Vulval pruritus: the experience of gynaecologists revealed by biopsy.

Pruritus of the vulva is a common symptom among patients attending to outpatient clinics. In the present study, we aimed to assess pathologies causing vulval pruritus in the reliability of biopsy in a tertiary referral centre. A total of 137 patients undergoing vulval colposcopy because of vulval pruritus were reviewed from the hospital records retrospectively. The mean age of the patients was 47.61 ± 11.88 years and 36.5% of the patients were postmenopausal. In 101 (73.7%) of the patients, macroscopic lesions were present. In 88 (64.2%) of the patients, tolidine-positive stained areas were determined under colposcopy. In total, 68 (49.6%) of the lesions were plain, whereas 51 (37.2%) of them were depigmented. Lichen simplex chronicus, lichen sclerosis and chronic inflammation were the major pathologies associated with vulval pruritus (25.5%, n = 35; 20.4%, n = 28; 14.6%, n = 20). In conclusion, several pathologies out of vulvovaginal candidiasis may lead to vulval pruritus and clinicians should be aware of the importance of biopsy in determining the underlying pathology.

Borderline ovarian tumors: outcomes of fertility sparing surgery.

AIM: Borderline ovarian tumors(BOT) account for ten to 20 percent of all epitelial ovarian carcinomas and often occur in reproductive ages. The aim of this study was to evaluate the clinical and reproductive outcomes of patients who were diagnosed with BOT and underwent fertility sparing surgery. MATERIALS AND METHODS: Patients younger than 40 years who underwent fertility sparing surgery for BOT from 2004 to 2012 were reviewed retrospectively and were evaluated according to the reproductive and clinical outcomes. RESULTS: Twenty-eight patients younger than 40 years with BOT underwent fertility sparing surgery. Median follow up time was 42 +/- 28.1 months. During the follow up period, two patients (7.1%) developed recurrence at 35 and 36 months, respectively. Five (17.9%) out of 28 patients became pregnant during the follow up period. CONCLUSION: Fertility sparing surgery should be the first choice for the treatment of BOT in patients who wish to preserve fertility.

Surgical intervention for adnexal masses during pregnancy.

We aimed to evaluate the influence of surgical intervention on gestational and neonatal outcomes in women who underwent elective surgery in the second trimester of gestation because of an adnexal mass. We retrospectively reviewed the hospital records of women who underwent elective surgery for adnexal masses in the second trimester of gestation between 2006 and 2012. The ages of the women ranged between 17 and 33 years. Eight women underwent a laparotomy, and one woman, who aborted on the day of the operation, underwent a laparoscopy. Dermoid cysts, cystadenoma and borderline ovarian tumours were present in four, two and two of the women, respectively. Eight women had no complications after surgery and delivered healthy newborns at term. We concluded that elective surgery on an adnexal mass in the second trimester of gestation is safe for both the mother and the fetus.

Platelet volume as a parameter for platelet activation in patients with endometrial cancer.

The objective of this study was to use mean platelet volume (MPV) as a measure of platelet activation in patients with endometrial adenocarcinoma and healthy controls. There was a total of 310 patients with endometrial adenocarcinoma retrospectively evaluated and 250 healthy controls. Preoperative haemoglobin, platelet counts and mean platelet volume were evaluated and statistical tests were conducted to determine the differences among early and advanced disease groups and controls. Median haemoglobin (13.0 vs 13.3 g/dl) and platelet count (282,000 vs 280,000/µl) values were similar in patients with endometrial adenocarcinoma and healthy controls (p > 0.05). Subjects with endometrial cancer exhibited slightly higher MPV than the control group (8.4 fl vs 8.2 fl) (p = 0.048). In patients with advanced-stage endometrial cancer, haemoglobin was significantly lower (p < 0.05) and MPV was significantly higher (p < 0.05) than in either patients with early-stage endometrial cancer or the control group. It was concluded that MPV was found to be a marker for predicting advanced-stage endometrial cancers.

