Comparison of Three Different New Bipolar Energy Modalities and Classic Bipolar in Vivo for Tissue Thermal Spread.

OBJECTIVE: The aim of this study was to compare three different new bipolar energy modalities and classic bipolar in vivo for tissue thermal spread. MATERIAL AND METHOD: This prospective, randomized, single-blind study was conducted between Septemsber 2012 and July 2013. Eighteen patients aged 40-65 years undergoing hysterectomy and bilateral salpingectomy for benign etiology were included in the study. Before the hysterectomy operation began, it was marked nearly distal third cm started from uterine corn and proximal close third cm started from fimbrial bottoms by visualizing both fallopian tubes. The surgery was performed using one 5 mm applicator of PlasmaKinetics™, EnSeal®, LigaSure™ or classic bipolar energy modality. The time each device was used was standardized as the minimum time of the audible warning of the device for tissue impedance and as tissue vaporization on classic bipolar. Tissues were dyed by both H&E and Masson's Trichrome in the pathology laboratory. Thermal spread was compared. RESULTS: Evaluation of the damage on the uterine tubes by each device used revealed that LigaSure™ was associated with increased thermal injury compared to PlasmaKinetics™ (p=0.007). Apart from PlasmaKineticsTM (p=0.022), there was no statistically significant difference between the three devices in terms of thermal damage spread in the distal and proximal fallopian tubes. CONCLUSION: To reduce lateral thermal damage, Plasmakinetics™ may be preferable to Ligasure™ among the three different new bipolar energy modalities.

The relationship between lipocalin-2 and free testosterone levels in polycystic ovary syndrome.

INTRODUCTION: Lipocalin-2 is an adipokine that is mainly produced from adipocytes and macrophages. Data related to PCOS and other obesity-associated disorders have shown divergent results. Here, we studied lipocalin-2 concentrations in women with PCOS and in healthy women, and investigated the potential contributors underlying lipocalin association with PCOS. MATERIAL AND METHODS: Forty-four women with PCOS and 47 age- and BMI-matched healthy women were enrolled. Fasting serum glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), high-sensitivity C-reactive protein (hs-CRP), and free testosterone levels were measured. The body fat percentage was measured by bioelectrical impedance. RESULTS: Lipocalin-2 concentrations were significantly higher in the PCOS group than in the control group (55.74 ± 17.54 ng/mL vs. 36.46 ± 19.62 ng/mL, p = 0.011). There was a correlation between lipocalin-2 levels and free testosterone. In a multiple regression model, the body fat percentage, HOMA-IR, and hs-CRP were not associated with lipocalin-2. However, only free testosterone was associated with lipocalin-2. A "lipocalin-2 = 11.214 + (1.943 × free-testosterone)" equation was obtained. CONCLUSIONS: Serum lipocalin-2 levels were higher in women with PCOS, and only free testosterone was associated with lipocalin-2. Lipocalin-2 levels and their influencing factors have discrepant results in both PCOS and other obesity- or insulin resistance-related metabolic disorders. Thus, the potential role of lipocalin-2 in PCOS should be clarified. (Endokrynol Pol 2017; 68 (1): 7-12).

Placental bed apoptosis is increased in pregnant women with pre-eclampsia versus normotensive pregnant women.

We hypothesised that apoptosis in the placenta is increased in pregnant women whose pregnancies were complicated by pre-eclampsia as compared to normal pregnant women. Biopsy samples were obtained by punch biopsy from placental beds in 15 pre-eclamptic and 15 normotensive pregnant women during cesarean section. Apoptosis in syncytiotrophoblasts, syncytial cluster, extravillous cytotrophoblast, and decidual and stromal cells were evaluated by caspase-3, bax and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labelling (TUNEL) immunohistochemical methods. A significant involvement was observed via caspase-3 and TUNEL methods in the syncytiotrophoblasts, syncytial cluster and extravillous cytotrophoblast cells of the pre-eclamptic group versus normotensive group (p < 0.001). Caspase-3 method found significantly increased involvement in the pre-eclamptic group versus normotensive group (p < 0.001). Although bax method found significantly increased involvement in syncytiotrophoblasts in the pre-eclamptic group versus normotensive group (p < 0.001), no significant difference was found between the groups in terms of involvement of other cell groups (p > 0.05). Apoptosis in the placental bed is increased in pre-eclamptic woman.

Chromosome aberrations [dup(1q)] in endometrial cancer: Gene analysis of 54 surgical specimens in Turkey.

OBJECTIVE: We aimed to evaluate the frequency of chromosomal aberrations and mutations in the k-ras or Her-2/neu genes in surgical specimens of endometrial carcinoma and their association with clinicopathological findings. MATERIALS AND METHODS: Fifty-four patients who were treated for endometrial cancer between April 2010 and May 2011 at the Kocaeli University Obstetrics and Gynecology Department, Kocaeli, Turkey were enrolled in a prospective study. Clinical and histopathological findings were recorded. Genetic analysis, which included the detection of chromosomal deletions and duplications, as well as k-ras and Her-2/neu mutations, was performed on endometrial samples from surgical specimens. RESULTS: In 70% of cases, tumor size was >2 cm or covered the entire uterine cavity, affecting mostly corpus (76%) and invading less than half of the myometrium (80%). Forty-six cases (86%) had endometrioid-type carcinoma, and early stage (Stage I, 65%) and higher grade (Grade II-III, 66%) tumors were predominant. Lymph node and lymphovascular involvement was positive in 11% and 28% of the patients, respectively. Chromosomal aberrations (deletion or duplication) and Her-2/neu and k-ras mutations were encountered in 44%, 15%, and 13% of surgical specimens, respectively. The most common chromosomal aberration was dup(1q) (n = 16). Oncogenic mutations in Her-2/neu or k-ras had no association with the severity of endometrial cancer, but the presence of chromosomal aberrations, as a whole or dup(1q) alone, were associated with higher tumor size, deeper myometrial invasion, advanced stage or grade, lymphovascular invasion, and lymph node involvement (p < 0.05 for all). CONCLUSION: Chromosomal aberrations, particularly dup(1q), are related to advanced disease in endometrial cancer. Genetic analysis of cancer tissues may provide important insights in determining disease prognosis.

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.

Epidermal cyst in an unusual site: A case report.

INTRODUCTION: Epidermoid cysts can occur in a variety of locations including face, trunk, neck, extremities and scalp. Up to now, those vulvar epidermal cysts reported in the literature were localized on the labia majora and the clitoris. This is the first case of epidermal cyst reported on the labia minora. PRESENTATION OF CASE: A 47-year-old, multiparous woman presented with a history of a palpable vulvar mass, without pain but causing difficulty in walking. The large mass was 6cm in diameter and located in the left labium minus. The labial mass was surgically removed. The final pathologic diagnosis was a vulvar epidermoid cyst. The patient was discharged from hospital without any complications. DISCUSSION: Total surgical excision of the mass is more appropriate for definitive histopathological diagnosis and for the prevention of future development of complications. MRI is very important in the localization of the mass and relationship with other tissues regarding treatment planning of larger vulvar masses. CONCLUSION: Epidermal cysts should be considered in the differential diagnosis of a vulvar mass.

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.