Correlation of endometrial glycodelin expression and pregnancy outcome in cases with polycystic ovary syndrome treated with clomiphene citrate plus metformin: a controlled study.

Objective. The purpose of this study was to evaluate the relationship between clomiphene citrate (CC) plus metformin treatment and endometrial glycodelin expression and to then correlate this relationship with pregnancy outcomes. Material and Methods. A total of 30 patients diagnosed with polycystic ovary syndrome (PCOS) according to the Rotterdam criteria constituted our study group. All had been admitted to the gynecology outpatient clinic between June 1, 2011, and January 1, 2012, for infertility treatment. Our control group consisted of 20 patients admitted for routine Pap smear control. They had no history of infertility and were not using contraceptives and they were actively attempting pregnancy. Midluteal progesterone measurement and pipelle endometrial biopsies were performed with both groups. For PCOS patients, metformin treatment was initiated right after the biopsy and CC was added in the second menstrual cycle. Pipelle endometrial biopsies were repeated. Histological dating and immunohistochemistry for glycodelin were performed by a single pathologist who was blinded to the patients' clinical data. Result(s). The posttreatment ovulation rate in the study group was 93.3%. No pregnancies were achieved in either group when glycodelin expression was not present, even in the presence of ovulation. When glycodelin expression was high in PCOS group, the pregnancy rate was 60% and all pregnancies ended in live births. In weak expression group, however, three out of four pregnancies ended as early pregnancy losses. Conclusion(s). Endometrial glycodelin expression is an important predictor of pregnancy outcomes in both PCOS and fertile groups.

Comparative evaluation of the risk of malignancy index scoring systems (1-4) used in differential diagnosis of adnexal masses.

BACKGROUND: To determine the cut-off values of the preoperative risk of malignancy index (RMI) used in differentiating benign or malignant adnexal masses and to determine their significance in differential diagnosis by comparison of different systems. MATERIALS AND METHODS: 191 operated women were assessed retrospectively. RMI of 1, 2, 3 and 4; cut-off values for an effective benign or malignant differentiation together with sensitivity, specificity, negative and positive predictive values were calculated. RESULTS: Cut-off value for RMI 1 was found to be 250; there was significant (p<0.001) compatibility at this level with sensitivity of 60%, positive predictive value (PPV) of 75%, specificity of 93%, negative predictive value (NPV) of 88% and an overall compliance rate of 85%. When RMI 2 and 3 was obtained with a cut-off value of 200, there was significant (p<0.001) compatibility at this level for RMI 2 with sensitivity of 67%, PPV of 67%, specificity of 89%, NPV of 89%, histopathologic correlation of 84% while RMI 3 had significant (p<0.001) compatibility at the same level with sensitivity of 63%, PPV of 69%, specificity of 91%, NPV of 88% and a histopathologic correlation of 84%. Significant (p<0.001) compatibility for RMI 4 with a sensitivity of 67%, PPV of 73%, specificity of 92%, NPV of 89% and a histopathologic correlation of 86% was obtained at the cut-off level 400. CONCLUSIONS: RMI have a significant predictability in differentiating benign and malignant adnexal masses, thus can effectively be used in clinical practice.

The correlation between immunohistochemical expression of MMP-2 and the prognosis of epithelial ovarian cancer.

OBJECTIVES: The Objectives: The goal of the study was to evaluate the correlation of matrix metalloproteinase-2 (MMP-2) expression with tumor spread, metastasis, survival and recurrence in early and advanced-stage Epithelial Ovarian Cancer (EOC). MATERIAL AND METHODS: Medical records of patients, hospitalized at the Department of Obstetrics and Gynecology Izmir Atatürk Training and Research Hospital between 2003 and 2008, were reviewed. Patient age, tumor size, localization, histologic type and tumor grade, stage, metastasis status, patient outcomes and follow-up data were obtained from the records of the obstetrics and gynecology clinic, as well as during face-to-face or telephone interviews. RESULTS: The percentage of MMP-2 staining (expression) in the epithelial cells was not significantly associated with tumor stage and grade, histologic type, tumor diameter recurrence and overall survival (p > 0.05). A significant correlation was found between the percentage of MMP-2 staining (expression) and metastasis status (p < 0.05). The staining intensity of MMP-2 was not significantly associated with tumor stage and grade, diameter recurrence, metastasis and overall survival (p > 0.05), but was with histologic type (p < 0.05). Total scores were not significantly associated with tumor stage and grade, histologic type, tumor diameter recurrence, metastasis and overall survival (p > 0.05). Stromal staining (expression) of MMP-2 was not significantly correlated with tumor stage and grade, histologic type, tumor diameter and outcomes (p > 0.05), but was with recurrence and presence of metastasis (p < 0.05). No significant association was found between the overall survival and percentage of MMP-2 staining (p > 0.05), total score (p > 0.05) and staining intensity (p > 0.05). The association of disease-free survival with the percentage of MMP-2 staining (p > 0.05), total score (p > 0.05), staining intensity (p > 0.05) and stromal staining (p > 0.05) was not statistically significant. The survival of patients with positive stromal staining was significantly shorter compared to cases with negative stromal staining (p < 0.05). CONCLUSIONS: Large-scale, comprehensive research is needed to verify whether MMP 2 may be used as a routine prognostic factor for EOC.

