Educational Study to Increase Breast Cancer Knowledge Level and Scanning Participation among Women Working at a University.

OBJECTIVE: The aim of the study is to increase the participation level of women in screening programs by increasing the level of knowledge about early diagnosis and screening methods for breast cancer (BC). MATERIALS AND METHODS: This was a pretest-posttest one group design study held in Eskisehir Osmangazi University, Turkey. The sample consisted of 405 women in all departments of the University. Data were collected using socio-demographic forms and questionnaires. Training about BC was provided for participants. The questionnaire used prior to the training to measure levels of knowledge about BC was re-administered 3 weeks after the training. RESULTS: The women were most commonly aware of the breast self-examination (68.1%). The ratio of women who had had mammography in the previous year was 11.4%. The BC knowledge level significantly increased after the training (p=0.001). CONCLUSION: This study determined that the level of knowledge about BC in terms of early detection and screening was low and that the percentage of participation in screening was also low.

Comparison Of Early-Stage High-Grade Serous Primary Fallopian Tube Cancers and Epithelial Ovarian Cancers: A Multicenter Study.

INTRODUCTION: We compared the disease free-survival (DFS) and overall survival (OS) rates of patients with high-grade serous primary fallopian tube cancer (HG-sPFTC) and high-grade serous epithelial ovarian cancer (HG-sEOC). METHODS: 22 early-stage cancer patients (International Federation of Gynecology and Obstetrics (FIGO) stages I-II) with HG-sPFTC were retrospectively evaluated. In addition, 44 control patients diagnosed with HG-sEOC were matched to these patients with respect to tumor stage at diagnosis. All patients underwent complete surgical staging, followed by adjuvant chemotherapy. Kaplan-Meier curves were used to generate survival data. RESULTS: The mean age of HG-sPFTC patients was 59.4 ± 6.2 years, and that of HG-sEOC patients 55.2 ± 11.0 years (p = 0.002). All patients underwent 6 cycles of platinum-based adjuvant chemotherapy. All operations were optimal. The 5-year DFSs were 77.3% for HG-sPFTC patients and 75% for HG-sEOC patients (p = 1.00).The 5-year OS rates were 81.8% in women with HG-sPFTC and 77.3% in those with HG-sEOC (p = 0.75). CONCLUSION: The DFS and OS rates of patients with early-stage (FIGO stages I and II) HG-sPFTC and HG-sEOC were similar. The surgical and adjuvant therapy management of these malignancies should be similar.

Amelanotic malignant melanoma of the uterine cervix diagnosed by cervical smear.

The melanocytic cells of the cervical epithelium are capable of forming the complete spectrum of melanocytic lesions, from benign lentigines to melanoma. Primary malignant melanoma of the uterine cervix is a rare neoplasm with aggressive behavior. The absence of melanin pigment can lead to misdiagnosis as carcinomas, sarcomas, or lymphoma. Immunohistochemical studies should be used for confirmation. In order to consent the cervix as a primary site, exclusion of any other probable primary sites of melanoma is needed. Here, we present a 61-year-old female patient with postmenopausal vaginal bleeding. After cervical smear, diagnosis was confirmed by cervical punch biopsy. Diagn. Cytopathol. 2016;44:535-537. © 2016 Wiley Periodicals, Inc.

Do Leukaemia Inhibitory Factor and Vascular Endothelial Growth Factor Have Any Roles in Intrauterine Device Mechanism of Action? An Experimental Rat Study.

OBJECTIVE: To assess leukaemia inhibitory factor (LIF) and vascular endothelial growth factor (VEGF) expression as markers of intrauterine device (IUD) efficacy in a rat model. METHODS: Twenty nulliparous female Wistar rats were divided into two groups with 10 animals per group: group I (IUD) and group II (control group, no IUD). In group I, a 2-cm 3-0 silk suture was placed into one horn of the rat bicornuate uterus. On day 20 (after IUD insertion) rats were sacrificed and their uteri removed. The number of vessels and the distribution of LIF and VEGF were compared among the uterine horns. RESULTS: There were no significant differences in LIF and VEGF expression in the groups and all horns (p > 0.05). The number of vessels was higher in the IUD+ horn than in the IUD- horn of group I and in the horn of group II (p < 0.05). There was no significant difference in the number of vessels between the IUD- horns of groups I and II (p > 0.05). CONCLUSION: LIF and VEGF expression did not correlate with IUD efficacy in a rat model. An IUD may increase the number of vessels in the uterine horn independent of VEGF expression. © 2015 S. Karger AG, Basel.

Prognostic Significance of Retroperitoneal Lymphadenectomy, Preoperative Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio in Primary Fallopian Tube Carcinoma: A Multicenter Study.

