OBJECTIVE:The Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) score has been proposed to facilitate patient selection for secondary cytoreductive surgery. However, this model has not been validated for low-grade subtypes of ovarian cancer. This study evaluates the reproducibility of a positive AGO score in predicting complete resection in recurrent low-grade epithelial cancers. METHODS:We retrospectively analyzed 76 patients with recurrent grade-I serous, grade-I/II endometrioid, and mucinous ovarian cancers who underwent cytoreductive surgery between January 2001 and April 2023. Univariate and logistic regression analyses were performed to evaluate associations between clinical factors and surgical outcomes. RESULTS:Complete resection was achieved in 31 of 55 patients (56.3%) undergoing surgery at first recurrence and in 9 of 21 patients (42.9%) in subsequent treatment lines. Among patients experiencing first recurrence with a treatment-free interval of ≥6 months, the positive predictive value of the AGO score for complete resection was 70.6%. However, multivariate analysis revealed that Eastern Cooperative Oncology Group score (p = .62), International Federation of Gynecology and Obstetrics stage (p = 1.00), ascites (p = .14), and residual disease after primary surgery (p = .59) were not independent predictors of complete resection at first recurrence. Results were consistent in subgroup analyses, including serous and endometrioid subtypes with a treatment-free interval of ≥6 months. Ascites ≥500 mL was present in only 7.9% of patients, while 92.1% had no or low-volume (<500 mL) ascites. Diffuse carcinomatosis was observed in 58.7% of patients. In patients who had achieved complete resection at primary surgery, a treatment-free interval of >28 months was associated with higher complete resection rates (83.3% vs 50%, p = .038). CONCLUSIONS:Our study highlights a critical limitation of the AGO score in low-grade ovarian cancers. None of the clinical elements included in the AGO score were independently associated with surgical results. Despite the high positive predictive value, a positive AGO score may not reliably predict complete resection in patients with recurrent low-grade ovarian cancers and should be interpreted with caution.

Peritoneal carcinomatosis-associated malignant bowel obstruction is a common feature that merits more attention in advanced and recurrent ovarian cancer. Decompressive gastrostomy is one of the most preferred methods to palliate distressing symptoms and maintain patients’ quality of life. We retrospectively identified 31 patients with ovarian cancer-associated MBO, who underwent decompressive CT fluoroscopy-guided percutaneous gastrostomy (CT-PG) between September 2015 and April 2023 at our institution. A systematic literature review was conducted for CT-guided gastrostomy in ovarian cancer. Prior to CT-PG, 27 (87%) patients underwent unsuccessful attempts at endoscopic gastrostomy or surgery due to bowel obstruction; a total of 55% had received ≥3 lines of chemotherapy. CT-PG could be successfully inserted in 25 of 31 (81%) patients without grade 4–5 complications. CT-PG insertion was feasible in 76% of patients with previous unsuccessful attempts of endoscopic gastrostomy. A total of 80% of patients with a successful insertion had considerable symptom relief and could tolerate fluid intake. Mean survival after the procedure was 44.4 days. Chemotherapy could be administered in 7 of 25 (28%) patients following the CT-PG insertion. CT-guided percutaneous gastrostomy is a safe procedure that effectively manages intractable symptoms of bowel obstruction in ovarian cancer. This minimally invasive technique should be emphasised as a routine instrument within the palliative management of MBO.