Prediction of suboptimal cytoreduction of epithelial ovarian carcinoma by preoperative computed tomography.

In an aim to evaluate the diagnostic efficacy of preoperative abdominal-pelvic CT for the prediction of suboptimal cytoreduction of epithelial ovarian carcinoma (EOC) at primary surgery, CT scans of 48 patients who underwent primary surgery for EOC were retrospectively analyzed. The presence of at least one of the following CT findings: multiple implants > 1 cm in maximum diameter in the mesenteria of the small or large intestines, porta hepatis or intersegmental fissure or on the hepatic surface, diaphragmatic peritoneum, gastrohepatic or gastrosplenic ligaments or the extension of tumor infiltration > 2 cm on the omentum towards the spleen or stomach or the intestines encased by the tumor > 2 cm, diffuse peritoneal thickening or invasion of the lateral pelvic wall > 1 cm or multiple lymph nodes > 1 cm at the cardiophrenic and suprarenal levels were accepted as the critical markers for predicting suboptimal cytoreduction. Suboptimal surgery, defined as leaving a residual tumor mass > 1 cm, was determined in 18 (37.5%) patients. CT predicted suboptimal cytoreduction with 83.3% (15/18) sensitivity, 90% (27/30) specificity and 87.5% (42/48) accuracy. PPV and NPV values were 83.3% (15/18) and 90% (27/30), respectively. These results suggested that preoperative CT could successfully predict suboptimal surgery in patients with EOC.

Comparison of histopathologic classification and surgical stage by cytokeratin 8 and cytokeratin 18 in endometrial cancer.

PURPOSE OF INVESTIGATION: The aim of the study was to show the role of the cytoskeletal proteins CK8 and CK18 in endometrial cancer invasion and to histopathologically classify endometrial cancer patients. METHODS: This study was a prospective analysis of 49 histologic samples of consecutively surgically operated endometrial cancer patients. After histopathologic classification the most invasive tumor area was selected for immunohistochemistry. Monoclonal antihuman keratin Ab-4 and keratin Ab-1 were applied. RESULTS: CK8 and CK18 stained tumoral tissue and tumoral cell debris in the lymphovascular space were significantly correlated with stage (p < or = 0.005). CONCLUSIONS: To understand the causes of early treatment failure in endometrial cancer patients, further studies are needed to show the role of enhancing factors of endometrial cancer invasion.

Prognostic significance of fascin expression in endometrioid carcinoma.

PURPOSE OF INVESTIGATION: Actin bundling protein fascin has been previously associated with tumor progression in human cancers. We evaluated whether fascin also plays a role in endometrioid carcinomas. METHODS: Cases of 28 proliferative and hyperplastic endometrium and 43 endometrioid carcinomas were examined by immunohistochemistry using antihuman fascin antibody. RESULTS: Weak fascin expression in glandular epithelium was observed in 39% of non-neoplastic samples and various degrees of fascin expression were observed in 74% of neoplastic samples. The number of positively stained samples and intensity of epithelial staining were significantly higher in endometrioid carcinoma compared to the non-neoplastic group (p < 0.001). The number of positively stained samples and total fascin scores of stroma were significantly higher in proliferative and hyperplastic endometrium biopsies compared to the endometrioid carcinoma (p < 0.001). Higher grade endometrioid carcinoma cases had significantly increased total epithelial fascin scores (.042, p < 0.05). There was also a significant difference between tumor grade and patient survival (.040, p < 0.05). There was a significant correlation between microvessel count and disease-free survival (r = .412, p = .006). In the proliferative and hyperplastic endometrial biopsies microvessels stained homogeneously in all cases (28/28), but in the endometrioid carcinoma group eight out of 43 cases showed heterogeneous fascin staining of microvessels. The difference was significant (.019, p < 0.05). CONCLUSIONS: Our study supported the dynamic role of actin bundling protein fascin in generating and maintaining endometrial neoplasms. It also showed that in the development of neoplasia, stromal fascin expression decreases but epithelial fascin expression up-regulates.