PURPOSE: The purpose of this study is to evaluate the prognostic role of preoperative neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) and the need for para-aortic lymphadectomy in patients with primary fallopian tube carcinoma (PFTC). MATERIALS AND METHODS: Ninety-one patients with a diagnosis of PFTC were identified through the gynecologic oncology service database of six academic centers. Clinicopathological, surgical, and complete blood count data were collected. RESULTS: In univariate analysis, advanced stage, suboptimal surgery, and NLR > 2.7 were significant prognostic factors for progression-free survival, whereas in multivariate analysis, only advanced stage and suboptimal surgery were significant. In addition, in univariate analysis, cancer antigen 125 ≥ 35 U/mL, ascites, advanced stage, suboptimal surgery, NLR > 2.7, PLR > 233.3, platelet count ≥ 400,000 cells/mm(3), staging type, and histological subtype were significant prognostic factors for overall survival (OS); however, in multivariate analysis, only advanced stage, suboptimal surgery, NLR > 2.7, and staging type were significant. Inclusion of pelvic and para-aortic lymphadenectomy in surgery showed significant association with longer OS, with a mean and median OS of 42.0 months and 35.5 months (range, 22 to 78 months), respectively, vs. 33.5 months and 27.5 months (range, 14 to 76 months), respectively, for patients who underwent surgery without para-aortic lymphadenectomy (hazard ratio, 3.1; 95% confidence interval, 1.4 to 5.7; p=0.002). CONCLUSION: NLR (in both univariate and multivariate analysis) and PLR (only in univariate analysis) were prognostic factors in PFTC. NLR and PLR are inexpensive and easy tests to perform. In addition, patients with PFTC who underwent bilateral pelvic and para-aortic lymphadenectomy had longer OS.

Adjuvant treatment modalities, prognostic predictors and outcomes of uterine carcinosarcomas.

PURPOSE: The purpose of this study is to evaluate the clinicopathological characteristics, treatment, and prognosis of uterine carcinosarcoma (UC). MATERIALS AND METHODS: A retrospective review of three cancer registry databases in Turkey was conducted for identification of patients diagnosed with UC between January 1, 1996, and December 31, 2012. We collected clinicopathological data in order to evaluate factors important in disease- free survival (DFS) and overall survival (OS). RESULTS: A total of 66 patients with UC with a median age of 65.0 years were included in the analysis. The median survival time of all patients was 37.5 months and the 5-year OS rate was 59.1%. In early stage patients (I-II) who received adjuvant chemotherapy (CT) with radiation therapy (RT), the median DFS and OS was 44 months and 55 months, respectively, compared to 34.5 months and 36 months, respectively, in patients who received adjuvant RT or CT alone (hazard ratio [HR], 1.4; 95% confidence interval [CI], 0.7 to 3.1 for DFS; p=0.23 and HR, 2.2; 95% CI, 0.9 to 5.3 for OS; p=0.03). In advanced stage patients (III-IV), the median DFS and OS of patients receiving adjuvant RT with CT was 25 months and 38 months, respectively, compared to 23.5 months and 24.5 months, respectively, in patients receiving adjuvant RT or CT alone (HR, 3.1; 95% CI, 0.6 to 16.0 for DFS; p=0.03); (HR, 3.3; 95% CI, 0.7 to 15.0 for OS; p=0.01). In multivariate analysis, advanced International Federation of Gynecology and Obstetrics (FIGO) stage and suboptimal surgery showed significant association with poor OS. CONCLUSION: In patients with early or advanced stage UC, adjuvant CT with RT is associated with improved DFS and OS, as compared to CT or RT alone.

Menopause Rating Scale as a screening tool in rural Turkey.

INTRODUCTION: Women living in rural areas of Turkey experience difficulties in accessing healthcare services, and this is attributed to distance from urban healthcare centers, financial barriers and poverty, a low education level, and gender discrimination. The purpose of this study was to test the applicability of the menopause rating scale (MRS) as a screening tool by primary healthcare professionals for identifying women with severe menopausal symptoms. The objectives of the study were to test the validity and reliability of the MRS in rural areas of Turkey, to determine estimation values for referral to the secondary level of healthcare, and to assess the prevalence of severe menopausal symptoms among rural Turkish women. METHODS: The sample size was 600 women. The Turkish version of the MRS and the Kupperman index were used to evaluate the severity of symptoms. The internal consistency coefficient (Cronbach's alpha) of the MRS was computed using the test-retest method. The influence of the MRS with regard to the decision to seek medical advice due to menopausal symptoms was considered the validity criterion, and the sensitivity and specificity of the test were established according to this criterion. Estimation values of the test were determined by ROC analysis. Independent variables for the severity of menopausal symptoms were determined using a logistic regression model. RESULTS: A positive correlation between the MRS and the Kupperman index was revealed (r=0.86, p=0.000). The estimation value or the MRS score that would predict whether a woman had visited a gynecologist at least once due to the severity of menopause symptoms was found to be 16, its sensitivity and specificity were both 60%. The MRS score was higher among participants who evaluated their general health as 'unfit' or who had advanced age, chronic disease, a history of dysmenorrhea, or who had had two or more miscarriages. CONCLUSIONS: This evaluation of the MRS indicates that the instrument is a comprehensible, useable, reliable screening test for the identification of women with severe menopausal symptoms. By screening using the MRS it is possible for primary healthcare workers in rural areas to identify women in need of referral to an upper-level healthcare institution.