Introduction/Background Peritoneal carcinomatosis-associated ileus is frequent in advanced-recurrent ovarian/peritoneal/fallopian cancer and affects the quality of life due to severe symptoms of obstruction.CT-guided insertion of percutaneous gastrostomy (CT-PG) is a new minimal-invasive treatment option within the palliative management of gynaecological cancer patients. Methodology Based on retrospective analysis we evaluated 18 patients undergoing percutaneous radiologic gastrostomy between September/2015 and April/2022. Clinical characteristics,complications, symptom-relief,need of secondary interventions and surgery for ileus,ability of receiving chemotherapy and mortality were identified.CT-guided gastrostomy was applied by Seldinger technique in local anesthesia. Results The indication of CT-PG was peritoneal carcinomatosis-associated ileus in all patients. 15-patients had already undergone a frustrating endoscopic gastrostomy (PEG) placement or ileus operation prior CT-PG insertion.CT-PG could be successfully placed at 14 patients without any major interventional complication other than a local bleeding which was conservatively managed. The commonly observed metabolic complication after insertion was hypokalaemia requiring parenteral substitution. Symptom relief:10 of 14 patients who had successful CT-PG showed considerable symptom relief without need of any other subsequent invasive interventions other than one CT-PG re-insertion. Almost in all patients (13) surgery for ileus could be safely omitted.Only 3 patients needed additional PEG-insertion by gastroscopy due to inefficient flow-rate of radiologically inserted gastric-tube.Prognosis: 30-days mortality including patients who lost-to-follow-up in all intention-to-threat-population was 72% (13/18) with observed 5-events. Mean hospital stay after successful placement was 9.9 days(2–27 days). Chemotherapy could be administrated in 3 patients; however only 1 patient with primary diagnosis could receive 3-cycles of neoadjuvant chemotherapy.All other patients had been managed according to best-supportive-care principles due to high frailty and were placed on hospice/palliative station shortly after receiving gastrostomy. Conclusion The CT-PG is minimal invasive, safe, highly symptom-oriented palliative procedure in advanced/recurred peritoneal cancer. CT-PG procedure should be a routine instrument in the palliative management of bowel obstruction in patients with heavily-pretreated ovarian cancer.

Objective: This study aimed to evaluate the diagnostic accuracy of preoperative 18F-fluorodeoxy- glucose (FDG) positron emission tomography/computed tomography (PET/CT) metabolic parameters for the prediction of risk factors and detection of lymph node metastasis (LNM) in patients with endometrial cancer. Material and Methods: This study included 26 patients with endometrioid carcinoma who underwent preoperative PET/CT and treated with adjuvant local radiotherapy. The maximum standard uptake value of the tumor (SUVmax-T), SUVmax of the pelvic and/or para-aortic LNs, metabolic tumor volume (MTV), and tumor lesion glycolysis (TLG) with cut-off values of 30-40% were calculated. International Federation of Gynecology and Obstetrics stages 3 and 4, highgrade disease, lymphovascular invasion (LVI), cervical involvement (CI), and myometrial invasion (MI) ≥50% were established as high-risk features. Disease-free survival and overall survival were analyzed in comparison with 18F-FDG PET/CT parameters. Results: SUVmax-T was only associated with tumor diameter (p=0.01). It was not correlated with MI, high-grade disease, CI, or LNM. With SUVmax-P ≥2.81 as a cut-off value, the sensitivity, specificity, and accuracy in the detection of LNM were high (90%, 83.3%, 71.4%, respectively). For LNM, the mean MTV-30 (p=0.021), TLG-30 (p=0.030), and SUVmax-P (p=0.009) were significant predictors. According to the regression analysis, MTV-40 (p=0.043) was an independent predictor of LNM, and LVI (p=0.037) was the only significant predictor of MI. MTV-30 was a significant predictor of CI (p=0.04). Conclusion: SUVmax-P, MTV, and TLG cut-off values, to predict LN metastases, increase diagnostic accuracy for EC.

Objective. Low-grade epithelial ovarian cancers (EOC), constitute the minority among all epithelial cancers. Our study objective was to focus on low-grade recurrent EOC and compare the survival with high-grade disease, as well as in regard to "platinum-sensitive" and "-resistant" recurrences according to platinum-free interval. Methods. This is an exploratory analysis within the North-Eastern German Society of Gynecological Oncology (NOGGO) database including five randomized phase II/III trials comparing different chemotherapy regimens in recurrent EOC. We conducted survival analyses and cox-proportional regression models. Results. Out of 1050 patients having the first recurrence, 42 (4%) patients had low-grade and 1008 (96%) patients had high-grade disease. In the subgroup of platinum-sensitive recurrences, progression-free survival (PFS) (8.7 m vs 9.7 m, p = 0.7) and overall survival (OS) (23.9 m vs 24.8 m, p = 0.9) did not differ between low-grade and high-grade diseases. In platinum-resistant recurrences, patients with low-grade ovarian cancer had significantly better PFS (7.6 m vs 3.6 m, p = 0.03) and OS (41.9 m vs 9.5 m, p = 0.002) in comparison to those with high-grade cancer. At low-grade EOC, there were no significant PFS (p = 0.91) and OS (p = 025) differences between platinum-sensitive and -resistant recurrences. Patients with low-grade non-serous histology had lower PFS with compared to those with low-grade serous histology (p = 0.004). At cox regression analysis presence of ascites and residual disease after secondary cytoreductive surgery were independently associated with poor PFS within low-grade recurrent EOC. Conclusion. Our study indicates, platinum-free interval does not have any prognostic significance at recurrent low-grade EOC and non-serous histology is associated with poorer outcome in recurrence. Secondary surgical cytoreduction to no-gross residual disease and ascites are independently associated with disease progression. (C) 2019 Published by Elsevier Inc.

