Aim: comparison of the similarities of grade 3 endometrioid type endometrial cancer with clear cell and serous type endometrial cancer in terms of clinicopathology and survival and examination of prognostic factors affecting survival. Material and methods: the medical records of 207 patients who were diagnosed with clear cell, serous and grade 3 endometrioid type endometrial cancer and who underwent surgery at Zekai Tahir Burak Women's Health Training and Research Hospital between June 2007 and September 2019 and at Ankara City Hospital between September 2019 and April 2022 were reviewed and their demographic, surgical and pathological features were analyzed. The patients were divided into two groups as grade 3 endometrioid type endometrial cancer and serous/clear cell endometrial cancer, and the patients were compared in terms of clinical and demographic features with univariate-multivariate analyses. Results: the mean age of the patients was 63.3±9.3 years. The rate of early stage disease in the grade 3 endometrioid group was significantly higher (66.3%-44.9%, p=0.002). In the grade 3 endometrioid group, adnexal invasion rate (13.5%-31.4%, p=0.003), uterine serosal invasion rate (10.1%-22%, p=0.023), positive cytology rate (10.1%-29.7%, p=0.001), lymph node metastasis rate (20.2%-43.2%, p=0.001) and abdominal metastasis rate (9%-28%, p=0.001) were significantly lower than in the serous/clear cell group. There was no significant difference between the two groups in terms of overall survival times of 12-18-24-36 months (p=0.910). According to the univariate analysis between the groups, there was a significant risk for overall survival in age categories (p=0.039) and stages (p=0.034). In the multivariate analysis, age over 63 and advanced stage disease were evaluated as poor prognostic factors. Conclusion: there was no significant difference in survival between grade 3 endometrial cancer and serous and clear cell endometrial cancers. Being over 63 years of age and having advanced-stage disease were considered poor prognostic factors.

Background: The aim of this study was to evaluate the serous borderline ovarian tumours (BOTs), the recurrence rates, and the factors affecting recurrence. Methods: A total of 165 patients diagnosed with serous BOT between 2004 and 2019 were included. The patients were evaluated in respect of age, preoperative CA125 levels, FIGO stage, tumour size, stromal micro-invasion, the presence of non-invasive implants, surgical procedures, and lymphadenectomy performed, or all that affects disease-free survival. Results: Early-stage BOT (stage I–II) was determined in 149 (90.3%) patients. Conservative surgery was performed in 57 (34.5%) patients. The non-invasive implantation was detected in 19 (11.5%) patients, and micro-invasion was determined in 31 (18.8%) patients. The median follow-up was 120 months, and recurrence was observed in 8 (4.8%) patients. The 5-year disease-free survival rate was 95.2%, and the 10-year disease-free survival rate was also 95.2%. Univariate analysis showed that elevated preoperative CA125 levels and the presence of micro-invasion were associated with poor disease-free survival outcomes. In the multivariate analysis, the presence of micro-invasion was the only independent poor prognostic factor (HR: 8.944, 95%CI: 2.060–38.833; p:0.003). Conclusions: The micro-invasion was the main factor for recurrence in patients with serous BOT.

We aimed to demonstrate the sensitivity of frozen section for patients with adult granulosa cell tumor (AGCT) and analyze the clinico-pathological factors that may be associated with sensitivity. This is a multicenter study including data of 10 Gynecological Oncology Departments. Frozen-section results of patients who had ovarian AGCT at the final pathology report were retrospectively analyzed. The relation between clinico-pathological characteristics such as age, tumor size, Ca-125 level, presence of ascites, omental metastasis, menopausal status and peritoneal cytology, and the sensitivity of frozen section in patients with AGCT were evaluated. The sensitivity of frozen section diagnosis was determined by comparing the frozen section result with the final pathological diagnosis. Frozen section results of 274 patients with AGCT were obtained. The median age of the patients was 52 years (range, 17–82 years). Totally, 144 (52.7