Prognostic relevance of F-18 fluorodeoxyglucose positron emission tomography and computed tomography in molar pregnancy before evacuation.

OBJECTIVE: To assess prognostic significance of tumor metabolic activity of molar tissue by preevacuation F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) and computed tomography (CT) in patients clinically diagnosed with molar pregnancy. STUDY DESIGN: A total of 11 consecutive patients with clinical diagnosis of molar pregnancy before evacuation were enrolled. After evacuation of molar tissue, histopathologic findings and clinical follow-up were used as reference standards for the study. RESULTS: Six patients, 5 with complete and 1 with partial hydatidiform mole, had good outcome and normalization of beta-human chorionic gonadotropin (beta-hCG) levels within 5-7 weeks of evacuation. In the other 5 patients, serial measurements showed persistently and/or progressively elevated beta-hCG serum levels. These patients were treated with first-line single methotrexate or second-line etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine (EMA/CO) chemotherapy regimen. Standardized uptake value of molar tissue within the uterus in patients with persistently/progressively elevated beta-hCG levels was significantly higher than that in patients whose serum beta-hCG levels normalized after evacuation of molar tissue. CONCLUSION: Preliminary results suggest that F-18 FDG uptake within the uterus assessed by preevacuation PET/CT is predictive for probability of high-risk features of gestational trophoblastic disease or choriocarcinoma in patients with molar pregnancy.

Diffuse uterine adenomatoid tumor in a patient with chronic hepatitis C virus infection.

Uterine adenomatoid tumors are usually solitary lesions. Adenomatoid tumors diffusely infiltrating the entire myometrium have rarely been reported in the literature. A feature common to half of the reported cases of diffuse uterine adenomatoid tumor was an immunocompromised status of the patient caused by the medications for renal transplantation. In this article, we describe an unusual case of diffuse uterine adenomatoid tumor in a patient with chronic hepatitis C virus infection. Pelvic examination showed an irregular and enlarged uterus. Supracervical hysterectomy and bilateral salpingo-oophorectomy was performed with a clinical diagnosis of uterine leiomyoma. Pathological examination showed, in addition to multiple leiomyomas, diffuse uterine adenomatoid tumor. We suggested that the diffuse pattern in our patient might be related to immunosuppression secondary to chronic hepatitis C virus infection.

PAP smear screening among married women living in Osamangazi University ALPU training area.

An inquiry including questions about socio-demographic and fecundity properties and covering the knowledge and attitudes of women about Pap smears was applied to 585 women living in Alpu district of Eskisehir, Turkey. Smear specimens were taken from 513 women and colpography was performed before and after acetic acid application with a digital camera. The women who had cervical lesions and/or aceto-white epithelium during the gynecological examination and/or had pathological findings in the smear and/or had suspicious findings at the colpography were invited (n=125, 24.4%) to the Department of Gynecology for colposcopic evaluation. Colposcopy was performed to 77 and biopsies were taken from 40 of the women during colposcopic examination. Of the biopsy specimens, 31 were accepted as benign while 9 were reported as pathology positive, one being high grade squamous intraepithelial lesion (HGSIL) and 8 low grade squamous intraepithelial lesion (LGSIL).

Results and lessons learned from a small medical abortion clinical study in Turkey.

This article presents results from a small, introductory clinical study offering a simplified regimen medical abortion to women in Turkey. A total of 208 women from five sites were recruited from July 2000 through March 2001. All eligible consenting women were given 200 mg oral mifepristone at the clinic followed by 400 microg oral misoprostol 2 days later either at home or at the clinic. The overall success rate of 84.1% is lower than in previous studies of this regimen, and a surprisingly high proportion of women (9.1%) were diagnosed with incomplete abortion. In spite of the higher than expected failure rate, women expressed a high degree of satisfaction. Several challenges were faced during this study, providing valuable insights about ways to introduce medical abortion into new settings with the best chances for success.

