Publications by authors named "Alper Karalök"

64 Publications

Recurrence pattern and prognostic factors for survival in cervical cancer with lymph node metastasis.

J Obstet Gynaecol Res 2021 Jun 25;47(6):2175-2184. Epub 2021 Mar 25.

Health Sciences University Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Gynecologic Oncology Surgery Department, Ankara, Turkey.

Aim: The aim of this study is to evaluate the recurrence pattern and oncological outcomes in cervical cancer (CC) patients with lymph node metastasis.

Methods: This study included 224 International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IB1-IIIB CC patients with pathologically proven lymph node metastasis. Surgical intervention was grouped as hysterectomy performed/not performed. Adjuvant therapy decision was made by the tumor board. Radiotherapy was applied to all patients with lymph node metastasis.

Results: Only paraaortic lymph node metastasis was determined as an independent prognostic factor for recurrence. Presence of paraaortic lymph node metastasis increased the risk of recurrence more than two times (odds ratio: 2.129; 95% confidence interval: 1.011-4.485; p = 0.047). An independent prognostic factor for death because of disease was age only. Risk of death was nearly doubled with younger age (odds ratio: 2.693; 95% confidence interval: 1.064-6.184; p = 0.037).

Conclusion: The most of recurrences were located at distant sites and multiple regions. Paraaortic lymph node metastasis was the only independent prognostic factor for recurrence, in spite of that age was an independent predictor for risk of death in patients with early stage or locally advanced CC and also with surgically proven metastatic lymph nodes. Furthermore, the presence of the paraaortic lymph node metastasis was significantly associated with distant recurrence. Therefore, more appropriate and individualized therapy strategy focusing on intenser systemic chemotherapy options in addition to radiotherapy should be taken into consideration according to paraaortic lymph node metastasis and age.
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http://dx.doi.org/10.1111/jog.14762DOI Listing
June 2021

Pulmonary morbidity related to diaphragm surgery performed for gynecological cancers.

Turk J Obstet Gynecol 2020 Dec 10;17(4):292-299. Epub 2020 Dec 10.

University of Health Sciences Turkey, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey.

Objective: To evaluate pulmonary morbidity related to diaphragm surgery performed for gynecological cancers and to identify the impact of transdiaphragmatic thoracotomy.

Materials And Methods: We reviewed clinical and pathologic data of 232 women who had undergone diaphragm surgery as a part of cytoreductive surgery procedures performed for gynecological cancers.

Results: Transdiaphragmatic thoracotomy occurred in 52 patients (22.4%). Rate of pulmonary complications among patients who had a transdiaphragmatic thoracotomy was higher compared with patients who did not have a transdiaphragmatic thoracotomy (40.4% vs 20.6%, p=0.004). Transdiaphragmatic thoracotomy [odds ratio (OR), 2.66; 95% confidence interval (CI), 1.20-5.92; p=0.016], colon resection (OR, 5.21; 95% CI, 2.34-11.63; p<0.001), ileostomy (OR, 19.61; 95% CI, 1.64-250.0; p=0.019), and any extra-pulmonary complication occurrence (OR, 2.35; 95% CI, 1.13-4.88; p=0.023) were identified as independent predictors of pulmonary morbidity. Patients with transdiaphragmatic thoracotomy developed pleural effusion, pleural effusion necessitating drainage, pneumothorax, pneumonitis, and atelectasis more frequently compared with patients who did not have transdiaphragmatic thoracotomy. Rate of admission to postoperative intensive care of patients with transdiaphragmatic thoracotomy (30.8%) was significantly higher than that of patients without transdiaphragmatic thoracotomy (12.2%) (p=0.001).

Conclusion: Transdiaphragmatic thoracotomy is an independent predictor of pulmonary morbidity among patients who underwent diaphragm surgery. Avoiding accidental transdiaphragmatic thoracotomies with maximal attention and performing full-thickness resection procedures with alternative surgical techniques preventing a thoracotomy may help decrease pulmonary morbidity rates and postoperative care costs.
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http://dx.doi.org/10.4274/tjod.galenos.2020.54781DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7731606PMC
December 2020

Performing gynecologic cancer surgery during the COVID-19 pandemic in Turkey: A multicenter retrospective observational study.

Int J Gynaecol Obstet 2020 Oct 11;151(1):33-38. Epub 2020 Aug 11.

Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Medeniyet University, Istanbul, Turkey.

Objective: To report the perioperative outcomes of 200 patients with gynecologic cancer who underwent surgery during the Novel Coronavirus Disease (COVID-19) pandemic and the safety of surgical approach.

Methods: Data of patients operated between March 10 and May 20, 2020, were collected retrospectively. Data were statistically analyzed using IBM Statistical Package for the Social Sciences (SPSS) Statistics for Windows v. SP21.0.

Results: Data of 200 patients were included. Their mean age was 56 years. Of the patients, 54% (n=108), 27.5% (n=55), 12.5% (n=25), and 2% (n=4) were diagnosed as having endometrial, ovarian, cervical, and vulvar cancer, respectively. Of them, 98% underwent non-emergent surgery. A minimally invasive surgical approach was used in 18%. Stage 1 cancer was found in 68% of patients. Surgeons reported COVID-related changes in 10% of the cases. The rate of postoperative complications was 12%. Only two patients had cough and suspected pneumonic lesions on thoracic computed tomography postoperatively, but neither was positive for COVID-19 on polymerase chain reaction testing.

Conclusion: Based on the present findings, it is thought that gynecologic cancer surgery should continue during the COVID-19 pandemic while adhering to the measures. Postponement or non-surgical management should only be considered in patients with documented infection. Gynecologic cancer surgery should continue during the COVID-19 pandemic while adhering to measures. Only 1% of patients developed COVID-19-related symptoms during the postoperative follow-up period.
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http://dx.doi.org/10.1002/ijgo.13296DOI Listing
October 2020

Unusual usage of the automated stapler in gynecologic oncology: method for diaphragmatic full thickness implant resection without entrance to pleural space

J Turk Ger Gynecol Assoc 2020 12 16;21(4):301-302. Epub 2020 Jun 16.

