Research groups have identified 4 groups [polymerase epsilon (POLE) mutant, mismatch repair-deficient, p53-abnormal, and no specific molecular profile)] reflecting the Tumor Cancer Genomic Atlas Research Network subgroups in endometrial carcinomas, improving the clinical applicability of molecular classification. We have analyzed the histopathologic and prognostic characteristics of our cases based on the ProMisE classification, supported by growing data on recommended treatment regimens. The study included 118 cases of endometrial carcinoma diagnosed between 2016 and 2020, which underwent mismatch repair and p53 immunohistochemistry. Next-generation sequencing was performed for POLE mutation analysis, dividing the cases into 4 subgroups. The histopathologic and clinical characteristics of these groups were then analyzed statistically. Four cases(3.4%) were classified as POLE mutant, 31 (26.3%) as mismatch repair-deficient, 22 (18.6%) as p53 mutant, and 61 (51.7%) as no specific molecular profile. We categorized 118 patients with endometrial carcinoma into low (n=43), intermediate (n=28), high-intermediate (n=21), high (n=22), and advanced metastatic (n=4) risk groups regardless of the molecular subtypes of their disease. When we reclassified all cases according to the molecular subtypes of endometrial carcinoma only the risk group of 3 (2.5%) cases changed. Using the new algorithm we designed, after narrowing down the number of patients, the microcystic, elongated, and fragmented pattern of invasion was revealed as an independent prognostic factor that reduces overall survival time (hazard ratio: 16.395, 95% CI: 2.140-125.606, P=0.007). In conclusion, using the new algorithm we have designed, and by identifying patients for whom molecular classification could alter risk groups, we observed that molecular tests can be utilized more efficiently in populations with limited economic resources and, in doing so, we discovered a new morphologic marker with prognostic significance.

BJECTIVES: To elucidate prognostic factors, determine the best course of treatment methods, and assess oncological results in individuals diagnosed with uterine sarcoma. STUDY DESIGN: Between January 2001 and August 2023, 30 patients with uterine sarcomas (US) were included and analyzed in this study. Sixteen patients (53.3%) had uterine leiomyosarcoma, 6 patients (20%) had high-grade endometrial stromal sarcoma, 8 patients (26.7%) had low-grade endometrial stromal sarcoma. RESULTS: The median follow-up of all participants was 50 months. Recurrence was detected in 43.3% of the patients. 5-year survival ratio was 73.3%, 5-year disease-free survival ratio was 66.7%, the overall survival ratio was 70% and the overall disease-free survival rate was 56.6%. No difference was observed between groups in terms of survival comparisons. No statistically significant effect of adjuvant systemic chemotherapy, adjuvant radiotherapy, and combined treatments on median overall survival and median disease-free survival was detected (p>0.05). CONCLUSION: Uterine sarcomas are uncommon malignancies characterized by a poor prognosis, even in early stages, and they are associated with a high recurrence ratio. The most effective treatment method remains unclear to date.

We aimed to compare the expression levels of anti-apoptotic and proapoptotic genes in the parametrium, sacrouterine and round ligaments with respect to menopausal status in women presenting without any indication of pelvic organ prolapse (POP). We hypothesized that apoptosis related gene expressions in female pelvic tissues may be altered during menopause. The study groups consisted of pre-menopausal (n = 10) and menopausal (n = 10) females who did not have POP symptoms. Three different types of tissue samples (Parametrium, Round Ligament and Sacrouterine Ligament) were obtained and RNA was isolated from these tissues. After purifying and quantifying RNA samples, qPCR was used to determine the expression levels of anti-apoptotic and pro-apoptotic genes. BCL-2 gene expression levels were significantly lower in all the tissues of menopausal patients compared to those of premenopausal patients. In comparison to premenopausal patients, the sacrouterine ligament tissue BAD expression level was significantly high (p = 0.035), and the BCL-2/BAD ratio was significantly lower in menopausal patients (p = 0.006). Apoptosis-related protein levels change during menopause; pro-apoptotic gene expressions decrease and anti-apoptotic gene expressions increase. The significant alteration of BCL-2 and BAD expression in sacrouterine ligament with respect to menopausal status was observed and this suggested that when compared to other pelvic tissues, the sacrouterine ligament, which plays a crucial role for genital organs in restoring normal pelvic anatomy and providing support, could be affected more by menopause.