Uptake of 2-[18F]fluoro-2-deoxy-D-glucose in uterine leiomyoma: imaging of four patients by coincidence positron emission tomography.

Uterine leiomyomas, benign tumours of the human uterus, are the most common uterine neoplasm and are composed of smooth muscle with varying amounts of fibrous connective tissue. As a functional imaging modality, 2-[F]fluoro-2-deoxy-D-glucose (F-FDG) positron emission tomography can be used to obtain information about glucose metabolism in tissues. In this study, the findings of the F-FDG scans of four patients who were suspected of having malignant gynaecological tumours because of clinical and radiological findings and finally diagnosed as uterine leiomyoma based on histopathological examination were evaluated. Moderately intense F-FDG accumulation was detected in uterine mass localization in lower pelvis. The reason for the accumulation of F-FDG in uterine leiomyomas is not known. It may be explained by the existence of higher levels of growth factors, including basic fibroblast growth factor, transforming growth factor beta, granulocyte-macrophage colony-stimulating factor and receptors, and proliferation of smooth muscle cells in leiomatous uterus.

Health risks for early (< or =19) and late (> or =35) childbearing.

Both adolescents and women of advanced reproductive age comprise distinct groups of obstetrics patients. Each has special needs and is susceptible to different obstetric risks. Pregnant teenagers appear to be at increased risk for poor maternal weight gain, abortions, hypertensive disorders and delivery of low birthweight infants. Pregnant women over the age of 34 have an increased risk for a poor obstetric outcome as a result of an increased risk for chromosomal aneuploidies and their higher likelihood of having a chronic disease, such as chronic hypertension or diabetes mellitus, to complicate their pregnancies. This study emphasises the increased maternal and fetal risks for pregnancies at these extreme age groups in a retrospective way. Prepregnancy counselling is essential for these age groups in order for a woman to be able to make an informed decision regarding the timing of childbearing.

Transvaginal ultrasonography and uterine artery Doppler in diagnosing endometrial pathologies and carcinoma in postmenopausal bleeding.

Routine dilatation and curettage (D&C) in all patients with postmenopausal bleeding (PMB) is debatable, as 70%-80% will eventually receive benign diagnoses. Endometrial thickness (ET) measurements by transvaginal ultrasonography (TVUS) are used with high sensitivity to detect patients who would benefit from D&C, yet they suffer from low specificity that fails to reduce undue invasive procedures. The aim of this study was to define optimal cutoffs for ET in diagnosing endometrial pathologies in PMB and to assess a possible complementary role for Doppler ultrasonography. The study population consisted of 97 women with PMB; 39, 22 and 36 of whom had endometrial cancer (EC), benign endometrial pathologies and normal endometrial findings, respectively, defined by D&C performed after TVUS, which was used to measure uterine dimensions and ET, together with pulsatility and resistance indices (PI and RI, respectively) of the uterine arteries. Receiver operating characteristics curves revealed ET to be the most valuable parameter to prognosticate both EC and any endometrial pathology (sensitivities of 90% and 89%, and specificities of 79% and 94% with optimal cutoffs of 9.6 and 7.7 mm, respectively). Binary logistic regression revealed uterine artery RI to be the only independent variable that could be used together with ET, which increased the sensitivity of ET to 97% and 93% for EC and any endometrial pathology, but caused its specificity to regress to 58% and 53%, respectively. Same levels of sensitivity, yet better levels of specificity of 60% and 89%, respectively, were attained by using a cutoff of 6.3 mm for ET alone. Assessing uterine artery Doppler indices has no complementary role for measuring ET in evaluating PMB.

Pedunculated uterine leiomyoma associated with pseudo-Meigs' syndrome and elevated CA-125 level: CT features.

A 38-year-old woman presented with a 1-week history of low back pain, distension, weakness, and loss of appetite. Laboratory studies showed a serum CA-125 level of 281 U/ml (normal value 1.2-32 U/ml). Abdominopelvic sonography revealed massive ascites, left pleural effusion, and a heterogeneous, hypoechogenic, and smoothly outlined solid mass. The mass had a close proximity and to the anterior side of the right ovary. Doppler sonography showed that the mass was hypervascularized. Computed tomography demonstrated numerous, tortuous vascular structures around the mass and along the omentum indicating its auxiliary vascularization from the omentum. Exploratory laparotomy and histopathological examination revealed pedunculated leiomyoma with parasitized blood supply from the omentum. Ascites and pleural effusion disappeared 6 months after surgery. We present the clinical and CT features of a parasitic leiomyoma adhering to the omentum.