Amaç: Hipertermik intraperitoneal kemoterapi (HİPEK), ileri evre over kanserlerinde uygulanan tedavi yöntemidir. Isı ile birlikte kanser ilaçlarının doğrudan periton içerisine verilerek sitoredüktif cerrahi ile birlikte peritoneal metastazların kontrolünü amaçlar. Çalışmamızda ileri evre over kanseri tanısı alıp primer sitoredüktif cerrahi ile tedavi edilen ve nüks sonrası sekonder sitoredüksiyon + HİPEK uygulaması ile tedavi edilen hastaların ilk tedavi sırasındaki klinikopatolojik özellikleri ile sağkalım arasındaki ilişkiyi incelemeyi amaçlamaktadır Gereç ve Yöntem: İleri evre over kanserinin primer tedavisi sonrası nüks tespit edilen ve sekonder sitoredüktif cerrahi ve beraberinde HİPEK ile tedavi edilen hastalar retrospektif olarak incelenmiştir. Hastaların demografik özellikleri, evreleri, laboratuvar ve klinik seyirleri retrospektif olarak incelenmiştir. Bulgular: HİPEK ile tedavi edilen toplam 29 nüks ileri evre over kanseri hastası dahil edilmiştir. Primer cerrahi sırasında sekiz olguda R0, 20 olguda R1 ve bir hastada R2 rezeksiyon mevcuttur.. R0 rezeksiyon uygulanan hastalarda istatistiksel olarak anlamlı şekilde daha yüksek sağkalım oranı gözlenmiştir (p

Objective: The main feature of adult granulosa cell tumors (AGCT) is their capacity to secrete hormones, with nearly all of them capable of synthesizing oestradiol. The primary goal of this study is to identify synchronized endometrial pathologies, particularly endometrial cancer, in AGCT patients who had undergone a hysterectomy. Materials and Methods: The study cohort comprised retrospectively of 316 AGCT patients from 10 tertiary gynecological oncology centers. AGCT surgery consisted of bilateral salpingo-oophorectomy, hysterectomy, peritoneal cytology, omentectomy, and the excision of any suspicious lesion. The median tumor size value was used to define the relationship between tumor size and endometrial cancer. The relationship between each value and endometrial cancer was evaluated. Results: Endometrial intraepithelial neoplasia, or hyperplasia with complex atypia, was detected in 7.3% of patients, and endometrial cancer in 3.1% of patients. Age, menopausal status, tumor size, International Federation of Gynecology and Obstetrics stage, ascites, and CA-125 level were not statistically significant factors to predict endometrial cancer. There was no endometrial cancer under the age of 40, and 97.8% of women diagnosed with endometrial hyperplasia were over the age of 40. During the menopausal period, the endometrial cancer risk was 4.5%. Developing endometrial cancer increased to 12.1% from 3.2% when the size of the tumor was >150 mm in menopausal patients (p = 0.036). Conclusion: Endometrial hyperplasia, or cancer, occurs in approximately 30% of AGCT patients. Patients diagnosed with AGCT, especially those older than 40 years, should be evaluated for endometrial pathologies. There may be a relationship between tumor size and endometrial cancer, especially in menopausal patients.

Objective: Uterine corpus involvement was demonstrated radiologically or diagnosed by endometrial biopsy in the previous reports. Thus, there are few studies that detect uterine corpus involvement in radical hysterectomy specimens. This study was designed to investigate the factors that influence uterine corpus involvement in surgically treated cervical cancer patients. Materials and Methods: A total of 269 patients with clinical early-stage (stageIB1-IIA2) cervical cancer who underwent radical hysterectomy and pelvic-paraaortic lymphadenectomy at Zekai Tahir Burak Women's Health Training and Research Hospital and Ankara Bilkent City Hospital between January 2008 and August 2021 were recruited, and their clinicopathologic data were extracted from their patient files or the hospital's electronic database. Results: Uterine invasion was positive in 102 (37.9%) patients. Tumor size of patients was ≤20 mm in 66 (24.5%) patients and >40 mm in 82 (30.5%). Parametrial invasion was detected in 44 (16.4%) patients. In the multivariate analysis; tumor type (adenocancer vs. other tumor types) (HR: 8.94; 95% CI: 3.569–22.401; p35 mm vs. ≤35 mm) (HR: 2.34; 95% CI: 1.234–4.440; p=0.009) depth of stromal invasion (>1/2 vs. ≤1/2) (HR: 6.63; 95% CI: 2.205–19.952; p