Plain Language SummaryCancer surgeries in the female reproductive system can sometimes cause severe complications, including death. Proper anesthesia management is crucial to reducing such negative outcomes. This study looked at patient records to understand the factors that led to bad results with anesthesia. Researchers focused on both pre-surgery preparations and post-surgery care. They found that factors like needing a blood transfusion, wound infections, getting chemotherapy after surgery, and low blood albumin levels increased the death rate. Strict monitoring of fluid balance and blood circulation during surgery improved survival chances. The work begins long before the operating theater. Anesthesiologists should carefully assess patients before surgery, and teamwork between the anesthesiologist and surgeon is vital throughout treatment. Identifying risks, taking precautions, and minimizing high-risk interventions can decrease the days passed at the hospital, improve recovery, and reduce deaths from surgery complications. ObjectivesThis study assessed postoperative mortality, morbidity, and complications associated with anesthesia administration for gynecologic oncology abdominal surgery and investigated the risk factors for the development of these complicationsMethodsWe conducted a retrospective cohort study analyzing the data of patients who underwent elective gynecologic oncology surgery between 2010 and 2017. The demographic data; comorbidities; preoperative anemia; Charlson Comorbidity Index; anesthesia management; complications; preoperative, intraoperative, and postoperative periods; mortality; and morbidity were investigated. The patients were classified as surviving or deceased. Subgroup analyses of patients with endometrial, ovarian, cervical, and other cancers were performed.ResultsWe analyzed 416 patients; 325 survived and 91 were deceased. The postoperative chemotherapy rates (p < 0.001), and postoperative blood transfusion rates (p = 0.010) were significantly higher in the deceased group, while the preoperative albumin levels were significantly lower in the deceased group (p < 0.001). Infused colloid amount was higher in the deceased group of endometrial (p = 0.018) and ovarian cancers (p = 0.017).ConclusionsPerioperative patient management for cancer surgery requires a multidisciplinary approach led by an anesthesiologist and surgeon. Any improvement in the duration of hospital stay, morbidity, or recovery rate depends on the success of the multidisciplinary team.

This paper reports the measures taken to manage the impact of the COVID-19 pandemic on O&G services in a tertiary referal centre and their outcomes. All the patients included in this study received inpatient treatment and underwent surgery between March 10 2020 and end of June 2020, including obstetric or gynaecologic cases combined. Data including age, diagnosis, operation, duration of preoperative and postoperative hospital stay, COVID-19 status were recorded. COVID-19 status of the patients was diagnosed with a nasopharyngeal swab test. Thirty-seven (20%) of 177 operations were performed because of gynaecologic reasons. The rest of them were caesarean sections (C/S). In gynaecologic cases, 22 (59%) of 37 were emergent operations, nine (24%) cases were oncologic and six (16%) cases were elective gynaecological surgeries. On the other hand, 43 (30%) of 140 patients, who underwent caesarean sections, were urgent surgeries. The rest were elective and planned caesarean sections. Only five patients (2.8%) who had undergone caesarean sections were tested positive for COVID-19. No COVID-19 transmission to staff was recorded in this period. Measures against the COVID-19 pandemic must be multidisciplinary and is crucial to prevent the spread of the disease to staff in close contact.Impact StatementWhat is already known on this subject? COVID-19 pandemic has been a crucial health problem worldwide. Healthcare workers work intensely to protect people from the pandemic. It is especially important to protect healthcare professionals and hospitalized patients from virus transmission. Therefore, utilization of personal protective equipment such as masks, gloves and goggles is obligatory, and hygiene rules such as sanitization of hands are strictly followed.What the results of this study add? This study adds the experience and success of a tertiary centre regarding the measure against COVID-19 to the literature. No viral transmission was detected to healthcare workers and other patients from COVID-19 patients. Hence, measures that mentioned in the present study should be an example to other centres for protection against pandemic.What the implications are of these findings for clinical practice and/or further research? As mentioned above, measures that are explained in the present study should be an example to other centres for protection against the pandemic. Further larger size clinical studies are needed to prove the beneficial effect of the measures that still used against pandemic.