Actin bundling protein fascin expression in ovarian neoplasms: comparison of histopathologic features of tumors obtained by the first and secondary cytoreduction surgeries.

PURPOSE OF INVESTIGATION: The aim of the study was to compare the fascin expression pattern and histopathologic features of malign epithelial ovarian tumors obtained by the primary and secondary surgeries. METHODS: The samples of 94 epithelial ovarian carcinomas, 35 secondary surgeries for ovarian carcinomas, 13 borderline epithelial ovarian tumors, 25 cystadenomas and four normal ovarian tissues were stained by means of fascin immunohistochemistry. Secondary surgeries included in the study were secondary cytoreduction at the time of second-look laparotomy (SLL), interval debulking surgery after neoadjuvant chemotherapy or secondary cytoreductive surgery in patients with recurrent epithelial ovarian carcinoma. RESULTS: Mean rank value of the stromal fascin score was higher in 94 cases of malign epithelial ovarian carcinomas than borderline epithelial tumors, cystadenomas and normal ovaries (.000, p < 0.001). There was no significant difference in terms of total epithelial fascin score (.685, p > 0.05) and total stromal fascin score (.572, p > 0.05) between the primary and the secondary surgeries of epithelial ovarian carcinomas. CONCLUSIONS: Regarding the results of stromal fascin expression in 94 epithelial ovarian carcinomas, we hypothesized that cell-matrix interaction was an important step in the progression of malign epithelial ovarian neoplasms. Our study showed that the initial tumorigenic phenotype did not change with time and use of cisplatinum-based combination chemotherapy. Further studies with close follow-up of patients are necessary to reveal the role of fascin on matrix degradation mechanisms which might be the cause of the recurrences in ovarian neoplasms.

The role of actin bundling protein fascin in the progression of ovarian neoplasms.

PURPOSE OF INVESTIGATION: The aim of the study was to investigate the role of fascin in tumor progression and to investigate the role of fascin on endothelial cell migration and angiogenesis in ovarian neoplasms. METHODS: In the study, 94 malign epithelial ovarian neoplasms, 13 borderline epithelial ovarian neoplasms, 25 serous and mucinous cystadenomas and four normal ovarian tissues were examined by means of immunohistochemistry, using monoclonal antihuman fascin antibody, clone IM20. RESULTS: Total stromal fascin score in cases of borderline and malign epithelial ovarian tumors was significantly higher compared to normal ovaries and benign epithelial ovarian tumors (.000, p < 0.001). There was no statistically significant difference in terms of total epithelial fascin scores of samples between groups (.080, p > 0.05). Presence of vascular invasion (.000, p < 0.001), psammomatous calcifications (.001, p = 0.001), and lymphocytic infiltration (.000, p < 0.001) were significantly higher in malign neoplasms. There was no significant difference in terms of mean microvessel count and homogeneous or heterogeneous fascin expression of microvessels between the benign and malign groups (respectively p = .228 and p = .143). CONCLUSIONS: This study suggests that up-regulation of fascin in tumoral tissue may promote invasion of ovarian carcinoma by cell-matrix adhesion.

Fascin, an actin-bundling protein expression in cervical neoplasms.

PURPOSE OF INVESTIGATION: Our objectives were (1) to examine expression of fascin in cervical tissues with chronic inflammation, intraepithelial neoplasms and invasive carcinomas, and (2) to investigate the role of fascin on endothelial migration and angiogenesis in cervical neoplasms. METHODS: In this study we investigated by means of immunohistochemistry fascin expression in 92 cervical biopsy samples representative of chronic inflammation (n=13), squamous intraepithelial lesions (SILs, n = 33) and invasive carcinomas (n = 46). RESULTS: Various degrees of fascin expression were observed in 94% of the samples of SILs, in 67% of the samples of invasive cervical carcinoma and in 69% of the samples of chronic inflammation. Total epithelial fascin scores of samples were significantly higher in high-grade (H)SILs compared to low-grade (L)SILs, invasive carcinoma and chronic inflammation of the cervix (p < 0.05). Mean microvessel count was 55.00 +/- 5.17 in HSILs, 40.76 +/- 3.57 in LSILs, 37.11 +/- 2.91 in carcinoma and 25.69 +/- 3.98 in chronic inflammation. We found a significantly higher microvessel count in HSILs compared to invasive carcinoma and chronic inflammation (respectively, p = .004, p = .000). CONCLUSION: Epithelial fascin expression up-regulated when the malignant tumor cell phenotype had occurred in the cervix. Similarly, microvessel count increased with the beginning of cervical tumorigenesis.