Clinic of Obstetrics and Gynecology, University of Health Sciences Turkey, Ankara Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey

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http://dx.doi.org/10.4274/jtgga.galenos.2020.2020.0008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7726463PMC
December 2020

Primary leiomyosarcoma of the ovary: a report of three cases and a systematic review of literature.

J Gynecol Obstet Hum Reprod 2021 Jun 1;50(6):101825. Epub 2020 Jun 1.

Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Gynecologic Oncology Clinic, Health Sciences University, Turkey. Electronic address:

Primary ovarian leiomyosarcomas (POLMs) comprise <0.1 % of all ovarian malignancies. Here we aimed to define the clinical, surgical, and pathological features, as well as the oncologic outcome, of POLM. A systematic review of the medical literature was performed to identify articles about POLMs. An electronic literature search was conducted for English language abstracts of articles published between 1975 and December 2018.51 articles were included in the study. The primary endpoint of the study was disease-free survival (DFS) and overall survival (OS), whereas the secondary endpoint was clinicopathological features. Five-year DFS and OS for the entire cohort was 15 % and 26 %, respectively. The DFS and OS were significantly related to paraaortic lymphadenectomy, a mitotic index>10/high power field, and advanced cancer stages. Eventually, we were unable to obtain clear results, this might be due to the limited number of cases at the literature.With more authors presenting their own cases, it will be possible to have clearer results.
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http://dx.doi.org/10.1016/j.jogoh.2020.101825DOI Listing
June 2021

Can preoperative inflammatory markers differentiate endometrial cancer from complex atypical hyperplasia/endometrial intraepithelial neoplasia?

J Obstet Gynaecol Res 2020 Jul 28;46(7):1148-1156. Epub 2020 May 28.

Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey.

Aim: The aim of this study was to identify the differences between complex atypical hyperplasia/endometrial intraepithelial neoplasia (CAH/EIN) and endometrioid-type grade 1 endometrial cancer in terms of preoperative systemic inflammatory markers and to evaluate the effectiveness of such markers in predicting cancer.

Methods: Between January 2005 and September 2018, a total of 372 patients with final histopathologic diagnoses of CAH/EIN (n = 143) and endometrioid-type grade 1 endometrial cancer (n = 229) were included in the study. Neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and platelet distribution width (PDW) were used as preoperative inflammatory markers. Receiver operating characteristics (ROC) analysis was used to assess the diagnostic prediction of NLR, PLR and PDW values to distinguish the two groups. Univariate and multivariate logistic regression analysis was performed by regrouping the patients according to the cut-off values found in the ROC analysis.

Results: The univariate analysis revealed that advanced age, decreases in PDW and also PLR could be predictors of cancer. The cut-off values were as ≤48.9% for PDW and ≤133.3 for PLR. The values defined using ROC analysis were found to be statistically significant for PDW and PLR in identifying endometrioid grade 1 endometrial cancer. For PDW, sensitivity, specificity, positive predictive value and negative predictive value were 52.8%, 62.2%, 68.9% and 45.5%, respectively (P = 0.001); for PLR, those were 55.9%, 59.4%, 68.8% and 45.7%, respectively (P = 0.005). In multivariate analysis, advanced age (>53 years), low PDW (≤48.9%) and low PLR (≤133.3) were related to statistically significant odds ratio for diagnostic prediction to differentiate endometrioid grade 1 cases from CAH/EIN of 8.01 (P < 0.001), 1.79 (P = 0.019) and 1.73 (P = 0.025), respectively.

Conclusions: The PLR and PDW values in the preoperative blood parameters could be used to differentiate endometrial cancer from precancerous lesions.
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http://dx.doi.org/10.1111/jog.14314DOI Listing
July 2020

Mucinous endometrial cancer: Clinical study of the eleven cases.

North Clin Istanb 2020 3;7(1):60-64. Epub 2019 Jul 3.

Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey.

Objective: In this study, we analyzed surgico-pathologic factors of mucinous type endometrial carcinoma and examined its frequency of recurrence.

Methods: In this study, eleven cases, definitely diagnosed as pure mucinous type endometrium carcinoma between January 1993 and May 2013, were reviewed.

Results: Of 1640 women with endometrium carcinoma, 11 (0.67%) of them had a mucinous cell type. Mean age of the study group was 55 years. According to the FIGO 2009, 10 (90.9%) cases were evaluated as stage I and 1 (9.1%) as stage IIIC1. The presence of lymph node metastasis was noticed in only one (12.5%) of eight patients who underwent lymphadenectomy. In this case, metastasis was detected in the pelvic lymph node. Four patients underwent adjuvant therapy as pelvic radiotherapy. Median follow-up time was 50 months (range, 5-84). Recurrence was observed in one (9.1%) patient with stage IIIC1 endometrial cancer in 30 months after primary surgery. The site of recurrence was only in the upper abdominal region.

Conclusion: Based on our study, mucinous endometrial carcinoma has good prognostic factors, and long term survival can be achieved surgically alone in patients with stage I.
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http://dx.doi.org/10.14744/nci.2019.17048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7103747PMC
July 2019

Bone recurrence after radical hysterectomy and lymphadenectomy in early-stage cervical cancer.

Turk J Obstet Gynecol 2019 Dec 28;16(4):266-270. Epub 2020 Feb 28.

Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Gynecologic Oncology, Ankara, Turkey.

Objective: To present the clinical, surgical, and pathologic features of bone recurrence in patients who underwent radical hysterectomy for early-stage uterine cervical cancer.

Materials And Methods: Data of 412 patients who underwent type III radical hysterectomy and pelvic ± paraaortic lymphadenectomy for stage 1B-2A epithelial cervical cancer were reviewed. Seven (1.7%) patients with bone recurrence in the first recurrence were included in the study.

Results: The median follow-up of the main cohort (n=412) was 46 (range=1-300) months. In this period, recurrence developed in 53 (12.9%) patients and recurrence was observed in bone in 13.2% (7 of 53) of these recurrences. Time to recurrence ranged from 9 to 45 months. Of the recurrences, five were in the axial skeleton and two were in the appendicular skeleton. Recurrence was observed in lumbar vertebrae in three patients, thoracic vertebrae in one patient, sacral vertebrae in one patient, lumbosacral vertebrae in one patient, and the left femur in two patients. Four patients had multiple recurrence in 3 patients despite isolated bone recurrence. Patients with multiple recurrences died within 6-25 months. All isolated bone recurrences were in the axial skeleton. Complete clinical response with salvage therapy was achieved in two patients with isolated bone recurrence.