Objectives: To evaluate the influence of mucinous differentiation in endometrioid endometrial cancer regarding spread and prognosis. Material and methods: Endometrioid endometrial cancer cases between 2015 and 2020 were collected retrospectively and divided into two groups according to the cytoplasmic mucin including. Prognostic factors and cancer spread related parameters were evaluated. Results: A total of 219 patients were enrolled in this study. One hundred twenty-two (55.7%) were endometrioid and 97 (44.3%) were in the mucinous differentiated endometrioid catagory. Age was similar between the groups (59.3 vs 58.7, p = 0.62), however, grade 3 lesions were more frequent in endometrioid type endometrial cancer (8.7% vs 1.4%, p < 0.01). Poor prognostic factors including myometrial invasion, lymphovascular space invasion (LVSI), lymph node metastases, peritoneal cytology, endocervical involvement, and stage were not significantly different between groups (p = 0.23, p = 0.49, p = 0.40, p = 0.15, p = 0.17, p = 0.55). The median overall survival time of endometrioid and mucinous differentiated endometrioid type endometrial cancer patients was determined 88.5 and 96.8 months, respectively (p = 0.46). Conclusions: Mucinous differentiation in the endometrioid type of endometrial cancer does not seem to affect the prognosis in endometrioid endometrial cancer patients.

The immune prognostic index (IPI) is a new score that combines pretreatment serum lactate dehydrogenase (LDI-I) levels with a derived neutrophils/(leukocytes minus neutrophils) ratio (dNLR). Our objective was to determine the prognostic value of the endometrial cancer. This study included 94 patients diagnosed with endometrial cancer after surgical resection 2016. Clinicopathological data including preoperative laboratory results were analyzed retrospectively. The patients were divided into two groups according to the IPI score (good IPI, factor 0; poor IPI, factor 1-2). Of the 94 patients, 70 (74.5%) patients had II-IIIA-IIIB, and 24 (25.5%) patients had stage IIIC cancer; 68 (72.3%) had endometrioid histologic type. The good IPI group 38 (40.4%) and the poor IPI group included 56 (59.6%) patients. The median DFS was 105.50 (95% CI: 79.89-131.11) months in the good IPI group and 82.61 (95% CI: 67.16-98.06) months in the poor IPI group (p= 0.791). The median OS was 120.05 (95% CI: 97.28-142.81) months in the good IPI group and 92.53 (95% CI: 79.10-105.96) months in the poor IPI group (p= 0.671). In the IPI group, the rate of stage IIIC patients was higher than those in the good IPI group (33.9% and 13.2%, respectively; p= multivariate analysis, a poor IPI score was independently associated with lymph node metastasis (OR: 3.59, 95%CI: 1.06-12.14, 0.040). In the endometrial cancer population, a poor IPI score may play a remarkable role in guiding optimal treatment strategies. IPI in between 2000 and stage I -included poor 0.030). In p=

Objectives: The present study aims to evaluate the relationship between microribonucleic acid (miRNA) and target gene expressions with clinical and histopathological data in ovarian cancer. Methods: We evaluated 96 archival samples of paraffin-embedded tissue. Some potentially significant miRNA and target gene expressions were evaluated in different histopathological characteristics. These were quantified using realtime-polymerase chain reaction (RT-PCR) in tumor and normal tissue. In miRNA expressions, twofold changes are accepted as significant. Results: According to histopathological groups, 38 (39.6%) were endometroid adenocarcinoma, 11 (11.5%) were borderline serous, 29 (30.2%) were serous, and 18 (18.8%) were mucinous carcinoma. When evaluated according to their stages, 26 (27.1%) patients were stage 1A/1B. A relationship was found between miR200a and miR200c and histopathologic groups, between miR141 and estrogen receptors, between CXCL1 and survival status, and between KEAP1 and ki67. Additionally, miR200a in endometrial and miR200c in mucinous adenocarcinoma were overexpressed. When the relationship between all miRNAs and histopathological groups was evaluated, a significant change was found only in miR200c expression. It was significantly higher in serous than endometrial tumors and significantly higher in mucinous than endometroid tumors. Conclusion: These suggested that miR200a and 200c expressions might be useful for the evaluation of histopathological subgroups of ovarian cancer.