Massive ovarian edema: a case report.

Massive ovarian edema is considered a non-neoplastic lesion characterized by a tumor-like enlargement of one or occasionally both ovaries secondary to an accumulation of edema fluid within the stroma. It is an uncommon entity that usually leads to oophorectomy as an unnecessary treatment in children, adolescents and young women. A diagnostic wedge resection with subsequent frozen section is essential. A definitive diagnosis of massive ovarian edema can not be made on preoperative imaging. In this article a case of massive ovarian edema in a 15-year-old female thought to be a solid neoplasm in the preoperative period is described.

Sclerosing stromal tumor of the ovary associated with Meigs' syndrome: a case report.

Sclerosing stromal tumors of the ovary are distinct, but rare benign neoplasms. These tumors appear solid and are very vascular giving the impression of malignant tumors. They occur mostly in young women. Morphologically they have distinct characteristics which differentiate them from other stromal tumors. Benign ovarian tumors associated with Meigs' syndrome are rare. In this article a case of ovarian sclerosing stromal tumor associated with Meigs' syndrome in a 17-year-old women is described and the differential diagnosis is also discussed.

Computed tomography findings of primary serous papillary carcinoma of the peritoneum in women.

With the aim to describe preoperative computed tomography (CT) findings, the clinical, histopathological, and CT findings of the 12 consecutive patients with a confirmed diagnosis of primary peritoneal serous papillary carcinoma (PPSPC) were retrospectively evaluated. Of the 12 patients with a mean age of 57.5 +/- 10.3 years, ten (83.3%) were postmenopausal. Serum Ca-125 levels were elevated in all patients. Ten (83.3%) had Stage III and two (16.7%) patients had Stage IV disease and none of the excised ovaries had deep parenchymal involvement. The most common CT findings were the omental (n = 11), mesenterial (n = 11) and parietal peritoneal involvements (n = 10), and variable amount of ascites (n = 10). Pelvic peritoneal involvement in four (33.3%) patients was so extensive that it resembled a mass in the Douglas pouch. Thickening of the wall of gastrointestinal viscera (n = 9), lymphadenopathy (n = 5) and pleural effusion (n = 5) were the other CT findings and calcification was seen in only three (25.0%) patients. Although, none of them was characteristic, CT features of diffuse peritoneal, omental and mesenterial involvement especially in middle-aged or elderly postmenopausal women with normal-size ovaries in the absence of an identifiable primary site in conjunction with elevated level of serum CA-125 should suggest the possibility of PPSPC.

Bcl-2 expression in preinvasive and invasive cervical lesions.