Conclusion: Complete clinical response and long postoperative survival can be achieved with salvage treatment when bone recurrence is solitary in cervical cancers.
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http://dx.doi.org/10.4274/tjod.galenos.2019.26932DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7090266PMC
December 2019

Pulmonary recurrence after radical hysterectomy for uterine cervical carcinoma.

J Obstet Gynaecol 2020 Nov 6;40(8):1155-1159. Epub 2020 Feb 6.

Gynecologic Oncology Surgery Department, Health Sciences University Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey.

Pulmonary spread from carcinoma of the uterine cervix, though uncommon, has been reported in 2.2-9.1% of all cervical cancers. The aim of this study was to evaluate the surgical, clinical, pathological factors and clinical outcomes of cervical cancer patients with pulmonary recurrence (PR).This study included 17 cervical cancer patients with PR after radical hysterectomy. The entire cohort consisted of 413 patients whose surgeries (type III radical hysterectomy + pelvic ± para-aortic lymphadenectomy) had been performed in our Gynaecologic Oncology Clinic between 1993 and 2018. Tumour size, lymph node metastasis and receiving adjuvant therapy were found to be effective for PR on univariate analyses in the main cohort ( .042,  < .001 and  = .001, respectively). Therefore, performing adjuvant therapy to reduce the PR must be assessed properly with the information of lymph node status and tumour size obtained from the final pathology reports.Impact Statement Pulmonary spread from carcinoma of the uterine cervix has been reported in 2.2-9.1% of all cervical cancers. Data related to clinico-pathological features of patients with pulmonary recurrence (PR) is limited. Diagnosis of a PR is considered to worsen the prognosis. Tumour size, lymph node metastasis and receiving adjuvant therapy were found to be effective for PR on univariate analyses. Performing adjuvant therapy to reduce the PR must be assessed properly with the information of lymph node status and tumour size obtained from the final pathology reports in patients with uterine cervical carcinoma.
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http://dx.doi.org/10.1080/01443615.2019.1706158DOI Listing
November 2020

Factors predicting recurrence in patients with stage IA endometrioid endometrial cancer: what is the importance of LVSI?

Arch Gynecol Obstet 2020 03 27;301(3):737-744. Epub 2019 Dec 27.

Department of Gynecological Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey.

Purpose: The aim of this study is to define the clinical and pathological prognostic factors for recurrence and to evaluate the recurrence patterns and adjuvant therapies used in this group of patients with stage IA endometrioid type endometrial cancer (FIGO 2009-International Federation of Gynecology and Obstetrics).

Methods: Among the patients with epithelial endometrial cancer operated between January 1993 and May 2013 in a single institution, 720 patients with stage IA endometrioid endometrial cancer were included. Patients with a tumor type of serous, clear cell, mucinous, undifferentiated, and mixed type and with a tumor containing sarcomatous component and the patients with a secondary primer cancer were excluded from the study.

Results: Lympho-vascular space invasion (LVSI) was present in 60 (8.3%) patients. Pelvic and para-aortic lymphadenectomy was performed in 266 (36.9%) patients. Median follow-up time was 48 months (range 3-240). Recurrence occurred in 23 (3.4%) patients and 6 (0.9%) died of disease. The median time-to recurrence (TTR) was 24 months (range 4-52 months) in the patients with recurrence. LVSI was associated with recurrence in the univariate analysis. Five-year disease-free survival (DFS) decreased from 96.8 to 80.1% in the presence of LVSI (p < 0.001). This association could not be shown in patients who had had lymphadenectomy (p = 0.136). Extra-pelvic recurrence occurred in 6.7% and 1% of the patients with and without LVSI, respectively, (p = 0.001). Any independent prognostic factor could not be detected in the multivariate analysis.

Conclusions: Only LVSI and tumor grade were associated with DFS and disease-specific survival (DSS), respectively, in the 686 patients with stage IA endometrial cancer in the univariate analysis, since these associations could not be shown in multivariate analysis.
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http://dx.doi.org/10.1007/s00404-019-05418-zDOI Listing
March 2020

Which factors predict parametrial involvement in early stage cervical cancer? A Turkish multicenter study.

Eur J Obstet Gynecol Reprod Biol 2019 Dec 22;243:63-66. Epub 2019 Oct 22.

Health Sciences University, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Gynecologic Oncology Surgery Department, Ankara, Turkey.

Objective: To evaluate the clinical and pathological factors for predicting the parametrial involvement (PI) in early stage cervical cancer.

Study Design: This study included 406 patients with type III radical hysterectomy + pelvic ± para-aortic lymphadenectomy and FIGO stage I and II cervical adenocarcinoma, squamous type, and adenosquamous type cervical cancer.

Results: The entire cohort of patients had lymphadenectomy performed. Early stage cervical cancer patients were evaluated. FIGO 2014 stage, uterine invasion, LVSI, surgical border involvement, vaginal metastasis, stromal invasion and lymph node metastasis were found to be effective for PI on univariate analyses. However; age, tumor type and tumor size did not determine the parametrial invasion. LVSI (HR: 4.438, 95%CI: 1.771-11.121; p = 0.001), lymph node metastases (HR: 2.418, 95%CI: 1.207-4.847; p = 0.013) and vaginal involvement (HR: 4.109, 95%CI: 1.674-10.087; p = 0.02) are independent prognostic factors on multivariate analysis.

Conclusion: Lymph node metastases, LVSI and surgical border involvement are independent prognostic factors for PI in early stage cervical cancer patients. Therefore, less radical surgical approaches for early stage tumors with no nodal spread, negative LVSI and no surgical border involvement are applicable.
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http://dx.doi.org/10.1016/j.ejogrb.2019.10.033DOI Listing
December 2019

High-grade uterine corpus-confined endometrial cancer with lymphadenectomy: does adjuvant therapy improve survival?

Turk J Obstet Gynecol 2019 Sep 10;16(3):180-186. Epub 2019 Oct 10.

University of Health Sciences, Etlik Zübeyde Hanım Women's Diseases Training and Research Hospital, Clinic of Gynecologic Oncology, Ankara, Turkey.