Investigation of prognostic significance of CD109 expression in women with vulvar squamous cell carcinoma.

OBJECTIVE: The goal of this study was to investigate the between cluster of differentiation 109 (CD109) expression and tumor diameter, invasion depth, tumor grade, presence of lymph-node metastasis, and overall survival in patients with vulvar squamous cell carcinoma, which is the most common type of vulvar cancer. METHOD: Twenty-six patients who underwent an operation for vulvar cancer between 1999 and 2009 in our clinic were included in this study. Immunohistochemical staining was performed on formalin-fixed and paraffin-embedded tissue. RESULT: Tumor diameter was not found to be significantly associated with CD109 expression, intensity of cytoplasmic staining, or combined score (P = 0.325, P = 0.169, P = 0.352, respectively). Invasion depth and combined score were also not significantly correlated with CD109 expression (P = 0.324 and P = 0.174 respectively). There was a negative correlation between invasion depth and the intensity of cytoplasmic staining (P = 0.042). There was no significant correlation between tumor stage and CD109 expression, the intensity of cytoplasmic staining, and the combined score (P = 0.574, P = 0.389, P = 0.605, respectively). A significant positive correlation was observed between tumor grade and CD109 expression, the intensity of cytoplasmic staining, and the combined score (P = 0.003, P = 0.018, P = 0.008, respectively). No significant difference was found between the percentages of CD109 expression in patients with positive (48%) and negative (11%) lymph nodes (P = 0.058). The percentage of CD109 expression did not significantly differ in relation to overall survival (P = 0.483). CONCLUSION: Comprehensive and more extensive studies are needed to examine the relationship between CD109 expression and vulvar malignant lesions.

Endometrial spiral artery Doppler parameters in unexplained infertility patients: is endometrial perfusion an important factor in the etiopathogenesis?

OBJECTIVE: Uterine perfusion, particularly the endometrial blood flow, may have an important role in endometrial receptivity. In order to assess the contribution of sub endometrial blood flow in the etiopathogenesis of unexplained infertility mid luteal- peri-implantation period spiral artery transvaginal color Doppler parameters were measured and compared with fertile controls. MATERIAL AND METHODS: Forty-two consecutive patients admitted to Izmir Katip Celebi University Ataturk Training and Research Hospital, Department of Obstetric and Gynecology with the diagnosis of unexplained infertility after standard diagnostic work up constituted the study group and they were compared with a fertile control group admitted to hospital with non specific gynecological complaints or for check-up in the same period. Mid luteal transvaginal color Doppler ultrasonography was applied to each patient by the same radiologist who was blind to the diagnosis of the particular patient and, RI (resistance index) and PI (pulsatility index) values were calculated. RESULTS: There were no significant differences between the two groups, in respect to age, body mass index, basal hormonal and mid luteal progesterone levels (p>0.05). For the fertile control group, mid luteal-peri-implantation phase endometrial spiral artery mean RI values were calculated as 0.48±0.08 SD and mean PI values as 0.65±0.18 SD. For the study group, mean RI values were calculated as 0.54±0.07 SD, PI values were calculated as 0.80±0.16 SD. The differences for RI (p=0.009) and PI (p=0.004) were statistically significant. CONCLUSION: According to Doppler parameters, unexplained infertility patients have high impedance blood flow in spiral arteries which means that peri-implantation blood flow in these patient is lower than fertile controls. These findings suggest that endometrial perfusion may have an important contribution to etiopathogenesis of unexplained infertility.