PURPOSE: To determine the correlation between bcl-2 expression and clinicopathological findings in cervical intraepithelial neoplasias (CIN I, II, III) and invasive cervical lesions, and its effect on overall survival rate. METHODS: Fifty specimens derived from 22 preinvasive and invasive cervical cancer cases up to surgical stage IIb (21 squamous cervical carcinoma and 7 adenocarcinoma cases) were preserved in paraffin blocks from primary surgery and constituted the study group. Tissues were processed and stained by immunohistochemical methods to assess the degree of bcl-2 expression. RESULTS: Positive bcl-2 expression was detected in 54% (13/21) of invasive lesions, while negative in 46% of cases. In CIN's, overall bcl-2 positivity was detected in 68% of cases. Bcl-2 expression was highly relevant between low grade (CIN I) and high grade (CIN II-III) lesions (p < 0.05). As regards degree of tissue staining for bcl-2 in CIN III cases, a statistically relevant difference was detected in comparison with low-grade preinvasive lesions (p < 0.05). In invasive cervical cancer cases, patients with bcl-2 positivity had a longer survival rate. By using the Cox regression model, univariate analysis did not show any specific prognostic factor to be important for survival rate, whereas, on multivariate analysis, histopathologic subtypes (p = 0.0390) and stage of tumor (p = 0.0451) had a statistically significant impact on overall survival rate. CONCLUSIONS: Bcl-2 expression, especially in preinvasive lesions, may play a role in the apoptotic process and be regarded as a marker for disease progression. In invasive cervical carcinomas, bcl-2 expression has not been shown to be effective in overall survival rates.

Multidrug resistance gene-1 (Pgp) expression in epithelial ovarian malignancies.

OBJECTIVE: To assess the value of P-glycoprotein (Pgp) expression in advanced epithelial ovarian cancer with regard to clinicopathological findings and disease prognosis. METHODS: Twenty-four cases diagnosed as primary epithelial ovarian malignancies, between 1993-1999, were enrolled in this study. All of the cases had undergone cytoreductive surgery and an optimal staging procedure. Following cytoreductive surgery, in 18 patients, cisplatin+cyclophosphamide, and in six patients, cisplatin+paclitaxel combination chemotherapy regimens were initiated. After six courses of chemotherapy, cases were evaluated by pelvic examination, transvaginal ultrasound, pelvi-abdominal tomography and serum Ca-125 levels for the presence of residual disease. Following this evaluation residual tumor was detected in 14 cases and secondary cytoreductive surgery was undergone. In ten cases without any clinical and laboratory confirmation of the presence of tumor, second-look laparotomy was performed. In 24 epithelial ovarian cancer cases, both in primary or secondary cytoreductive surgery, Pgp expression was determined by immunohistochemical methods. RESULTS: Following primary surgery, in 25% (6/24) of cases, analysis of tumor specimens showed presence of Pgp expression. In cases recurring after first-line chemotherapy, Pgp expression was not statistically different in regard to chemotherapy regimen (p = 0.098). Pgp expression in tumoral tissues after chemotherapy did show a higher Pgp expression than before chemotherapy (p = 0.016). No significant correlation was relevant between Pgp expression and Ca-125 levels, histopathological differentiation, histologic subgroups of tumor, primary and residual tumor sizes and overall survival. CONCLUSION: In epithelial ovarian cancer, Pgp expression has no effect on overall disease survival.

Hydatidiform mole at extreme ages of reproductive life in a developing country from 1932 to 2000.

PURPOSE OF INVESTIGATION: To determine the rates of hydatidiform mole (HM) cases at extreme reproductive life in a developing country. METHODS: A descriptive study was performed to assess the number of pregnancies and deliveries in Turkey, from 1932 to 2000, based on nationally or internationally published data from different university and state maternity hospitals. RESULTS: A spectrum of prevalence rates in different hospitals were depicted. Almost all of represented data were hospital-based. Percentages of all HM cases < 19 years old and > 40 years old compared to the total number of HMs in each study were not mentioned. In addition, the number of HM compared to total number of deliveries and pregnancies in those age groups were not provided in those studies. CONCLUSION: There appears to be a need for further descriptive studies on a national basis, in regard to assess total number of HM cases per total pregnancies and deliveries for those age groups.

The significance of local cellular immune response of women 50 years of age and younger with endometrial carcinoma.