Objective: To evaluate the necessity of adjuvant therapy and other prognostic factors in high-grade uterine corpus-confined endometrial cancer (EC) with lymphadenectomy performed.

Materials And Methods: This study included 120 patients who had endometrioid-type grade 3, serous-type, clear cell-type, and undifferentiated-type EC and underwent lymphadenectomy.

Results: Patients with high-grade uterine corpus-confined EC who underwent lymphadenectomy were evaluated. The modality of adjuvant therapy performed was not a predictor for the site of recurrence. The loco-regional recurrence rate decreased from 9.5% to 3.8% in patients who received radiotherapy. However, this difference was not statistically significant (p=0.206). In addition, performing adjuvant chemotherapy did not alter the risk of extrapelvic recurrence. Only International Federation of Gynecology and Obstetrics 2009 stage was significant in the univariate analysis. On the other hand, age, tumor type, number of removed lymph nodes, presence of myometrial and lymphovascular space invasion, tumor size and adjuvant therapy modality were not related with disease-free survival.

Conclusion: Performing adjuvant therapy and therapy modality does not improve oncologic outcomes in intermediate and high-risk patients. However, radiotherapy reduced the risk of local recurrence by more than 50%. Vaginal brachytherapy was efficient as external beam radiotherapy. Therefore, vaginal brachytherapy should be used for these patients in order to reduce loco-regional recurrence even if it is not reported to be effective on disease-free survival.
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http://dx.doi.org/10.4274/tjod.galenos.2019.04578DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6792051PMC
September 2019

Can we predict surgical margin positivity while performing cervical excisional procedures?

J Obstet Gynaecol 2020 Jul 4;40(5):666-672. Epub 2019 Sep 4.

Gynecologic Oncology Department, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey.

We designed this study to evaluate any factors associated with positive surgical margin in conisation specimens and to determine the optimal cone size. The medical records of patients who had undergone a loop electrosurgical excision procedure (LEEP), cold-knife conisation (CKC) and needle excision of the transformation zone (NETZ) procedure were reviewed retrospectively. Two hundred and sixty eight women fulfilled the inclusion criteria. Univariate analyses showed that 'postmenopause', 'HSIL on smear', 'previous colposcopic examination revealing HSIL in endocervical curettage (ECC) material and in two or more ectocervical quadrants' and 'managing with LEEP' were significant predictors of surgical margin positivity. Nulliparous patients showed significantly lower rate of surgical margin positivity. 'Postmenopause', 'previous colposcopic examination revealing HSIL in ECC material and in two or more ectocervical quadrants' and 'HSIL on smear' were identified as independent predictors of surgical margin positivity according to multivariate analyses.IMPACT STATEMENT Previous studies demonstrated 'menopause', 'Age ≥50', 'managing with LEEP', 'disease involving >2/3 of cervix at visual inspection', 'training level of the surgeon', 'cytology squamous cell carcinoma' and 'mean cone height' as factors associated with positive surgical margin in conisation specimens. In our study, univariate analyses showed that 'postmenopause', 'HSIL on smear', 'previous colposcopic examination revealing HSIL in endocervical curettage material and in two or more ectocervical quadrants' and 'managing with LEEP' were associated with surgical margin positivity. On the other hand, nulliparous women showed significantly lower rate of surgical margin positivity compared with parous women. Multivariate analyses showed that 'postmenopause', 'previous colposcopic examination revealing HSIL in endocervical curettage material and in two or more ectocervical quadrants' and 'HSIL on smear' were independent predictors of surgical margin positivity in conisation specimens. We can predict high-risk patients with regard to surgical margin positivity. Prediction of high-risk patients and management with a tailored approach may help minimise surgical margin positivity rates.
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http://dx.doi.org/10.1080/01443615.2019.1645101DOI Listing
July 2020

Herlyn-Werner-Wunderlich Syndrome; laparoscopic treatment of obstructing longitudinal vaginal septum in patients with hematocolpos - a different technique for virgin patients

J Turk Ger Gynecol Assoc 2020 12 27;21(4):303-304. Epub 2019 Aug 27.

Clinic of Obstetrics and Gynecology, University of Health Sciences Turkey, Ankara Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey

We aimed to define a new laparoscopic treatment approach for patients with hematocolpos and obstructed hemi-vagina due to longitudinal obstructing vaginal septum. This technique is particularly useful for patients who desire to preserve virginity. To the best of our knowledge this is the first case reporting laparoscopic resection of vaginal septum with an obstructed hemivagina and hematocolpos.
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http://dx.doi.org/10.4274/jtgga.galenos.2019.2019.0046DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7726462PMC
December 2020

Cytoreductive surgery in advanced stage malignant ovarian germ cell tumors.

J Gynecol Obstet Hum Reprod 2019 Sep 19;48(7):461-466. Epub 2019 Jun 19.

Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Gynecologic Oncology Division, Ankara, Turkey. Electronic address:

Introduction: To evaluate the survival effect of cytoreductive surgery in advanced stage malignant ovarian germ cell tumors (MOGCT).

Material And Methods: Clinicopathological data of patients with MOGCT that were treated between 1991 and 2014. Maximal debulking was defined as no gross residual tumor after primary or recurrence surgery; optimal and suboptimal debulking were used for patients with residual tumors of ≤1cm and >1cm, respectively.

Results: In total, 31 patients with advanced stage MOGCT were analyzed. The median age at diagnosis was 21 (14-57) years. The median follow-up duration was 64.1 months. Of these 31 patients; 7 patients underwent sub-optimal debulking, 5 patients had optimal surgery and 18 had maximal debulking. Five-year DFS according to surgical resection rates were 29% in suboptimal debulking group, 75% in optimal debulking group and 93% in maximal cytoreduction group (p<0.001). Three of seven patients who underwent sub-optimal debulking were died of disease, however no deaths were seen in patients with optimal and maximal debulking. Five-year OS was 32% in suboptimal debulking group, and 100% in optimal and maximal debulking groups (p=0.001).