AIM:The aim of our study is to examine the clinical, surgical, and pathological factors of stage 1C adult granulosa cell tumor (AGCT) patients and to investigate the effects of adjuvant therapy on recurrence and survival rates in this patient group.METHODS:Out of a total of 415 AGCT patients treated by 10 tertiary oncology centers participating in the study, 63 (15.2%) patients with 2014 FIGO stage IC constituted the study group. The FIGO 2014 system was used for staging. Patient group who received adjuvant chemotherapy was compared with patient group who did not receive adjuvant chemotherapy in terms of disease-free survival (DFS), and disease-specific survival.RESULTS:The 5-year DFS of the study cohort was 89%, and the 10-year DFS was 85%. Those who received adjuvant chemotherapy and those who did not were similar in terms of clinical, surgical and pathological factors, except for peritoneal cytology. In the univariate analysis, none of the clinical, surgical or pathological factors were significant for DFS. Adjuvant chemotherapy and type of treatment protocol had no impact on DFS.CONCLUSION:Adjuvant chemotherapy was not associated with improved DFS and overall survival in stage IC AGCT. Multicentric and randomized controlled studies are needed for early stage AGCT in order to confirm these results and reach accurate conclusions.

OBJECTIVE:The Papanicolaou (Pap) smear test is a standard screening test that detects cervical lesions and cancers. In this multicentric study, we performed a retrospective analysis of cytological results associated with atypical glandular cells, not otherwise specified (AGC-NOS).METHODS:We retrospectively reviewed Pap smear tests that resulted as AGC-NOS. A total of 254 women who underwent colposcopy due to a Pap smear result of AGC-NOS were included the study between 2003 and 2021. The ages, Pap smear results, HPV results if any, colposcopic biopsy results, endocervical and endometrial pathology results, and management of these patients were analysed.RESULTS:Two hundred fifty-four patients with AGC-NOS Pap smear results were included in the study. A total of 70 (27.6%) patients had cervical and endometrial premalignant or malignant lesions. Malignancy was observed in 17 (6.7%) patients (endometrium, n = 11 [4.3%]; cervix, n = 6 [2.4%]). Isolated premalignant or malignant lesions of the cervix and endometrium were detected in 57 (22.4%) and 12 (4.7%) patients, respectively.CONCLUSIONS:Patients diagnosed with AGC-NOS should undergo a careful evaluation with all clinicopathological features. Because cancer of the cervix and endometrium is not rare in patients diagnosed with AGC-NOS, colposcopic examination with endocervical sampling should be a priority based on a cervicovaginal smear. Endometrial sampling is also required according to the patient's clinic, age, and examination characteristics.

Özet Amaç: Bu çalışmada Evre IIIC1 ve evre IIIC2 endometrium kanserinde, hasta grupları arasında klinik, cerrahi ve patolojik risk faktörlerinin dağılımını incelemek ve farklılığı tanımlamak amaçlanmıştır. Gereçler ve Yöntem: Kliniğimizde FIGO 2009 kriterlerine göre evre IIIC1-2 endometrium kanseri tanısı alan 115 hasta çalışmaya dâhil edildi. Hastaların demografik, klinik, cerrahi ve patolojik özellikleri hasta dosyalarından ve patoloji raporlarından retrospektif olarak elde edildi. Bulgular: Hastaların 39’unda (%33.9) sadece pelvik lenf nodu metastazı, 14’ünde (%12.2) sadece paraaortik lenf nodu metastazı, 62’sinde (%53.9) ise hem pelvik hem paraaortik lenf nodu metastazı mevcuttu. Otuz dokuz (%33.9) hasta FIGO IIIC1, 76 (%66.1) hasta FIGO IIIC2 evredeydi. Evre IIIC2 hasta grubunda evre IIIC1’e göre derin myometrial invazyon ve malign peritoneal sitoloji istatistiksel olarak anlamlı yüksekti. Buna karşın yaş, tümör boyutu, çıkarılan lenf nodu sayısı, preoperatif CA 125 değeri, FIGO grade derecesi, lenfovasküler alan invazyonu, servikal tutulum durumu ve adneksal metastaz durumu ile hastalığın paraaortik bölgeye yayılıp yayılmaması arasında anlamlı farklılık gözlenmedi. Sonuç: Evre IIIC endometrium kanserinde paraaortik lenf nodu metastazı varlığında derin miyometrial invazyon ve malign peritoneal sitoloji görülme olasılığı artmaktadır.