OBJECTIVE: Local cellular immune response and traditional histopathologic parameters in endometrial carcinoma patients 50 years old and younger were compared with those of patients older than 50 years of age. MATERIALS AND METHODS: We retrospectively compared the clinicopathologic factors and outcomes of 24 younger and 82 older women who were operated on for endometrioid type endometrial carcinoma at our institution. RESULTS: No significant difference was determined in survival with respect to age and menopausal status in patients with endometrial carcinoma. Younger and older age groups had a similar distribution of most pathologic features including myometrial invasion, cervical involvement, lymph node metastasis, vascular invasion, perivascular lymphocytic infiltrates and tumor infiltrating lymphocytes. While older women had higher-grade tumors, younger women had more frequent ovarian metastasis. Tumor infilrating lymphocytes were seen more frequently in the postmenopausal group than those of the premenopausal group. CONCLUSION: The distribution of local cellular immune response, most histopathologic parameters and survival were the same for younger and older women.

Prognostic significance of DNA topoisomerase II-alpha (Ki-S1) immunoexpression in endometrial carcinoma.

OBJECTIVE: In order to determine the significance of proliferative activity (PA) in endometrial carcinomas, we analysed the expression of cell cycle-related antigens in routinely processed tissue. MATERIALS AND METHODS: Serial sections of 113 endometrial carcinoma specimens were immunostained with the monoclonal antibody DNA Topoisomerase II-alpha (Ki-S1). In addition to Topoisomerase II-alpha (Ki-S1) staining, histologic type, International Federation of Gynecology and Obstetrics (FIGO) stage. FIMO grade, depth of myometrial invasion, tumor size, lymphovascular space invasion, serosal and/or adnexal involvement, lymph node metastasis, age and peritoneal cytology were evaluated as prognostic indicators. The median follow-up time was 23 (range, 1 to 126 ) months. RESULTS: FIGO stage, FIGO grade, tumor size, lymphovascular space invasion, lymph node metastasis, peritoneal cytology and Topoisomerase II-alpha (Ki-S1) expression all significantly influenced survival in univariate analyses (p < or = 0.05). In the Cox regression analysis, Topoisomerase II-alpha (Ki-S1), serosal and/or adnexal involvement, and lymph node metastasis expression were the only variables with independent prognostic impact (p < or = 0.05), whereas FIGO stage, FIGO grade, histologic type FIGO grade, depth of invasion, tumor size, lymphovascular space invasion, age and peritoneal cytology had no independent influence (p > 0.05). Topoisomerase II-alpha (Ki-S1) staining was significantly elevated in advanced (Stage II, III, IV) as opposed to early (Stage I) carcinomas (p < or = 0.05). CONCLUSION: The association with established prognosticators for endometrial carcinomas, and the results of uni- and multivariate analysis indicate that the additional evaluation of DNA Topoisomerase II-alpha (Ki-S1) peptide antibody (PA) is useful for classifying patients into subgroups with low and high risk of relapse which might help to individualize the therapeutic strategy in endometrial carcinomas.

A hospital-based multicentric study results on gestational trophoblastic disease management status in a developing country.

OBJECTIVE: To determine the clinical management of gestational trophoblastic disease in Turkey. MATERIAL AND METHODS: An inquiry form was sent to 55 health centers including university hospitals, maternity hospitals with residency programs and maternity hospitals without residency programs in 1997. The inquiry consisted of questions about the type of classification systems in use, distribution of cases according to those classifications, use of prophylactic chemotherapy and its indications, and drug preference for single-agent or combined chemotherapies. RESULTS: The overall response rate to the conducted inquiry was 47.1%. A clinical classification system was identified in 60% of the hospitals in Turkey. Generally, methotrexate was the most used single-agent chemotherapy. With regard to first-line combined chemotherapy, MAC (methotrexate, antinomycin-D, cyclophosphamide) was the preferred combination. EMA-CO (etoposide, methotrexate, actinomycin-D, cyclophosphamide, vincristine) was the most common used second-line chemotherapeutic regimen. CONCLUSION: Due to insufficient data acquisition from all the medical centers and a lack of national population-based studies, it is difficult to draw a conclusion with respect to the interpretation of the data about the management protocols of gestational trophoblastic disease.