Discussion: The benefit of cytoreductive surgery is less well-established in MOGCT of ovary compared to ovarian tumors of epithelial origin due to rareness of this histological subtype. Patients with MOGCT are usually younger and preservation of fertility is an important issue which may lead to suboptimal procedures, sometimes in exchange for diminished survival. Our data demonstrated that maximal cytoreduction should be aimed in patients with advanced stage MOGCT, as it is significantly associated with improved overall survival.
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http://dx.doi.org/10.1016/j.jogoh.2019.06.006DOI Listing
September 2019

Sertoli-Leydig cell tumor of the ovary: Analysis of a single institution database and review of the literature.

J Obstet Gynaecol Res 2019 Jul 20;45(7):1311-1318. Epub 2019 May 20.

Department of Gynecological Oncology, Etlik Zubeyde Hanim Women's Health Education and Research Hospital, Ankara, Turkey.

Aim: To evaluate the clinical characteristics and outcome of ovarian Sertoli-Leydig cell tumors (SLCTs) managed at a single institution.

Methods: The hospital records of 17 patients with the diagnosis of ovarian SLCT between 1994 and 2018 were reviewed retrospectively.

Results: The median age of the patients was 30 years (range, 18-67 years). All the patients had unilateral tumors. All of the 17 were stage 1 tumors. Two (11.8%) patients were stage 1C1 and two (11.8%) patients were stage 1C2. Thirteen (76.5%) patients were stage 1A. Three (17.6%) of the tumors were well differentiated, 11 (64.7%) were intermediately differentiated, 1 (5.9%) was poorly differentiated, and the degree of the differentiation was not identified for 2 (11.8%) patients. One showed retiform pattern and one had heterologous elements at the histopathologic evaluation. Among the 17 patients, we identified structural/vascular renal and ureteral anomalies in 3 (17.6%) patients. Eight patients underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy, seven underwent unilateral salpingo-oophorectomy or oophorectomy and two underwent cystectomy with or without additional surgical staging procedures. Four patients received adjuvant chemotherapy. All the 17 patients were alive and free of disease for 1-287 months after the diagnosis. Median follow-up time was 78 months. None of the patients recurred.

Conclusion: Sertoli-Leydig cell tumors are rare ovarian malignancies with low recurrence rates and have a favorable outcome compared to malignant epithelial tumors of the ovary. Main treatment is surgical resection and it is appropriate to prefer fertility sparing conservative surgeries for young patients.
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http://dx.doi.org/10.1111/jog.13977DOI Listing
July 2019

Hormone therapy following surgery in low-grade endometrial stromal sarcoma: Is it related to a decrease in recurrence rate?

J Chin Med Assoc 2019 May;82(5):385-389

Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, University of Health Sciences, Ankara, Turkey.

Background: Low-grade endometrial stromal sarcoma (LGESS) is, in most cases, a slow-growing malignancy; however, it is related with high recurrence rates. The aim of this study is to determine which factors may be associated with the recurrence rate of LGESS.

Methods: The clinicopathological features and treatment options in 37 patients with LGESS were evaluated.

Results: All patients underwent the hysterectomy and bilateral salpingo-oophorectomy. Additionally, lymphadenectomy was performed in 56.8% (n = 21) of the patients. Among the patients who underwent lymphadenectomy, 14.3% (n = 3) had lymph node metastasis. The disease was limited to the uterus in 75.7% of patients. Treatment following surgery was radiotherapy in three patients, chemotherapy in seven patients, hormone therapy in 12 patients, and chemotherapy plus hormone therapy in one patient. Megestrol acetate was used in all patients who received hormone therapy. Median follow-up time was 96 months. The 5-year disease-free survival and disease-specific survival were 72% and 97%, respectively. The recurrence rate was 27%. Only hormone therapy following surgery was significantly associated with a lower recurrence rate, even in patients with stage 1 disease. None of the patients treated with hormone therapy following surgery had recurrence, whereas recurrence occurred in 38.5% of the patients who underwent surgery only (p = 0.039).

Conclusion: Hormone therapy after surgery should be considered a viable option for decreasing the LGESS recurrence rate, regardless of the disease stage.
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http://dx.doi.org/10.1097/JCMA.0000000000000039DOI Listing
May 2019

Prognostic factors and oncological outcomes of ovarian yolk sac tumors: a retrospective multicentric analysis of 99 cases.

Arch Gynecol Obstet 2019 07 13;300(1):175-182. Epub 2019 Apr 13.

Division of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Etlik, 06010, Ankara, Turkey.

Purpose: To investigate the clinico-pathological prognostic factors and treatment outcomes in patients with ovarian yolk sac tumors (YST).

Methods: A multicenter, retrospective department database review was performed to identify patients with ovarian YST who underwent surgery between 2000 and 2017 at seven Gynecologic Oncology Centers in Turkey.

Results: The study group consisted of 99 consecutive patients with a mean age of 23.9 years. While 52 patients had early stage (stage I-II) disease, the remaining 47 patients had advanced stage (stage III-IV) disease. The uterus was preserved in 74 (74.8%) of the cases. The absence of gross residual disease following surgery was achieved in 76.8% of the cases. Of the 54 patients with lymph node dissection (LND), lymph node metastasis was detected in 10 (18.5%) patients. Of the 99 patients, only 3 patients did not receive adjuvant therapy, and most of the patients (91.9%) received BEP (bleomycin, etoposide, cisplatin) chemotherapy. Disease recurred in 21 (21.2%) patients. The 5-year disease-free survival (DFS) and overall survival (OS) in the entire cohort were 79.2% and 81.3%, respectively. In multivariate analysis, only residual disease following initial surgery was found to be significantly associated with DFS and OS in patients with ovarian YST (p = 0.026 and p = 0.001, respectively).

Conclusions: Our results demonstrate the significance of achieving no visible residual disease in patients with ovarian YST. Fertility-sparing approach for patients with no visible residual disease affected neither DFS nor OS. Although high lymphatic involvement rate was detected, the benefit of LND could not be demonstrated.
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http://dx.doi.org/10.1007/s00404-019-05160-6DOI Listing
July 2019

Maximal cytoreduction is related to improved disease-free survival in low-grade ovarian serous carcinoma.

Tumori 2019 Jun 27;105(3):259-264. Epub 2019 Mar 27.

1 Department of Gynecologic Oncology, Faculty of Medicine, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey.

Objective: To evaluate the factors predicting oncologic outcomes in low-grade ovarian serous carcinoma (LGOSC).