Abstract Objective: The main feature of adult granulosa cell tumors (AGCT) is their capacity to secrete hormones, with nearly all of them capable of synthesizing estradiol. Endometrial pathology is caused by granulosa cell-produced estrogen exposure. The primary goal of this study is to identify endometrial pathologies, particularly the endometrial cancer, in AGCT patients who had undergone hysterectomy. The secondary objective of the study is to define the factors that predict endometrial cancer in AGCT. Materials and Methods: The study cohort was formed with 316 AGCT patients from ten tertiary gynecological oncology centers. Surgery for AGCT consisted of bilateral salpingo-oophorectomy, hysterectomy, peritoneal cytology, omentectomy, excision of any suspicious lesion. Endometrial hyperplasia was categorized as simple hyperplasia without atypia, complex hyperplasia without atypia, complex hyperplasia with atypia or endometrial intraepithelial neoplasia (EIN). The median tumor size value was used to define the relationship between tumor size and endometrial cancer. The relationship of each value with endometrial cancer was evaluated. Results: EIN or hyperplasia with complex atypia was detected in 7.7% of patients and endometrial cancer in 3.2% of patients. The relationship between tumor size and endometrial cancer was evaluated by taking the tumor size as a cut-off value of 150 mm. Therefore, tumor size ≤150 mm four (3.2%) and >150 mm four (12.1%) patients had endometrial cancer (p=0.036). Tumor size was statistically significant in relation to endometrial cancer in menopausal AGCT patients. Conclusion: Our present study determined that 7.3% of patients had complex hyperplasia with atypia or EIN and 3.1% of patients had endometrial carcinoma. During the menopausal period, endometrial cancer risk was 4.5%. The study revealed that, the likelihood of developing endometrial cancer increased to 12% from %3.2 when the size of the tumor was >150 mm in menopausal patients.

Objective To evaluate the feasibility and oncological safety of ovarian preservation in early stage endometrial adenocarcinoma (EC) patients aged 40 and below. Methods A total of 11 institutions from eight countries participated in the study. 169 of 5898 patients aged <= 40 years were eligible for the study. Patients with EC treated between March 2007 and January 2019 were retrospectively assessed. Results The median duration of follow-up after EC diagnosis was 59 months (4-187). Among 169 participants, ovarian preservation surgery (OPS) was performed in 54 (31.9%), and BSO was performed in 115 (68.1%) patients. Although patients younger than 30 years of age were more likely to have OPS than patients aged 30 to 40 years (20.4% vs. 9.6%, P = 0.021), there was no significant difference by the mean age. There were no other relevant baseline differences between OPS and BSO groups. The Kaplan-Meier analysis revealed no difference in either the overall survival (P = 0.955) or recurrence-free survival (P = 0.068) among patients who underwent OPS, and BSO. Conclusion OPS appears to be safe without having any adverse impact on survival in women aged <= 40 years with FIGO Stage I EC.