Objective: To make predictions for antenatal evaluation by using anthropometric data of the newborns which undergo the complications of brachial plexus palsy, clavicle fracture and shoulder/humerus fracture in cases with low risk in terms of shoulder dystocia. Methods: After the risk factors that may cause deliveries with dystocia such as fetal macrosomia, maternal diabetes, maternal obesity and excessive weight gain during pregnancy, history of shoulder dystocia, labor induction and epidural anesthesia were ruled out, birth complication cases found in the hospital database retrospectively were matched one by one with data of the newborns which had same obstetric and demographic characteristics, same weights and genders but did not undergo labor trauma. Results: A total of 185 newborn complications were observed, and of these complications, 149 were classified as clavicle fracture, 8 as shoulder and humerus fracture, and 28 as brachial plexus palsy. It was seen that the 2nd stage of labor was significantly longer in the cases which underwent birth complication (p=0.01; 22.41±6.98 minutes vs. 24.23±6.43 minutes). Shoulder dystocia was more frequent in the study group which had complications (p=0.0001; 32.97% vs. 2.7%). In terms of anthropometric measurements, the ROC analysis of thorax circumference / head circumference ratio was significant, and it was seen that shoulder dystocia and the complications could be predicted in case that the ratio is higher than 0.97 (AUC=0.903; sensitivity 77.84%, specificity 89.73%, PPV 88.3%, NPV 80.2%, LR 7.58). It was found that the rate of complications increased significantly in cases which were above 4000 g (p=0.029). Conclusion: Shoulders and its extensions are vulnerable to trauma within birth canal. In our hypothesis, neonatal anthropometric data were significantly correlated with the complications. In order to make a prediction, bisacromial diameter and thorax circumference measurements as well as fetal head measurements may be helpful during antenatal period and labor in particular.

Objective Determining the risk factors associated with parametrial involvement (PMI) is of paramount importance to decrease the multimodality treatment in early-stage cervical cancer. We investigated the preoperatively assessable clinical and pathological risk factors associated with PMI in surgically treated stage IB1–IIA2 cervical cancer. Methods A retrospective cohort study of women underwent Querleu-Morrow type C hysterectomy for cervical cancer stage IB1–IIA2 from 2001 to 2015. All patients underwent clinical staging examination under anesthesia by the same gynecological oncologists during the study period. Evaluated variables were age, menopausal status, body mass index, smoking status, FIGO (International Federation of Obstetrics and Gynecology) stage, clinically measured maximal tumor diameter, clinical presentation (exophytic or endophytic tumor), histological type, tumor grade, lymphovascular space invasion, clinical and pathological vaginal invasion, and uterine body involvement. Endophytic clinical presentation was defined for ulcerative tumors and barrel-shaped morphology. Two-dimensional transvaginal ultrasonography was used to measure tumor dimensions. Results Of 127 eligible women, 37 (29.1%) had PMI. On univariate analysis, endophytic clinical presentation (P = 0.01), larger tumor size (P < 0.001), lymphovascular space invasion (P < 0.001), pathological vaginal invasion (P = 0.001), and uterine body involvement (P < 0.001) were significantly different among the groups with and without PMI. In multivariate analysis endophytic clinical presentation (odds ratio, 11.34; 95% confidence interval, 1.34–95.85; P = 0.02) and larger tumor size (odds ratio, 32.31; 95% confidence interval, 2.46–423.83; P = 0.008) were the independent risk factors for PMI. Threshold of 31 mm in tumor size predicted PMI with 71% sensitivity and 75% specificity. We identified 18 patients with tumor size of more than 30 mm and endophytic presentation; 14 (77.7%) of these had PMI. Conclusions Endophytic clinical presentation and larger clinical tumor size (>3 cm) are independent risk factors for PMI in stage IB–IIA cervical cancer. Approximately 78% of the patients with a tumor size of more than 3 cm and endophytic presentation will require adjuvant chemoradiation for PMI following radical surgery. Considering clinical tumor presentation along with tumor size can enhance the physician's prediction of PMI in early-stage cervical cancer.