Methods: Seventy patients with LGOSC were included in the study. According to the residual disease present at the end of the initial cytoreductive surgery (CRS), surgical outcomes are defined as follows: maximal CRS for absence of macroscopic residual tumors, optimal CRS for macroscopic residual tumors with diameters ranging from 0.1 to ⩽1 cm diameter, and suboptimal CRS for macroscopic residual tumors measuring >1 cm in diameter.

Results: Five-year disease-free survival (DFS) and cancer-specific survival (CSS) were 61% and 83%, respectively. Surgical outcomes were suboptimal in 3 (4.3%) patients, optimal in 8 (11.4%) patients, and maximal in 59 (84.3%) patients. Stage and surgical outcomes were related to DFS ( < 0.05). Compared with maximal CRS, the presence of residual tumors (suboptimal and optimal debulking) was related to threefold increased risk of disease failure (recurrence or progression) (hazard ratio [95% confidence interval] 3.00 [1.27-7.09]; =0.012). CSS was associated with disease stage alone (=0.03). Advanced stage was related with lower DFS and CSS.

Conclusions: Maximal CRS facilitates an improvement in DFS. Achieving no residual disease after the completion of surgery should be a cornerstone of LGOSC management.
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http://dx.doi.org/10.1177/0300891619839293DOI Listing
June 2019

Effect of Adjuvant Therapy on Oncologic Outcomes of Surgically Confirmed Stage I Uterine Carcinosarcoma: a Turkish Gynecologic Oncology Study

Balkan Med J 2019 07 15;36(4):229-234. Epub 2019 Mar 15.

Department of Gynecologic Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey

Background: Uterine carcinosarcoma is rare neoplasm that mostly presents as metastatic disease. Stage is one of the most important prognostic factor, however, the management of the early stage uterine carcinosarcoma is still controversial.

Aims: To evaluate prognostic factors, treatment options, and survival outcomes in patients with surgically approved stage I uterine carcinosarcoma.

Study Design: Cross-sectional study.

Methods: Data of 278 patients with uterine carcinosarcoma obtained from four gynecologic oncology centers were reviewed, and 70 patients with approved stage I uterine carcinosarcoma after comprehensive staging surgery were studied.

Results: The median age of the entire cohort was 65 years (range; 39-82). All patients underwent both pelvic and paraaortic lymphadenectomy. Forty-one patients received adjuvant therapy. The median follow-up time was 24 months (range; 1-129). Nineteen (27.1%) patients had disease failure. The 3-year disease-free survival and cancer-specific survival of the entire cohort was 67% and 86%, respectively. In the univariate analysis, only age was significantly associated with disease-free survival (p=0.022). There was no statistical significance for disease-free survival between observation and receiving any type of adjuvant therapy following staging surgery. Advanced age (<75 vs ≥75 years) was the only independent prognostic factor for recurrence (hazard ratio: 3.8, 95% CI=1.10-13.14, p=0.035) in multivariate analysis. None of the factors were significantly associated with cancer-specific survival.

Conclusion: Advanced age was the only independent factor for disease-free survival in stage I uterine carcinosarcoma. Performing any adjuvant therapy following comprehensive lymphadenectomy was not related to the improved survival of the stage I disease.
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http://dx.doi.org/10.4274/balkanmedj.galenos.2019.2018.12.75DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6636652PMC
July 2019

The preoperative serum CA125 can predict the lymph node metastasis in endometrioid-type endometrial cancer.

Ginekol Pol 2018;89(11):599-606

Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Department of Gynecology, Ankara, Turkey.

Objectives: To evaluate the predictive value of preoperative CA125 in extra-uterine disease and its association with poor prognostic factors in endometrioid-type endometrial cancer (EC).

Material And Methods: A total of 423 patients with pathologically proven endometrioid-type EC were included in the study. The association between preoperative CA125 level and surgical-pathological factors was evaluated. The conventional cut-off value was defined as 35 IU/mL.

Results: A high CA125 level ( > 35 IU/mL) was significantly associated with all of the studied poor prognostic factors, except grade. The risk of lymph node metastasis (LNM) increased from 15.9% to 45.7% when CA125 level was > 35 IU/mL (p < 0.05). The optimal cut-off value for the prediction of LNM in patients aged > 50 years was determined to be 16 IU/mL (sensitivity, specificity, positive predictive value, and negative predictive value were 71%, 60%, 35%, and 87%, respectively.) Conclusions: Preoperative CA125 level was significantly related with the extent of the disease and LNM. The age-dependent cut-off level of CA125 can improve the prediction of LNM in endometrioid-type EC. For older patients, CA125 level of > 16 IU/ml could be used to predict LNM. However, further studies are needed to evaluate the appropriate cut-off level of CA125 for younger patients.
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http://dx.doi.org/10.5603/GP.a2018.0103DOI Listing
February 2019

Recurrence in Uterine Tumors with Ovarian Sex-Cord Tumor Resemblance: A Case Report and Systematic Review.

Turk Patoloji Derg 2018 ;34(3):225-233

Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences , ANKARA, TURKEY Department of Pathology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences , ANKARA, TURKEY.

Objective: The aim of this study was to evaluate the prognostic factors of recurrence in uterine tumors resembling ovarian sex-cord tumors (UTROSCT) and to determine clinical-pathological characteristics, treatment options and outcome.

Material And Method: An electronic literature search was conducted from 1976 to 2018. After the comprehensive evaluation and conjunction with our case, the study included 79 cases.

Results: The median age at initial diagnosis was 49 years (range; 16-86 years). The age was under 40 years in 21 (26.6%) patients. Whereas 68 patients underwent at least hysterectomy, 9 patients had organ sparing surgery. There was necrosis in 4 (5.1%) patients, atypia in 16 (20.3%) patients, and infiltrative tumor border in 34 (43%) patients. At least one mitosis per 10 high power fields was determined in 36 (45.5%) patients. The tumor involved at least part of the myometrium in 54 (68.3%) patients. Median follow-up time was 30 months (range; 3-296 months). Recurrence was determined in 5 (6.3%) patients. The disease free survival (DFS) was significantly related only to surgery type. None of the pathologic features were associated with DFS. The 5-year DFS was 86% and 96% in patients who underwent organ sparing surgery or not, respectively (p=0.038).

