Granulosa cell tumor presenting with ovarian torsion and de novo borderline mucinous ovarian tumor in the contralateral ovary.

The authors report a case of 25-year-old women with a rare acute presentation of granulosa cell tumor (GCT) as an ovarian torsion. Right salpingoo-ooferectomy was performed. The pathological diagnosis was GCT One month after the surgery there was a three-cm ovarian cyst in the contralateral ovary and the tumor size increased to six cm in diameter in the following month. Serum inhibin-B levels progressively increased. Cystectomy was performed to contralateral ovary as frozen-section examination indicated mucinous tumor. Final histopathological examination revealed borderline mucinous tumor. Regarding her request, the patient was reoperated again and unilateral oophorectomy and hysterectomy were performed. Clinicians must be aware of the possibility of an underlying malignancy associated with adnexal torsion even in young patients. Frozen section will be helpful in order to avoid incomplete surgeries. Cyst rapidly growing in the ovary in young women should raise the suspicion of a de novo malignancy.

The use of HbA1c as an aid in the diagnosis of gestational diabetes mellitus.

The ability of HbA1c was evaluated in the diagnosis of gestational diabetes mellitus (GDM) and for the implications of its use in clinical practice. A total of 339 pregnant women with an estimated gestational age of 24-28 weeks were evaluated for GDM using an oral glucose tolerance test (OGTT) based on International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria. A ROC curve was drawn to determine the sensitivity and specificity of HbA1c in detecting GDM. An HbA1c cut-off value of ≥ 5.2% had sensitivity of 64.15% and specificity of 67.48% in diagnosing GDM, and a positive predictive value of 26.77%. Using two cut-offs in the 'rule-in and rule-out' algorithm, 94.4% of the GDM cases would have been detected but 33% (43 of the 130) women would had been misclassified. HbA1c is not suitable to use alone for the diagnosis of GDM and is not useful in decreasing the need for OGT testing.

The value of transvaginal sonography in detecting endometrial pathologies in postmenopausal women with or without bleeding.

AIM: The aim of this study was to estimate the incidence of endometrial pathologies and compare the findings in postmenopausal women with or without bleeding who had endometrial thickness ≥5 mm. METHODS: Between January 2010 and December 2012 medical records of postmenopausal patients who underwent endometrial biopsy were reviewed retrospectively. 91 patients who presented with postmenopausal bleeding (Group A) with an endometrial thickness equal to or greater than 5 mm and 44 patients with an incidental finding of increased endometrial thickness (≥5 mm) on ultrasound without bleeding (Group B) were included in the study. RESULTS: The mean endometrial thickness of patients in group A (9.3±4.6) was significantly lower than women in group B (11±4.6). Seven (7.7%) cases of endometrial hyperplasia and 6 (6.6%) cases of endometrial carcinoma were detected in women with bleeding, 2 (4.5%) cases of endometrial hyperplasia and no cases of endometrial carcinoma were diagnosed in group B women. The prevalence of endometrial carcinoma associated with endometrial thickness in group A women whereas we cannot see this relation in group B women. The mean endometrial thickness was highest in women with the histopathologic diagnosis of polyps in this group. CONCLUSION: In postmenopausal women with bleeding, the risk of endometrial carcinoma increases with increasing endometrial thickness; however, the use of endometrial thickness as a screening test for endometrial carcinoma may not be effective in women without bleeding. 6.5 mm cut-off seems to be acceptable thickness for polyp detection in postmenopausal women with bleeding.