Amaç: Serviks kanseri hastalarında lenf nodu metastazının (LNM) değerlendirmesi tedavinin bireyselleştirilmesi için önemli bir konudur. Çalışmamızın amacı, serviks kanserli hastalarda LNM'nin prediktif faktörlerini belirlemektir. Gereç ve Yöntem: Bu retrospektif çalışmaya, 2007'den 2019'a kadar Uluslararası Jinekoloji ve Obstetrik Federasyonu (FIGO) evre IB1-IIA2'nin serviks kanseri hastaları dahil edildi. LNM insidanslarıyla beraber tek ve çok değişkenli modellerde pelvik ve paraaortik LNM için risk faktörlerinin prediktif değeri belirlendi. Bulgular: Çalışmaya dahil edilen 212 hastadan pelvik LNM olan hasta sayısı 81(%38.2), paraaortik LNM'li hasta sayısı 17(%8) idi. Serviks kanseri hastalarında multivariyant analize göre parametriyal tutulum (hazard ratio [HR]: 2.75, 95% confidence interval [CI], 1.18-6.40, p=0.019) ve lenfovasküler tutulum ([HR]: 3.83, 95% [CI], 1.76-8.38, p=0.001) pelvik LNM için bağımsız risk faktörleriydi iken paraaortik LNM için parametriyal tutulum bağımsız risk faktörüydü ([HR]: 3.62, 95% [CI], 1.20-10.98, p=0.023). Sonuç: Serviks kanseri hastalarında pelvik LNM'nin prediktif faktörleri parametrial tutulum ve LVSI iken paraaortik LNM için prediktif risk faktörü parametrial tutulumdu.

AIM:We aimed to compare weekly methotrexate (MTX) regimen and methotrexate-folinic acid (MTX-FA) 8-day regimen in the first line treatment of low-risk gestational trophoblastic neoplasia (GTN).METHODS:The study included 73 patients with low-risk GTN according to FIGO risk score (FIGO risk score < 7). All patients received either weekly MTX (30-50 mg/m2 intramuscular weekly) or MTX-FA 8-day (MTX 1 mg/kg IV on day 1, 3, 5, and 7, FA 15 mg orally on day 2, 4, 6, and 8 given 24 h after each MTX dose, every 14 days) regimens in the first-line treatment of low-risk GTN. The baseline clinicopathological characteristics and treatment outcomes were analyzed retrospectively.RESULTS:The median age of all patients was 29 (18-51) years, and the median FIGO risk score was 3 (1-6). Of the patients recruited, 53 received MTX-FA 8-day, and 20 had MTX weekly regimens. There was a significant difference between the two groups with respect to FIGO risk scores (3 [1-6] vs. 2 [1-5], p = 0.023, MTX-FA 8-day vs. MTX weekly, respectively). The complete response rate was significantly higher in MTX-FA 8-day group compared to MTX weekly group (83% [44/53] vs. 60% [12/20] p = 0.038). In univariate and multivariate regression analyses, only presence of lung metastasis was found to be an independent risk factor for treatment resistance (OR: 3.959, 95% CI 1.105-14.179, p = 0.035).CONCLUSION:MTX-FA 8-day regimen is more effective than weekly MTX regimen in the first line treatment of low-risk GTN including patients even with higher FIGO risk scores. Treatment resistance may develop especially in patients with lung metastasis.

This study aims to determine the frequency of germline BRCA 1/2 mutations in Turkish women with epithelial ovarian cancer (EOC) and evaluate its relationship with clinicopathological characteristics.