Conclusion: The accurate pathologic diagnosis of UTROSCT has great value in shaping surgical management and management during the follow-up period. Organ sparing surgery was related to poor DFS. Although recurrence is rare, it should be kept in mind for patients with UTROSCT.
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http://dx.doi.org/10.5146/tjpath.2018.01429DOI Listing
December 2018

Blood Vessel Invasion in Endometrial Cancer Is One of the Mechanisms of Spread to the Cervix.

Pathol Oncol Res 2019 Oct 25;25(4):1431-1436. Epub 2018 Oct 25.

Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey.

To evaluate the association between type of invaded vessels (blood or lymphatic) and cervical involvement in endometrial cancer (EC). Pathological slides of 93 patients with EC who had vascular space invasion in hematoxylin-eosin staining underwent immunohistochemical assay with CD31 and podoplanin. CD31 and podoplanin were used to identify blood and lymphatic invaded vessels, respectively. Cervical stromal invasion (CSI) was determined in 21 (30%) patients. The rate of CD31-positivity was significantly higher in patients with CSI than without (76.2 and 34.7%, p = 0.001; respectively). Podoplanin-positivity was determined in 47.6 and 81.6% of patients with and without CSI, respectively (p = 0.005). Age, myometrial invasion and the combination of CD31-positivity with podoplanin-negativity were found as independent predictors for CSI. Blood vessel invasion is an important factor for CSI in EC. Blood vessel invasion rather than lymphatic vessel invasion is one of the predominant ways by which EC spreads to the cervix.
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http://dx.doi.org/10.1007/s12253-018-0498-1DOI Listing
October 2019

Uncommon borderline ovarian tumours: A clinicopathologic study of seventeen patients

J Turk Ger Gynecol Assoc 2019 11 4;20(4):224-230. Epub 2018 Sep 4.

Department of Gynecologic Oncology Surgery, University of Health Sciences, Etlik Zübeyde Hanım Women Disease Training and Research Hospital, Ankara, Turkey

Objective: To evaluate uncommon types of borderline ovarian tumors (BOT) and define the clinical, surgical, and pathologic features.

Material And Methods: Seventeen patients who were treated in our hospital between 1990 and 2017 were identified. Patients’ data were collected from the gynecologic oncology clinic electronic database, patients’ files, and pathology reports. Conservative surgery was defined as preservation of the uterus and at least part of one ovary.

Results: The mean age was 47 (range, 22-70) years. Based on histopathologic tumor type, there was mixed tumor in five (29.4%) patients, endometrioid-type in nine (52.9%), seromusinous-type in two (11.8%), and Brenner-type in one (5.9%). Conservative surgery was performed in 4 patients. Two patients with endometrioid BOT had synchronous endometrial pathology, including one (11%) patient with endometrial cancer, one (11%) with endometrial hyperplasia without atypia, and 3 (33%) patients had endometriosis. The median follow-up was 19 (range, 1-137) months. No recurrence was observed during the follow-up period.

Conclusion: In our small volume case series, it could be said that non-serous/non-mucinous BOT has excellent prognosis. However, endometrial pathology should be checked in endometrioid type.
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http://dx.doi.org/10.4274/jtgga.galenos.2018.2018.0098DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883761PMC
November 2019

Vaginal Closure with EndoGIA to Prevent Tumor Spillage in Laparoscopic Radical Hysterectomy for Cervical Cancer.

J Minim Invasive Gynecol 2019 May - Jun;26(4):602. Epub 2018 Jul 29.

Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey (all authors).

Study Objective: To demonstrate a method of vaginal closure with the EndoGIA surgical stapler (Medtronic, Istanbul, Turkey) to prevent tumor spillage in laparoscopic radical hysterectomy.

Design: A step-by-step explanation of the procedure using a video.

Setting: Women's health teaching and research hospital.

Patient: A 40-year-old woman with clinical stage IBI cervical squamous cell carcinoma.

Interventions: Laparoscopic type C radical hysterectomy with pelvic lymph node dissection and ovarian transposition. Institutional ethical committee approval was not sought. However, the patient signed an informed consent that allows us to use her clinical data.

Measurements And Main Results: Minimally invasive surgery is increasingly being used in cervical cancer surgery. However, there is a current and significant debate regarding the safety of these methods. Colpotomy, which is the last step of laparoscopic radical hysterectomy, could be related to an increased risk for tumor spillage. Vaginal closure before colpotomy may be an option to prevent this spillage. In this method, after completion of the radical hysterectomy steps, the initial 5-mm left lower quadrant trocar was changed to a 15-mm trocar to allow for the placement of an EndoGIA with a green cartridge. The uterine manipulator was removed, and the uterus was elevated with a myoma screw. Then, the stapler was placed, and we checked that no other unintended structure was included in the jaws of the stapler before the firing. The EndoGIA surgical stapler was fired 2times to close the vagina. The stapler places 2 triple-staggered rows of titanium staples and knife blade cuts simultaneously between them. Once the vagina was divided, the stapler was released. The upper part of the vaginal cuff was excised and sent to pathology as a surgical margin, and the uterus was removed through the vagina. Finally, the vaginal cuff was closed with intracorporeal suturing.

Conclusion: Vaginal closure with the EndoGIA surgical stapler before colpotomy provides a safe and easy method to prevent tumor spillage and could improve the unfavorable results related to minimally invasive surgery in patients with cervical cancer.
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http://dx.doi.org/10.1016/j.jmig.2018.07.015DOI Listing
August 2019

Independent predictors of survival in endometrium cancer: platelet-to-lymphocyte ratio and platelet/neutrophil/monocyte-to-lymphocyte ratio

J Turk Ger Gynecol Assoc 2018 Jun;19(2):78-86

Department of Gynecologic Oncology, University of Health Sciences, Etlik Zübeyde Hanım Women’s Diseases Training and Research Hospital, Ankara, Turkey

Objective: To evaluate the association between ratios of inflammatory markers and survival in endometrium cancer (EC).