Objective; We present a case report regarding a 71-year-old woman with postmenopausal virilization caused by ovarian hilus cell hyperplasia and Sertoli-Leydig cell tumor who was suffered from hair loss, clitoromegaly and hirsutism. Case Report; The patient’s plasma testosterone levels were high. In the MRI examination, a nodular formation of 20x26mm in size was observed in the right ovary. At the transvaginal ultrasound, a cystic mass of 28x28mm was seen in the right ovary. Then we performed a total laparoscopic hysterectomy and bilateral salpingo-oophorectomy. The final pathology showed a poorly differentiated Sertoli Leydig cell tumor at the right ovary and hilus cell hyperplasia at the left ovary. Sertoli-Leydig cell tumors, which are relatively less common, are extremely rare to be seen in the postmenopausal period. Conclusion; What distinguishes this case from others is that Sertoli-Leydig cell tumor and hilus cell hyperplasia may cause virilization symptoms together, in addition to its prevalence in advanced age.

Amac: Bu calismada amacimiz; klinik olarak ileri evre over kanseri (OK) dusunulen olgularda, alt gastrointestinal sistem (GIS) endoskopisinin; kolon invazyonunu saptamadaki degerini ve ayrica primer sekonder OK ayrimindaki onemini arastirmaktir. Gerec ve Yontem: Eylul 2012 – Mayis 2017 yillarinda, DEUTF Hastanesinde opere edilen ve DSO ICD-10 2016 versiyonuna gore malign adneksiyal kitle tanisi kodlanan ve laparotomi uygulanan, ileri evre (evre III-IV) 113 olgunun dosya kayitlari alt GIS endoskopisi uygulananlar ve uygulanmayanlar olarak karsilastirildi. Bulgular: Malign adneksiyal (en sik over) kitle on tanisiyla laparotomi uygulanan, evre III- IV,113 olgu, klinik ozellikler ve barsak rezeksiyonunu ongorme acisindan (alt GIS endoskopik inceme yapilanlar, 51 olgu, yapilmayanlar, 62 olgu) karsilastirildi. Kolonoskopi yapilan grupta 6 olguda kolon tutulumu gozlendi, 4 olguda tutulum intraoperatif saptandi. Kolonoskopi yapilmayan grupta 10 olguda intraoperatif rezeksiyon uygulandi. Iki grupta da 10’ ar olguya barsak rezeksiyonu gerekti. Rezeksiyon yapilan 20 olgunun ortalama yasi, 57,35 ± 13,53, rezeksiyon yapilmayan 93 olgunun ortalama yasi 55,81 ± 12,54 tur. En sik rezeksiyon rektosigmoid bolgede olup, (17 olgu) tum olgularin %85’ini olusturmaktadir. Kolonoskopinin barsak rezeksiyonunu on gormedeki pozitif prediktif degeri (PPV); %100, negatif prediktif degeri (NPV); %91 olarak bulundu. Sonuc: Ileri evre malign adneksiyal kitlelere cerrahi yaklasimda alt GIS barsak rezeksiyonlari tedavinin onemli bir komponentidir. Alt GIS endoskopisinde tumor tutulumunun saptanmasi cerrahi tedaviyi planlama, postoperatif donemde stoma problemleri ve emosyonel sorunlarla bas etmede ve metastatik tumorlerin ayirici tanisinda onemlidir.

Breast cancer is a common malignancy among women. Due to the improvement of social awareness and advances in imaging technologies, significant achievements are obtained at its diagnosis and treatment each passing day. A 54-year-old, multiparous and postmenopausal woman, who presented with a palpable lymph node in the right supraclavicular region and a right adnexal mass but had no findings from the breast examination, is reported in this article. Following advanced assessment, metastatic carcinoma was identified in the lymph node biopsy and the adnexal mass. During the exploration for the primary origin, microinvasive breast cancer was diagnosed following mammographic imaging and an excisional biopsy from the right breast. Microinvasive breast cancer, which did present itself with clinical findings with metastases despite the lack of local findings, was discussed with the review of the literature.