Objective: Wide variation exists in ovarian cancer incidence rates suggesting the importance of environmental factors. Due to increasing environmental pollution, trace elements and heavy metals have drawn attention in studies defining the etiology of cancer, but scant data is available for ovarian cancer. Our aim was to compare the tissue concentrations of lead, selenium and nickel in epithelial ovarian cancer, borderline tumor and healthy ovarian tissues.Methods: The levels of lead, selenium and nickel were estimated using atomic absorption spectrophotometry in formalin-fixed paraffin-embedded tissue samples. Tests were carried out in 20 malignant epithelial ovarian cancer, 15 epithelial borderline tumor and 20 non-neoplastic healthy ovaries. Two samples were collected for borderline tumors, one from papillary projection and one from the smooth surface of cyst wall.Results: Pb and Ni concentrations were found to be higher both in malignant and borderline tissues than those in healthy ovaries. Concentrations of Pb and Ni in malignant tissues, borderline papillary projections and capsular tissue samples were not different. Comparison of Se concentrations of malignant, borderline and healthy ovarian tissues did not reveal statistical difference. Studied metal levels were not found to be different in either papillary projection or in cyst wall of the borderline tumors.Conclusions: This study revealed the accumulation of lead and nickel in ovarian tissue is associated with borderline and malignant proliferation of the surface epithelium. Accumulation of these metals in epithelial ovarian cancer and borderline ovarian tumor has not been demonstrated before.

If an open abdominal patient develops enteric fistulae, the condition will be defined as enteroatmospheric fistulae (EAF). As it is not covered with tissue and does not have a fistula tract, it cannot be considered a real fistula. In total, 25% of open abdominal patients develop EAF and have a mortality rate of approximately 42%-75%. In this article, we present the case of a patient with EAF developing post sitoreductive surgery. As the recovery time of grade 4 open abdominal patients can be 6 months or longer, it was our aim to convert the fistula mouth to a stoma.

GIRIS: Kist hidatik cogunlukla Echinococcus granulosus ve nadiren de Echinococcus alveolaris'in neden oldugu ulkemizde sik gorulen paraziter kistik bir hastaliktir. Tum organlarda gorulebilse de en sik yerlestigi organlar karaciger ve akcigerdir. Adneksiyal alanda gorulen kist hidatik hastaligi ise oldukca nadirdir. OLGU: 24 yasinda karin agrisi ve karinda siskinlik sikayeti ile klinigimize basvuran hasta, yapilan ultrasonografi ve bilgisayarli tomografi tetkikleri neticesinde bilateral musinoz adneksiyal kitle dusunulerek opere edilmistir. Frozen inceleme sirasinda hidatik kist oldugu tespit edilip post-operatif donemde buna yonelik tedavi baslanmistir. SONUC: Turkiye gibi endemik bolgelerde adneksiyal kitlelerin ayirici tanisinda hidatik kist de akilda bulundurulmali ve taniyi kolaylastirmak icin kistin tipik ultrasonografik bulgularina asina olunmalidir. Tedavisinde tum kitlelerin cikarilmasi esastir ve kist iceriginin sacilmasini onlemek icin gerekli tedbirler alinmalidir.

