 14 days; > or =33 mIU/ml, 89%, 92%, 94%, 83%, 90%, 5.83 and, 11.55, respectively, for prediction of delivery before 35 weeks; and finally > or =27 mIU/ml, 76%, 50%, 85%, 37%, 71%, 1.34 and 1.52, respectively, for prediction of delivery before 37 weeks. CONCLUSIONS: Cervical hCG expression seems to be rewarding in accurate diagnosis of preterm labor. This test has the advantage of low cost and wide availability.