Over kanseri kadinlarda olumler arasinda 5. en sik olum nedeni olan kanserdir. Over kanseri tani ve tedavisi icin gunumuzde standart olarak jinekolojik muayene, ultarason ile degerlendirme ve CA-125 gibi serum olcumleri yer almaktadir. Ancak hem hastaligin tanisi ve tedavisi ile yol gosterebilecek yeni biyobelirteclere yogun bir ihtiyac bulunmaktadir. Kisa, protein kodlamayan RNA’lar olan mikroRNA’lar (miRNA), ozellikle kanserde biyobelirtec olmak icin oldukca kullanisli stabil endojen RNA’lardir. Bu derleme kapsaminda over kanserinde miRNA’larin bugune dek yapilan calismalarda ki rolunun irdelenmesi amaclanmistir.

Objective: To examine cases of mature cystic teratoma (MCT) that were diagnosed and treated in our clinic regarding their association with fertility, and to detect the rate of malignant degeneration and the types of malignancies. Material and Methods:Patients who underwent surgery due to adnexal mass between April 2012 and August 2017 and were diagnosed as having MCT were retrospectively examined.The mean age of the 80 patients who met the inclusion criteria was 30.60±10.5 years.Nine had infertility according to hospital records.Sixty-seven percent of these (n=6) had accompanying endometriosis and MCT was bilateral in 55.5% (n=5).Malignant degeneration was present in 6.25% (n=5), all were monodermal tumors.Malignant degeneration was more common among patients with larger diameter adnexal masses (9.1±2.9 cm) and in those of postmenopausal age.Tumor markers were within the normal range for patients who developed malignancy.Malignant degeneration was not present among infertile patients with endometriosis.Results: Although MCTs do not seem to negatively affect the ovarian reserve, infertility is prominent in patients with concurrent endometriosis.During assessment, concurrent endometriosis should be considered.Imaging findings, large adnexal masses, and postmenopausal period are important for the assessment of MCT concerning malignant degeneration.It should not be overlooked because tumor markers may be normal. Conclusion:MCTs can be present concurrent with endometriomas.In such cases, infertility is more distinct.In MCT malignant degeneration, mass diameter, complex mass internal structure, and postmenopausal status are important factors.(

Objectives: To investigate gene expression differences and related functions between primary tumor, malignant cells in ascites, and metastatic peritoneal implant in high-grade serous ovarian cancer. Methods: Biopsies from primary tumor, peritoneal implant, and ascites were collected from 10 patients operated primarily for high-grade, advanced-staged serous ovarian cancer. Total RNA isolation was performed from collected tissue biopsy and fluid samples, and RNA expression profile was measured. Messenger RNA expression profiles of 3 different groups were compared. Functional analyses of candidate genes were carried out by gene ontology and pathway analysis. Results: There were significant differences in the expression of 5 genes between primary tumor and peritoneal implant, 979 genes between primary tumor and malignant cells in ascites, and 649 genes between peritoneal implant and malignant cells in ascites. Three commonly enriched gene ontology functions between "primary tumor and malignant cells in the ascites" and "peritoneal implant and malignant cells in the ascites" were protein deubiquitination, ubiquitin-dependent protein catabolism, and apoptotic processes. All genes related to these functions belonged to USP17 gene family. Conclusion: Gene expression difference between primary tumor and the peritoneal implant is not as much as the difference between primary tumor and free cells in the ascites. These results show that malignant cells in the ascites return into its genetic origin after they invade on the peritoneum. Significantly increased expression of DUB-enzyme genes, SNAR gene family, and ribosomal pathway genes in epithelial-mesenchymal transition suggests that this regulation is ubiquitin-proteasome dependent. Especially, this is the first study that offers USP17 as a potential target for epithelial-mesenchymal transition.

OBJECTIVE: To investigate the preventive effect of anti-macrophage migration inhibitory factor (MIF) antibody on lipopolysaccharide-induced preterm delivery in mice. STUDY DESIGN: This is a prospective, placebo-controlled, experimental study. Lipopolysaccharide (LPS) was administered intraperitoneally to pregnant Balb/c mice to induce preterm delivery. For the first set of experiments, dams were treated intraperitoneally with anti-MIF antibody simultaneously with LPS treatment or 2 . hours before LPS injection. A second set of experiments was performed to determine the influence of anti-MIF antibody on intrauterine production of tumor necrosis factor alpha (TNF-alpha) and interleukin-6 (IL-6). RESULTS: The duration of gestation was significantly longer in the group of mice that received anti-MIF antibody 2 hours before LPS injection than in the group of mice that received solely LPS (p=0.004). TNF-alpha and IL-6 concentration in gestational tissues was significantly reduced in mice that received anti-MIF antibody simultaneously with LPS treatment (p=0.010 and 0.025) or 2 hours before LPS treatment (p=0.010 and 0.006) than in those that received LPS alone. CONCLUSION: We have demonstrated for the first time that anti-MIF antibody can delay LPS-induced preterm delivery in mice.