Material And Methods: Four hundred ninety-seven patients with epithelial EC were included. The evaluated ratios were neutrophil (N)/lymphocyte (L), neutrophil count divided by the lymphocyte count; platelet (P)/lymphocyte, platelets divided by the lymphocyte count; lymphocyte/monocyte (M), lymphocytes divided by the monocyte count; NM/L, neutrophil plus monocyte divided by the lymphocyte count; PNM/L, the sum total counts of platelets, neutrophils and monocytes divided by the lymphocyte count.

Results: The median follow-up time was 24 months (1-129). Recurrence and exitus occurred in 34 (7%) and 18 (3.7%) patients, respectively. Metastasis in pelvic or para-aortic lymph nodes were significantly related only with low L/M. None of the inflammatory ratios were associated with disease-free survival. In multi-variant analysis, only high P/L (>168) and high PNM/L (>171) were related with a statistically significant hazard ratio for death of 2.91 (p=0.024) and 2.93 (p=0.023), respectively.

Conclusion: The P/L and PNM/L were in relation with worse overall survival and also independent prognostic factors for OS.
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http://dx.doi.org/10.4274/jtgga.2017.0112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994810PMC
June 2018

Prognostic effect of isolated paraaortic nodal spread in endometrial cancer

J Turk Ger Gynecol Assoc 2018 11 28;19(4):201-205. Epub 2018 Mar 28.

Clinic of Gynecologic Oncology, University of Health Sciences, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey

Objective: To evaluate the prognostic effect of isolated paraaortic lymph node metastasis in endometrial cancer (EC).

Material And Methods: This retrospective study included patients with FIGO 2009 stage IIIC2 disease due to isolated paraaortic lymph node metastasis (LNM). Patients with sarcomatous histology, synchronous gynecologic cancers and patients with concurrent pelvic lymph node metastases or patients that have intraabdominal tumor spread were excluded. Kaplan-Meier method was used for calculation of progression free survival (PFS) and overall survival.

Results: One thousand six hundred and fourteen patients were operated for EC during study period. Nine hundred and sixty-one patients underwent lymph node dissection and 25 (2.6%) were found to have isolated LNM in paraaortic region and these constituted the study cohort. Twenty (80%) patients had endometrioid EC. Median number of retrieved lymph nodes from pelvic region and paraaortic region was 21.5 (range: 5-41) and 34.5 (range: 1-65), respectively. Median number of metastatic paraaortic nodes was 1 (range: 1-32). The median follow-up time was 15 months (range 5-94). Seven (28%) patients recurred after a median of 20 months (range, 3-99) from initial surgery. Three patients recurred only in pelvis, one patient had upper abdominal spread and 3 had isolated extraabdominal recurrence. Involvement of uterine serosa, positive peritoneal cytology and presence of adnexal metastasis were significantly associated with diminished PFS (p<0.05).

Conclusion: The presence of serosal involvement or adnexal involvement is as important as gross peritoneal spread and is related with poor survival in patients with isolated paraaortic nodal spread in EC. Chemotherapy should be the mainstay of treatment in this patient cohort which may eradicate systemic tumor spread.
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http://dx.doi.org/10.4274/jtgga.2017.0152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6250084PMC
November 2018

Vanishing endometrial carcinoma in hysterectomy specimens: probable implications for fertility sparing management

Turk J Med Sci 2017 Dec 19;47(6):1744-1750. Epub 2017 Dec 19.

Background/aim: The vanishing cancer phenomenon was first reported in radical prostatectomy specimens in the absence of neo-adjuvant treatment. Reported cases are mostly well-differentiated and low-volume tumors. A similar entity was described for hysterectomy specimens of patients with biopsy proven endometrial cancer (EC). In this study, we discuss the probable reasons for vanishing EC and long-term follow-up results of EC patients without residual tumors in hysterectomy specimens. Materials and methods: This study was carried at two institutions in Ankara, Turkey, in a retrospective design. The computerized databases of both institutions were searched for endometrioid type EC patients whose final pathological specimens failed to show any residual tumor. Results: We evaluated 38 endometrial biopsy confirmed EC patients with no residual tumor detected in the hysterectomy specimens among a total of 224 women (17%) with the disease confined to the endometrium. During the follow-up period, no recurrences were noted among the patients. Conclusion: It can be suggested that premenopausal women with FIGO grade 1 endometrioid type EC with MRI proven "absent myometrial invasion" would have a significant probability of having no residual tumor after endometrial biopsy without any further medical treatment.
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http://dx.doi.org/10.3906/sag-1607-93DOI Listing
December 2017

The Clinicopathological Study of 21 Cases With Uterine Smooth Muscle Tumors of Uncertain Malignant Potential: Centralized Review Can Purify the Diagnosis.

Int J Gynecol Cancer 2018 02;28(2):233-240

Objective: The objective of this study was to investigate the clinicopathological features and factors associated with recurrence in patients with uterine smooth muscle tumor of uncertain malignant potential (STUMP).

Methods: Forty-six cases diagnosed between 2000 and 2014 from 2 tertiary centers underwent blind slide review. Initial diagnosis included smooth muscle tumors with equivocal diagnosis, STUMPs, and cases that were named as leiomyosarcomas (LMS) or low-grade LMS despite not fulfilling the Stanford criteria.

Results: In total, 21 patients with a final diagnosis of STUMP were available. Fifteen (68.1%) of 22 patients with an initial diagnosis of STUMP, 4 (22.2%) of 18 cases with an equivocal smooth muscle tumor diagnosis, and 2 (33.3%) of 6 cases with an initial diagnosis of LMS were interpreted as STUMP after slide review. The mean age at diagnosis was 43 years (range, 20-64 years). The mean follow-up time was 65.9 months (range, 10-154 months). Four patients (19.0%) developed recurrent disease. Recurrent tumors were LMS in 3 patients (75%). One patient (4.8%) with recurrence succumbed to disease. There was no difference in patients' age (P = 1.0) or type of initial surgery (uterus conserving versus hysterectomy) (P = 0.57) between patients who recurred and did not recur.

Conclusions: Uterine STUMPs can harbor significant uncertainty regarding the original diagnosis and clinical outcomes. Recurred cases may have an aggressive clinical course associated with multiple relapses and death. Uterine mesenchymal tumors other than ordinary myomas and overt sarcomas deserve a second opinion in centers with experience because the real diagnosis may vary significantly.
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http://dx.doi.org/10.1097/IGC.0000000000001178DOI Listing
February 2018