Background: Effects of human umbilical cord blood (HUCB) as a valuable source for stem cell-based therapies have not been studied in persistent post-5-alpha reductase inhibitors (5ARI) erectile dysfunction (PPED). Aim: To determine the effect of intracavernosal injection of HUCB mononuclear cells (MNCs) on ED associated with dutasteride treatment. Methods: Twenty five adult male Sprague-Dawley rats were divided into 5 groups (n = 5 per group): (i) control, (ii) 8-week dutasteride (0.5 mg/kg/day, in drinking water), (iii) 12-week dutasteride, (iv) 8-week dutasteride+HUCB-MNCs (1 x 10(6)) and (v) 12-week dutasteride+HUCB-MNCs. HUCB-MNCs were administered intracavernosally after eight weeks of dutasteride treatment. Experiments were performed at 4 weeks following the injection of HUCB-MNCs. Erectile responses and isometric tension of corpus cavernosum (CC) were measured. The protein expressions of phosphodiesterase type 5 (PDE5), endothelial nitric oxide synthase (eNOS), neuronal NOS (nNOS), hypoxia-inducible factor (HIF)-1 alpha and smooth muscle/collagen contents in penile tissue were evaluated by Western blotting, immunohistochemistry, and Masson's trichrome staining, respectively. Main Outcome: In vivo erectile function, in vitro relaxant and contractile responses of CC, protein expression and localization of PDE5, eNOS, nNOS, HIF-1 alpha, and smooth muscle content in penile tissue. Results: Erectile responses in the dutasteride-treated groups were significantly decreased compared with controls (P < .001), persisting after 4-wk of washout. HUCB-MNCs restored diminished intracavernosal pressure responses, acetylcholine-, sodium nitroprusside-, sildenafil-induced relaxations, and increased phenylephrine and electrical field stimulation (EFS)-induced contractions. Decreased EFS-induced relaxations in dutasteride-treated groups were not restored by HUCB-MNCs. Increased PDE5 and reduced nNOS expressions in dutasteride groups were restored by HUCB-MNCs in the 12-week dutasteride group. eNOS and HIF-1 alpha protein expression and serum total and free testosterone levels were similar among groups. HUCB-MNCs reversed the decreased smooth muscle/collagen ratio in dutasteride-treated tissues. There was a significant increase in PDE5 and HIF-1 alpha staining in 8-week dutasteride animals. Clinical Translation: This study demonstrates the corrective potential of HUCB-MNCs on some persistent structural and functional deterioration caused by 5ARI treatment in rats, which may encourage further evaluation of HUCB-MNCs in men with PPED. Strengths and Limitations: Therapeutic application of intracavernosal HUCB-MNCs is a novel approach for the rat model of post-5ARI ED. Lack of serum and tissue dihydrotestosterone measurements, vehicle injections and characterization of the cells remain limitations of our study. Conclusion: The persistent ED after prolonged administration of dutasteride in rats is reversed by HUCB-MNC treatment, which holds promise as a realistic therapeutic modality for this type of ED. Copyright (C) 2021 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

This study aims to determine the frequency of germline 1/2 mutations in Turkish women with epithelial ovarian cancer (EOC) and evaluate its relationship with clinicopathological characteristics. In this cross-sectional study, all women with recently diagnosed EOC presenting to Zekai Tahir Burak Women's Health Training and Research Hospital Medical Oncology Clinic between 2016 and 2019 were referred for testing. Peripheral blood samples were obtained from 76 patients applying to Medical Genetics and genes were sequenced using next-generation sequencing. The American College of Medical Genetics and Genomics 2015 criteria were followed for classification of genetic variants. Twenty-four women (31.6%) had pathogenic germline mutations. Of these, 17 patients (22.4%) harbored germline mutations and 7 (9.2%) had mutations. When we compared the patients with and without mutations, there was significant difference in terms of family history (41.7% vs 9.6%, respectively,  = .001). Among all patients, 15 (19.7%) had history of breast or ovarian cancer in first- or second-degree relatives. Germline mutations were detected in 66.7% of patients with family history, while these mutations were found in 22.9% of patients without family history (  = .001). In this sample 31.6% of Turkish women with EOC harbored germline 1/2 mutations, which seems higher compared to other ethnic groups except for the Ashkenazi Jews population. All women with EOC should be referred for testing regardless of family history, age at diagnosis, and histological subtype.

Paraaortic lymph node zone is one of the frequent metastatic sites of endometrial cancer. During paraaortic lymphadenectomy, retrocaval (postcaval) and retroaortic (postaortic) lymph nodes are not routinely dissected. However, in case of a bulky disease, all the macroscopically pathologic nodes need to be harvested. During resection of the bulky lymph nodes; obtaining a clear cleavage between the vessel and the tumor node, and a careful dissection are extremely important for an uncomplicated surgery. at the retrocaval area care should be taken to the lumbar arteries and veins.