Aims: The objective of this study is to identify the diagnostic performance of three-dimensional transvaginal ultrasonography (3D-US) and magnetic resonance imaging (MRI) in detecting myometrial, lower uterine segment and/or cervical invasion in endometrial cancer patients. Materials and methods: In this prospective study, 40 patients diagnosed with endometrial cancer were performed 3D-US and MRI, preoperatively. Deep myometrial, lower uterine segment and cervical invasion were evaluated subjectively and results were compared with the final histology as a gold standard. Results: Diagnostic accuracy of 3D-US for detecting deep myometrial, lower uterine segment and cervical invasion were 87.5%, 80% and 85%, respectively. The same results for MRI were 75%, 65% and 70%, respectively. For deep myometrial, lower uterine segment and/or cervical invasion in endometrial cancer, 3D-US had higher sensitivity, specificity, negative and positive predictive value and accuracy than MRI. The combination of these two imaging techniques had an increased sensitivity of detecting all parameters related with tumoral invasion but decreased specificity and the accuracy. Conclusion: 3D-US had better performance in detecting myometrial, lower uterine segment and/or cervical invasion than MRI in endometrial cancer patients. Combination of these techniques was not preferred according to this study.

Introduction: Liver transplantation (LT) has been the prominent treatment option in patients with end-stage liver failure. Patients who underwent LT can maintain their usual activities of daily living with a professional care and multidisciplinary follow-up. In this abstract, we present 12 patients who had an uneventful gestation and delivery after liver transplantation. Patients: Between 2002 and 2015, 12 patients at fertility age became pregnant after LT in our clinic. Etiology of end-stage liver disease was chronic Hepatitis B and D in 4 patients, Wilson's disease in 2 patients, Budd–Chiari syndrome in 1 patient, autoimmune hepatitis in 1 patient, primary sclerosing cholangitis in 1 patient, familial intrahepatic cholestasis in 1 patient, and 2 patients had cryptogenic cirrhosis. LT was performed from living donors in 10 patients and deceased donors in 2 patients. Postoperative follow-up was performed with routine office visits in our transplantation policlinic by a multidisciplinary team including supervisor liver transplantation physician, senior transplant surgeons and gastroenterologists. Along with the gestation and delivery period, patients have been followed closely; immunosuppressive medications have been rearranged and an obstetrician has joined the team. Tacrolimus based immunosuppressive regimen was used all patients. Fifteen uneventful gestations and births occurred in 16 patients. One newborn had a low birth weight, than he died because of sepsis. There were any malformation in newborns. Conclusion: Patients who underwent LT at fertility age can have a usual pregnancy and delivery period with a close follow up performed by a multidisciplinary team.

We present two cases of twin pregnancies without resolution of preeclamptic symptoms after intrauterine death of one twin.CASE 1:A nulliparous woman aged 37 years was referred at 26 weeks of gestation because of arterial hypertension, edema, and growth restriction in one twin. Three weeks later the restricted twin died. During the following three weeks, ultrasound examinations showed a reduced growth velocity of the surviving fetus and reversed umbilical flow. At the end of the 34th week of gestation, cesarean section was performed and a healthy female infant was delivered.CASE 2:A nulliparous woman aged 33 years with a 27-week twin pregnancy was referred because of arterial hypertension and discordant growth. The restricted twin died at 31 weeks of gestation. Following the death, within two weeks the growth of the co-twin started to slow down and reversed end diastolic flow presented. At the end of the 33rd week of gestation, cesarean section was performed and a healthy female infant was delivered.The interesting point of these cases was the secondary effects on the co-twins. During the time after intrauterine deaths of one twin, the surviving fetuses started to show a reduced growth velocity and reversed umbilical flow and mothers had increased blood pressure and proteinuria again. We think that both cases are evidence of late on-set systemic maternal effects (such as systemic maternal endothelial activation and/or systemic maternal inflammatory response) depends on preeclampsia.