Sertoli-Leydig hücreli tümör (SLHT)'lerin %70-75'i 40 yaşın altında, %10?dan azı menarştan önce veya postmenopozal dönemde görülmektedir. Bu çalışmada, postmenopozal lekelenme şeklinde vajinal kanama ile hastanemize başvuran, sağ adneksiyal kitle saptanan 59 yaşındaki kadın olgu sunulmuştur. Olguya batın yıkama sıvısı örneklemesi, total abdominal histerektomi ve bilateral salpingooferektomi yapıldı. İntraoperatif frozen kesitlerin değerlendirilmesinde seks kord stromal tümör düşünüldü. Periton biyopsileri, omentektomi ve pelvik, paraaortik lenf nodu diseksiyonu ile evreleme cerrahisi yapıldı. Solid ve kistik alanlar içeren kitleden hazırlanan kesitlerin histopatolojik incelemesinde; immatür görünümdeki sertoli hücrelerinin tübüller yanı sıra geniş sarkomatöz dağılım paterni oluşturduğu görüldü. İmmünohistokimyasal çalışmada CD 56 ile kuvvetli, kalretinin, inhibin ile fokal pozitif boyanma görüldü. Histopatolojik ve immünohistokimyasal bulgular değerlendirilerek az diferansiye SLHT tanısı verildi. Az diferansiye SLHT nadir görülen, ayırıcı tanısında iğsi hücre komponentli tümörlerin düşünülmesi gereken overin seks kord stromal tümörüdür. 70-75% of Sertoli-Leydig cell tumors (SLCT) are diagnosed at before age of 40, and less than 10% takes place before menarche and following menapouse. We report a case of right adnexal mass in a 59 year-old postmenapousal woman who presented with vaginal bleeding. Sex-cord stromal tumor was diagnosed at peroperative frozen section assesment. Staging surgery consisting of peritoneal biopsies, omentectomy and pelvic paraaortic lymph node dissection was performed. In histopathologic assesment of the slides which were prepared from solid-cyctic areas of the mass, revealed immature sertoli cells forming tubules and a wide sarcomatoid differantiation. Immunhistochemically, neoplastic cells stained strongly and diffusely positive with CD 56, focal positive with calretinin and inhibin. Poorly differentiated SLCT was diagnosed with the consideration of both histopathologic and immunhistochemical findings. Poorly differantiated SLCT are unusual sex cord stromal neoplasms of ovary of which differantial diagnosis should include spindle cell neoplasms.

Pregnancies resulting in viable fetuses are extremely rare in accompanying a hydatiform mole, often due to the development of maternal complications, including preeclampsia and vaginal bleeding. The risk for gestational trophoblastic neoplasm is another concern because of the delayed evacuation of the molar tissue. In this paper, the authors present a case of complete mole hydatiform with a live co-twin fetus (CHMLF) resulting in the delivery of a healthy male infant with the partial regression of the molar tissue and the decline of serum beta human chorionic gonadotropin (P-hCG) during the pregnancy. In the management of CHMLF, each patient must be considered individually and eligible patients can be followed in the absence of serious maternal complications. Serial ultrasound examinations and close clinical and laboratory surveillance of the mother are certainly indicated.

ÖZETGiriş: Metotreksat; değişen rejim ve dozlarda çeşitli endikasyonlarda günümüzde yaygın kullanım alanı bulan, folik asit metabolizmasını antagonize eden kemoterapotik ajandır.Kullanım alanları, başta romatolojik hastalıklar olmak üzere, hematolojik maligniteler, gestasyonel trofoblastik neoplaziler ve bazı solid tümörleri içerir

Purpose: The purpose of this study was to analyze retrospectively the risk factors for incisional hernia (IH) in a group of gynecological cancer patients operated with abdominal midline incisions. Methods: We retrieved retrospectively data of gynecological cancer patients with midline incisions from the clinical database of Kanuni Sultan Suleyman Training and Research Hospital Gynecological Oncology Department, within the time period 2001 to 2015. Patients with IH were analyzed for age, body mass index (BMI), smoking, and the presence of additional medical disorders, previous laparotomies, supraumbilical extension of incision, operative complications, postoperative hemoglobin levels, surgical site infections (SSI), adjuvant chemotherapy, abdominal radiotherapy and duration of follow-up. Results: 1369 gynecological cancer patients were operated with midline incisions. 80 patients had IH with a rate of 5.84% (95% CI: 4.56-7.04) incidence. With univariant analysis of demographic findings and risk factors; age, BMI, operative complications, postoperative hemoglobin levels, SSI, adjuvant chemotherapy and duration of follow-up were statistically significant. Multivariate analysis revealed; age [OR: 1.06 (95% CI: 1.02-1.09)], SSI [OR: 2.74 (95% CI: 1.08-7)], adjuvant chemotherapy [OR: 2.67 (95% CI: 1.2-5.9)] and duration of follow-up [OR: 1.03 (95% CI: 1.1-3.5)] as independent predictors of IH. Conclusion: In gynecological cancer patients operated with a midline incision, presence of independent risk factors (i.e.: the patient age, SSI, adjuvant chemotherapy) and prospects for survival may necessitate continued attentiveness to the persisting risk of IH formation in a longer term follow-up. In the presence of risk factors and an expectancy of a prolonged remission; it remains to be further proven in randomized controlled prospective studies, whether prophylactic mesh placement at the time of index procedure, may prevent this unpleasant morbidity.